Does “bone on bone” knee pain always require surgery?
No, almost never.
Really? My knee pain can go away without drugs or surgery!?
Yes, that’s right.
Just because a radiologist (who has never examined you in person) writes a report stating that one of your joints has lost most or all of its cartilage and is then regurgitated to you by your primary doctor or surgeon as being “bone on bone,” doesn’t mean that surgery is a necessity. And no, I don’t mean just live on pain meds the rest of your life. I help patients routinely to get out of knee pain without surgery and without medication. When you fix the cause of your joint dysfunction, the pain goes away, even when the cartilage is gone. Really? Hmm… How’s that possible? Are you sure?
Even though I routinely help people get out of “bone on bone” joint pain in my practice, I never was 100% sure that I could help a new case each time he/she came to me. At least not until I read Stu Mittleman’s book, “Slow Burn.”
In his book he tells his personal story about how he damaged his knee ligaments requiring surgery at the age of approximately 25. After the successful surgery, and after his physical rehab, he asked his surgeon when he would be able to start running again? His surgeon laughed at him and told him that he had no cartilage left in that knee and it was in fact bone on bone. He told him that he would never be able to run again without significant knee pain.
Stu didn’t like that answer so he found a doctor like me who found out why his cartilage wore out and then helped him fix these underlying causes. After 6 months, Stu was able to run again without pain! And not only that, he went on to become a world class ultra-marathon champion!!! All without knee pain! Now that is impressive!
No, Stu’s cartilage did not regenerate….. So if his cartilage did not regenerate, then how did he get his knee to be pain-free? Well, it was unique to his situation, just as each patient I treat has a unique situation along with a unique treatment process. But I’ll give you the basic formula.
Before I do, I want to say that once I read this story of Stu Mittleman’s, I realized that if he can run hundreds of thousands of miles over his lifetime on a knee that’s bone on bone with no pain, then it is definitely highly possible for anyone to get out of pain without joint surgery, especially since they likely don’t strive to be a long distance runner, but instead just want to walk around the house or at the grocery store without pain.
Plus, my success rate at helping bone on bone cases has gone up to nearly 100% since my advanced training in 2015 in Michigan and my subsequent implementation of cox flexion distraction treatment tables.
So with all the stars aligning, I thought it was time to write this article for you guys and for your friends and family who may be needlessly suffering and contemplating surgery, or who have had a failed joint surgery.
First let’s briefly go over what causes a knee to wear out in the first place:
1) Weak muscles surrounding the joint, causing the joint to track poorly, causing the two cartilage surfaces of the joint to bump into each other every time you move the joint, over time wearing out the cartilage.
2) Low level body-wide chronic inflammation, including in the joint that’s wearing out. This inflammation swells the cartilage slightly so that the two surfaces bump into each other even more, wearing them out even faster.
So now that we know generally what causes the joint to wear out, all we have to do is fix numbers 1 and 2 above and, believe it or not, the pain goes away! So in other words, it’s the grinding and internal bumping of the two cartilage surfaces into each other, during normal daily movements, combined with inflammation that causes the pain. If we can somehow get rid of the inflammation and help the joint to track properly by increasing the strength of the surrounding muscles, we’re golden.
That’s it!
Of course I could write a whole book on the specifics of what causes the joint’s muscles to be weak (there are 100’s of causes) and what causes the body to be inflamed (again, hundreds of causes). But let me just say what is NOT the cause of the muscle weaknesses around your bone on bone joint: wait for it…… weak muscles. Huh?
Except in very very rare conditions (like Myasthenia Gravis, which you don’t have or your doctor would have told you by now), the only cause of a truly weak muscle is having it in a cast for 6 weeks. I call this primary atrophy, or “small muscle.” The cure for this is physical therapy, aka exercise. But unless you’ve been in a cast over that joint for 6 weeks, you don’t have primary atrophy, and therefore, physical therapy won’t fix the underlying cause of the muscle weaknesses around your joint. And, more likely, the physical therapy will wear out the joint faster because it’s not tracking right during your physical therapy exercises.
So, pretty much in virtually all cases, the “muscle weakness” is actually due to poor nerve or poor nervous system function. The nerves and nervous system tell the muscle when to contract, how hard to contract, and when not to contract. In other words the muscle is stupid because it has no brain, instead your brain directs and coordinates the muscles via the nerves. So a weak, or more accurately, dysfunctional muscular system, is really a dysfunctional nervous system. You have to fix the nervous system, including the peripheral nerves that supply the muscles to that joint, in order to enable the muscles to do their job of moving the joint without it grinding the two surfaces of cartilage together.
This is what I specialize in. Once the nervous system coordinates the muscles correctly again so that the joint tracks right, the pain goes away…. as long as there is no body-wide inflammation.
The most common causes of body-wide inflammation are: bad oils in the diet, especially trans-fats and rancid oils, too many omega 6 oils, deficiency of omega 3 oils, hidden food sensitivities, too much sugar feeding yeast or other dysbiotic organisms in your gut, or liver congestion from all of the above. And, sadly, all too often, there is a body-wide inflammation as a side effect of prescription medications.
But never fear, I’ve got plenty of simple and natural things to fix these things too. Stay tuned for more on this.
So in summary, if you have a joint that is painful and your doctor says it is bone on bone and needs surgery, you would do well to come see me so I can diagnose why your nervous system can’t control the joint’s muscles correctly. I find this out by combining the specific information you give me about the history of your condition with the information I glean from physically examining your neuromuscular system using mostly traditional neurological tests (that neurologists rarely use anymore because they have become overly reliant on radiologist reports from your MRI or x-rays). Your history and examination (and MRI findings if available) must correlate to make a solid diagnosis. Once this is accomplished, the treatment can be rather straight forward.
Please forward this to anyone you know who has joint pain.
Best Wishes!
Dr. John B. Campise, D.C.