The benefits of treating chronic knee pain

Cutaneous intermittent vibration is a new therapy showing promise in the treatment of chronic knee pain.

Despite the prevalence of chronic knee pain, which affects approximately 25% of adults, there is still a significant demand from patients for new treatment options. Evidence-based recommendations for the treatment of chronic knee pain emphasize the importance of noninvasive, nonpharmacologic and self-care approaches,^, underscoring the ongoing need for innovative solutions. Recently, the use of cutaneous intermittent vibration timed to movement applied to the area surrounding the knee has been shown to significantly reduce knee pain and improve muscle function in individuals afflicted by chronic knee pain.

As a doctor of chiropractic, you likely have goals for your patients’ chronic pain management, including pain relief, maximizing patient function and satisfaction and reducing reliance on pain medications, achieved using a multifactorial treatment approach. The addition of an easy-to-use treatment patients can utilize at home between in-person visits to move with less pain can complement this treatment approach and offer patients a resource to manage their chronic knee pain.

The science of intermittent vibration timed to movement for chronic knee pain relief

Intermittent vibrational stimulation applied at the knee during movement is an innovative, noninvasive solution that can enhance the care you provide and can be used by patients at home between chiropractic sessions. The use of intermittent vibration timed to movement to reduce knee pain is based on principles of the Gate Control Theory of Pain. This theory suggests non-painful input, such as pressure and vibration, can reduce or gate painful input, thereby reducing the amount of pain sensation reaching the brain (Figure 1). By applying cutaneous vibratory stimulation to the area around the knee during movement, large nerve fibers of the somatosensory system are activated. These nerve fibers transmit signals to the brain faster than the smaller nerve fibers of the somatosensory system, which transmit pain, leading to a reduction in perceived pain. The use of an intermittent vibratory stimulus timed to movement avoids the potential for a diminished benefit that can occur with the use of a constant vibratory stimulus, where the body can habituate to the vibratory input.

Enhancing quadriceps muscle function with intermittent vibration

Intermittent vibration timed to movement also aids in restoring quadriceps muscle function, which is often inhibited with conditions causing chronic knee pain like knee osteoarthritis, the most common cause of knee pain in people over age 50. The quadriceps muscles play a critical role in knee stability, patient satisfaction, functional status and surgical treatment outcomes. By reducing knee pain during activity, intermittent vibration timed to movement can improve quadriceps function during ambulation. It can also aid in rehabilitation, allowing patients to perform prescribed rehabilitation exercises with less pain.

Clinical evidence

Clinical research supports the efficacy of using cutaneous intermittent vibrational stimulation in patients with knee pain. Research in individuals with chronic knee pain due to osteoarthritis, meniscus injury and anterior cruciate ligament injury showed that intermittent vibrational stimulation timed to motion significantly reduced knee pain and symptoms and improved quadriceps muscle function during walking. The intermittent vibration was applied via two bands placed above and below the knee (Figure 2) and was timed to the patient’s movement, turning on prior to heel strike and turning off at mid-stance of the gait cycle. In a single testing session, patients saw a significant improvement in quadriceps muscle function, with patients with the initial greatest deficit in quadriceps function having the greatest response to the intermittent vibration.

In a longitudinal, randomized, controlled cross-over study, patients with symptomatic knee pain due to prior injury or osteoarthritis exhibited a significant improvement in pain and symptoms during walking after four weeks of using intermittent vibrational stimulation timed to movement at the knee. This symptomatic improvement was not seen after four weeks of wearing a passive knee brace providing only compression, demonstrating that in patients with painful knees, using an intermittent vibrational stimulus synchronized to movement provides the necessary stimulus to reduce ambulatory pain and improve symptoms.

Benefits of intermittent vibration in chiropractic care

As a DC, you focus your care on treating musculoskeletal disorders with holistic approaches. Integrating a device providing intermittent vibration timed to movement into your care can offer several advantages for your practice and your patients with chronic knee pain:

Noninvasive, drug-free pain relief: Intermittent cutaneous vibration timed to movement provides a noninvasive, drug-free alternative for pain management, aligning with chiropractic principles that prioritize natural healing methods. By reducing reliance on medications, patients can avoid potential side effects associated with long-term drug use.

Activity promotion: Maintaining an active lifestyle is crucial for overall health and well-being. Alleviating pain through intermittent vibratory stimulation during movement between chiropractic sessions enables patients to engage more comfortably in physical activities. Improved mobility also facilitates participation in rehabilitative exercises, promoting overall joint health.

Complementary therapy: Intermittent vibration can be used by patients at home alongside chiropractic therapies to provide a comprehensive treatment approach. The ability of intermittent vibrational stimulation to reduce pain and improve muscle function during ambulation complements manual therapies aimed at restoring joint alignment and muscle balance.

Patient empowerment: Patients can take an active role in their pain management by incorporating a device providing intermittent vibrational stimulation timed to movement into their daily lives. Regular use can lead to sustained improvements in pain levels and functional abilities, enhancing patient autonomy.

Integration into chiropractic practice

DCs can incorporate cutaneous intermittent vibration timed to movement into their treatment protocols by:

Assessment: Evaluating the suitability for individual patients with chronic knee pain based on their specific condition and medical history.

Education: Instructing patients on the proper use of intermittent vibration timed to movement to ensure optimal results.

Monitoring: Regularly assessing patient progress as necessary to achieve desired outcomes.

Final thoughts

You can deliver comprehensive pain management solutions to your patients by integrating intermittent vibrational stimulation applied around the knee during movement into your chiropractic treatment plans. You can expand your treatment offerings, improve patient outcomes and differentiate your services in a competitive market. This noninvasive, drug-free treatment aligns with the holistic philosophy of chiropractic care, empowering you to address your patients’ knee pain effectively and naturally.

Jenny Hledik, PhD, has a doctorate in biomechanical engineering from Stanford University. She is currently the chief operating officer at SomaTX Design Inc. and co-inventor of KneeMo^®, a noninvasive device delivering intermittent vibration timed to movement for knee pain relief. Hledik has held positions as a researcher at several institutions and medical device companies. She can be contacted at jhledik@somatxdesign.com or via thekneemo.com.