In this video today I'm going to cover with you three common reasons that people continue to
have knee pain, chronic knee pain, even though they've already had a knee joint replacement.
The third reason the last reason that we'll talk about in this video is one that most healthcare
professionals just don't know about, and they won't be able to tell you, so make sure you
watch the whole video to catch that one. My name is Dr. David Middaugh, and I'm a
specialist physical therapist at El Paso Manual Physical Therapy. And this channel is dedicated
to helping people stay healthy, active and mobile, while avoiding unnecessary surgery,
injections and pain medications. Please consider subscribing to our channel so
that you don't miss out on any of the helpful videos we upload every week. Let's get to it.
The first most common reason that I see people have continued knee pain, chronic knee pain, even
knee pain, it's worse after the surgery than what they had before the knee joint replacement surgery
is a muscle imbalance. A muscle imbalance put simply is it when we're talking about the knee,
the quad muscles are on the front of the leg here and the glute muscles are in
the back of the hip on the buttock area. And when there's too much quad strength
and not enough glute strength that causes the thigh bone to move inappropriately. And it causes
excessive pressure, too much pressure at the knee joints, the success of pressure at the knee joint
also sets a foot weakness, you could also get a foot muscle imbalance, it's usually the toe
muscles that aren't strong enough to support the arch of the foot, which ends up changing the way
that the bottom part of the knee joint, the shin bone interface interfaces with the knee joint.
So if you have muscle imbalances, then that is going to set up continued chronic knee pain.
But you may be thinking I went through physical therapy; I've been doing all this exercise since
I've had the surgery and I felt my muscles working. But what you have to realize is
that after you have your knee joint replaced, you are going through physical therapy. So to get the
strength back to be able to stand and walk and get back to being as active as you were before.
Now before you had your surgery, though you probably had severe arthritis. And
that muscle imbalance was already there. muscle imbalances don't hurt by themselves.
But it's the side effects that they cause, which is that pressured in a joint it could
be at the hip too, that it causes too much pressure or down to put an ankle or even
the back when that muscle imbalance is there. It sets up that excessive pressure that sets
up the knee arthritis and then leads you to the point where you have to have the knee
joint replaced when it gets severe enough muscle imbalances typically are not talked about in the
healthcare field, a physical therapist that helped you out right after your knee replacement surgery
was probably not thinking about it, they're looking at getting you all the motion back.
There are other priorities to address right at the beginning months after a knee joint replacement.
In fact, we made a video that talks all about what you should expect in every month for the
first 12 months after the joint replacement. We'll link it in the description below. In case
you're wondering if you're on track or not. Or if you're looking at getting a new replacement
surgery because you haven't had one yet, then you can go through that and see what you can expect
for the coming year after you have the surgery. The second most common problem that we see
is bad movements. And this is related to the muscle imbalance. And the way this typically
looks is when you're going to go stand or sit or even during walking or just everyday motions.
There's a slight inward motion of the knees. And what I want you to do is watch me move
I'm going to show you how the movement happens bad movement in my own legs.
But then I want you to go watch yourself in the mirror. Especially if you have a full body length
mirror, you can see your reflection, or even just look down at your knees if you don't have anything
that you can see reflection on. But what I see often is when people go to stand up or sit down
in their knees, I'm observing them all the time. And when I see them sit down and my treatment
room or the waiting room or get up their knees, just shove in words for a moment. I'm going to
show you this bad moment but I'm going to angle the camera down just a bit so that you can see
what my feet and legs are doing. I'm looking at people's knees when they go
to stand up and sit down and what you'll see is their knees come in just a little
bit like this. I'm going to exaggerate. But once people are going to go to stand up
their bodyweight typically leans forward over their feet. Nose over toes is what physical
therapists often say. They might even put their hands on their knees just to get some
more balance and stability. And then when they come up their knees do this for a moment. They
what soon as the pressures on their legs and knees go, you're and then they
even out after that. And then when they go to sit down the same thing happens as they come down.
Knees start to come in words as they sit and then they'll usually plop down or, or land kind of
faster than they should that inwards motion right there. When you put your knee in words like that.
It causes you to use your quad muscles quite a bit to control the sitting down or standing up.
You aren't using your glute muscles at all. In fact, you're shutting them down by moving
your knee inwards, you're making these muscles not functioning very well. And you're forcing the
quad muscles in the front of your knee to work extra, which feeds into that muscle imbalance.
So what you've got to start to do is move with your knees outward. So when you go to stand up,
keep the legs out like this and think about using the glutes.
And same thing on the way down is come down this way. It's this bad movement, when repeatedly done
hundreds of times 1000s of times as the as the day goes on, if you think about it,
every time you get up and get down, you sit down to eat a meal, you get up out of bed,
often on the commode in and out of vehicles. If you're at a doctor's appointment, you're
sitting in the chairs there, you're having to get up and get down several times, many,
many times throughout the day. And if every time you go to do it, your knees are coming inwards,
you're not using your glutes, you're creating excessive press right your knee joint,
you're collapsing your foot muscles down as well, because your arch has to collapse when
you do that. And it's setting up excessive pressure at the knee joint setting up,
it's feeding into that muscle imbalance too, because you're using the quads excessively.
That's why this bad movement that I'm talking about is a second most common problem that I see
why people have continued pain after they've had a knee replacement surgery.
The third most common reason this is the one that gets by all the healthcare professionals,
they just don't think about this, they there's a nerve, there's a nerve that
runs down on the inside of the knee joint right here, under wraps around the front of the knee,
that nerve can become irritated and caused pain, especially on the inside of the knee.
But even on other parts of the knee. When the surgery is done, when a knee joint replacement
is done, the surgeon is cutting you open right on the front of the knee joints to expose the
inside of the joints and do what they have to do in there. Well, that nerve, that saphenous nerve,
it runs on the inside of your thigh and goes all the way down to the inner ankle, the inner foots.
But there's some branches are called the recurrent branches that run over the front of the of the
knee joint right along the knee joint line. And when the surgeon makes their incision,
they have to cut those nerves. So your saphenous nerve is already a
little irritated from the actual procedure. Some people are just more sensitive to recovering
the nerves and others, they just go slower. And it could be that your chronic knee pain is coming
from that nerve, never really recovering. And there's things you can do to make that nerve
happier. If you already have numbness on the front of your knee, because that nerve was cut,
you feel a spot usually right around here, that is just doesn't have good sensation, and then you're
getting chronic pain on the inside of your knee specifically, then you likely have an irritated
nerve, that is just not going to get better until you do the right things. And now this is connected
to the second reason that I gave a bad movement. When your knees collapse inwards like that,
you put tension through that saphenous nerve. So to show you on the skeleton here, that nerve runs
on the inside of the knee right here. And when you go to stand up and your knees collapsing inwards,
whenever you go to sit down or to stand up you do that, that nerve just gets tension,
it just gets pulled and irritated. And if you're doing that repeatedly throughout the day,
you're going to keep that nerve irritated. So these three reasons that I gave you the muscle
imbalance, the bad movements, and then the nerve problem. They're all interrelated. And really,
they tie back to that muscle imbalance that is rarely ever talked about. If you're six months
out of your knee replacement or more, even if you're a few years out of your knee replacements,
and you're still dealing with this chronic knee pain problem.
You've got to look at how you're using your glutes, how you're using your foot muscles,
what your movements like, and consider the fact that it might be your nerve problem
that's causing you this pain, it doesn't mean you need to go get a knee revision. In fact,
you may have had the frustration of going back to your doctor because your knee still hurts.
You went back to the surgeon said Hey, what the heck, man,
my knee is still hurting, and you replace the joints already. And then they might do an x ray
on you and show you the X ray and show your new knee that's in there and tell you everything's
fine. The surgery looks great, nothing's loose, everything's in position the alignments great.
There's nothing else I can do for you. You want some pain medication or injections or maybe we'll
refer you out to a pain management doctor and see what we can do from there. But there's no
reason to operate on you to do a revision surgery. If you've had the frustration of
going through that because you're thinking in your head, why does my knees still hurt?
What else can I do? I thought that getting the joint replaced would end this knee pain
and I'm still dealing with it. The reason for that is because you haven't fixed the muscle
imbalances and you probably haven't seen a specialist that can guide you through that.
And so that's what I'm talking about here. You need to address those muscle imbalances.
Take the pressure off the knee joint movements. directly and take the pressure off of your nerve
as well, that saphenous nerve needs to calm down. So that's good news for you. That means that this
is fixable, you can address it and it is in your control. And in fact, we've got a program that can
help guide you through a system to improve the motion and get strength in the right places and
make sure that your nerve is moving very well. It's called the 28 Day Knee Health And Wellness
Boosts Program, you can find out more details about it in the description below.
That program is 100% online, and it's on demand. So once you sign up for it, you can access it from
wherever you want. As long as you've got internet connection, you can do it on your mobile phone,
or on a computer. And it's me guiding you through the proper exercises to correct
the muscle imbalance and to move appropriately. And that should take the tension off the nerve.
This program is okay to do if you're at least six months or more out of having the replacement
and you've been cleared by the doctor to exercise obviously, and the exercises in
the program they're modifiable, you can make them a lot easier or a lot harder from where
we show them and we talked about how to modify it. There are no weights involved just a little bit of
weights. It's optional, but you can go through the whole program without having any weights and you
can repeat the program. Once you've gone through the first 28 days and you've had some improvements
in your knee problem. You could continue to do it again. Go through the second or third
time and continue to exhaust the benefits that you can impossibly get off pain medication and sleep
better at night and move better throughout the day. And be happier with your knee replacements
so that you can protect it for the future. Guys, if this video was helpful for you,
please give us a thumbs up. And don't forget to subscribe if you haven't already and
share this with somebody that you think needs to hear this because there's tons of people out there
suffering from knee pain after they've had any replacement surgery. And we want to put an end
to that there's ways to address it. Thanks so much everyone and we'll see the next video bye