When you are over 35 and have knee pain, an MRI will likely show degenerative changes. You will then be diagnosed accordingly – patella-femoral dysfunction, osteoarthritis, meniscal damage, etc.
But this can be utterly wrong over 40% of the time!
Sanshiro Hashimoto, M.D., is an orthopedic surgeon specializing in the knee and trained in Mechanical Diagnosis & Therapy (MDT*).
Mechanical Assessment Reveals Underlying Root Cause of Symptoms
Dr. Hashimoto published research on a retrospective chart review of 101 of his patients that had complaints of non-acute knee pain (symptoms for at least one month). The data collected from the charts showed that 44.6% of the patients had knee pain caused by a lumbar spinal disorder and not a knee pathology. Even though the primary complaint was a problem with their knee, a mechanical assessment and follow-up treatments found no knee pathology. Instead, symptoms were referred in over 40% of the cases.
*MDT is an advanced assessment and treatment system that all VPT clinicians are certified.
Lumbar spine derangement
A derangement is a problem within the joint. A lumbar derangement is caused by a disc in the lumbar spine (low back) that is not working correctly because its nucleus is disrupted from its central position. A disc bulge is a tear in the disc that does not go to the outer layer, while a herniation goes to the outer layer. The disrupted disc can refer pain, numbness, burning, and tingling down your leg, including your hip, knee, ankle, and toes. The location of symptoms depends on what nerve or soft tissue the disc bulge or herniation puts pressure on.
Another study took it a bit further and investigated the rate of spinal pathology for all extremities and found a spinal disorder again caused a high incidence (43.5%) of isolated extremity symptoms. In this study, the patients all believed that their specific extremity was the cause of their problem but responded to spinal interventions. Another exciting find was that those with a spinal pathology responded better than those diagnosed with an actual extremity disorder.
The problem is that it is not common for those with shoulder, elbow, wrist, hip, knee, ankle, or foot pain to first receive a spinal examination. Many may not respond to treatment because they are not treating the correct joint and are misdiagnosed!
Every patient with extremity symptoms must receive a physical exam ruling out the spine.
Doesn’t a low back problem have to cause low back pain?
In Dr. Hashimoto’s chart review of the 45 patients with knee pain caused by a lumbar spine derangement, 31 had low back pain. But 14 patients did not have any back pain at all! If you suffer from knee pain and also have low back pain, there’s a 60% chance that your knee pain is being referred from the spine. If you have knee pain without low back pain, there’s about a 30% chance that the pain is referred from the spine.
Ruling out the spine should be the foundation of all orthopedic assessments. But unfortunately, this is rarely done, and instead, the focus is on MRI results and a 3-minute exam. Clearing the spine only takes a few minutes.
For a complete assessment, seek out physicians and clinicians trained in the mechanical evaluation (Cert. MDT).