Joint Pain


Many of our patients come into the clinic after a few sessions complaining that their joint pain has increased since their initial evaluation. This is not meant to whitewash those concerns, as an increase in joint pain due to a specific exercise is fairly common. However, typically the significant increases in joint pain will only come while performing that specific exercise, and subside significantly, if not entirely, a short time after. 

An increase in pain for longer periods of time, like 1-2 days, is more indicative of muscle soreness - not joint pain. While muscle soreness can be just as, if not more, debilitating compared to joint pain, muscle soreness is a good sign. 

Most of the time when patients come in with joint pain, they'll have been limiting activity that could increase that joint pain. For example: a patient comes in, chief complaint is knee pain, they'll likely have been avoiding stairs, bending down or squatting to pick something up or participate in hobbies, such as gardening, and moving slowly and cautiously. In physical therapy, to first lessen the pressure on the inflamed joint, we'll need to strengthen the muscles around the joint. To do so, patients will complete a number of exercises that don't necessarily aggravate those painful symptoms at the time, but can lead to soreness later. The soreness occurs because the muscles surrounding the joints are likely very out of practice - as your natural instinct to avoid an increase in pain is to minimize all causes of the pain. In turn, the muscle soreness will increase as they adapt to the newly added activities. 

Fortunately, muscle soreness doesn't last forever. It lasts a few days, maximum, and will decrease thereafter - usually leaving patients in less pain than they started. Patients need not worry that they'll reproduce that soreness each time, as each time they complete their Home Exercise Program, the muscles will continue to strengthen and therefore, adapt faster. Most of the time, patients will not be sore after a few visits to the clinic - given that they're doing their exercises as prescribed. Soreness from that point on will only increase as the intensity or difficulty of the exercises increase, but increases in difficulty means progression. 

Differences in joint pain versus muscle soreness include:

- Joint pain is sharp, stabbing, debilitating, while muscle soreness is dull, burning, achey

- Muscle soreness leads to problems you may not be used to: say your knee pain was below the kneecap, but now is above and on the sides of the kneecap

- Joint pain will increase during a specific movement, and decrease after the movement, whereas muscle soreness will decrease or become more manageable the more the movement is performed

- Muscle soreness only lasts 1-3 days, whereas joint pain will continue to hurt each time you do specific movements for an undefined amount of time, and can possibly even get worse

Still think it's joint pain? There are tests we can do here at CHAMPION Performance and Physical Therapy that can help us as professionals determine where the pain is stemming. It's our job as therapists to educate you on the circumstances of your pain.  Keep in mind, every patient is unique and your pain may continue to stem from the joint as we progress - and that's a bridge we'll cross when we get there. Our goal is to improve your quality of life back to functionality status at the very least, or in other words, give you the ability to do the things you love. 



Osteoarthritis is the medical term for the more common "arthritis" and refers to the general deterioration of cartilage that leads to damage on articulating surfaces of joints. 

Osteoarthritis can occur in any joint, some as small as the bones in the hand/fingers, and as large as the hip and knee joints. 

Preventing osteoarthritis in the knee, or delaying onset, is a lifetime practice, as many of the causes that lead to deterioration of bone articulating cartilage are due to overuse during youth, adolescence, and early adulthood. Other increased risks come from lifestyles, and habits that are typically formed at a younger age. 


  • Extremely active lifestyle, where the joints take a beating
    • Participating in physical activity that heavily load the joint, such as running, put large loads onto the body that continuously put stress on the cartilage and articulations of joints, running the articulation cartilage thin.
  • Extremely sedentary lifestyle, where the joints receive very little to no load
    • Sedentary lifestyles tend to lead to a decrease in bone density, and a decrease in bone density leads to an increase risk of osteoarthritis
  • Ligament, tendon, or cartilage tears
    • Tearing your ACL, MCL, and PCL all show an increase risk for early onset osteoarthritis, as the joint lacks stability, and therefore overloads cartilage 
  • Misalignments
    • Having leg length discrepancies, wearing shoes that lack arch/medial support, etc. lead to increased pressure on one side of the body compared to the contralateral side, and results in deterioration of cartilage
  • Musculoskeletal discrepancies
    • Having weak muscles on one aspect of the leg compared to the other leads to decreased stabilization in the knee, which leads to increased load on one aspect of the joint. 
    • This is the highest, non-impact cause that is correlated with an increased risk of developing osteoarthritis in both adults and children


Prevention is key. Having musculoskeletal evaluations, leg length, joint alignment measured by a physical therapist prior to your child starting physical activity is key to identifying potential problems early. Children are resilient, physically, but those same joints may not be so quick to heal at age 40, and like wearing sunscreen, it's extremely necessary to attempt prevention at a young age. 

Preventative physical therapists, including us here at CHAMPION, can take your children, or even you through preventative programs to help decrease risk, delay onset, or even delay surgical repair. 


Why do muscles feel tight? Does that mean they are short? That they can't relax? And what can you do about it?  

Tightness Is A Feeling, Not Just A Mechanical Condition  

When someone says they feel tight in a particular area, they might be referring to several different complaints. So I try to find out: 

Are they talking about poor range of motion? 
Or maybe range of motion is fine, but movement to the end range feels uncomfortable or takes excess effort.
Or maybe the problem isn’t really with movement, but just that the area never reels feels relaxed. 
Or maybe the area feels basically relaxed, but has some vague sense of discomfort - a feeling that is unpleasant but too mild to be called pain.  
This ambiguity means that the feeling of tightness is just that - a feeling - which is not the same thing as the physical or mechanical property of excess tension, or stiffness, or shortness. You can have one without the other. 

For example, I have many clients tell me their hamstrings feel tight, but they can easily put their palms to the floor in a forward bend. I also have clients whose hamstrings don't feel tight at all, and they can barely get their hands past their knees. So the feeling of tightness is not an accurate measurement of range of motion.

Nor is it an accurate reflection of the actual tension or hardness of a muscle, or the existence of "knots." When I palpate an area that feels tight to a client (let’s say the upper traps), they often ask - can you feel how tight that is?! 

I often say something like: 

Ummmmmm ...... no. It feels just like the surrounding tissues.
But I completely understand that it FEELS tight in this area and you don't like it. 
I don't like the feeling of tightness either so I want to help you get rid of it. But the feeling of being tight isn’t the same thing as that area actually being physically tight. Make sense? 
This actually does make sense to most people, and they find it mildly interesting. I want people to understand this because it might help them reconsider a misconceived plan they may have already developed for curing their tightness - such as aggressive stretching, fascia smashing, or adhesion breaking. So now they are willing to consider an approach that is a bit more subtle than driving a lacrosse ball halfway through their ribcage. 

Why Do Muscles Feel Tight If They Are Not Actually Tight?

So why would a muscle feel tight even if it physically loose? 

I think we can use pain as an analogy. Pain can exist even in the absence of tissue damage, because pain results from perception of threat, and perception does not always match reality. Pain is essentially an alarm, and alarms sometimes go off even when there is no real danger.

Perhaps a similar logic is involved in the feeling of tightness. The feeling happens when we unconsciously perceive (rightly or wrongly) that there is threatening condition in the muscles that needs a movement correction.

So what is the threatening condition that a feeling of tightness is trying to warn us about? Surely it is not just the presence of tension - muscles are made to create tension and we often feel tightness in muscles even when they are almost completely relaxed. 

So tension is not a threat, but the absence of adequate rest or blood flow is a threat, which could cause metabolic stress and activate chemical nociceptors. So the problem that a feeling of tightness is trying to warn us about is not the existence of tension, but the frequency of tension or the lack of blood flow (especially to nerves, which are very blood thirsty.) 

With this in mind, I think of the feeling of tightness as a variety of pain, perhaps a pain too mild to deserve being called pain. But it is definitely bothersome. And it has a certain flavor or character that motivates an interest in changing resting posture, or moving around or stretching. Which is different from certain pains, which often make you want to keep still. Maybe we could say that pain is warning us to not move a certain area, while tightness is warning us to get moving.  

How Can You Cure Muscle Tightness?

I think we can probably treat the feeling of tightness in the same way we treat pain - by changing one of the many "inputs" that cause the nervous system to perceive threat in the body, such as nociception, thoughts, emotions, memories, etc. 

Some pains are very obviously related to movement or postural habits. We can know this if someone says something like: "It hurts when I do this, and it hurts even more when I do more of this, and it hurts less when I do less of this." In this case, changing movement or posture is likely to help because it will reduce the main driver of the pain – mechanical nociception caused by movement.

On the other hand, there are many other cases of pain, particularly chronic pain, that are more complex – the pain doesn't correlate very much with certain movements or postures, but instead with other variables like time of day, sleep duration, emotional state, stress level, diet, general exercise, or some random unknown factors. In this event, it is unlikely that mechanical nociception caused by movement is the main driver of the pain, and more likely that peripheral or central sensitization are playing more of a role.

I think we can look at the feeling of tightness in the same way.

In most simple cases of feeling tight, the cause is obvious – we  have been stuck in the same posture or movement pattern for too long, and our muscles need a rest or change of position to reduce the ischemia or metabolic stress that is causing nociception in certain areas. For example, if we spend hours in a car, or an airplane, or behind a computer, we will instinctively feel compelled to stretch and move, and this will usually alleviate any feelings of stiffness or yuckiness.

Of course, most clients who complain of chronic tightness have already tried and failed at this simple strategy. The feeling of stiffness remains for hours and days at a time, comes and goes as it pleases, and is less related to posture and movement. 

In these cases, the driver of the discomfort may have more to do with the nervous system becoming either peripherally or centrally sensitized to the need for more blood flow in certain areas. This could happen through local inflammation, adrenosenstivity, increased sensitivity at the dorsal horn, or maybe even learned associations between certain environments (say computers) and certain sensations (e.g feeling like crap). 

So how do we reduce this sensitivity? 

There isn't an easy answer to this question, because if there was, it would solve the problem of chronic pain, and no one is figured out how to do that yet. But if I'm right that the feeling of tightness is a mild form of pain, then it should at least be easier to deal with.

Below is a list of several methods people often use to address a chronic feeling of tightness, along with some thoughts about each strategy from the above perspective. You'll notice that some of the recommendations run exactly opposite to what people often do. 


We instinctively stretch muscles that have remained in a short position for a while, and this usually makes us feel immediately better.

But, as noted above, most people who suffer from chronic tightness have already tried and failed at this strategy, which suggests the issue is less about bad mechanics and more about increased sensitivity.

The problem is that many people, and indeed many therapists, will think that the failure of a few simple stretches indicates the need for a far more aggressive program.
Damn hip flexors STILL feel tight.
Damn hip flexors STILL feel tight.

This would of course make sense if the root of the problem was short or adhered tissues. But if the root problem is in fact increased sensitivity, then aggressive stretching might just make the problem worse. On the other hand, stretching can often have an analgesic and relaxing effect.


There are various soft tissue treatments (deep tissue massage, foam rolling, Graston, ART, IASTM) intended to lengthen short tissues, break adhesions, or melt fascia, etc. This is very likely impossible, as I and many others have pointed out. 

But could these treatments decrease sensitivity and make someone feel less tight? For sure, by activating descending inhibition of nocicieption, which is a well-known effect of painful stimulation that is expected to bring health benefits.

But of course these treatments also create nociception, which tends to increase sensitivity. It's a fine balance that depends on the individual and many other variables. Again, if it feels good do it, but it's an option not a necessity, it's only temporary, and you should keep in mind the reason for doing it.


Many forms of movement therapy are essentially motor control approaches – they seek to change movement, postural and breathing habits so they are more efficient, eliminate parasitic tension, develop the skill of relaxation, etc.

Habits are hard to break, but this strategy is worth a shot, especially in cases where tightness seems related to certain postures or movements. Of course, where the situation is more complex, motor control shouldn't be expected to fix the problem on its own.


People tend to associate strength training with becoming tighter. During exercise, muscles of course become very tense, and they may feel stiff the next day because of delayed onset muscle soreness. There is also the (false) idea that strength training makes muscles shorter and less flexible. 

These concerns are unfounded. In fact, full range of motion strength training can increase flexibility, perhaps more than stretching. It creates local adaptations in muscle that may improve endurance and make them less likely to suffer metabolic distress. And exercise also has an analgesic effect and can lower levels of inflammation that cause nervous system sensitivity. 

Here's a personal anecdote. Back in the days when I did yoga I had much more flexibility, but my hamstrings always felt tight. Then I quit yoga and started doing a lot of kettlebell swings. My forward bend decreased a bit, but the feeling of hamstring tightness was GONE, even though I was working the hamstrings HARD. In its place was a feeling of functional strength and capacity, which I imagine decreased any perception of threat related to lengthening my hamstrings.  

Of course if you overwork your muscles from strength training and don't let them recover, they will get sensitive, stiff and sore. But if you work them the right amount - enough to create an adaptation and not too much to cause injury or prevent full recovery - then you will make them healthier, stronger, and yes - less stiff.


Here at Champion Performance and Physical Therapy, we have a number of patients who, while they eat healthy, exercise consistently, and get plenty of nourishment and water, are in pain because they're missing one of the most under appreciated aspects of physical health in their daily lifestyles - stretching. 

It may seem like the most basic additive, but you must remember: the skeletal body is a lever system manipulated by musculature. In other words, your skeletal system will not move without the help of your muscular system, and each bone is almost entirely surrounded by muscles for this purpose.

During exercise (and after your warm up), your body is warm due to increased blood flow, the muscles are loose and firing.  Afterward, the muscles will cool, and if not properly stretched, will stiffen due to the biochemical aftereffects of exercise. While an effective fitness program should absolutely consist of cardiovascular training and strength training, the flexibility component is often overlooked. 

This is where skeletomuscular injuries come into play, specifically those relieved via physical therapy. When muscles tighten and stiffen, they pull just slightly on the bones in their direction. For example: runners often have tight hip flexors and quadriceps (the front of the thigh).  These muscles attach and originate along the anterior aspect (front) and inside of the pelvis. When they stiffen, they pull the pelvis slightly forward. Over a long period of time, the pelvis will shift so far forward that it will start to cause low back pain that can sometimes radiate into the hips, and SI - sacroiliac - joint, which is the point of attachment between the spine and pelvis. This can even radiate down the leg and into the knees, as the muscular insertion for the quadriceps are just below the knee on the tibia (shin bone).  Often times when patients come in with knee pain and all X-rays and MRI scans show no injury, it is because the muscles have pulled the skeletal system just out of sync enough for you to notice. 

Flexibility exercises are not only an essential part of recovering from aerobic activity, but can reduce your risk for further injury. The American Academy of Orthopaedic Surgeons (AAOS) encourages individuals to incorporate these exercises into their daily workouts.

“Increasing your flexibility improves your ability to move easily,” said orthopaedic surgeon and AAOS spokesperson Raymond Rocco Monto, MD. “Some joints lose up to 50 percent of motion as we age. There are many ways to improve your joint flexibility including controlled stretches held for 10-30 seconds, stretches that rely on reflexes to produce deeper flexibility, as well as yoga and pilates.”

Before skipping flexibility exercises during your next workout, consider these five benefits of adding them to your workout regimen:

  • Less back and joint pain: A 2011 study in the Archives of Internal Medicine found that regular stretching was effective in relieving chronic back pain. Other research has shown quadriceps stretches helped decrease knee pain.
  • Better circulation: A 2009 study in the American Journal of Physiology discovered that torso stretches decreased stiffness and improved blood flow. This also may be why regular bedtime hamstring and calf stretches decrease the frequency and intensity of night-time leg cramps.
  • Improved joint motion: Flexibility naturally decreases with age. Stretching can help restore lost joint motion and improve function.
  • Better athletic performance: Like a good rubber band, muscles and tendons generate more force under tension when they are supple and compliant. 
  • Improved muscle health: Mobility exercises can increase the amount of stress muscles can handle in high tension activities that involve jumping and cutting movements.

Get the most out of your flexibility training by following these simple guidelines:

  • Always warm up before your stretch. Stretching cold muscles can cause injury.
  • Stretch slowly and gently. Breathe into your stretch to avoid muscle tension. Relax and hold each stretch 10 to 30 seconds.
  • Do not bounce your stretches. Ballistic (bouncy) stretching can cause injury.
  • Stretching should not hurt. If you feel pain, take the stretch easier, breathe deeply and relax into it.

    Stretching is important and can be tough to master to maximum efficiency. The trouble is, it takes some time to stretch muscles back out to a healthy length. A combination of stretching, manual therapy to help relieve some tension in the joints that are being pulled on, and strengthening the opposing muscles to those inflicting pain should easily solve the problem and have you pain free within weeks. Here at Champion Performance and Physical Therapy, this is probably the most common cause of injury we see, and we approach it with a unique, biomechanically-based mechanism meant to relieve pain and tension through multiple planes of your body. Why?  Because your body doesn't move in just one plane. 

    Talk to your doctor today about what physical therapy can help do for you. For more information, visit us on the SW corner of 75th and State Line Road in Prairie Village, or by phone at 913-291-2290.


Our last post, ARE YOU AT RISK FOR OSTEOARTHRITIS? focused on the "before" aspect of a diagnosis, and what risk factors increase your chances for a diagnosis. DIAGNOSED WITH OSTEOARTHRITIS is going to focus on the "after" aspect - what to do after you've been diagnosed. 

1. First and foremost: do not self diagnose.

See your primary care physician, or an orthopaedic specialist. A series of tests and health history questions will allow most medical practitioners to be positive about an osteoarthritis diagnosis, but for physical proof, you'll need either an X-ray or an MRI. 

Why an X-ray? More advanced cases of osteoarthritis will be visible in an X-ray.  Severe cartilage degeneration will be visible (or more realistically, will be nonexistent) by recognizing what's out of place in comparison to where they're anatomically in place.  Joints that are suffering from osteoarthritis will look noticeably different in an X-ray compared to that of a healthy joint. 

2. Talk to your doctor about your options.

Depending on the severity of your case, your doctor may present you with a multitude of paths to assess, or potentially just a fair few.

Non-surgical opportunities include but are not limited to: steroid injections to lessen inflammation and reduce pain, physical therapy to strengthen muscles and therefore lighten the load on the joint, or pain medications to allow you to continue functioning with minimal pain.

Surgical opportunities, or joint replacements, are extremely common. Depending on age or the severity of your case, you may be a prime candidate for a partial or total joint replacement. This will require physical therapy to aide your body in returning to full range of motion and strength, but most cases are completely successful and will allow you to return to the lifestyle you enjoy with less pain than in you have had in probably 5 or more years. 

3. In the meantime: less is not more.

While it may feel as though movement is going to aggravate and inflame that joint, lack of movement is consequentially worse. The lack of movement weakens the muscles, and therefore, adding more pressure on the joint when it's loaded. Lack of movement will essentially make it significantly more painful to move - and therefore, making the condition feel much worse. Movement, as well as strengthening, is key to maintaining a quality of life until the correct treatment option for you can be identified and agreed upon. 

4. Ice, and Anti-inflammatories

Icing the joints can lead to some stiffness, but it can also decrease the activity of inflammatory responses that lead to increased swelling from bone-on-bone activity and therefore, decreases the residual pain. Not only does it limit the inflammatory response by constricting the blood flow into that joint, but also allows you to feel relief temporarily until the numbness from the cold entirely wears off. An anti-inflammatory can help aide in minimizing your inflammatory (immune) response, but be sure to talk with your doctor about which anti-inflammatory works best for you and your specific medication protocol. 


What is osteoarthritis?

Osteoarthritis, also known as Degenerative Joint Disease (DJD) but more commonly known as "arthritis", is the degeneration of cartilage in a joint leading to bone-on-bone degradation. 

What causes osteoarthritis?

Osteoarthritis results in the deterioration of the cartilage that acts as a protective cushion between bones.  It is more common in the general population in partially weight-bearing joints, such as the hips and knees. As bones grind against one another, it can result in hardening of the joint, inflammation of the fluid-filled, protective bursa sacs, and possibly bone spurs and other problems that lead to pain. 

What risk factors increase my chances of getting osteoarthritis? 

Unfortunately, not qualifying for any risk factors does not guarantee you'll never have osteoarthritic symptoms, but it can help to decrease chances. Some risk factors are out of our control, but some definitely aren't!

1.  Old Age increases your risk significantly, as not only do the proteins in the body that recreate and make up cartilage become more sparse in the joints, but the fluid that protects the cartilage is produced less as you age, as well. 

2. Obesity puts added stress on weight-bearing joints, and adipose (fatty) tissue produce proteins that can lead to harmful, degrading inflammation in the joint cavities. 

3. Joint Injuries that stemmed from an accident or sports injury can increase your risk of osteoarthritis.

4. Bone Deformities or Protein Deficiencies can increase the amount of stress on a certain area of the joint that will later lead to a breakdown of cartilage, and life-long protein or hormonal deficiencies diagnosed at a young age can eventually cause an early onset of osteoarthritis. 

5. Genetics has also proven to be a major factor in developing osteoarthritis, not only because of gene function, but lifestyles. Some are more prone to the breakdown of cartilaginous proteins and fibers. As far as genetically inherited lifestyles, that's probably more accurate when described as a nuture versus a nature problem. More often than not, children are going to have similar lifestyles to that of their parents. Parents who developed osteoarthritis due to being extremely active in their youth and adulthood likely passed those same habits onto their child, which could, in turn, potentially lead to the same osteoarthritic developments. 

Does meeting these risk factors necessarily mean you'll develop osteoarthritis? No. Like every medical condition, qualifying for a risk factor is not a guarantee. Simply worry about the ones you can control. 

OUR NEXT BLOG POST: What to do when you already have osteoarthritis. 


P: (816) 561 - 3003

(816) 303 - 2400

P: (816) 561 - 3003

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Jeffrey Krempec, MD

Focus lies within the lower extremity, with focuses in the hip and knee. Dr. Krempec's primary focus in the hip is preservation, by means of resurfacing, revision, and replacement. He treats a wide range of ages, however, with expertise in the treatment of hip injuries in young adults, ranging from labral tears to dysplasia, with top-of-the-line techniques. 

Paul Nassab, MD

Focus lies within the upper extremity, with specialties in trauma, reconstruction, and disorders of the hand, elbow, and shoulder. Dr. Nassab is a former member of the United States Army, spending his years of service as an Urgent Care Center Physician, Flight Surgeon, and Dive Medical Officer. 

Craig Satterlee, MD

Focus lies within the upper extremity - primarily the shoulder and elbow - but is however a general surgeon who treats a multitude of disorders, diseases, and injuries. Dr. Satterlee is Kansas City's only standing member of the prestigious American Shoulder and Elbow Surgeons society, with published works he's presented internationally. He is among Kansas City's top shoulder and elbow surgeons, with high patient ratings across the board. 

Alexandra Strong, MD

Focus lies within sports medicine, with subspecialties in the shoulder and knee, but is listed as a general orthopaedic surgeon as she treats a multitude of injuries and disorders across various joints. Dr. Strong is a Board Certified Sports Medicine surgeon, with clinical interest in the female athlete. She is a standing partner of Drisko, Fee, & Parkins, LC medical group, and was named to the 2013-2015 Missouri Super Doctor's list. 

Christopher Wise, MD

Focus lies within the lower extremity, with subspecialties ranging through orthopaedic traumas. Dr. Wise's listed clinical interests include complex fractures of the pelvis, acetabulum, and lower extremity, as well as fractures that have failed to heal correctly. He even teaches his techniques to other physicians in the Kansas City area!

For more information, please visit

Our blog segment titled MEET THE PHYSICIANS provides general focus information of some of the best, and most prominent orthopedic clinics in the Kansas City metro area, respectively. From these clinics, a number of their most prominent surgeons refer to us here at CHAMPION Performance and Physical Therapy. 


You may have heard this term before, or had a friend or family member who struggled with the same, but what exactly is it?

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse.

The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.

Anyone can be affected by avascular necrosis. However, it's most common in people between the ages of 30 and 60. Because of this relatively young age range, avascular necrosis can have significant long-term consequences. Although it can happen in any bone at any joint, osteonecrosis is most likely to occur at the epiphysis (end) of a bone, and more commonly in the ball-and-socket joint, such as the shoulder or hip. 


Many people have no symptoms in the early stages of avascular necrosis. As the condition worsens, your affected joint may hurt only when you put weight on it. Eventually, the joint may hurt even when you're lying down.

Pain can be mild or severe and usually develops gradually. Pain associated with avascular necrosis of the hip may be focused in the groin, thigh or buttock. In addition to the hip, the areas likely to be affected are the shoulder, knee, hand and foot.

Some people develop avascular necrosis bilaterally — for example, in both hips or in both knees.

When to see a doctor?

See your doctor if you have persistent pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.


Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

  • Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels.
  • Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.
  • Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher's disease, also can cause diminished blood flow to bone.

For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.

Risk Factors

  • Trauma. Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.
  • Steroid use. High-dose use of corticosteroids, such as prednisone, is the most common cause of avascular necrosis that isn't related to trauma. The exact reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow and leading to avascular necrosis.
  • Excessive alcohol use. Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.
  • Bisphosphonate use. Long-term use of medications to increase bone density may be a risk factor for developing osteonecrosis of the jaw. This complication has occurred in some people treated with these medications for cancers, such as multiple myeloma and metastatic breast cancer. The risk appears to be lower for women treated with bisphosphonates for osteoporosis.
  • Certain medical treatments. Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

Medical conditions associated with avascular necrosis include:

  • Pancreatitis
  • Diabetes
  • Gaucher's disease
  • Systemic lupus erythematosus
  • Sickle cell anemia

Possible Complications

Untreated, avascular necrosis worsens with time.  Eventually the bone may become so weakened that it collapses.  Avascular necrosis also causes bone to lose its smooth shape, potentially leading to severe arthritis and residual pain.

Questions to Ask Your Doctor

  • What's the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • What treatments are available?
  • I have other health conditions. How can I best manage them together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

Testing and Diagnosis

During a physical exam your doctor will likely press around your joints, checking for tenderness. Your doctor may also move the joints through a variety of positions to see if your range of motion has been reduced.

Imaging tests

Many disorders can cause joint pain. Imaging tests can help pinpoint the source of pain. The options include:

  • X-rays. They can reveal bone changes that occur in the later stages of avascular necrosis. In the condition's early stages, X-rays usually appear normal.
  • MRI and CT scan. These tests produce detailed images that can show early changes in bone that may indicate avascular necrosis.
  • Bone scan. A small amount of radioactive material is injected into your vein. This tracer travels to the parts of your bones that are injured or healing and shows up as bright spots on the imaging plate.

Treatment Options

The goal is to prevent further bone loss. Specific treatment usually depends on the amount of bone damage you already have.

Medications and Therapy

In the early stages of avascular necrosis, symptoms can be reduced with medication and therapy. Your doctor might recommend:

  • Nonsteroidal anti-inflammatory drugs. Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may help relieve the pain and inflammation associated with avascular necrosis.
  • Osteoporosis drugs. Medications, such as alendronate (Fosamax, Binosto), may slow the progression of avascular necrosis, but the evidence is mixed.
  • Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood may help prevent the vessel blockages that can cause avascular necrosis.
  • Blood thinners. If you have a clotting disorder, blood thinners, such as warfarin (Coumadin, Jantoven), may be recommended to prevent clots in the vessels feeding your bones.
  • Rest. Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
  • Exercises. You may be referred to a physical therapist to learn exercises to help maintain or improve the range of motion in your joint.
  • Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and Other Procedures

Because most people don't start having symptoms until avascular necrosis is fairly advanced, your doctor may recommend surgery. The options include:

  • Core decompression. The surgeon removes part of the inner layer of your bone. In addition to reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  • Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of your body.
  • Bone reshaping (osteotomy). In this procedure, a wedge of bone is removed above or below a weight-bearing joint, to help shift your weight off the damaged bone. Bone reshaping might allow you to postpone joint replacement.
  • Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts. An estimated 10 percent of hip replacements in the United States are performed to treat avascular necrosis of the hip.
  • Regenerative medicine treatment. Bone marrow aspirate and concentration is a novel procedure that in the future might be appropriate for early stage avascular necrosis of the hip. Stem cells are harvested from your bone marrow. During surgery a core of dead hip bone is removed and stem cells inserted in its place, potentially allowing for growth of new bone.

Source: Mayo Clinic Diseases and Conditions Education