What if surgery is not the only option?
WHY DOES IT HURT?
Knee pain is common among the general population. Knee pain may originate from various structures located in or close to the knee joint, such as the menisci, the collateral ligaments, the patella and the tendons, but it may also be pain referred from proximal structures such as the hip joint or the lumbar spine. A frequent cause of knee pain has to do with the cartilage rings called the menisci.
A range of patho-anatomical diagnoses are routinely applied to these symptoms, such as meniscal, cruciate, or collateral ligament tears, patella-femoral pain syndrome or osteoarthritis. The diagnosis is usually based on the location of the pain, diagnostic imaging, and the knee’s response to special orthopedic tests that are aimed at identifying discrepancies in the integrity of certain tissues. The challenge to both the patient and the therapist is that this diagnosis does not necessarily offer a patient specific conservative treatment plan. It too often only presents two extreme options, namely surgery or slow recovery over a long period of time.
WHAT ELSE COULD BE WRONG?
It would appear that an alternative method of diagnosis and classification is need. One such a system is the McKenzie method of mechanical diagnosis and therapy (MDT).This method involves a structured mechanical evaluation of repeated or sustained movements to assess for symptomatic and mechanical responses to classify patients into a specific mechanical syndrome.
Under the patho-anatomical approach a cricket player presenting with an acute medial knee pain and a positive McMurray test would typically be diagnosed with a medical meniscal tear and treated with surgery and subsequent 6 – 12 week rehabilitation, or rest and gradual rehabilitation. However, under the MDT approach, this patient may be diagnosed, for example, as an extension derangement knee. If he is provided the correct movement strategy, the patient could see a rapid reduction in symptoms and full restoration of knee movement and function within as little as 2 weeks, without any surgery.
SO IF ITS NOT NECE SSARILY A TORN MENSICIS?
In a study done by May & Ross in 2009 it was found that as many as 43% of patients with knee pain were actually due to a derangement of the knee and could be reduced without any surgical intervention. The conceptual model for the ‘derangement syndrome’ is that it occurs due to internal dislocation of articular tissue that causes a disturbance in the normal resting position of the affected joint surfaces
In conclusion it is seen that a thorough mechanical evaluation and interpretation of the history and physical examination of the problem is needed without relying on the responses of individual orthopedic special tests and diagnostic imagining in isolation. If you are suffering from acute or chronic knee pain, it could be sensible to undergo a structured assessment according to the principles of MDT in order to consider the possibility of a specific mechanical syndrome that could be managed effectively with the relevant movement strategy that would reduce pain and improved mobility and function up to a point of full recovery.
TAKE HOME MESSAGE
– Diagnostic imaging may or may not accurately identify the origin of the knee’s symptoms.
– Orthopedic testing may identify a defect in certain knee structures that are not necessarily the cause of the symptoms.
– A thorough mechanical evaluation according to the McKenzie protocol could assist in establishing the location and the nature of the source of the symptoms, as
well as suggest the likelihood of it being treated effectively through conservative treatment.
– Injuries to joint structures such as the menisci and ligaments could often be treated effectively without surgery.