Orthopedics: A Tale of Two Knees
© Colleen Huber, NMD
The two knees that I will tell you about belong to different people.
One, a 59-year old knee, is mine. I am a naturopathic physician and an amateur athlete, practicing figure skating six times per week.
Part One: Treating a Knee Sprain Naturally
On Tuesday of this week, I was landing a single loop jump, and at the moment of landing, I felt as if my knee came apart. It lost all strength, and I crumpled to the ice. I got up and was able to put some weight on it, and made my way to the benches. I don’t remember such a sudden knee injury before this, from impact with the ice, other than the rare coffee table collision or the like.
I was on my way to work, and could not take time off or cancel patient appointments. Besides, I could walk, while noticing a slight twinge; I just could not skate.
I then did the following three things before it repaired.
Osteopathic manipulation: “Muscle Energy”
Before transferring to naturopathic medical school, I had finished the osteopathic medicine academic portion at osteopathic medical school. There I learned a technique that I have used very productively since then, with patients, family and myself: Muscle Energy.
First, while still on the bench, I located the most painful area of the knee and the area most limited in range of motion. It turned out to be the insertion of the patellar tendon, just below the patella. The quadriceps muscles insert at the patellar tendon on the tibial tuberosity, and the tibialis anterior muscle originates very close to it. So I contracted those muscles in turn, against resistance, with the rest periods in-between that we were taught as fundamentally important to healing by osteopathic faculty. This Muscle Energy technique is profoundly healing especially when done soon after injury. It is a way of allowing neuro-muscular communication to inform the brain, which then informs the affected muscle, that it is now able to release spasm.
I like to do more reps of Muscle Energy Technique than I was taught in osteopathic school, with especially long rest intervals, finding my modifications to be very healing. Osteopathic physicians are taught these techniques in osteopathic schools, but not all osteopathic physicians use them. . Naturopathic students are taught these as well in our physical medicine courses, but similarly, not all naturopathic physicians use them. .
I still felt that I could use more help with my knee. So that night, I rubbed the area on and around the patella with a cream that I made of Galangal, an anti-inflammatory herb that is related to ginger, and is very helpful in a variety of inflammatory conditions.
The next morning, my knee felt a lot better, but later gave me a strong twinge when I bent down to a deep squat to pick something off the floor. So I used DMSO gel on the knee and rubbed it in. Di-methyl sulfoxide (DMSO) is derived from wood pulp, and has a longer history of use in veterinary medicine, being helpful for racehorse injuries, among other uses.
The morning after I injured my knee, I skated gingerly, not trusting my knee with much weight or strain, and favoring it. I did not try to jump at all, and stayed on the ice about an hour, mostly stroking around the rink with shallow bends, and the inside and outside edges that shift weight onto each side of the knee.
Again that day, when I bent to a deep squat, my knee grabbed me a bit the first time, but not so much on a subsequent squat.
By this morning, three days after the injury, my knee was fine. I skated up to my usual level of skating today, doing all four of the double-rotation jumps that are at my current personal best, multiple times, not holding back at all. My knee felt fine throughout the skating session and has been fine all day. I am diagnosing a mild sprain that healed very quickly, especially for a middle-aged person. Again, I’ll be 60 my next birthday.
Part Two: What NOT to do with a sports injury of the knee
Now I will tell you what I would not do, and this is exactly what is done with a knee sprain in conventional medicine. Rest, ice, compression and elevation (RICE) is the recommended protocol, which is okay, not bad if it's all that's available to you. But gentle osteopathic techniques, such as Muscle Energy and Counterstrain, are very often better. If subluxation is the problem, chiropractic may be most helpful. But with the knee, sprained or torn ligaments seem to be more common than subluxation of patella or other bone.
Very unfortunately, a steroid is usually prescribed. This alleviates swelling / edema in the short-term, but is a usually a disaster in the long-term. Steroids such as prednisolone are catabolic, ultimately weakening the support structures of the knee and, just as weakening the support beams in a building, this can set you up for more structural problems in the future.
It is possible for even one dose of a steroid to cause permanent health problems. I will never forget a patient I once saw whose health problems began with one 40 mg dose of a common steroid drug, some years before I met him, and from which many interventions were tried over years to eliminate his side effects from that one dose, with little success.
Even a short course of steroids can cause avascular necrosis (AVN) of the hip, and in fact, that is the most common cause of hip AVN aside from trauma. Even Mayo admits it: http://www.mayoclinic.org/diseases-conditions/avascular-necrosis/basics/risk-factors/con-20025517.
Cataracts are the most common cause of blindness worldwide. Steroid use increases risk of developing cataracts.
Steroids are such a common cause of pre-diabetes, that a term exists for this condition: steroid hyperglycemia.
If a knee injury can be repaired relatively easily, quickly and locally, let’s not either destroy the overall health of the individual or weaken the knee long-term with unwarranted drugs.
Colleen Huber NMD is a Naturopathic Medical Doctor in Tempe, Arizona. She was the Keynote Speaker at the 2015 Euro Cancer Summit, the 2016 World Congress on Cancer Therapy, and a keynote speaker at the 2016 World Congress on Breast Cancer. Dr. Huber is President of the Naturopathic Cancer Society. She is a Naturopathic Oncologist and Fellow of the Naturopathic Oncology Research Institute. She authored the largest and longest study in medical history on sugar intake in cancer patients, which was reported in media around the world in 2014. Her other writing includes her book, Choose Your Foods Like Your Life Depends On Them, and she has been featured in the books America’s Best Cancer Doctors and Defeat Cancer. Her academic writing has appeared in The Lancet and other medical journals. Her research interests are in the use of therapeutic approaches targeting metabolic aspects of cancer.