How To Add Knee Pain Niche

Hey there and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now. Hello and welcome to the Practice Builders Podcast. My name is Dr. Vince Leone.

And I am Dr. Kyle Penkin, and the team is back together again for today's podcast. We're super excited. We had a little break over the New Year and over Christmas and so forth. And so we did, we flew solo a couple different episodes, but we're back together. We're excited to be back. And today we're going to bring the goods. We got a new topic that Dr. Leone will introduce for us. And Let's learn and have some fun together.

Yeah, it's good to get the gang back together, of course. And I hope everyone had a fantastic holiday season and happy new year to you. Today's topic is the case for adding a dedicated knee program in 2026. And, you know, of course, Specialized Practice really focuses on spinal decompression, but we have always supported knee pain and neuropathy as niches. So, you know, we both have a pretty deep understanding of this niche. Both have offered this niche to great success. And so let's go ahead and dive into this topic there, Dr. Kyle, starting with why doctors may want to consider adding this niche to their practice.

That is a great, uh, intro. So I think the biggest reasons you'd want to add your niche is just simply volume of people that suffer from knee pain. Every month I gather research for our clients at Specialized Practice. And every final Tuesday of each month, I do about a half hour to an hour presentation of some of the latest research that pertains to what our doctors need to know. And this study was just December of 2025. And this was Prevalence of Musculoskeletal Disorders and Physiotherapy Utilization in Primary Care is the name of the study. And no surprise to anybody in our world, low back pain was the most common diagnosis followed by cervicalgia. So low back and neck pain, but knee osteoarthritis had the highest estimated total number of visits.

Mm-hmm.

And so that is a— so behind low back and neck, right behind that, boom. You have chronic knee pain. And I think before we came on, you shared a couple of interesting stats about what percent of the population deals with chronic knee pain. Could you inform our listeners of that, Dr. Leone?

Yeah, absolutely. So, you know, in the United States, about 100 million people suffer from neck and back pain. That's a big number, right? So, but in the US, about 25% of US adults report chronic knee pain. So that's about 75 million people. So it's a big niche, a huge niche. And so that's— obviously, we like and love spinal decompression because there's such a large— it's a large patient base. It's right in our wheelhouse. But right behind that is chronic knee pain. And I think that, you know, you already have these patients in your office. That's the really good thing is, you know, one of my mentors used to say the easiest way to increase revenue in a business is to just add a service and offer it to your existing customers, right? So this is that concept, right? You already have the patients, both past patients and patients under care and new patient flow? Well, a lot of them have chronic knee pain and they're going to address it with somebody. And if they've already, or if you've already established trust and rapport and done a great job treating their neck and back, then if they know that you have invested in the training and the equipment to treat it effectively, why would they go anywhere else? No one wants to go to Knee surgery, um, that's a, what, a 6-month rehab on top of, you know, obviously having to, you know, to have the surgery itself. So, um, it's a, it's a real wonderful opportunity. And, um, the only caveat is if you haven't figured out decompression, like if you're doing decompression and you have not optimized that niche, don't, don't, don't fall into the shiny object syndrome and say, wow, I can't quite figure out Decompression, I'm going to jump to knee. Well, if you haven't figured out decompression, you probably won't figure out knee. So optimize the first primary niche, um, and then go to the next niche. It would be my recommendation.

I agree. This is a secondary niche, docs. Decompression, we think, should be the first niche for all chiropractors because it is, like you said, it's our wheelhouse. These people, it's the most prevalent condition, low back, neck, and decompression is a big, big tool in the list of tools that we can use to help these. But once you have that down, this is a nice thing to dovetail into next, to add the knee decompression protocol. And You need the right tools of the trade, which I think is one of the next things we're going to talk about, right, Doc?

Yes, sir. So, yeah. So, you know, what are the tools? And just to back up a little bit, you know, the primary culprit in chronic knee pain is osteoarthritis.

Yeah.

And so that's great, right? Because, you know, it's something that we can treat effectively with the tools that we have at our disposal. So those tools are things like, obviously, knee decompression, like Dr. Pankin had mentioned, deep tissue laser therapy, shockwave therapy, obviously bracing, supplements. All those kind of go into our protocol to treat this condition effectively. Because, again, you don't want to promise the moon and deliver the dirt. And so you need a real robust protocol. So this is not a Kind of do it over the weekend type of thing. You really, just like decompression, you need to make the investment training-wise so that you become an expert in this particular condition. And then you have to have all the tools, and it's not a small investment. Lasers and shockwaves and knee decompression units are tens of thousands of dollars. So there— now, is it profitable long-term? Yeah, 100%.

Yeah.

That would be, I'd probably say, one of the drawbacks is there is a pretty significant investment to be able to treat this effectively.

Yes, there is some definite investment. I'll briefly touch on, docs that are listening to this, some of the options in the world of knee decompression. So in, in my own practice, we use a device called the NeonTrack, which is made by Ergoflex Technologies. It's a standalone I think it's the only standalone right now unit on the market for doing knee decompression. And then there are some decompression tables on the market that also can be utilized for spine but also knee. That I believe is the KDT table. I believe the Triton is potentially one of them as well. And I think the AccuSpina—

Yeah.

is coming out with an attachment or a device called the Accu-Knee. That's a new one that's, I believe, either just came onto the market or will be coming on soon. So those are some of the options that you have if you want to add knee decompression to your practice. And like Dr. Leone said, in your protocol, you're gonna marry that Decompression with some high-end therapy like laser or shockwave or a combination of both. And there's, there's other things that we teach that go into the protocol, but for in-office things, those will be your big 2 guns is knee decompression combined with the laser and/or shockwave. And so yeah, there's definitely investment, but if you price these out right, It doesn't take that many cases to see a significant return on your investment in a fairly short time.

Yeah, well, I think that's a nice transition into the pricing. Like, what, uh, in your opinion, what do you think is a fair price for a full knee decompression protocol? And is that one knee, both knees? Do you discount for the second knee? Do you typically see it bilateral? What's been your experience, Doc?

Yeah, you're gonna see a lot of bilateral ones. Not all, but I would say it's about 50/50. About 50% of my patients, it's bilateral, and 50%, it's single knee. So a typical plan in that I— in our— what I do and what I hear when I talk to other doctors is about $3,000 to $5,000, in that range.

Yep.

For a typical knee case. And if you're gonna add on a second knee, you know, then you're probably gonna be Another half of whatever that is, is pretty typical for a typical knee case. So these are, you know, you price them out just like you do a spinal decompression program and similar protocols in the sense that, you know, you need a certain number of visits to effectively do a spinal decompression protocol. You need a certain number of visits in a knee decompression protocol. And all your ancillary things that built around your decompression to make an effective protocol. And, uh, the thing I always tell people with this is, and doctors know this, but it's just like the spine. If they go to the, or the, the neurosurgeon, they're going to get a pill, a shot, or a surgery. That's their, that's their tools. If they go to the knee orthopedic, the orthopedist doctor, it's the same thing. It's either a pill, a shot, or a surgery. Well, Pills don't fix nothing, shots don't fix anything, and not all cases need surgery. And so people are looking for alternatives. They're looking for non-drug, non-surgical alternatives. And you have— if you have a nice protocol built and you have the equipment and the training and you know how to do good knee exams, this is a money niche. This is a win-win for both patient and doctor.

Hey there, it's Dr. Vince. And if you're getting value from this episode, please make sure to hit that subscribe button so you never miss an episode. And if you know another doc who's ready to grow their practice, share this with them. It might be exactly what they need right now. Thank you in advance. And now back to the show. Yeah, not to put down the surgeons. I mean, they do an excellent job and they have an excellent success rate. I would, I would, I don't have the data on this, but I think that there's a higher, much higher success rate with knee surgeries versus say spinal surgeries. And so, but at the same time, like Dr. Kyle said, it's like if patients can avoid surgery, then they certainly, I think by and large, would prefer to do that. What are some of, Dr. Kyle, the pitfalls you would see or anticipate doctors may fall into if they're not doing this correctly?

Well, the big thing is you gotta be good at your exams so that you can select The right candidates.

Yeah.

Who are gonna benefit from your program that I see. 'Cause there are some cases that are just beyond, you know, you're bone on bones. Doc, I'm too old to have surgery and my— but their knee is completely bone on bone. Some of those cases, you just can't help anymore. They're just too far gone. So that is a pitfall that you gotta, You have to be clinically intellectual enough, or however you want to phrase that, that you know which are the right cases to take on and which are to say, nope, this one needs to go to surgery, or this one is too far gone. That is one of them. And the only other hiccup that you see is some people just don't equate chiropractor with knee pain.

Yep.

And so, see, so you gotta, you gotta kind of overcome the obstacle of some people thinking, well, I would never go to a chiropractor for my knee pain. So there's a little bit of resistance with the general public thinking that you're only a spine doctor and not gonna go to you. So it takes more patient education sometimes to bring these people on board And realize that you have an answer for them. So those are the 2 big ones I see.

Yeah, those are great thoughts. And how about marketing? Um, you know, of course you need to obviously invest in your skill sets, the clinical skill sets, the equipment, but now we need to reach the patients. Um, you know, from my perspective, This isn't something I'd run out and, and run paid ads for. I, I would be targeting, you know, um, your 3 assets, right? New patient flow, patients under care, past patient base. And you can do it in a very simple and inexpensive manner. First, um, signage. This is one of the most simple things that you can do, um, that is essentially quote-unquote automated, though it's not tech involved, but Just good quality signage in the office that, you know, alerts your patients that, hey, this is a new service that you offer. Email marketing. If you're not email— if you're not communicating with your patients at least once a month, I recommend twice a month, but you should be communicating with your patients via email with good quality information on a monthly basis, ideally twice a month. And then you can use email to notify patients about Uh, this new service that you offer. Postcards, again, low-tech stuff, highly effective. Um, and, um, and then just word of mouth. But I think that's where I would personally start, is just making sure that all your— those 3 assets are aware of this new service that you offer. And then obviously offer an evaluation to figure out if they're a good candidate for care.

If 25% of the population has chronic knee pain and you treat 100 patients a week, you know, several of those people come in and have knee pain. And if you have thousands of patients in your database from over the years, you got everything you need right there.

Yeah.

Just utilize that. And the email thing, that's right on the money. I do a series every month called the Did You Know series? It's a couple emails. Did you know that we can treat chronic knee pain? And then you lay out what you can do for it and send out a couple of those a month. Or did you know we can help arthritis in your knee or things like that? Those are just simple ways to do it. And the signage thing, like for instance, like Cutting Edge Laser, which we recommend their MLS for a lot of our clients.

Mm-hmm.

Yeah, these beautiful pull-up— what are those things called?

Uh, just a pop-up banner.

Pop-up banners that, yeah, you can put those right in your waiting room and, you know, it directs people to, hey, I want to know more about that laser and all the things that you can treat with them. One of those is going to be knee pain. And so those are great simple tools that you can use To launch this niche without having to spend hardly any money on the marketing component of it.

Yeah, 2 other really easy things would be in your intake paperwork, um, just a simple question: are you also experiencing knee pain? Check a box. Because then obviously you can address that with the patient. Say, hey, sounds like the spine, your low back, is the primary issue. What's going on with your knee? Right. And then you could do an exam on that. Okay. Well, we don't want to treat both at the same time, but let's address your back first, because a lot of those times, those, they're correlated, right? The knee and the back. So, um, once you start looking for it, you're going to see more of it. It's like, you know, you buy a red car, all of a sudden every car is red. Um, so same thing with this. Once you start, um, you know, investing into the knee niche, you're going to start seeing and attracting more patients with that condition. But that's a very simple thing. Just a checkbox. Are you also experiencing knee pain?

Yeah.

So that you can address that with the patient, then treat it sequentially, right? Back, then knee. And then also very simple, you know, Knee Pain Awareness Month. You could do that twice a year and just do an internal workshop, invite all your patients, friends, and family that have knee pain, and walk through your protocol. Offer, you know, on-the-spot evaluations. You know, if you're just trying to add say $10,000, $15,000 a month, and every care plan's around $5,000. Um, I mean, it's just not that difficult to get 2 to 3 starts a month, um, to— and then you'll have a very profitable additional revenue stream.

Yeah. And for our decompression doctors listening to this out there, what Dr. Vince was saying, the connection between hip or knee and spine— there's actually been studies that have come out just this last year in 2025 For instance, people that have back surgery but they have a hip that's not very good, surgery doesn't work as well. If they have back surgery and they have a bum knee, surgery doesn't work as well. It's no different with our decompression protocols. If you have a decompression patient that's not getting great results, it could be because they got a bad knee or a bad hip that needs attention as well. And so you may have to clean up the knee or the hip with a protocol either in addition to or following, or in some cases maybe before, depending on what clinically you think is the most relevant. I actually find personally that if a person has chronic back condition and a chronic knee, a lot of times I will address the extremity.

Mm-hmm.

In some instances, put a heavier emphasis on that sometimes first, and then we'll go to the spine and get really good results. So it all depends, every patient is different, but that is something to keep in mind, docs. And if you're— if you— if you add these tools in, hey, you're going to have patients that are going to do 2 different decompression programs.

Mm-hmm.

And especially if they're happy with one of them, they're going to like to say yes to the next one.

The easiest sale is the second sale.

Yeah.

It's an old saying in sales. One thing I'd also mention is that these patients by and large are typically really active patients, right? In other words, they wanna get back to golfing. They wanna get back to exercising. They wanna get back to tennis. This knee condition is standing in the way. So they're highly motivated and they're typically not quite so old, right? In their 50s, maybe early 60s. So you have someone that will typically respond quite well. And again, highly motivated because it's taking away the thing that they really enjoy doing. And that's fun to be able to help people.

Yeah.

Get back to whatever passion or hobby that they have, especially golf. Like a lot of doctors, like, you know, I'm a big golfer. Shoot, man, if something's standing in my way, like I'm going to get it addressed. But that goes for any passion, you know, that patients have. So I think that can also steer you in terms of how you would be looking for these types of patients. I mean, a lot of doctors are in Florida.

Yeah.

And shoot, There's a golf course on every corner. So you can really tap into this niche, but obviously we want to do it in the right way. And that starts with the clinical side of things, becoming a true expert in the knee, building out the protocol with the proper modalities, and then it's just execution.

Yeah, final thing I would say on that is, if you look in like, okay, well, how many of these people can I help? I actually statistically record this in my practice every year, have for several years now, and I've never had a year where we've been able to help fewer than 80% of cases. And much to my amazement, this last year, uh, I just looked at my stats from 2025. We did not have a failure in 2025.

Hmm.

Most years, on average, it's about 85 to 90%. All these more challenging knee cases though, with the right protocol, the right tools, you will help them to achieve minimum 50% or greater improvement of their chronic knee pain. And just like Dr. Leone said, you're going to give them their life back in many ways so that they can golf again, they can walk again, they can, you know, do those things that they want to do and enjoy to do because knee pain. robs people of a lot of things in their life when it turns chronic.

Yeah, 100%. And then I guess the final bow on this thing is it's again, staff-driven, right? Staff, systems, technology, that's what we kind of rely on to deliver these protocols. So, you know, this is— staff's gonna be putting them on and off laser, on and off decompression, et cetera. The systems are gonna process the patients effectively. The technology is going to deliver the bulk of patient care. This is, again, really positioning you to focus on the highest value activities, which is designing the system and protocols, doing a proper and thorough evaluation. But after that, everything is taken care of by essentially your staff and office. So that's the beauty of it, I think, in addition to everything else we talked about. So if you are an entrepreneurial doctor and Again, you want to stack one more revenue stream and you're not doing this yet, I think it's a fantastic niche. A lot of doctors, they kind of have adopted neuropathy, and I've talked to a lot of doctors that don't really like neuropathy. It's too complex, they get uneven results, et cetera, et cetera, et cetera. If you fall into that category, knee, in my experience, is much easier.

Yeah.

It's just more straightforward, right? It's musculoskeletal, it's osteoarthritis versus neuropathy, which has a wide array of potential causes. It's a complex condition. It can be very frustrating for patient and doctor. And so if you're not like just super clinically sharp, neuropathy can be very challenging. But if you've kind of experienced that and you're like, well, I still wanna add another niche, neuropathy wasn't mine, I got decompression going, I think that's where knee is a real winner.

Knee is, I do all the niche of those 3 niches, knee is the easiest. It's the easiest to examine. It's, you don't have to, other than the initial exam, the midway exam, and the final exam, you most of the time not seeing the patient at all. And you're gonna have a high rate of success and you're gonna have a lot of, Happy patients, and you're gonna not have so many frustrations as a doctor as you do with some of the neuropathy cases. Well, turn you a little gray along the edges.

So, uh, no doubt, no doubt. Um, okay, well, look, I think that, um, that should give doctors a good high-level look at the knee pain niche. Um, any parting or final words there, Dr. Pankinen?

No, just give it, just give it a thought in the sense, is this a nice dovetail for your practice once you have your spinal decompression program down? And, uh, a lot of doctors find a lot of satisfaction in this niche. So if you're not offering it, give it some thought. I think, uh, it's well worth pursuing.

100%. So hope that, um, this I hope this podcast was valuable for all our eager listeners. Again, this was the case for adding a dedicated knee program in 2026. And we want to thank everyone for, again, tuning into the show. You know, I talk to doctors, Dr. Kyle, on a regular basis who they really like this podcast. And it's so cool to hear because, you know, obviously we don't have even thou— we certainly don't have millions, but we don't even have thousands of listeners. It's in the, You know, lower than that. But I think what's cool is just hearing the impact. Even our, our private clients are listening to this and getting a lot of value out of it as well. So, um, I just, you know, want to thank all our listeners for tuning in on a, on a regular basis. We try to do this once a week, um, and, uh, we again just, just hope you continue to get value out of it. If you do, please like and subscribe and you know, share it with a colleague. We, we want to continue to grow it. We enjoy doing this. It's a lot of fun. It's our way to give back to the profession. And we're going to continue to go strong in 2026. So for Dr. Kyle Penkin, and I'm Dr. Vince Leone, this was the Practice Builders Podcast. We'll see you all on the next episode. Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast, with high-value decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support, and it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.