LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

hyaluronic acid injection

Thinking About Injections for Knee Pain? Read This First

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Knee osteoarthritis symptoms can be debilitating and wreak havoc on your quality of life, severely limiting what you love to do.  Injections are an option that many consider.

Usually, the first type of injection that comes to mind is a cortisone or steroid injection.  Hands down the worst idea you could come up with for any type of pain, even if it does seem to help for a day or week or even 6 months.  The long-term damage done by the cortisone to the soft tissues of the knee is tough to recover from.

The other type of injection that has become more popular over the past decade or so is hyaluronic acid injections in the knee.  In general, patients who have had this done seem to do well, or, if they did not see an improvement, there were no downsides (other than a single patient in our office whose knee went septic, but that was a procedural problem and not a problem with the injection itself).  I have covered the benefits of this type of therapy in a previous blog post that can be read by clicking here.

So what if something was even better and safer than these hyaluronic acid injection for knee osteoarthritis symptoms and didn’t need a physician to administer the therapy?

According to this particular study, a simple at-home device used for 20 minutes, 3 times per week for 4 weeks, resulted in greater improvements in pain at 6 weeks as well as at 3 months (as measured by the Visual Analogue Scale and the Lequesne index).

A Transcutaneous Electrical Nerve Stimulator (or TENS for short) is a simple device that uses a 9-volt battery to send a consistent pulse to an area in order to block pain from making it to the spinal cord and your brain.  You can read more about TENS units in a product review blog article by clicking here.

I do find it interesting that the use of a TENS unit had long-lasting effects because TENS units are generally considered to only manage pain and not affect healing or inflammation.  Maybe the study participants felt better in the short-term using the TENS unit and, as a result, became more active than the injection group.  Since exercise and activity are well-known to help with knee osteoarthritis symptoms, this may actually make sense.

Either way, it would make sense to ask your doctor to prescribe a TENS unit or look into getting one yourself.

 

Knee Cartilage Damage? Alternatives to Knee Replacement

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The knees bear a tremendous amount of abuse in a lifetime, resulting in knee cartilage damage. Luckily, there are many viable alternatives to knee replacement.

Treatment in our office can be very, very effective at relieving knee pain. However, even we understand that there are limits to pain relief that can be obtained. While the numbers are low, we have had patients who did not respond proceed to knee or hip replacements.

Personally, I want to save everybody from surgery and keep them as functional as they want to be. In a perfect world this would be an obtainable goal.

Luckily, there are additional options that are available to arthritis sufferers that were not available even 10 years ago.

Before we get into those other options, we need to cover some important points first.

  1. Just because you have arthritis does NOT mean it is causing your pain. Countless times we have had patients with “arthritis pain” get total relief in just a few visits.  We did nothing to the arthritis, but the arthritis was not causing the pain.
  2. Treatment around the knee HAS to consist of solid soft tissue techniques such as Graston, fascial manipulation or ART. Anything less is not the best. That means that mobilization, manipulation, exercises, ultrasound, laser and interferential therapies are just likely not going to cut it.
  3. You HAVE to get off your butt and use the darn joint. It is abundantly clear that exercise and strengthening the knee joint will improve arthritis pain and function.
  4. The use of any type of anti-inflammatory may likely keep you from getting the best improvement possible because it blocks the healing process.
  5. Weight loss will always help. Drag out the old physics book and do some math on how much extra force the knee has to deal with at 10 extra pounds. Jack that number up to 50 and the forces start to have more zeros on the end. The weight’s go to go.

Ok…now that that’s out of the way we can address the findings of this particular article.

I remember the first time I had a discussion with a patient about injections of hyaluronic acid into the knee (Sandy–if you’re reading this I’m talking about you…). It was probably about 12-13 years ago, so this is not a new technology.

Basically, the procedure involves injecting hyaluronic acid, or some version of it, into the joint. Hyaluronic acid injections contain the building blocks of cartilage, so it makes at least some sense that this might be a good idea.

The results over the years seems to have been okay. Not stellar, but okay. With one exception (a patient who developed an infection in the joint after the injection–but this was a technique problem and not a problem with the treatment), I have not seen any downsides to this. Some seem to respond, some don’t.

In this particular study, researchers compared the effectiveness of two types of substance used in the injections. Hyalgan has been one of the main products available almost since the beginning and is considered a low molecular weight product. The results on pain reduction were compared to an intermediate weight product.

The pain reduction was better with the intermediate weight product. While the difference was not great, it was enough to suggest that this product was a better option for pain control and certainly adds to the total picture of what this type of approach can add to treatment of knee arthritis.

Have you tried these injections before? If so, how did they work for you?