Multimodal Chiropractic Management of Knee Pain: A Retrospective Case-Series of 19 Patients

Abstract

Background: Chronic knee pain is a prevalent and debilitating condition often managed with conservative care. This article examines outcomes for patients receiving multimodal chiropractic treatment. Methods: A retrospective case-series was conducted by reviewing the clinical files of 19 patients who presented with knee pain at a private chiropractic clinic in Magnolia, TX (Sandstone Chiropractic - Magnolia). All included patients had completed a course of care and had documented pre- and post-treatment pain scores. Interventions were patient-specific and could include knee decompression, spinal adjustments, cold laser therapy, and cryotherapy. The primary outcome measure was the percentage change in self-reported pain on a 0-10 numeric rating scale. Results: The cohort of 19 patients reported a mean pain reduction of 83% (median: 83%) following the completion of their treatment plans. Case vignettes illustrate these results, including a patient who avoided potential surgery and another whose knee pain resolved after addressing related hip mechanics. Conclusion: The findings suggest that a multimodal chiropractic approach may be effective in significantly reducing self-reported pain for patients with various knee conditions. These results support the role of conservative management and warrant further investigation through prospective controlled trials.

Methods

This study was conducted as a retrospective case-series. Data were sourced from the clinical records of patients at Sandstone Chiropractic - Magnolia, a private practice in Magnolia, TX. The providers involved in delivering care were Dr. Tony DeRamus (DC) and Dr. Rachel Brewton (DC). The inclusion criterion for this analysis was a presenting chief complaint of knee pain. A total of 19 de-identified patient files met this criterion and contained complete data, including self-reported pain scores at the initiation and conclusion of a treatment plan.

The patient cohort presented with a variety of knee-related complaints. Treatment protocols were not standardized but were tailored to each patient's specific diagnosis and clinical presentation. The therapeutic interventions available at the clinic and utilized in these cases included, but were not limited to, Knee Decompression Therapy, Spinal Decompression Therapy, Spot Cryotherapy, Cold Laser Therapy, and chiropractic adjustments to the spine and extremities.

The primary outcome measure was the change in patient-reported pain, documented using a 0-10 Numeric Rating Scale (NRS), where 0 represented 'no pain' and 10 represented 'the worst pain imaginable'. Initial and final pain scores were extracted from patient records. The percentage of pain reduction was calculated for each case. Aggregate data were analyzed for the mean and median pain reduction across the cohort (n=19). No formal tracking of mobility improvement was available for aggregate analysis. This study was subject to the inherent limitations of a retrospective design.

Discussion

The results of this retrospective case-series suggest that a multimodal chiropractic treatment plan can be a highly effective strategy for reducing pain in patients with knee-related complaints. The observed mean pain reduction of 83% across a cohort of 19 patients is a clinically significant finding. This level of improvement indicates that the combination of chiropractic adjustments with targeted modalities like knee decompression, cold laser, and cryotherapy may offer substantial relief for this patient population.

The individual case vignettes provide valuable context to the aggregate data. The resolution of knee pain following the correction of hip and pelvic mechanics, as seen in Case 4 and Case 9, supports the clinical principle of assessing and treating the entire kinetic chain rather than focusing solely on the site of pain. This approach may be particularly relevant for chronic or recalcitrant knee conditions where local treatment alone has failed. Furthermore, the experience of Case 3, a patient who reported avoiding a potential knee surgery, highlights the potential for this conservative approach to serve as a viable alternative to more invasive procedures for some patients.

While these outcomes are promising, they must be interpreted within the context of the study's design. Without a control group, it is impossible to definitively attribute the entirety of the observed improvement to the interventions provided. However, the magnitude of the reported pain reduction in patients, many with chronic conditions, suggests a strong therapeutic effect. These findings provide a compelling basis for future, more rigorous research, including prospective randomized controlled trials, to validate the efficacy of this multimodal approach and compare it to other conservative care protocols.

Limitations

This study has several important limitations inherent to its design. As a retrospective case-series, the data were not collected under a controlled research protocol, which can lead to variability in documentation. The primary outcome, pain, was measured via self-report, which is subjective and was not supplemented with objective functional measures like goniometry or strength testing. A significant limitation is the absence of a control or comparison group, making it impossible to rule out the influence of the placebo effect, the natural history of the condition, or regression to the mean. Furthermore, this study reflects the outcomes of a single clinic, and the results may not be generalizable to other settings, providers, or patient populations. There is also a potential for selection bias, as the analysis only includes patients who completed a course of treatment; individuals who discontinued care, possibly due to a lack of improvement, are not represented. Therefore, the findings should be considered preliminary.