Injections for joint pain: Education to the community

According to the American academy of Orthopedic Surgeons (AAOS) guidelines for injections and osteoarthritis (OA), the effects of steroid injections are inconclusive at best- there just isn’t a lot of evidence, here!

For a procedure commonly administered in an orthopedic office, why are we lacking answers to this important topic?

You might have been told you are “bone-on-bone” or have “degenerative joint disease”. The truth is that this is just a medical diagnosis. Don’t let it define you!

Instead let’s look at what we know..

Knee osteoarthritis (OA) is a normal part of aging, this happens to joints as we grow older. Now that we know this, the important question is what can WE do each day to keep our joints healthy?

Understanding the benefits of low impact exercises like exercise bikes, strength training with weights, elliptical trainers and purposeful walking all move your joint which improves fluid and nutrition to the joint!

Correct exercise dosage and GRADUAL pacing of activities helps limit inflammatory responses. This is where Physical Therapy can help. Through education and proper goal setting at ProMet Physical Therapy.

One research study suggests doing x-ray imaging before and after injection to see if there was any acceleration of joint stresses such as bone loss, cartilage damage or less joint space. Conversations like this need to be brought up before getting the injections.

Education on the risks should be a part of informed consent in all discussion prior to getting the injections.

Let’s look at Physical Therapy vs Steroid injections

Fun Facts!

Once the patient goes down the medical pathway with prescribed medication, MRI/X rays, injections and eventually surgery this momentum keeps them away from Physical Therapy.

This also costs a lot of money, time and increases your stress levels. Time is valuable, spend your time working on YOU rather than looking at the medical community for answers.

The Takeaway!

PT is low risk/low cost and …

PT VS steroid injection article by Delye in the New England Journal of Medicine:

Patients did better with PT than with injections supported by the fact that they had less pain, stiffness, did better on measurable tests, as well as the ability to walk pain free.

Favorited PT at all time points but with increased significance at 6 months and 1 year

Also PT provided short term benefits that were at least, as effective as the injections.

Important because our patients come in usually during knee crisis- with extremely painful knees and the literature is showing us that PT provides short term as well as long term relief.

Patients in the study after injections: rest 72 hours, ice, rest, pain meds (feeding to sedentary behavior)

Patients in the study after PT: walk better less pain, not as stiff, easier to walk (promoting activity and positive behavior)

How long will I have to do PT for?

Lengthy physical therapy is the misconception. Frankly, you’re missing the point if you’re thinking about how long it will take”.

This study showed benefits of PT with as little of 2 to 12 visits. Of course people are going to feel better, but the real test is what you will be doing on your own and has your Physical Therapist instilled you with confidence to be independent in your exercise routine.

Food for thought

There’s never 1 treatment, 1 injections, 1 surgery or even 1 exercise or stretch that will benefit you. It ismore important that we look at lifestyle as multiple slices to a pie. Different slices of lifestyle factors make up the whole pie.

For instance, sleep, nutrition, weight management, exercise, occupation, stress, relationships.

All these make up a well-rounded individual and without first addressing these lifestyle factors. Surgery, injections, medications should not be a thought until we look at lifestyle modifications first!

The Benefits of injections are ALL short term- think long and improve on lifestyle habits!

References

Deyle GD, Allen CS, Allison SC, et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. 2020;382(15):1420-1429.

Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?. Radiology. 2019;293(3):656-663. doi:10.1148/radiol.2019190341

Martin CL, Browne JA. Intra-articular Corticosteroid Injections for Symptomatic Knee Osteoarthritis: What the Orthopaedic Provider Needs to Know. J Am Acad Orthop Surg. 2019;27(17):e758-e766. doi:10.5435/JAAOS-D-18-00106

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