Knee pain does not care about your age or your overall health. It does not care how rich or poor you may be either… Sharp knee pain can effect you differently and we will discuss how to help effectively treat this problem in this article, so read on my friend…

Despite the origination of your sharp knee pain, there is one thing in common: It hurts!

Sharp knee pain can stop you in your tracks, put a damper on your activities, and generally decrease your quality of life. What’s more interesting is that sharp knee pain causes can be difficult to identify because numerous factors may be contributing to your discomfort. If you are able to figure out what your sharp knee pain was caused by, then this is a step in the right direction.

Of all the joints in the human body, the knee joint seems to cause the most trouble for most people. In general, 9 out of 10 individuals will indicate that they have suffered from knee pain problems at some point in their lives.

Sharp knee pain causes are often hard to pinpoint because of the inconsistency of the pain. It may come on from time to time, or it may be present for only certain activities. Actually, this seeming inconsistency may hold the key to identifying sharp knee pain causes, so it is important to keep track of when you experience the sharp pain, and what activities you were doing at the time.

Some of the causes of sharp knee pain are self-evident. Sudden injury to the anatomical structures of the knee joint (i.e. twisting the knee) can result in severe knee discomfort. Moreover, trauma to the knee joint(i.e. falling and hitting the knee cap), can result in sharp knee pain issues. On the other hand, some causes of knee discomfort are not always so noticeable. A few of the more common, less obvious causes are as follows:

Arthritis: Arthritis can develop slowly, gradually affecting the mobility of the knee until one day, you begin to experience sharp pain.

Free-Floating Matter: Bits of bone or cartilage can break off within the knee and shift around, interfering with the mechanics of the knee and causing sharp pain.

Chondromalacia: This condition occurs when the cartilage under the knee cap (patella) becomes soft, allowing the knee cap to rub against the bone, causing sharp pain.

Malalignment: The knee joint can become malaligned, forcing the patella out of place and putting extra stress on the muscles and ligaments. This problem, sometimes caused by such simple things as improper gait, bad posture, and overuse, can be a cause of sharp knee pain.

Bursitis or Tendonitis: Sometimes, the bursae (sacs of fluid) around the knee joint, or the tendons within the knee become inflamed, and becomes another of the many knee pain causes.

There are several other causes of intense knee pain. In order to properly diagnose the causes of your knee pain, you need to be evaluated by a qualified medical professional. Still, in the interim, whatever the cause of your knee pain, you may be able to obtain some relief through the use of a well designed knee brace.

In the vast majority of cases, a knee brace can help protect your knee and help alleviate your painful symptoms. Well designed knee supports can come in several different styles, and they are not difficult to use. Some are more rigid (which can be a good thing) with a hinge that prevents excessive painful movements; others are soft, being more flexible in nature.

Regardless of the style or type, knee braces are designed to help support your knee, helping to take the pressure off the joint and thus helping to reduce any inflammation that may be causing discomfort.

Knee braces are also designed to help keep the knee properly aligned, thus helping to prevent sharp pain caused by malalignment while also helping you to avoid traumatic injury.



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Sacroiliac joint pain

 Sacroiliac (SI) joint pain has gained a lot of attention in the last ten years as an underappreciated cause of back pain with some studies indicating it is responsible for 15% to 40% of low back pain. The increased attention is due to the increasing knowledge of the SI joints intimate role in pelvic stability.  I hope more physicians consider SI joint pain in their differential after reading this article.

Pathophysiology

SI joint dysfunction due to inflammation within the joint itself is called sacroilitis. Pain from within the SI joint is common in rheumatoid patients and spondyloarthropathies.

The other cause of SI joint dysfunction stems from instability of the SI joint.  Many experts feel that SI joint pain is a component of a larger problem of pelvic instability (1). Pelvic instability has traditionally been underappreciated as a cause of low back pain, buttock pain, groin pain, and leg pain. Physical therapists and doctors of osteopathic medicine have been teaching these concepts for years but only relatively recently has this dissemination of knowledge trended towards mainstream thinking among medical doctors.

The SI joint complex (the SI joint and its associated ligaments) is the major support structure of the pelvic ring and is the strongest ligament complex in the body.  The complex consists of interosseous sacroiliac ligaments, iliolumbar ligaments, posterior sacroiliac ligaments, and the sacrotuberous and sacrospinous ligaments. The SI joints are two of the three joints involved in the stability of the pelvic ring.  The pelvic ring is the meeting place of the force vectors from the upper body and the lower extremities.  The third joint in the pelvic ring is the pubis symphysis. Pelvic instability causes pelvic rotation which can also cause twisting of the pubis symphysis.  Coupling this with its anterior location appears to provide an explanation as to why patients with SI joint instability can also experience anterior groin pain. Anecdotal evidence for this is seen when patients undergo a successful SI joint intra-articular injection relieving all of their posterior back, buttock, and leg symptoms but the patient still has groin pain. Groin pain is almost never eliminated by SI joint injections unless pelvic symmetry is corrected.

 If the SI joints are unstable, it can lead to significant pain and discomfort over the SI joints as well as numerous referred areas.  If an individual affected by SI joint pain has pain only over his or her SI joint, he/she  should be considered lucky. Most often SI joint instability causes unnatural strain on the entire low back and pelvic region causing a sometimes confusing clinical picture. Pain referral patterns of SI joint pain are often confused with L5 or S1 radiculitis or radiculopathies.

Referral patterns of SI joint dysfunction (2)

SI joint dysfunction often presents with a confusing clinical presentation.

1.       Buttock pain 94%

2.       Lower lumbar pain 74%,

3.       Lower extremity pain 50%, with 28% of these lower extremity pains going distal to the knee

4.       Pain goes all the way into the foot 13%. Younger patients are more likely to refer pain distal to the knee.

5.       Groin pain 14%. 

Most patients with SI joint instability also experience pain over the buttock region due to secondary muscle spasm of the gluteus muscles and piriformis complex.  Lower extremity symptoms are explained by the piriformis muscles natural tendency to spasm or tighten over the sciatic nerve whenever the SI joint is out of alignment.  This spasm of gluteus and piriformis muscles can cause a mechanical crowding or impingement of the sciatic nerve as it exits just below the SI joint (see figure 1. note the intimate association of the piriformis muscle, SI joint, and sciatic nerve).  Patients often complain of buttock pain and radiation of pain down to the knee and even down to the foot. Not all back pain and leg pains are due to a pinched a nerve from an intervertebral disk herniation.  SI joint dysfunction very closely mimics S1 or L5 radiculitis’ or radiculopathies because of the above described sciatic nerve irritation or impingement.

Groin pain and abdominal pain are not uncommon with SI joint instability.  Often times the groin pain is mistaken as a urologic problem like pudendal neuralgia, prostatitis,  genitofemoral neuralgia, or sterile epidydymitis(1). This is likely either due to unnatural tension on the nerves and ligaments around the pubis symphysis or actual impingement of the pudendal nerve which lies between the sacrospinous ligament and sacrotuberous ligament. The distance between these two ligaments abruptly narrows when the Ilium and sacrum are out of alignment i.e. SI joint instability.

The typical history of SI joint dysfunction consists of lateral or bilateral low back pain almost always below the pelvic rim. Pain can also radiate into the hip, groin, pelvis, leg, and foot.  The most common location of pain is in the buttock with pain extending down to the knee. Females are much more affected than males though the ratio is unclear.  The mechanism of injury is a continuum from completely atraumatic events to more obvious trauma like motor vehicle accidents, childbirth, or falls. A little over one third of failed back surgery patients suffer from SI joint dysfunction. In my practice, I often see patients who lose a substantial amount of weight and then develop SI joint dysfunction.  The etiology of this is unclear. Women who have had multiple births also seem to have a higher incidence of SI joint dysfunction.  The symptoms may be acute or may present as a remote or cumulative injury with chronic waxing and waning of symptoms with slow progression over time.  Patients often experience some degree of temporary relief with manipulation.  Patients must change positions frequently to avoid pain.  This is called “Theater Party Cocktail Syndrome”. Patient’s legs can also feel like they’re going to give out, but with objective testing of motor strength, no dysfunction is found. This is called a “Slipping Crutch syndrome”. Patients usually have a difficult time sleeping and getting out of bed in the morning can be excruciatingly painful. Continued movement after waking up tends to improve the pain.

There are many provocative physical exam maneuvers used to help establish the diagnosis of SI joint dysfunction. Going through each one of these provocative maneuvers is beyond the scope of this article.  It is important to note that the predictive value of provocative SI joint maneuvers in determining SI joint dysfunction is only 60%(4).  The conclusion of a recent study by Slipman et al(5), was that physical exam techniques can at best enter SI joint dysfunction into the differential diagnosis of a patient’s low back pain.  Of the alleged signs of sacroiliac joint pain, maximum pain below L5 coupled with pointing to the PSIS or local tenderness just medial to the PSIS (sacral sulcus) has the highest positive predictive value (PPD) at 60%(4).

Diagnosis

The gold standard for making a diagnosis of SI joint dysfunction is a fluoroscopically guided SI joint injection. Fluoroscopy is needed to accurately and consistently inject the sacroiliac joint.  Only 12% of patients had intra-articular SI joint injections when fluoroscopy was not utilized (3).  Also important is to anesthetize the entire SI joint complex.  In my experience as an interventional pain physician this cannot be consistently done by palpation alone, especially in obese patients.  It is humbling to see anatomy change under fluoroscopic guidance. What you perceive with palpation is sometimes markedly different than the actual location of the structure that you palpate.  Also vitally important is that these diagnostic injections are followed up with another physical exam while the patient is in the recovery room. Sending a patient home, having them follow up in several weeks, and then determining if this “diagnostic” injection was successful has consistently been shown to be an inaccurate way of establishing a pathoanatomic diagnosis.

Treatments

There is no one specific treatment for SI joint dysfunction which helps all patients.  The treatment varies if the dysfunction is intra-articular (inflammatory), or if it’s a lack of stability. Conservative treatment should first be tried including the manipulation by a qualified physical therapist or osteopathic physician to restore normal motion and balance,  home self-correction exercises,  a walking program (avoid heavy axial loading maneuvers), and core strengthening exercises (Pilates, Yoga, or guided physical therapy). Some patients also benefit from a quality SI joint support belt.  If conservative therapy is not helpful then I recommend a diagnostic SI joint complex injection.  The injection should include the SI joint ( intra-articularly) and the supporting ligaments with pain relief lasting for the duration of the local anesthetic and achieving greater than 75% pain relief. If there is any question about the positivity of this diagnostic test,  it should be repeated.

Radiofrequency Denervation

If the diagnosis has been established by an intra-articular SI joint injection and pain relief using conservative therapy affords no long-term pain relief, then consideration for other treatments can be made.  Radiofrequency denervation of an SI joint carries about a 65% success rate for patients who have failed other conservative therapies and only mild instability around the joint. The procedure involves the neurotomy of the lateral branch nerves that lay over the sacrum and innervate the posterior SI joint. The advantage of SI joint radiofrequency is that it is a very safe procedure with almost no documented morbidity.

Prolotherapy

Another treatment for SI joint pain is Prolotherapy.  Prolotherapy works by stimulating an inflammatory cascade which leads to fibroblastic activity thereby strengthening the entheses of ligaments and tendons. Prolotherapy on SI joints usually requires very strong Prolotherapy solutions.  In my experience, hypertonic Dextrose Prolotherapy only relieves 20 to 30% of most patients’ pain.  More aggressive prolotherapy usually reduces pain by 50% or greater in roughly 75% of patients. The greatest advantage of Prolotherapy is that it is provides a level of permanent relief.

SI joint Fusion

If the patient fails radiofrequency and prolotherapy, the last treatment option would be consideration for an SI joint fusion.  The outcome data on SI joint fusions is not highly favorable.  However, there are new minimally invasive SI joint fusions that have recently been approved by the FDA that appear promising. Patients with very diffuse pelvic pain and leg pains are not good candidates for fusion surgery. 



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Back pain is reported to be the most common cause of missed work, right after flu and colds. In fact, back pain is so common that many people consider it inevitable, especially with increasing age.

But it may be possible to avoid some types of back pain by better understanding its causes and avoiding or preventing them in the first place.

And while over-the-counter pain relief medications can help lessen back pain once it occurs, exercise, improved posture, and good furniture can strengthen and heal your back and even prevent back pain from occurring in the first place.

This article will guide you in both ways: how to avoid back pain and how to find back relief.

Back Pain Causes

The back is a powerful structure comprising bone, muscle, and elastic discs. This marvel of efficiency allows you to bend, twist, and carry weight. However, its flexibility makes it susceptible to injury and pain. Not surprisingly, back pain often results from neglect or other lifestyle factors such as:

* Bad posture – A normal adult spine resembles a double ‘S’. When you slouch, the pelvis and the stomach thrust forward, the knees bend, and the back muscles are strained. This strain can easily lead to back pain.

* Sedentary lifestyle and stress – Lack of exercise tends to weaken the muscles in the body. At the same time, stress can lead to muscle tension, causing the unprepared muscles to spasm.

* Weak abdominal muscles – Back pain is often related to weak stomach muscles, which can place added stress on the back.

* Obesity – Overweight people may find it difficult to maintain proper posture, and the burden of additional weight puts pressure on the back.

* High heels – They push the body’s center of gravity forward. To offset this, people tend to bend their knees and move their torsos forward. This can exaggerate the spine’s inward curve, leading to back pain.

People can also experience back pain as a result of specific health conditions:

* Spondylosis – Arthritis of the spine occurs due to degenerative spinal changes, and is often characterized by back pain.

* Spondylolisthesis – This occurs when one spinal vertebra slips forward on top of another one, causing back pain.

* Spinal stenosis – When the space around the spinal column and nerve roots is reduced, nerves are pinched or pressed, resulting in back pain. Arthritis and bone overgrowth trigger this condition.

* Herniated disc – One of the most common causes of back pain, this condition occurs when a spinal disc presses on a nerve. It’s also referred to as slipped disc.

* Sciatica – Sharp, shooting pain that radiates through the lower back or buttocks to the back of the leg when a herniated disc presses the sciatic nerve.

* Spinal infection – When this occurs, back pain is often accompanied by fever and tenderness.

Back Pain Relief Options

Not every type of back pain is a condition you have to put up with. In addition to medication and home therapies, there are a variety of complementary and alternative therapies that can provide back pain relief.

Bed rest may help relieve acute, temporary back pain. But this may not work for chronic back pain, which may require long-term treatment.

Here are just some of the methods you can try to get back pain relief:

* Heat and ice treatment – For lower back pain relief, use an ice pack first to sooth the sore muscles. You can use a cold compress several times a day for up to 20 minutes per treatment. A warm compress or a heating pad loosens the muscles and increases blood flow, which can provide some back pain relief.

* Chiropractic care – Some research on pain relief has shown that chiropractic manipulation may be as effective as pain relief medication for certain patients.

* Acupuncture – In this alternative medicine procedure, the practitioner inserts sterilized stainless steel needles at specific points on the body. This may stimulate the brain to release natural endorphins, which can provide some level of back pain relief.

* Electrical stimulation – Transcutaneous electrical nerve stimulation (TENS) often works for acute back pain. In this procedure, weak electrical pulses sent to nerve pathways through specific points prevent pain signals from reaching the brain. This back pain relief procedure may be appropriate for those who prefer to avoid medication.

* Over-the-counter medication – Drugs such as aspirin and ibuprofen can help reduce inflammation and relieve back pain, while acetaminophen controls pain without addressing inflammation.

* Prescription medication – When over-the-counter drugs fail to provide pain relief, doctors may prescribe a nonsteroidal anti-inflammatory drug (other than aspirin or ibuprofen), a muscle relaxant, or other medication.

* Epidural injections – When other measures fail to relieve back pain, doctors may prescribe epidural injections of anti-inflammatory medication such as cortisone to provide pain relief.

Back Pain Don’ts

* Do not exercise while suffering from severe back pain.

* Do not sit for long periods when suffering from back pain. Sitting exerts more pressure on your nerves than standing or lying down. This can exacerbate back pain.

* Do not slouch or overarch your back, as this increases pressure on the lower back and may cause back pain to become more intense.

How To Avoid Back Pain

Many people who suffer from chronic back pain have found that a few lifestyle changes and healthy work habits can help them avoid recurrences of back pain:

* Exercise – Exercise not only helps to maintain proper weight, but also helps build and maintain strong muscles. However, if you already suffer from back pain, consult your doctor before starting an exercise routine.

* Good posture – A balanced posture allows the body to relax while maintaining an erect position. If you stand for long hours, avoid back pain by placing one foot on a stool or a box to avoid stressing the pelvis. While sitting, make sure that your lower back is supported and that your feet stay flat on the floor.

* Bend and lift properly – Improper bending is a common cause of back pain. When bending down, bend your knees, separate your feet about shoulder width apart, and keep your back straight. When lifting things, let your legs bear your weight, keep objects close to your body, and ask for help if the load is too heavy.

* Sleeping position – Sleep on your side, with your knees bent towards the chest. Place a pillow between the knees to reduce pressure on the back.

* Heel inserts – To reduce the risk of back pain, some doctors recommend heel inserts to alleviate stress on the lower back and provide shock absorption.

* Medium-firm mattresses – Sleep on a mattress that is firm enough to support your body but does not distort the body’s natural curves.

* Car seating position – Tilt your car seat back slightly, so that your knees are higher than your hips. Place the seat close enough to the wheel to let your arms bend.

Treating your back with respect is one key to avoiding back pain. However, if you already do have back pain, a variety of pain relief medications and treatments are available.



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