Chronic knee pain: is it really arthritis?

There are few injuries that will slow you down as much as knee pain. In circumstances where there is trauma and /or accident, the diagnosis and treatment are fairly obvious. Think of someone being tackled from the side and their knee buckles in. This is likely a tear of one or more ligaments of the knee. Treatment depends upon the degree of damage, and surgical reconstruction may not be a bad idea. But more often the pain is more mysterious. It arises with no obvious cause. It comes and goes at seemingly random times. Many people conclude it must be arthritis.

If you follow this blog or my Facebook page you likely have likely read about how there is POOR CORRELATION of pain to joint damage and arthritis. Scientists have always assumed that x-rays, CT scans and MRI imaging were the "gold standard" for diagnosing musculoskeletal pain. What they are looking for is evidence of joint damage and/or arthritis. But recent studies have shown that MRIs of "normal" or "healthy" populations WITHOUT pain also show significant levels of damage and arthritis. So the question is- how can you be certain that it is the cause of YOUR pain, when there are so many other people with the same damage and NO PAIN?
So here is some perspective. The old way of thinking goes something like this:

In the old way of thinking, ALL damage was due to overuse and overactivity. The problem with this is that everything is considered "too much". Is it really "too much" when someone squats down to pick up a small child? What about going up or down stairs? Should an otherwise healthy 25 year old woman need to stop running 5k races because it is "too much" for her knee arthritis? I think not.

The new way of thinking looks something like this. It is a double feedback loop.

You can see how even if you surgically "fix" damage and arthritis, the pain is likely to continue. It's not that damage and arthritis are always completely unrelated to pain, it's just that it's not a direct one to one relationship as previously thought.

Too often in the past, we have been told to be "careful", and "don't overdo it". Unfortunately this has led to many of us being overly cautious and fearful of daily activities. We start to see our bodies and weak, and need to avoid pain at all costs. Opioid prescriptions are a good example. They don't heal you. Your body does the healing. We just need to optimize the heeling environment. How do we do this? MOTION! Gradually increasing the activity level is crucial. Muscular resistance exercise is necessary. Studies have shown that even in the presence of arthritis, training the surrounding muscle structures helps to improve function and decrease pain. So the first question is- does such training decrease the level of arthritis? No. Arthritis can't be undone. Then there is the second question. Is the pain really from arthritis?