Knee injections for pain
A question I get asked a lot is this:
Will an injection make my knee stop hurting?
The quick answer: It can.
Let’s break it down…what are your options for knee injections for pain?
Knee pain as we age is generally due to arthritis and a loss of the cartilage in the knee. That cartilage is a valuable entity; it gives your knee joint cushioning and helps properly distribute loads across the joint. As that cartilage wears away, you end up with pain and a “bone on bone” situation. Most folks assume that a knee replacement is their only option at this point. Not necessarily. As an exercise therapist, my first recommendations to you are conservative treatments. Think:
Exercise. A must. You want the muscles surrounding the knee and NOT the joint itself to sustain loads as much as possible.
Proper movement mechanics. We want to keep unnecessary loads out of your knees. For example, if you have flat feet and don’t correct for this, your knees will be affected.
Anti-inflammatories. Over-the-counter NSAIDS like ibuprofen can work wonders for achy knees, reducing swelling and pain.
Icing. Proper icing of the knee joint will take down swelling and improve pain.
If you have exhausted all of your conservative treatment options, it may be time to try one of two main injection types.
The first is an anti-inflammatory (a corticosteroid) that is injected directly into the knee joint. While this won’t fix an injured knee, this type of injection can be effective in relieving pain and decreasing inflammation, possibly for several months or sometimes even longer. They work for many folks, but others notice no change. Generally, you’ll feel pain relief soon after the injection if it is going to be helpful to your knee. After a steroid injection, you’ll want to avoid strenuous activity for 24-48 hours.
The downside: Some experts have questioned whether steroid injections are a good option. Research published in 2019 suggested that steroid injections may increase the risk of joint damage and speed up the development of osteoarthritis. And a 2020 study found that folks who underwent physical therapy for one year had better results than those who received steroid injections.
Yet a cortisone injection MAY be helpful if you need to quickly reduce a build-up of inflammation and fluid so that you CAN do the exercises that will strengthen your knee. In my experience, I received my first-ever cortisone injection in my knee last fall. I know that I have a meniscus tear, which generally responds quite well to stretching and keeping my knee strong. However, this injury flared up during a hiking trip and never settled down. I developed a tremendous amount of swelling within the joint, and my pain level was getting (and staying) quite intense. I knew what I needed to do, but the pain and inflammation made my tried-and-true rehab program impossible to do. So I visited an excellent orthopaedic surgeon and he agreed…get the inflammation out of that joint and see how the exercise/flexibility goes. And, so far (5 months out), things are working well.
Option two: hyaluronic acid (HA) injections. Hyaluronic acid is a natural substance in the body, found in the synovial fluid within the joints. Basically, HA is a lubricating chemical that helps the endings of bones interact smoothly. When arthritis eats away at the joint cartilage, the theory is that HA injections provides more of the ingredients that allow joints to move with more lubrication and less pain.
Though pain relief can take longer (up to 4 weeks) than injection with steroids, HA treatment can last longer, by several months. Your physician will either do a single injection (depending on the product used) or a series of 3-5 injections spaced one week apart. My active clients have preferred using HA, since they want to help heal the joint by providing reparative building blocks, rather than simply easing up the inflammation (which is the function of steroid injections). And the injection series can be repeated if needed in another 6 months or so.
The ultimate goal of either injection is to hold off knee replacement as long as possible. And oftentimes, these clients are successful – especially when they maintain an effective exercise plan. Since a knee replacement lasts about 15 to 20 years, the goal is to get you far enough down the road so that a potential replacement would be a one-time procedure for you.
But if you haven’t yet tried an effective strengthening and stretching regimen, it’s time to get in touch with an exercise therapist who can safely and effectively prescribe the right program for you. Get in touch with me…it would be a privilege to get you back to pain-free living.