Knee Arthritis and Steroid Injections

Arthritis is a common chronic condition of the joints that involves breakdown of the cartilage and the ends of the bones and inflammation of the joint lining. The disease tends to affect heavily used joints, such as those in the hands and spine, and the weight bearing joints in the knees and hips. It has been estimated that knee OA affects more than 9 million Americans, and it is a leading cause of disability and medical costs.

Many treatments for arthritis target inflammation to reduce pain. Direct injection of corticosteroids into the joint is a standard treatment for conditions such as knee arthritis.  However, the treatment is somewhat controversial with regard to the benefit of both single and repeated injections.  Current evidence shows that the improvements made are modest at best.  In addition, there is a risk that repeated cortisone injections could result in early wear and tear of joints. The use of corticosteroid injections to treat knee arthritis is based on the medicine’s capacity to reduce inflammation. However, corticosteroids have also been reported to have destructive effects on cartilage.

According to Dr. McAlindon of the Tufts Medical Center in Boston,

“We now know that these injections bring no long-term benefit, and may, in fact, do more harm than good by accelerating damage to the cartilage.”

While steroid injections have a time and place (e.g. intense pain after an acute injury) it should not be viewed as a long-term solution. One should always ask why the knee has developed arthritis and seek to address the underlying factors contributing to joint degeneration.

In our physical therapy practice, we often find musculoskeletal problems that affect movement quality and predispose a joint to developing arthritis.  In the case of knee arthritis, stiffness at the ankle and weakness of the hip and buttock muscles can place undue to strain on the knee joint. In addition, imbalances of the core muscles can affect movement quality, which may aggravate arthritic conditions. However, the only way to know what is contributing to pain and injury is to perform a complete assessment and observe how someone moves.

When pain and stiffness is found during an assessment, our approach includes manual mobilization of the soft-tissue and joints to alleviate pain and improve mobility. We have found that dry needling of the quad, hamstring, and calf can work wonders for arthritic knee pain. Improvements can be made very quickly if the right regions are targeted. If weakness is found, we teach activation exercises to help our clients better engage muscles that are not firing well. Once pain is controlled and muscles engage better, our next step is teaching our patients to develop stability with patterns of movement (e.g. squat, hinge, step/lunge).

When addressed with a thorough physical therapy assessment and plan of care, even in patients who have been diagnosed with “bone-on-bone” arthritis can return to a high level of activity. The development of strength, mobility, and movement is enough to prolong the life of the joint for years to come.

However, ignoring the problem or engaging in repetitive activity with poor mechanics can cause knee arthritis to become worse. This may lead to the inability to remain active and/or joint replacement surgery. If you have knee pain and told you have arthritis, the physical therapists at Movement Solutions would be glad to provide a thorough assessment and give you a prognosis for your condition. We are available for a free 15-minute phone consultation to talk about how your knee is affecting you and discuss your treatment options. Call us at (864) 558-7346 and ask how we can help.

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