16/02/2024
Knee pain...... One of the condition which cripples a large percentage of population.
Knee Osteoarthritis - Knee OA the main culprit.
Wear and tear being the problem.
Various causes everyone knows, so I will discuss my view.
Knee joint is a Hinge type of synovial joint .
We know *Hilton's law-*
Nerve supplying the synovium of the joint will also supply muscles moving the joint and skin covering the joint.
This is *physiology*.
*Now Pathology-*
Nerve degeneration is a normal part and parcel of ageing.
Wallerian degeneration of nerves takes place more in weight bearing joints and Knee jjoint is not an exception.
Now the serious question❓
*Hen first or the Egg first?*
*Here what injures the synovium ?*
*What decreases the joint space?*
*If joint space is maintained by pull of muscles on opposite sides of knee joint, why joint space decreases?*
Obviously muscles are weak(Ageing causing *Wallerian degeneration of nerves*,causing weakness in muscles) , leading to decreased joint space, causing frictional injuries to the synovium of joint .
Now, applying *Hilton's law,* nerves come into picture, and again contract the muscles causing decrease in range of motion and pain on movement along the tense muscles and skin over the joint.
Now coming towards *Treatment by PRP....*
Platelet Rich Plasma is being used as regenerative therapy in various conditions.
Everyone knows how the various growth factors help in regeneration.
*But none of the paper's on PRP described the actual reason of mechanism of action.*
Simple things are just missed to complicate the subject.
*A New Thinking Process....*
PRP when injected for Knee pain helps to regenerate the synovium and cartilage of the joint.
So no more irritation of the nerves supplying the synovium, thus no more contraction of muscles, resulting in improvement in range of motion and decrease in pain due to relaxed muscles.
Furthermore medicines for pain, physiotherapy, correction of deficiency of Vitamin D3 and B12, and changing psychological makeup of the patients through Cognitive behavioral therapy plays role in recovery. *(Biopsychosocial way)*
At *Healex Clinic,Solapur*, while treatment of Knee joint,we do increase the conduction of nerve and decrease nerve pain by using *Noninvasive PRF- Pulsed Radiofrequency of STIMPOD NMS 460* TREATMENT(*US FDA APPROVED*).
Here care is taken to treat Facet Joint Arthropathy of L1-L4 along with L5-S1 and their respective distribution area as well.
For contracted muscles, we use *Needle Induced Yoga*- which is *Dry needling along with Cognitive behavioral therapy* based on Patanjali' Ashtanga Yoga, which increases blood supply to muscles and helps in repair and regeneration of both nerve and muscles.
Then *RRT - RAPID RELEASE TECHNOLOGY(US FDA APPROVED)* is used to relieve tightness of muscle and fascia using high speed VIBRATION THERAPY.
This is followed by *GAME READY TREATMENT (US FDA APPROVED)* which uses *Cold Compression* for Knee joints.
*This is my take on Knee OA*.
If only PRP is done ,it may help a few patients, but if we treat by above protocol, there is *definite healing* and the tensile strength comes only after 6-9 months.
*Dr Kailas S Waghmare*
*MD Anesthesiology*
*AFIH ,C C in Yoga*
*Fellowship in Chronic Pain Medicine (MUHS)*
*Healex Clinic, Solapur*
*+91 956 118 5892*
