Nolan Alexander (Host): Welcome to the podcast from the specialists at Southwest General Health Center. This is Southwest General Health Talk. I'm Nolan Alexander. And with me is Dr. Daniel Kana, orthopedic surgeon with Southwest General Health Center, as we talk about knee pain and when to get it checked out, from everyday aches to sports injuries, to the warning signs that you shouldn't ignore.

Dr. Kana, thank you so much for joining us today. How are you?

Daniel Kana, DO: Good. Great. Thanks for having me. I appreciate taking the time, and happy to be here.

Host: It's certainly our pleasure. And an interesting topic today because knee pain, it can hit anyone, but it isn't a one-size-fits-all. When someone comes to see you, what are the most common culprits? And how does the conversation differ between a younger person, an active athlete, and then an older adult?

Daniel Kana, DO: Yeah, yeah. No, absolutely. Knee pain is super common. You know, we break it up into two buckets. The one bucket being acute injuries or, you know, I had a twisting injury playing pickleball or playing high school football. I mean, those are more ligamentous injuries, sometimes meniscus tears, cartilage injuries in the knee itself. And then, the other common thing we do see is more chronic long-standing pain that has just been going on for a long time. And the driver and the main thing that we see with that would be arthritis, tendon injuries or tendinopathies, chronic wear and tear type issues that have been going on for a long time.

Host: So within that, how can someone at home tell the difference between what's maybe normal muscle soreness after a workout or just a long day and pain that signals an actual injury or an underlying condition?

Daniel Kana, DO: Soreness after activity is certainly normal as well. Soreness gets better with time. You know, so if you rest it, soreness tends to get better over a couple day period. Whereas something that may be a little bit more worrisome or something you may want to get checked out does not quite get better with time, is associated with swelling, is associated with instability, buckling, giving way, having your knee lock, catch, those types of things. But really, the main driver would be: is it getting better or is it not getting better?

Host: So, the main thing you said there is time, about two to three days?

Daniel Kana, DO: Yeah, I would say typically sometimes you can have some delayed muscle soreness after activities, which may not even really onset for a couple days. But still, you should see a progressive change in improvement in your symptoms if it's just regular soreness versus something that's more serious like a problem with an injury to a ligament or something more serious in the knee.

Host: Dr. Kana, what are some absolute red flags, the symptoms that mean somebody needs to see an orthopedic specialist sooner rather than later, even if the pain comes and goes?

Daniel Kana, DO: Red flags, again, kind of touching on what I said just prior, being if you had a popping injury followed by significant swelling in the knee, or if you have what we call mechanical symptoms, which would be locking or catching of the knee where you feel like, you know, you can't get through a range of motion or you can't bend it, you can't get it all the way straight.

Inability to bear weight is one thing certainly not to ignore. That could be concerning for even a fracture at times. Instability where your knee may buckle or try to give way and just not feel steady when you're trying to walk on it. And then, again, on the timeline side of things, we don't want to ignore pain that's just not getting better.

You know, pushing through it is one thing, but really trying to make sure that we're not ignoring the things that just aren't getting better. I always tell people that, you know, your body has a pain response for a reason. You may want to push through it and get back to the things you want to do on your own. But sometimes it's smart not to ignore your body and listen to your pain response, and get it checked out.

Host: That's an excellent point. And it makes me think of just this situation, right? Like, I think this happened to my father over the weekend. If someone's knee flares up or they just kind of tweak it over the weekend, I'm curious, what should they do immediately at home to help safely? And then, just as importantly, what should they absolutely avoid doing?

Daniel Kana, DO: Yeah. So, you know, in the acute phases where, after an injury or something may happen, we're trying to control inflammation. And what we're doing, you know, people hear RICE, which is rest, ice, compression, and elevation. So, just that really trying to kind of rest it for a few days, let your body kind of heal it up a bit.

Compression can be helpful with an ACE bandage or some ice. if you can take over-the-counter anti-inflammatories, that can be beneficial as well. Elevation, really just trying to stay off of it, seeing if it does get better. And if it doesn't get better over the weekend, if you had an injury, you know, playing pickleball on Friday, you know, maybe by Monday, you'd expect to see some significant improvements. And if you don't, maybe something, you know, to look into.

Host: That sounds easy. And for some people, they feel like going to see a specialist isn't. I mean, people often put off seeing a specialist because perhaps they feel anxious about what's going to happen. Let's peel back the curtain a little bit. Walk us through what a typical initial evaluation actually looks like in the office.

Daniel Kana, DO: Yeah. Yeah, absolutely. So, you know, we typically start with X-rays. We have an X-ray machine in both of our offices, just to get a starting point of your anatomy and to see the joint spaces and the alignment, and to make sure there's nothing wrong there. And then, a conversation is really where we start, getting a kind of an idea of, you know, what happened, what's bothering you, how long it's been bothering you, and getting some more details just on your issue at hand.

And then, we'll do an examination where we, you know, check your ligaments, and we check the stability of your knee, and we can kind of tailor that to, you know, your story, your situation, and then move forward and kind of make a plan together based on your specific goals and what happened to you or what you want to do or get back to.

And certainly, you know, surgery is never the first line for us. We always try to make sure we're, you know, kind of highlighting all the non-surgical things first and making a team-based approach and, you know, using a shared decision-making process and making a plan for you to get you, you know, back to doing what you want to do.

Host: I really like hearing that, Dr. Kana, because I think there's a common fear out there, right? That it means, as soon as you walk in to see an orthopedic specialist, okay, you're going to be signed up for surgery just automatically. But it sounded like, you know, there are some powerful tools and treatments and conversations that are available before you ever discuss surgery.

Daniel Kana, DO: Certainly, yeah. So, you know, we're always trying to make sure that we're doing as little as possible and as minimally invasively as possible to get you back to, you know, a pain-free lifestyle and doing those things in life that you want to be doing without pain. And, you know, with knee pain specifically, you know, the conservative things that we can start with certainly would be physical therapy. That's huge in making sure that we strengthen the muscles around the knee and make sure we have sort of a built-in dynamic brace available for you with good range of motion and strength. We can try anti-inflammatories, both over-the-counter and sometimes prescription strength. You know, and then talking about different injections, sometimes cortisone or corticosteroid injections can be helpful to kind of, you know, put out the fire of the swelling and inflammation at times.

Sometimes gel injections, which are like a hyaluronic acid or more to kind of lubricate the knee if it's been sort of worn out over the years. Those are an option. So, lots of things we can do non-surgically to get pain under control and get you back to the level of function that, you know, you want to be at.

Host: So with that, when does surgery actually become the right conversation to have? And what's the real risk of trying to just tough it out and live with the pain for too long?

Daniel Kana, DO: Trying to tough it out and living with the pain, that can certainly do damage and make things worse. We don't want to ignore things for too long because, you know, certain conditions in the knee can get better and worse, you know, over weeks and days and months. You know, you don't want to ignore them if they're not getting better.

Surgery certainly, you know, can play a role in our treatment algorithm, but it's really more so acutely when there's a ligamentous injury or a problem that can't correct itself. So if there's an issue with an ACL tear or a different ligamentous injury that can't heal itself, sometimes we do need to correct that surgically to get you back to the level of function you want to be at. And then, for more of the chronic type issues with arthritis and, you know, things that have been bothering you for a while, those types of issues, again, we try all the conservative things for as long as we can, but I always say, you know, when the pain, you know, prevents you from doing the things in life that you want to do or need to do, that's when, you know, certainly sometimes surgery is the last option to get you back to where you want to be. And, you know, even just simple things like taking your dog for a walk around the block or, you know, playing that round of golf or whatever you want to do. So, surgery, you know, while scary at times, does have a role and, you know, can be very beneficial.

Host: Well, Dr. Kana, you've given us a lot of great information when it comes to knees and knee pain and knee injuries. Is there anything else that you want to leave our listeners with today?

Daniel Kana, DO: You know, we always try to treat people, like they're family and making sure that, you know, you have all the options presented to you. I think part of my job is also being a teacher and making sure that people truly understand their knee condition and what's going on. You know, knee pain is a symptom, not a diagnosis. So, we got to make the diagnosis together with information, and then we can kind of work through what your goals are and tailoring that to a treatment plan for you, so we make a shared decision and get you back to doing the things in life you want to do.

Host: Very well said. Dr. Kana, thank you so much for your time today

Daniel Kana, DO: Absolutely. Thank you very much. Appreciate it

Host: That was Dr. Daniel Kana, orthopedic surgeon with Southwest General Health Center. To request an appointment with Dr. Kana, you can visit swgeneral.com. If you found this episode to be helpful, consider sharing us on your social channels and check out our full podcast library for topics of interest to you. And this has been another episode of Southwest General Health Talk.