News: Seven Key Concepts and Myths about Knee Pain

Myth 1: Pain is about damage to structure

FACT: Pain is not related to damage

Explanation: Pain is a protective messaging system of the body, its not just about damage. Pain is more about perceived threats than damage. There are plenty of minor conditions that cause severe pain (e.g. a muscle cramp) and plenty of serious conditions that often cause no pain at all (e.g. Diabetes, Cirrhosis, even some complete tendon or ligament ruptures can have only minor levels of pain compared to a strain of the ligament or tendon). In some situations your body can become overprotective with persistent pain.

Myth 2: Physical activity will damage my knee further and rest will make it better

FACT: Fear of physical activity, avoidance of physical activity and prolonged rest makes knee pain worse

Explanation: There is significant research suggesting – for almost all regions of the body – that rest is not beneficial in reducing pain. Fear and/or avoidance of physical activity and fear of damage are associated with higher levels of pain and increased disability. This is related to the concept (1), that pain is about threat/damage. Physical activity teaches your body these movements are not a threat and actually improves the strength of the cartilage, tendons, ligaments, bone and muscle around the knee and improves general health.

Myth 3: Popping or cracking is my bones grinding against each other

FACT: Popping and cracking sounds are normal, most people without knee pain have some popping or cracking

Explanation: The popping and cracking is caused by the movement of the joint fluid between the joint that lubricates it. The movement of the joint can cause the formation of gas bubbles in this joint fluid causing the popping or cracking sounds.  There is zero evidence popping or cracking of the knee correlates with pain or arthritis findings. Popping and cracking is often evidence of a healthy knee not an unhealthy knee!

Myth 4: Arthritis findings on my scan are the cause of my pain

FACT: Arthritis findings on imaging (e.g. X-ray or MRI) are common in most people without pain. The degree of arthritis findings does not predict your pain or your ability to do activities.

Explanation: Pain is much more complex than what an X-ray or MRI report says. There is very poor correlation between arthritis findings on scans and pain or the ability to function.  As described above, pain is about protection, not a reflection of anatomy or structure. Even elite level athletes can have “arthritic” imaging findings and it doesn’t hold them back from being the world’s best, so don’t let an X-ray or an MRI define your ability.

Myth 5: Having a “clear out” or arthroscopy will fix my knee and cure my pain

FACT: Knee arthroscopies are no more effective than a placebo

Explanation: Surgery has one of the biggest placebo effects out of all interventions. Often after surgery you get a good quality rehabilitation program and hence the improvements after the rehabilitation program in terms of your pain get attributed to your surgery. In a recent paper they compared two groups. 1) Actual knee arthroscopy to group 2) Just putting cuts either side of the knee (fake surgery). Then after following up with both groups after a good quality rehab program, there were no differences in outcomes between both groups.

Myth 6: Medications, injections, cupping, acupuncture, etc. (passive treatment) are good treatments for my knee pain

FACT: The highest value treatments are education, exercise and lifestyle changes

Explanation: Many people focus on passive interventions, hoping they will be a cure. Passive interventions are where the patient doesn’t have to do anything themselves e.g. medications, injections, cupping, acupuncture. They have very poor evidence of effectiveness in terms of long-term improvements in knee pain. However, education, exercise and lifestyle changes have strong evidence to support they improve knee pain.

Myth 7: Knee replacement is a cure for knee pain

FACT: Consider all other treatment options before undertaking a knee replacement, you may not need one

Explanation:  Knee replacement is not a cure for knee pain. Like all surgery, there is a risk of complications. The rehabilitation program is long and takes lots of hard work and there are no guarantees it will reduce your knee pain. I would recommend everyone at least try a high quality rehabilitation program for 6 months before opting for surgery. There is good quality evidence that people on the wait list for knee replacements who undertake an exercise program for just 3 months elect, in the majority of cases, not to undertake surgery due to improvements in their knee pain.

If you’re experiencing knee pain, scroll down to book an appointment with David. Our experienced Osteopath will assess, treat and provide advice on how to manage your knee issue. We have an onsite gym and David can put together a tailored rehab program for you.

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