Multimodal Chiropractic Management of Knee Pain: A Retrospective Case Series of 18 Patients

Abstract

Background: Knee pain is a prevalent musculoskeletal condition that significantly impacts mobility and quality of life. Conservative management is often advocated as a first-line approach. This article reviews patient outcomes following chiropractic care for knee pain at a single clinic. Methods: A retrospective case series was conducted on 18 patients who presented with a chief complaint of knee pain at Sandstone Chiropractic in Willis, TX. De-identified data were extracted from clinical files, including initial and final self-reported pain scores on a 0-10 Numeric Rating Scale (NRS). Treatment protocols were not standardized and were tailored to individual patient needs. The primary outcome measured was the percentage reduction in NRS pain score. Results: In this cohort of 18 patients, the mean reduction in self-reported knee pain was 80% (median: 81%). Individual cases showed significant improvement, including a 55-64 year old female whose pain from an old sports injury decreased from 9/10 to 1/10. Another patient, a 45-54 year old male with chronic pain, experienced an 81% reduction after care that addressed associated hip mechanics. Conclusions: The findings from this case series suggest that a multimodal chiropractic approach may be effective in reducing pain for patients with various etiologies of knee pain. These results highlight a potential non-surgical option, though further controlled research is needed to validate these observations.

Methods

This study was conducted as a retrospective case series to evaluate the outcomes of patients presenting with knee pain at Sandstone Chiropractic in Willis, TX. Data were compiled from the de-identified clinical records of 18 patients who had completed a course of treatment at the facility. Inclusion criteria for this series required that patients presented with a primary complaint of knee pain and had documented pre-treatment and post-treatment pain scores.

The primary outcome measure was the change in self-reported pain intensity, as recorded on a 0-10 Numeric Rating Scale (NRS), where 0 represents 'no pain' and 10 represents the 'worst imaginable pain'. Initial pain scores were taken during the patient's initial examination, and final pain scores were recorded at the conclusion of their active care plan. The percentage of pain reduction was calculated for each patient. Data regarding improvements in mobility or functional capacity were not systematically tracked with a standardized metric and thus were not included in the aggregate analysis.

Treatment protocols were not standardized across all patients, reflecting the nature of clinical practice where care is tailored to the individual's specific diagnosis and presentation. However, the providers at this clinic (Dr. Tony DeRamus, Dr. Garrett Smith, Dr. Blakelyn Mayeaux, Dr. Audrey Rios) utilize a range of techniques, including Spinal Decompression Therapy, Knee Decompression, Soft Tissue Therapy, Sports Rehabilitation, and Prenatal and Pediatric Chiropractic Care, as appropriate for the patient's condition. The timeframe for treatment varied between patients based on clinical progress and goals. No control group was used in this study.

Discussion

The results of this retrospective case series suggest that a multimodal chiropractic approach may be a beneficial component of conservative management for patients with knee pain. The cohort of 18 patients reported a mean pain reduction of 80%, a clinically meaningful improvement. This finding is notable given the variety of patient presentations, which included chronic pain from old injuries and biomechanical issues like patellar tracking problems, as detailed in the case summaries.

The effectiveness of the applied interventions may stem from their multifactorial nature. As suggested by the testimonial in Case 5, improvements were not solely attributed to treatment of the knee itself but also to the correction of underlying biomechanical faults in adjacent regions like the hip. This aligns with a foundational principle of chiropractic care, which emphasizes the kinetic chain and the relationship between structural integrity and function. By addressing joint mobility, muscle function, and movement patterns through a combination of techniques like knee decompression, soft tissue therapy, and spinal/extremity adjustments, practitioners can target the root causes of mechanical knee stress rather than just alleviating symptoms.

The outcomes, such as the patient in Case 4 who achieved complete pain resolution and felt she avoided surgery, indicate that this conservative approach can serve as a viable alternative for individuals considering more invasive procedures. The significant pain reduction allows for improved function, as noted by patients who could return to activities like running or climbing stairs without difficulty. While these results are promising, they originate from a single clinic and lack a control group. Nonetheless, they provide a strong rationale for conducting more rigorous, prospective studies, such as randomized controlled trials, to further elucidate the efficacy of multimodal chiropractic care for specific knee conditions and to compare its outcomes against other conservative treatments.

Limitations

This study has several important limitations inherent to its design. As a retrospective case series, data were collected from existing clinical records and were not gathered for a formal research purpose, which can lead to inconsistencies in documentation. The absence of a control group makes it impossible to determine whether the observed improvements were a direct result of the treatment provided, or if they were influenced by the natural history of the condition, placebo effects, or concomitant interventions.

Furthermore, the findings originate from a single clinic (Sandstone Chiropractic - Willis), which may limit the generalizability of the results to other clinical settings, practitioners, or patient populations. The reliance on self-reported pain scores as the primary outcome measure is another limitation, as this is a subjective metric. The study lacked objective, standardized measures of functional improvement, such as range of motion or timed physical performance tests. Finally, there is a potential for selection bias, as the series includes patients who completed a course of care, possibly excluding those who may have discontinued treatment due to a lack of perceived progress.