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Post #69 – Resources I used to rehabilitate my knee: Part II – Knee Misalignment Issue

05 Friday Jul 2024

Posted by purposelyliveto120 in knee-pain, Muscoskeletal alignment, Optimal Health, Uncategorized

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arthritis, fitness, health, knee-pain, Muscoskeletal aignment, osteoarthritis, The Egoscue Method

A little over two years ago, I hurt my knee. I was doing some vigorous aerobic workout style dancing. I might have twisted my right knee and it started to hurt really badly. I thought it would be fine in a couple of weeks by giving it the usual TLC. But it took over two years to heal it. And it turned out to be quite an opportunity to learn.

Whenever I talk to my contemporaries, the topic of knee pain comes up frequently. So, I thought I would share here my journey of healing my knee pain and more importantly the resources I found useful. Trust others will find this information useful.

In this Part 2 of this series of blog posts, I share different resources for the major underlying causes of knee issues, that is knee alignment.

History and Background

You see I have been dealing with knee pain off and on for a long time. About 30 years ago, I took up the goal of running a marathon. I started the training. Ran my first 5K and then my right knee started hurting whenever I would run. Could not figure out how to run pain free. So, that was the end of my marathon running goal.

Since that episode, over the last thirty years, I have been working on bringing my knee functionally to 100%, judging by the capacity and capability of my left knee. It is still not there 100%, but it is the closest it has come to that goal in thirty years.

Orthopedic specialist diagnosed the causes of my knee pain to be arthritis. Initially, arthritis was diagnosed as mild. At my last check up about two years ago, I was told it was more like mild to moderate.

But what caused my arthritis? And was there another reason for pain? So, could you I just everything I wanted to do in spite of my arthritis. After all, my left knee also has mild arthritis. But I never feel any pain issues in my left knee.

In Part I, I discussed structural issues of the knee that could lead to knee pain. Knee misalignment is the topic of this blog post.

Turns out if knee is not properly aligned between the hip and the ankle, that can be an issue two different ways.

First, if the weight is born disproportionately by the spot where the cartilage is missing, it will cause pain.

Second, the part of the cartilage that bears disproportionate amount of the body weight, repetitive motion, e.g., running or jumping rope, can also erode cartilage on that part of the knee.

Knee misalignment becomes a sort of a vicious negative cycle. So, fixing knee misalignment is imperative for a lasting solution.

Resource for Fixing Misalignment – The Egoscue Method

I got introduced to Pete Egoscue the creator of the Egoscue Method almost 30 years ago at Tony Robbins Life Mastery program in Hawaii. Pete Egoscue demonstrated a very unique way of correcting joint pains due to one or more body misalignment. Even more amazingly eliminating the pain through some simple exercises, he called e-Cises.

Unfortunately, when I first encountered my knee pain, Pete Egoscue was not easily accessible, since he lived and practiced on the west coast. On hindsight, I should have probably gotten on a plane and worked with him anyways. I basically relied on his first book. And, ended up helping myself and  a lot of other people with some issues, including back pains. But could not really fix knee misalignment on my own.

Now his technique is accessible through Egoscue clinics around the world. You can find probably one in every major city in the US. And now therapists can also work with you over a Zoom Call.

This time around, that is what I did, since my traumatic knee pain episode occurred in the middle of COVID pandemic. I worked with the Egoscue Clinic in Arlington VA.

The therapist takes pictures and checks out the alignment to diagnose what misalignment might be causing the issue. Here is one of set of my pictures. You simply draw a straight line from hip to the ankle. If the line does not cross in the middle it indicates misalignment can can cause knee issues over time.

Also, it is important to diagnose whether your knee is overly internally rotated, i.e., pronated, or overly externally rotated, i.e., supinated. During load bearing activities, either of these situations can lead to greater stress at the knee joints and the ligaments and can lead to knees issues and knee pain.

My right knee was bow-legged and externally rotated. See the below picture before I started the Egoscue therapy.

Those conditions were causing stress on the inside of the knee joint, where cartilage had also eroded. What came first the cartilage erosion or the bow-leggedness and the external rotation? That was the question, I have always wondered, but don’t know the answer to this chicken-or-egg question.

Based on the diagnosis, the therapist then have you try a series of e-Cises. Those e-Cises become the menu that you would do over the next couple of weeks or longer.

After practicing the give menu of e-Cises, with the therapist again, to reassess and create a new menu. Often, it becomes a process of “peeling the onion” by resolving first the superficial issue and then go on to resolving the deeper issues that might be at the core. Lot of time, taking care of the superficial issues often resolve the pain. However, it is really important to get the whole body in alignment to resolve things permanently and even preventatively.

The following picture shows alignments after working with the Egoscue therapist. As you can see, alignment of the right knee is a whole lot better, but head alignment still needs work. Ideally, head should be in line with shoulder, hips, knee and ankle. And, both shoulder should also be parallel to the ground.

My experience – Working with an Egoscue therapist, I discovered bow-leggedness and the tendency for my right knee to outwardly rotate lessened significantly. While working on the knee, the therapist also pointed out issue with the curvature of both my lower back and the upper back. These curvature issues were leading to pain in my lower back. I also worked on the back issues and significantly improved the alignment. Another important outcome was that I got quite aware of my posture and how that could lead to other musculoskeletal issues.

Bottom Line:

From my research and experience, I have found that it is important to find out what is the underlying structural issue for knee pain. It is equally important to diagnose to see if knee falls outside a straight-line connecting hip and ankle and if knees is rotated inward or outward. Either of these conditions can cause wear and tear of the cartilage and/or undue stress on the other connective tissue from repeated use under load-bearing conditions.   It can also be the source of knee pain.

Working with a therapist trained in the Egoscue Method can be very effective in re-aligning the knee. 

Of course, this is not medical advice, and you should check with a medical doctor about your specific situation.

What are your thoughts or experience on this subject?

Have you used other therapies or methods for correcting body misalignment.

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

Post #68 – Resources I used to rehabilitate my knee: Part I – Diagnose and Fix Structural Issue

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Posted by purposelyliveto120 in Quality of Life, Vitality, wellness

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Aging, arthritis, health, joint-pain, knee-pain, Lifestyle, optimal health, osteoarthritis, Vitality

A little over two years ago, I hurt my knee. I was doing some vigorous aerobic workout style dancing. I might have twisted my right knee and it started to hurt really badly. I thought it would be fine in a couple of weeks by giving it the usual TLC. But it took over two years to heal it. And it turned out to be quite an opportunity to learn.

Whenever I talk to my contemporaries, the topic of knee pain comes up frequently. So, I thought I would share here my journey of healing my knee pain and more importantly the resources I found useful. Trust others will find this information useful.

In this Part 1 of this series of blog posts, I share different resources for diagnose and fix the structural issues with my knee.

History and Background

You see I have been dealing with knee pain off and on for a long time. About 30 years ago, I took up the goal of running a marathon. I started the training. Ran my first 5K and then my right knee started hurting when I would run. Could not figure out how to run pain free. So, that was the end of my marathon running goal.

Since that episode, over the last thirty years, I have been working on bringing my knee functionally to 100%, judging by the capacity and capability of my left knee. It is still not there 100%, but it is the closest it has come to that goal in thirty years.

Resource #1 – Orthopedic Doctors

My first stop was to get my knee checked out by an orthopedic doctor. I even picked a practice specializing in Sports Medicine. They did a quick X-ray, showed me the picture and pointed out that I had a mild case of osteoarthritis in my knee.

So, what do I do then? I was told not to run. And, if I was to run, maybe use a knee brace. I bought a brace. Tried running with it. Did not really work.

Over the years, the pain went away but it did not really allow me to run. However, I became comfortable with a variety of activities, jumping rope, skiing, rollerblading and so on.

And this time around, which is about two years ago, another trip to the orthopedic knee specialist. A quick X-ray, was showed the picture and told that now I had mild-to-moderate osteoarthritis. Nothing broken, nothing torn. This time, my options were: a) Steroid injection in the knee, b) Injecting gel, if I got permission from the insurance company, c) Take ibuprofen, or d) Do nothing.  Learned that the steroid injection was not simply to relieve the pain but was also therapeutic, since it would relieve the inflammation. So, I chose to get the injection.

Other options offered at the orthopedic specialist’s office are arthroscopic surgery and knee replacement surgery.

Orthoscopic surgery was very popular up to a decade or so ago. These have lately fallen out of favor. Clinical trials done during the last few years have shown that orthoscopic surgery is no more effective than the placebo in the form of sham surgery.

Knee Replacement is an option only when the pain is so severe that you can no longer tolerate the pain whether awake or sleeping since the cartilage has pretty much worn out.

My experience – Orthopedic specialists are a great resource to find out if I broke anything or tore anything for which they have solutions. For osteoarthritis, other than a steroid injection basically, wait until the knee is ready for replacement.

Resource #2 – Hyaluronic Acid

A quick take on hyaluronic acid from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469223/

“…Viscosupplementation with intra-articular hyaluronic acid is a treatment option in knee OA that is included in the professional guidelines for treatment of this joint disease, but potentially should apply to all synovial joints in order to reduce pain and improve joint lubrication. Exogenous HA can enhance chondrocyte HA synthesis, prevent the degradation of cartilage and promote its regeneration. Moreover it can reduce the production of proinflammatory mediators and matrix metalloproteinases involved in OA pathogenesis. This mini review highlights the evidence of hyaluronic acid in reducing osteoarthritis symptoms and structural damage, as well as its ability to delay prosthetic surgery. Viscosupplementation should be considered as a long-term therapy.”

Basically, hyaluronic acid is a gel that if injected into the knee joint improves joint lubrication, reduces inflammation and may also regenerate cartilage improving the structure of the joint. Treatment may have to be repeated over time as a long-term therapy.

Typically, insurance companies do not cover this therapy. It is known to relieve knee pain and improve joint functions. Some orthopedic specialists may offer it. But mostly these are offered by those doctors practicing alternative therapies, e.g., functional doctors, chiropractors or doctors of osteopathy.

Resource #3 – Platelet Rich Plasma (PRP) Therapy

PRP therapy for osteoarthritis of the knee works by injecting platelet-rich blood into the area surrounding the knee to help reverse existing tissue damage. Blood is comprised of four components. Most of your blood is liquid, known as plasma. The other three components are platelets, white blood cells, and red blood cells.

Platelets play a key role in the clotting of the blood. They also contain growth factors that could help tissues repair themselves by causing new cells to form.

PRP Therapy involves taking blood from the veins, about the quantity typically used for blood tests. They spin it to separate plasma and platelets from the red blood cells. They then inject plasma into the joint, where the cartilage might be damaged, typically where it hurts to touch and/or where inflammation in the joint is.

PRP is still not mainstream as a standard of care. Here is one article, comparting results of various studies on PRP And Hyaluronic Acid,  https://pubmed.ncbi.nlm.nih.gov/34785294/ . The bottom line from this study is: Patients undergoing treatment for hip or knee OA with either PRP or HA injections can expect to experience similarly beneficial short-term clinical outcomes.

My experience – I underwent three different applications of PRP. And found those to be beneficial.

Resource #4 – Stem cell Therapy

Stem Cell Therapy procedures are non-surgical injection-based procedures for people suffering from knee pain due to common injuries to the knee Meniscus, ACL, MCL, and other structures, or who are experiencing degenerative conditions such as Osteoarthritis. These procedures utilize concentrated repair cells that are obtained from your own bone marrow or blood to promote your body’s own natural ability to heal.

I visited folks at StemCellArts to see what they could do for my knee. The procedures they perform are done by orthopedic doctors who have a lot of experience and have developed specific protocols. However, the procedure tends to be quite expensive and is also quite involved, especially the part about extracting stem cells from bone marrow and culturing those cells.

Later, I also learned about the stem cells that are now harvested from umbilical cords, packaged and then distributed for doctors to use. This approach seemed to be rather inexpensive compared to using bone marrow. I underwent this procedure and found it to be quite helpful. In fact, a few months after the stem cell procedure, I asked the doctor if he would recommend repeating it. He recommended that once the joint is seeded with the stem cell, it was more helpful to do a PRP procedure to provide the joint more “fertilizer” in the form of growth factors. That is why I ended up doing the third PRP procedure.

My experience – My knee used to be tender to touch on the left side of the knee, where X-rays showed cartilage had eroded. After the stem cell and PRP procedures the tenderness and accompanying pain totally went away.

Bottom Line:

From my research and experience, I have found that it is important to find out what is the underlying structural issue for knee pain. It could be osteoarthritis, meniscus tears, tendon & ligament tears, overuse injuries or some other condition. In my case, it was osteoarthritis, clearly showing eroded cartilage in certain part of the knee joint. The resources that were useful to diagnose and repair the structural damage were:  

  1. Visit to the Orthopedic surgeon and imaging
  2. Steroid injection for relieving inflammation.
  3. Alternatively, ibuprofen for relieving inflammation.
  4. Hyaluronic acid or PRP treatment for joint lubrication and repair.
  5. Stem Cell therapy for repair or regeneration.

Of course, this is not medical advice, and you should check with a medical doctor about your specific situation.

 What are your thoughts or experience on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

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  • Post #69 – Resources I used to rehabilitate my knee: Part II – Knee Misalignment Issue
  • Post #68 – Resources I used to rehabilitate my knee: Part I – Diagnose and Fix Structural Issue
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