There are a number of main knee conditions from the standpoint of Western and Eastern medicine. Between the two, Western medicine is by far the better at diagnosing and returning athletes to training/use. But Eastern medicine (including massage) is much better SOC (standard of care) for other populations.
Quite simple, really… Western medicine relies on using ice to stop swelling, numb pain, and then the athlete gets regular PT, surgery, in short constant care and contact which returns the vital flow of Qi and blood to the joint.
Long Term Expectations
ACL reconstruction surgery has a 90% success rate in terms of knee stability, patient satisfaction, and return to full activity.9 ACL reconstruction seems to protect the menisci from further injury and slow degenerative changes in the knee joint.2
The re-rupture rate of a reconstructed ACL is very low, one long-term study reported a 2.6% rupture rate at a mean of 2.5 years after surgery.12 After sustaining one ACL injury, risk of subsequent ACL injury in either the graft or the other leg increases substantially from 1 in 3,000 to 1 in 50.12
Patients who opt out of ACL reconstructive surgery may experience further injury to the knee joint. ACL deficient patents are at higher risk for later meniscectomy, 20% over the 5 years following ACL injury.2 Also, 70% of ACL deficient patients have signs of osteoarthritis in the knee, and ACL reconstruction can reduce the rate of osteoarthritis.11
Meanwhile, with a typical patient, post surgery there can be any range from 8 weeks of PT to none (that is if they even get it repaired, which by in large most people do not). The risk of re-injury with athletic use is high, especially in “weekend warriors” who have generally atrophied hamstrings, inner quads, tight IT bands, and lots of core incongruency (such as hip abductor/adductors, and lumber vs abdominals).
You add into this that athletes are generally healthier as a population, younger, and more active (meaning better circulation) and of course they can overcome the problems of icing joints. But the average person does not have the means of care, the hands on help, nor the time to focus solely upon recovery of their knee injuries.
This means that the longer term methods – the wisdom based methods – developed in Ayurveda, martial arts, and Chinese Medicine based systems tend to be better than SOC, in my clinical and martial arts experience.
Last year I tore my right lateral fibular collateral ligament in a martial arts accident. It was weak due to a moment of anger causing the IT band (GB channel) to tighten, and as I later learned, a lifetime habit of “knee dominance” (thank you Drew Watts!) which led to structural weakness.
My treatment was not to ice, but to use gravity, herbs, acupuncture, etc… and the muscle which caused the imbalance reset that very night. From then on I made steady, normal progress, and without surgery. I have resumed 100% functionality, and even with increased workouts (at DR Fitness), I have no more problems. Contrast this to before I was an acupuncturist and I tore my left ACL and used ice (over-iced, to be honest), and created a 1.5 year “trick knee” issue, and I still feel coldness if I go swimming. That knee has never regained 100%, it is about 98%, but Drew and I are working on it.
So, what are the main injuries we see, and what is the main method of rehabilitation?[pullquote align=”right”]”Qi-surgery” means using the mind to mentally remove, cut, or knit the area, sending intention to the location. My strangest experience with qi-surgery during meditation was I once removed a section of my nose which was itching, and replaced it with a new nose. All in the mind you see. When I was finished I scratched my nose and a nose-hair that was 2.5 inches long and hooked came out. The hook of it had been scratching me. ~Shifu[/pullquote]
- ACL/MCL – usually treated with acupuncture, liniments, elevation, and light rehabilitation after 3 weeks. Complete tears require surgery or much “qi-surgery” and time to heal.
- +Meniscus – this is generally a Qi-gong fix, otherwise, surgery. Meniscus “qi-surgery” is an advanced meditation technique, and again only works in minor tears. It is also better to nourish the knee through meditation and prevent meniscus damage than it is to repair afterwards.
- PCL – PCL is a bit frightening, because of the knee lock issue, and stability problems; aside from normal ACL work, and the same nourishing the knee capsule meditations as in #3, the PCL is strengthened through use, and I generally recommend developing the “moon-curve” tendencies of Taijiquan to avoid habitually putting one’s knee in a weakened, unstable position. If completely torn, like the ACL it is a surgery fix.[pullquote align=”right”]Nourishing your knees can be anything from supplementation to herbalism, to qi-gong where you specifically send energy and focus down into the knee capsule, to massage techniques like”pumping the well”.[/pullquote]
- LCL – the LCL is most compromised (aside from blunt trauma/clipping) by cold in the channels and shortened IT bands. Therefore chafing and moxa are the best prevention and healing methods, with liniment is preferred. No ice!
- Sprain (general) – a general “tweaked knee” swells, often to an unbearable level. Amazingly, to this day no one in sports performs ligament and tendon saving/pain reducing cupping+bleeding. Although I do not do this at BLHA, I will teach it. It can drastically reduce pressure in the knee. Otherwise, elevation and rest, with distal acupuncture.
- Fibular issues – weak fibulas, such as the tendons, ligaments, or even breaks, are the result of system liver/kidney qi issues, therefore in the fix must be included internal herbs and qi-gong/yoga breath work to revitalize the channels and “break through the dam” that is usually upstream, causing the fibula to degrade/destabilize.
- Bursitis/Synovitis – fluid inflammation is the result of overwork, repeated impacts, and tight muscles, all of which cause internal local heat. Treatments are bio-freeze, Zhen Gu Shui, Woodlock oil, massage, TENS/micro-estim, and of course qi-gong to “burst the dam” in the fluid draining. Long term, if undealt with, there will by synovial capsule degradation, loss of cartilage, and a knee replacement will become necessary. I also recommend nourishing the yin-fluids of the knee with Baxyl.
- Patellar issues – patellar glide issues are caused by imbalances of the inner and outer quads, and myofacial adhesions “knots”… cures include PT/rehab of the quads and hamstrings, hips and low back, as well as foam rolling.
- IT shortening – micro tears in the IT band from running with shortened IT bands can cause severe blood stagnation and pain even trochanter bursitis. Cures mostly iunclude cupping, guasha, and liniment, with foam rolling daily and PNF/partner stretching to work out the piriformis, glute, and TFL muscles and relieve the knee.
- Shin Splints – although not technically the knee, this is caused by knee dominant running from shortened tibialis anterior. Treatments include acupuncture, massage, stretching, and corrective exercises.
In short, although TCM will not replace surgery if necessary, probably 9/10 cases of knee issues can be resolved without surgical options if multiple approaches are used consistently and icing is avoided beyond the 2 hrs post-acute tear/injury to reduce inflammation and stop swelling (10 minutes on, 20 off). Icing slows blood flow and therefore healing rates, and furthermore it harms the Qi-body and reduces overall circulation of energy and essence, weakening the body.
It would be likened to sending a blizzard to a terribly important highway route into a city… of course it will affect the city’s overall available commerce and goods. Therefore ice must be minimized and circulation enhanced, not stopped for maximal prognosis.
For more information on why “ice is for dead people,” read “Tooth From a Tiger’s Mouth,” by Tom Bisio, a book on Eastern rehabilitation methods.