Thursday, April 24, 2014
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Knee pain: What are your options?

A new study has found that physical therapy may be just as good for treating arthritis and meniscal tears as going under the knife.

Knee pain: What are your options?


From seven-figure professional athletes to weekend warriors, knees are one of those things that have given every active person trouble at one time or another. Sometimes knee pain can be a sign of something bigger: a meniscal tear. These are especially common in people who play football and basketball, or other sports where players do a lot of pivoting, cutting, decelerating or twisting the knee. Meniscal tears with arthritis are also very common in those over 40, and can often be the result of wear and tear.

What’s the best option for treatment? While some more minor tears can be healed with the ever popular RICE method (rest, ice, compression and elevation) and anti-inflammatory medication, more serious tears have traditionally required surgery. But a new study has found that physical therapy may be just as good for treating these tears as going under the knife.

A recent study published in the New England Journal of Medicine randomly assigned patients with knee pain from arthritis and meniscal tears to be treated with surgery or physical therapy. Guess what they found? When they were assessed six and 12 months later, both groups showed the same amount of improvement in movement and pain reduction. In other words, physical therapy was just as effective as surgery for people with this type of injury.

So let’s say all those days on the court finally catch up to you and you begin to experience chronic knee pain or even a meniscal tear: do you opt for surgery or PT? These results suggest either would be beneficial. One benefit of choosing the physical therapy route is that it will address factors beyond the immediate problem. PTs take a “whole person” approach when treating these types of injuries, and can provide insight into why you are experiencing excess strain on your knees instead of just a quick fix. For example, is it because of a loss of strength or flexibility in the muscles? A problem with your overall joint alignment and posture? A result of carrying excess weight? Or just general wear and tear?

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When these causes behind the immediate problem are identified, your physical therapist will work with you to correct them. Your PT will prescribe a personalized exercise plan to target and address your specific issues—this is not a one-size-fits-all approach. These plans generally include exercises focused on strengthening and increasing flexibility in the quadriceps, hamstrings and gluteal muscles. Depending on the causes of your knee problems, these plans may also include weight management.

Because I know your brain was recently entrenched in March Madness, I’ll use a college ball analogy. Physical therapy is likethe ball team that uses fundamentals to light up the scoreboard, but isn’t known for its blowout wins. It’s a slower process, focused on correcting the basics versus the immediate problem. Even if you go to physical therapy and chose surgery in the end, you will still have built a foundation of exercises that will help you in your recovery.

Because there is a portion of the population that does experience great relief from surgery, it is ultimately up to you and your doctor to decide your best course of treatment. Just remember—there is more than one option when it comes to treating knee pain.

Read more Sports Doc for Sports Medicine and Fitness.

Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
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About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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