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Cortisone or Physical Therapy for Knee Osteoarthritis?

good good... let the cortisone flow through you - emperor ...



Arthritis of the knee is a real pain in the butt, but a little bit lower.  It's very common and there is a lot of conflicting evidence out there about what the best treatments are for them.  Some research has shown that nothing works particularly well and others will point to any number of things that do work, including

  • Weight Loss
  • Physical Therapy
  • Braces
  • Turmeric & Glucosamine/Chondroitin
  • Topical OTC pain relievers (Aspercreme, Arnica, Ben Gay)
  • Topical prescription anti-inflammatory medications (diclofenac)
  • NSAID's like ibuprofen or naproxen (more about that here)
  • Cannabis
  • Glucocorticoid (Cortisone is a brand name) injections
  • Hyaluronic Acid Injections (Synvisc is the main one I've heard of)
  • Prolotherapy
  • Stem cell injections
  • Knee surgeries
And there are probably more that I've missed but these are the major ones.  I've had patients who have done all of these - some swear by them, some say they've done nothing at all and some say they worked for a little while and then stopped.  

One limitation of our current medical system is that doctors often have the incentive to perform procedures instead of counseling and so more effective treatments may not be what they go with.  

From what I've seen, weight loss and physical therapy have been the most effective, lowest risk treatments, though they take the longest to work.  The orthopedists I've worked with often quote that every pound you lose takes 4 pounds off of your knees because of the torque they experience.  Physical therapy can teach you to use muscles you may have forgotten you had to take some of the pressure off of the knee as well, thus reducing pain and improving function.  

But Cortisone shots are what people most talk about - it sounds great to say, a lot of athletes do it and oftentimes does work.  But how well does it work?

There was a recent study in the New England Journal of Medicine looking at this which showed that while both physical therapy and glucocorticoid injections improved pain after 9 months, the physical therapy was much more effective.  

Given the risks of glucocorticoid injections (albeit minimal, but there is a remote chance of infection and it does slightly hasten cartilage loss), the more sustainable and apparently more effective answer is knee physical therapy combined with weight loss if you have weight to lose.

If you don't have access to a physical therapist, there are a lot of exercises you can get started with online - here are some I found.

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