When Your Knee Pain Tolerance is “Too High”

There are some people who will humbly admit to having a low pain tolerance while others are the “Go ahead, punch me in the stomach” type. While socially it’s perceived as more favorable to have a high pain tolerance, this can often get in the way of people seeking a solution to pain since they feel they’re able to bear it. But what can be gained by willfully ignoring the SOS signals your body is sending you?

Ignoring pain until it becomes excruciating is likely to only make you want to eliminate the experience of pain rather than decode the message. The typical ways people try to manage knee pain are the “eliminate the experience” kind – numbing with ice or creams, masking with medications, and now even destroying the nerves that dare send these signals with radiofrequency ablation (eg. COOLIEF*).

You could also get surgeries that remove the body parts sending the signals, but if a baby cries, do you get rid of the baby?

A little disclaimer is necessary here: some people do get better with a little ice, some people use medications to get through the exercises that get them better, and some people do need surgery. Even in the case of peripheral sensitization of the nervous system, radiofrequency ablation could be extremely helpful as well. The trick is not jumping too far ahead when you only needed the cheaper option with fewer side effects. (Read our other blog about what people aren’t saying about expensive MRI scans).

Now, hopefully, you’re wondering how you can go about decoding your pain to pick the right option for you. Wanting to figure out not just what structures are sending out the SOS but WHY is a good mindset to start with. In the case of knees, unless you’ve sustained a direct blow to the knee or some other acute injury, you should be suspicious that the WHY behind your knee pain is actually because of a hip or foot dysfunction.

Why you ask? Your hip is where the weight coming down from your upper body meets the force coming up from the ground and your foot is what makes contact with the ground. Your knee is sandwiched right in the middle and when everything is working efficiently, your knee simply passes forces from your foot to your hip and your hip to your foot. A dysfunctional (though not necessarily painful) foot alters the distribution of force through the knee joint to bias one side, and likewise with a dysfunctional hip.

Weak Glutes When Your Knee Pain Tolerance is “Too High”

When a single knee compartment is repeatedly taking the load that was meant to be spread across the whole knee, the tissues in the area rightly protest in the form of a pain signal. Perhaps those tissues even suffer damage over time but simply numbing, repairing, or replacing those tissues does not change the real force distribution problem that started it all, and thus the pain will persist. Arthritis and other meniscus issues are the result rather than the culprit.

Below is a quick outline of the impact typical knee pain management strategies have on dysfunctional knee loading:

  1. Ice – Muscles don’t activate well in the presence of inflammation, so reducing it with ice can help your muscles to do their job to maintain efficient force distribution. The trade-off is potential joint stiffness from the reduced blood flow.
  2. Medications – Masking your ability to perceive pain only allows you to continue moving with inefficient mechanics without your knowledge until the medication wears off again.
  3. Meniscus Debridement Surgery – Commonly referred to as a knee scope, this is a great option if a stray piece of meniscus causes your knee to frequently lock in place. Otherwise, if you’re just looking for pain relief, it’s no better than sham surgery because you haven’t altered those force lines in the image above.
  4. Total Knee Replacement Surgery – replacing your bones with steel means they can take the inefficient loading you’re subjecting them to, but the surrounding soft tissues just experienced a major trauma and will likely have their own alarms to sound in addition to their continued exposure to inefficient force distribution, which means pain relief isn’t guaranteed.
  5. Radiofrequency Ablation – If you’ve had a total knee replacement and are still experiencing pain after rehab, this may be helpful for addressing the nerves that didn’t get the memo and are still being overprotective of the knee area. Otherwise, this is yet another way of masking your ability to perceive pain, simply by eliminating your nerves. However, when the nerves grow back, the pain comes back too because again, you haven’t changed your knee loading strategy. Side effects also include skin numbness, worse pain due to muscle spasm, permanent nerve pain, and infection.
  6. Physical Therapy – The primary purpose and goal is to change the way you load your painful knee! Soft tissue and joint mobilization allow your hips, knees, and feet to assume efficient alignment while neuromuscular re-education and motor control training allows your muscles to keep you there and create efficient movement that spreads the load evenly throughout your joints so no one area is working harder or taking a pounding more than it should.

Knee pain doesn’t have to be something you live with for the rest of your life. Instead of telling people about your high pain tolerance, you could be living your life to the fullest. Instead of being constantly distracted by nagging pain, you could be forgetting what it even felt like to have knee pain.

Not convinced yet? Schedule a FREE knee screen with one of our skilled physical therapists and experience how changing the way you move can change your life.

As always, consult with your Licensed Physical Therapist for individualized advice. For those in Illinois, visit your PT immediately without a prescription or referral.

Give us a call at (877) 709-1090 for more information or fill out the contact us form and we will contact you.

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