Caring Medical Research Prolotherapy For Knee Pain
In published research in the Journal of Prolotherapy, Ross Hauser MD investigated the outcomes of patients receiving Prolotherapy treatment for unresolved, difficult to treat knee pain at a charity clinic in Illinois.
- 80 patients, representing a total of 119 knees, were treated quarterly with Prolotherapy.
- The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy.
- More than 82% showed improvements in walking ability, medication usage, athletic ability, anxiety, depression, and overall disability with Prolotherapy. Ninety-six percent of patients felt Prolotherapy improved their life overall.
Research Comparing Prp Injections Cortisone Injections And Hyaluronic Acid Injections
Doctors wrote in a January 2019 study that while PRP injections, cortisone injections, and hyaluronic acid injections are considered equally effective at relieving patient symptoms at three months, at 6, 9, and 12 months the;PRP;injections delivered significantly better results.
A July 2020 study published in the Journal of Pain Research also suggested that PRP injections provided better results for patients than hyaluronic acid injections. The studys conclusions were: Besides significantly higher satisfaction belonging to the group, there was a statistically significant improvement in pain and function scores at 12 months compared to hyaluronic acid injections
In research published in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, PRP was shown to provide significant healing of the meniscus;;as well as out out-perform hyaluronic acid in patients with knee joint cartilage degeneration. Similar results were documented in the journal Archives of physical medicine and rehabilitation.
In our article Platelet Rich Plasma for Knee Osteoarthritis: When it works, when it does not, we point to more research on when the treatment can be successful and when the treatment may not help you.
Corticosteroid Damaged Knee Cartilage And Provided No Significant Pain Relief After Two Years
In 2017, doctors from Tufts Medical Center in Boston;asked, What are the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on the progression of cartilage loss and knee pain in patients with osteoarthritis?
Writing in the Journal of the American Medical Association, ; they published their answer:
Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.
- Corticosteroid damaged knee cartilage and provided no significant pain relief after two years.
In other words, cortisone can either work or make the problem worse.
In February of 2020 a review study with the title Medical Reversals in Family Practice: A Review, published in the journal Current Therapeutic Research, Clinical and Experimental offered these points:
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High Levels Of Exposure
Cortisoneespecially when used on a long-term basismay break down tissues, such as tendons, ligaments, and cartilage in the knee joint.Cartilage acts as a shock absorber, reducing the friction between bones as they move.
For this reason, it is not recommended to get repeated cortisone injections in the same joint over a short period of time, as it may cause more harm than good. If more than one injection is given in the same joint, the injections should be scheduled at appropriate intervals. Patients should not receive more than three to four cortisone injections per year.
Anytime a needle is injected into the skin, there is a chance of infection. An antiseptic will be applied to the skin prior to injection to reduce the risk of infection.
What Are Cortisone Shots
Cortisone shots are injections of medicine that ease pain and swelling in different parts of the body. Doctors use these shots to treat injuries and conditions such as arthritis or autoimmune disorders .
Cortisone is a type of medication called a corticosteroid. Doctors use these drugs to treat inflammation caused by injury and illness. Sometimes cortisone shots are called corticosteroid shots. Commonly used cortisone variants include Kenalog® Depo-Medrol® , and Celestone® .
People most commonly receive cortisone shots in joints including the hip, knee, shoulder, spine, hands and feet. The cortisone reduces inflammation in and around the joint.
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In This Video Ross Hauser Md Explains How One Injection Of Prp Will Likely Not Work
A transcript summary is below the video
We will often get emails from people who had previous PRP therapy without the desired healing effects. We explain to these people that their treatment probably did not work because the single PRP injection did not resolve knee instability. The PRP may have tried to create a patch in the meniscus or cartilage to help with a bone-on-bone situation but the instability and the wear and tear grinding down the meniscus and cartilage remains.
When a person has a ligament injury or instability, the knee becomes hypermobile causing degenerative wear and tear on the meniscus and knee cartilage. In other words, the cells of the meniscus and cartilage are being crushed to death. When you inject PRP cells into the knee, without addressing the knee instability, the injected PRP cells will also be subjected to the crushing hypermobile action of the knee. The single injection PRP treatment will not work for many people. The knee instability needs to be addressed with comprehensive Prolotherapy around the joint. Prolotherapy is the companion injection of simple dextrose. This is explained in detail below.
Pain After Cortisone Injection: What Does It Mean
Generally, pain after cortisone injection is the most common reaction. We call this reaction a cortisone flare. Usually, a cortisone flare starts after 6 hours and lasts for up to 5 days. One study suggested that a cortisone flare can last up to 4 days. We suggest you rest from activity including sports until the pain settles. However, you can continue with exercise that doesnt activate the
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What Are Cortisone Injections
Cortisone injections are created from one key substance: corticosteroids. Yes, theyre a form of steroids, and no, they wont get you suspended for half an MLB season if youre caught using them as they are not anabolic steroids.
Theyre used due to the extremely potent anti-inflammatory properties they possess, and are commonly recommended to patients who have severe joint pain. Like a PRP injection, cortisone is administered directly into the target tendon or joint that needs relief. With corticosteroids being as powerful as they are, physicians will limit the amount of injections a patient receives due to potential harmful side effects.
Cortisone injections provide instant gratification, and a quick-fix solution to problematic pain that is caused by inflammation. If someone is really suffering, they might not be able to wait the lengthier time for a PRP injection to kick in, opting for the faster alternative.
Corticosteroids are also more cost-efficient than substitutions like platelet rich plasma therapy, though that should be a minor consideration when it comes to personal health, if offered the luxury.
Side Effects Of Steroid Injections
Possible side effects of steroid injections depend on where the injection is given.
Side effects of injections into the;joints, muscles or spine can include:
- pain and discomfort;for a few days;;paracetamol may help with this
- temporary bruising or a collection of blood under the skin
- flushing;of the face for a few hours
- an infection, causing redness, swelling and pain; get medical advice as soon as possible if you have these symptoms
- a loss of;fat where the injection was given; this;can cause;dimples in the skin and may be permanent
- paler skin around the site of the;injection this may be permanent
- if you have diabetes, your blood sugar level may go up for a few days
- if you have high blood pressure, your blood pressure may go up for a few days
Epidural injections can also occasionally give you a very painful headache that’s only relieved by lying down. This should get better on its own, but tell your specialist if you get it.
Side effects of injections given into the blood tend to be similar to;side effects of steroid tablets, such as increased appetite, mood changes and difficulty sleeping.
You can;report any suspected side effect to a UK safety scheme.
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If You Have Upcoming Surgery
Dr. Greene says most surgeons will refuse to operate if you’ve had a cortisone shot within the last three months.
“It significantly inhibits the body’s innate ability to heal. Thus, if surgery is a possibility in the near future, I would recommend avoiding the temporary pain relief via cortisone injection,” he says.
Research Tells Us More About Cortisone Benefits And Risks
Often, the initial injection delivers the most effective inflammation treatment and pain relief. Studies of specific conditions treated with cortisone give us more information.
- Tennis elbow. Studies have looked specifically at cortisone treatments for common extensor tendon injury, commonly known as tennis elbow. There is good evidence that a cortisone shot gives people about three months of benefit. After three months, cortisone is not going to be as helpful. More importantly, there is a risk that continued cortisone injections over time might make tennis elbow worse because cortisone can degrade the tendon. In fact, several studies have examined the effect of cortisone on tendon tissue health over a longer time period. One study compared two patient groups. The first group was given cortisone to relieve tennis elbow pain; the second group got no pain treatment. A year later, analysis suggested that the untreated group did better than the group receiving cortisone. Although a single study is not robust enough to be definitive, the data does suggest concerns with doing repeated cortisone shots in the common extensor tendon.
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How Is Knee Injection Performed
Knee injection is a relatively quick procedure and may be performed under local anesthesia to avoid pain. A needle of appropriate size and length connected to a syringe is introduced into the joint and the medication is injected. Radiological guidance may sometimes be used to aid injection.;;
After the procedure, the patient would need to rest for a few minutes, and then they can resume normal activities. Patients may experience pain, swelling, and bruising, which resolve in a few days. Ice packs and pain killers can help reduce pain and bruising.
Which Conditions Are Steroid Shots Used To Treat
Cortisone shots can treat both inflammatory arthritis and osteoarthritis, but they may be more effective at treating inflammatory arthritis than osteoarthritis, according to the Mayo Clinic. For osteoarthritis, sometimes people dont get relief, and its hard to predict why, says Dr. Sufka. In osteoarthritis patients with advanced disease, in which the cartilage in a joint is mostly worn away, it may be that the disease has progressed far enough along that the steroid injection isnt effective.
No matter what type of arthritis you have, steroid shots are just one part of an overall treatment plan. For osteoarthritis, this could include NSAID medication, exercise and physical therapy, weight loss, and heat and ice therapy. For inflammatory arthritis, treatment includes disease-modifying drugs as well as those options. Steroid injections can help relieve inflammatory arthritis pain in the short term while longer-acting treatments like DMARDs have time to take effect.
Treating joint pain usually involves multiple approaches, according to Dr. Schaefer on the Cleveland Clinics site. Depending on what condition is causing the pain, we try to find other long-term pain relief solutions through physical therapy, bracing, other medications or, in some cases, joint replacement.
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Are Hyaluronic Injections Low
A research letter in the Journal of the American Medical Association Internal Medicine, with the title: Are Hyaluronic injections low-value health care?;Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections,;backed that up withbased on high-quality evidence that hyaluronic acid injections were not associated with clinically meaningful improvement in symptoms compared with placebo injections.
This statement paper is from 2014, lets see if we can advance the research forward towards 2021.
The first stop is February 2016 and the journal Clinical Orthopaedics and Related Research. It is an editorial from Seth S. Leopold, MD. Here are the quoted learning points:
Tackle Achy Knees With Cortisone Injections
Ongoing knee pain can be quite debilitating. Your knees support you as you accomplish daily tasks. If you start limping to favor the knee and continue to do so over some time, you may also begin to have back pain and other musculoskeletal issues.;
Treating knee pain early so that your walking gait doesnt change could help avoid other pain types in your limbs and joints. Our board-certified orthopedic surgeons at Coastal Empire Orthopedics treat all knee pain types, from arthritis to torn tendons to ligament injuries. We use physical and imaging tests to diagnose your pains root cause and then develop a plan to relieve it.;
If youre having intense pain, we can give you a cortisone shot to calm your symptoms while developing a longer-term plan.
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How And When To Have Hydrocortisone Injections
A specialist doctor will usually give you your injection. This may be at your GP surgery.
If the injection is for pain, it may contain a local anaesthetic. You might also have a local anaesthetic by spray or injection to numb the skin before the hydrocortisone injection.
You can go home after the injection, but you may need to rest the area that was treated for a few days.
You may be able to have a hydrocortisone injection into the same joint up to 4 times in a year. The number of injections you need depends on the area being treated and how strong the dose is.
If you have arthritis, this type of treatment is only used when just a few joints are affected. Usually, no more than 3 joints are injected at a time.
The dose of hydrocortisone depends on the size of the joint. It can vary between 5mg and 50mg of hydrocortisone.
Are Cortisone Injections Painful
In an expert’s hands, the opposite is more often the case. That is, minimal pain from the procedure is noted while relief from the pain of the inflammation occurs rapidly. Occasionally, cortisone injections of joints that have degenerated or that are particularly small can be associated with temporary minor pain at the time of the injection. This is not generally expected. Less frequently, nerves can be irritated, either directly by the needle during the injection or by the corticosteroid medication. Again, pain after the injection is not common or anticipated.
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One Injection Just As Good As A Series Of Hyaluronic Acid Injections
The next stop will be a March 2019 study in the journal Current Therapeutic Research.
The question being asked here is maybe more than one injection would make the treatment more effective. In fact, the question is how this paper opens: Viscosupplementation of the synovial fluid with intra-articular hyaluronic acid is a well-known symptomatic treatment of knee osteoarthritis. The question arises whether a mono-injection could be as efficient as multi-injection regimens.
Here is how this paper concluded: In the symptomatic treatment of knee osteoarthritis with intra-articular hyaluronic acid, the results of mono-injections demonstrate to the multi-injections and also when compared to a placebo injection.
Bone Marrow Aspirate Concentrate Or Bone Marrow Concentrate Type Stem Cell Therapy
Using stem cells taken from a patients;bone marrow is becoming a therapy of interest due to the potential of these mesenchymal stem cells to differentiate into other types of cells such as bone and cartilage. This is not a new revolutionary treatment, this treatment has been studied and applied for many years. It is a difficult treatment for some doctors to give. You do need experience in all aspects of the treatment to give the patient the best chance at achieving their healing goals.
Bone Marrow is the liquid spongy-type tissue found in the hallow of bones. It is primarily a fatty tissue that houses stem cells that are responsible for the formation of other cells. These mesenchymal stem cells , also called marrow stromal cells, can differentiate into a variety of cell types including;osteoblasts ,;chondrocytes , myocytes , adipocytes , fibroblasts; and others when reintroduced into the body by injection. Bone marrow also contains;hematopoietic stem cells that give rise to the white and;red blood cells and platelets.
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How Long Do The Benefits From Cortisone Shots Last
Improvements in knee pain in from cortisone shots typically peak around two weeks and can persist for up to 24 weeks.6 After 24 weeks knee pain tends to return to its original intensity.2 Its also worth noting that after the first few weeks of treatment patients typically see very little benefits from cortisone shots compared with a placebo .
Potential Dangers Of Cortisone Shots
So why dont we use these all the time, if theyre so wonderful? Are cortisone injections bad for you?
A lot of doctors use these injections in lieu of counseling patients that they may benefit from surgery, Dr. Bheeshma Ravi, an orthopedic surgeon.
If appropriately used, they are a fantastic anti-inflammatory, but that should be used to allow you to start doing physical therapy, not to immediately jump back to whatever may have caused the underlying issue.
Cortisone FlareA period right after the shot where pain could be worse. This usually lasts for only 1-2 days and effects no more than 2% of people.
I am now convinced this is what occurred for me during the half marathon DNF. I had been running nearly pain free for months utilizing RockTape and yet in the day after that cortisone shot in knee I was nearly hobbled. The race course itself probably didnt help, but the pain was worse than it had been since my injury started.
Degeneration Tendons and CartilageMost doctors limit injections to no more than 3 per year in a given site, due to potential weakening of tendons and softening of cartilage that was shown to occur in animal studies. Which obviously could create longer term issues.
In places like the heel where runners get it for plantar faciitis it can actually reduce fat, which means less padding to help that heel run happy.
In fact, Emily of Mile At a Time Running, sent me this example from her own life:
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