March 7, 2022
By John Rugotzke, PT, DPT
Patients with knee pain and other orthopedic conditions are often given recommendations of steroid or cortisone injections, often even before consulting with a doctor of physical therapy. For someone in pain, a doctor’s recommendation of one or two joint injections for knee pain may seem like a great course of care. Injections are fast, readily available, highly recommended by physicians, and often involve little to no time off of work. So, it seems like this would be a great idea, right? Not necessarily.
In a Journal of American Medical Association article, patients with knee pain were placed into two groups: those who would get a series of standard steroid injections and those who would get a series of saline (placebo) injections every 12 weeks for 2 years. A MRI of the knee was done at the beginning, at one year, and then at the end of the study. Pain levels were recorded throughout the study.
At the end of the two year study, it was concluded that the effects of the cortisone shots were equal to those of the saline shots for pain relief. No difference in pain, stiffness, or function between the groups. The concerning factor is that the patients who had received cortisone had thinning of their cartilage after the shot series when compared to those who had the saline injections. The arthritic process was actually sped up by the use of steroids. This brings the Hippocratic Oath into question, “First, do no harm.”
As an orthopedic specialist, I have heard the report from an unfortunately large number of patients: “It helped for a little while, but then when back to how it was.” Instead of ignoring or altering the pain, why not solve the pain? A good history and examination with functional screening that includes the whole body will start this process off right. An Orthopedic Specialist (OCS) Doctor of Physical Therapy (DPT) is highly trained in this type of examination and can be your guide to solving your knee pain without the risk of an injection. The main point is, if your doctor recommends a steroid injection, ask them why and what else are your options.
Dr. John Rugotzke is a physical therapist with advanced specialty training in orthopedics and a Fellow of Applied Functional Science through the Gary Gray Institute. Questions can be directed to him through firstname.lastname@example.org.