Knee Pain: A Guide to Preventing Surgery

Millions of people deal with knee pain every day. Waking up and simply getting out of bed is challenging for some people, but it doesn’t have to be this way!

Knee pain can be very debilitating and often times the different treatments are either temporary or not very appealing (surgery). Whether you are young and suffered an injury, in your middle age and the wear-and-tear is starting to catch up with you, or older and now deal with arthritis on a day-to-day basis, there are answers to help with your pain. You just have to know where to look and who to talk to. That’s what I’m going to try to do today.

I’m Dr. Jesse Morse, and I am a sports medicine doctor practicing in Miami, FL. I specialize in non-surgical orthopedics and regenerative medicine (PRP, Stem cells). After running a walk-in orthopedic clinic for a couple of years, I began to realize that most people were just masking the pain with steroid/cortisone injections and not properly treating their issues. They were being reactive and not proactive. Essentially people were just ‘kicking the can down the road’ and buying time before they needed a knee replacement.

Let’s briefly discuss what steroid or cortisone injections actually do. Pain is usually caused by a combination of swelling and inflammation that either is due to torn cartilage (meniscus, articular cartilage), or a damaged tendon or ligament. Cortisone injections essentially temporarily decrease the inflammation and calm down the swelling, but they DO NOT structurally change or improve the injury. Actually, quite the contrary. Steroids can actually slowly damage the local cartilage, and weaken tendons and ligaments. So they are actually causing more damage to the knee over time. Steroids are a temporary band-aid.

So why do we still give steroid injections? Because they work! People hate being in pain. I get it, being in pain is awful. I speak from experience, as I’ve broken each arm twice, suffered a hernia that required surgery, and broke my neck when I was 18. It helps to talk to patients when you know first-hand exactly what they are dealing with because you’ve been there yourself.

Steroids injections (into the knee) usually are effective, but only for a couple of weeks, maybe 3 months if you’re lucky. Does the steroid injection structurally correct the issue that led to the pain in the first place? No. What about the ‘gel shots’ that help with arthritis? Nope. Hence why I’m writing this article. Stop getting temporary relief, correct the issue from the start! 

I realized that we need to take a much more preventative approach than most Americans are currently taking. There has been some data to support that supplementation with glucosamine-chondroitin, as well as a couple of other over-the-counter natural substances can help prevent damage to knee cartilage. Nothing Earth-shattering but the benefits outweigh the risks, which are low, to begin with. The most important way that I have found to prevent cartilage breakdown, leading to what seems like almost inevitable knee osteoarthritis, is maintaining a healthy weight. 

As a society, we have significantly increased our average body weight, and the majority of Americans are either overweight or obese. One amazing statistic that I like to share with my patients is that for every 1 additional pound of body fat over your normal expected weight is 4 pounds on the knee! So, if you are 20 pounds overweight, your knees are dealing with 80 extra pounds. Imagine the beating your knee joint is taking every single time you take a step!

Like tire tread on the tires of your car, that cartilage can only handle so much. So over a long period of time, what happens? The cartilage, which essentially serves as the protective layer over the bone, wears down and the bone underneath becomes exposed. This then creates additional fluid, and small pieces of calcium, called bone spurs, start to develop. What is this process that I am describing called? Arthritis, specifically osteoarthritis.

Encouraging patients to develop and maintain a healthy lifestyle has become a very important part of my practice. To not only exercise regularly, but also try to maintain a healthy weight to prevent the wearing down of the cartilage in the knees, which eventually leads us to arthritis and usually joint replacement.

What if you are dealing with an injury? Maybe you accidentally twisted your knee the wrong way, got a sharp stabbing pain, and unfortunately damaged your meniscus. Maybe you sprained one of the important ligaments or tendons surrounding the knee and this is causing you constant pain. 

Each of these situations should be addressed individually, but treatment should start with conservative management options with the primary goal of not only treating the injury but also preventing the injury from worsening to the point where surgery is the only option.

What if we could utilize our body to heal itself? Welcome to regenerative medicine. That’s exactly what this field does. We use cells from either our blood, fat, or bone marrow to not only decrease the pain but also structurally correct any weaknesses, imbalances and also can potentially reverse structural damages. Additionally, regenerative medicine has a way of preventing future damage by strengthening the ligaments, tendons, and overall structure of the knee.

While the term ‘stem cell’ may be taboo, this is only because it has been given a bad name. In actuality, our body heals itself every day using our own stem cells. We have been utilizing this technology for many years, and this field has made significant progress over the past 10 years.

Discussing regenerative medicine and different stem cell options could be an article by itself, so I only briefly mention it here. Just know that there are several different ways to not only treat pain and injuries but also prevent future damage as well.

Another thing that I want to stress is the importance of physical therapy. Many knee injuries start off due to muscle weakness and imbalance, which eventually lead to changes in gait and cause excessive wear down of cartilage. The ‘snowball effect’ leads to the development of osteoarthritis, which in turn usually requires joint replacement surgery.

If you are able to identify the muscle weakness, correct the imbalances, address the gait changes you can get ahead of the cartilage damage and ideally prevent joint replacement surgery altogether. 

I hope you found this article helpful! Honestly, this is just the tip of the iceberg in terms of knee pain, and discussing different strategies and treatment options to help prevent future injuries, cartilage damage, and surgeries. If you are interested in a consult, either by telephone or in-person, I’d be more than happy to help!