We’ve been using Hyaluronic Acid injections at the practice for a number of years now to assist in the treatment of arthritis and yet many people don’t know too much about it. It is a treatment used for joint conditions, including arthritis, which affect many joints including the knee, hip, ankle, big toe, thumb and shoulder. With all new treatments come a degree of scepticism but HA has been around for well over 20 years and there is now substantial evidence in support of its use for a wide range of conditions. The treatment was famously referred to as ‘synovial fluid replacement therapy’ when it was widely attributed to be the reason Freddie Flintoff was able to help England win the Ashes in 2009. Since then its use in sport has rapidly grown and is recommended by many leading clinicians.


So, how does it work?

Hyaluronic acid is a naturally occurring molecule found in all synovial joints. It has viscoelastic properties which means it plays a role in normal joint function in absorbing load within the joint (elasticity) and assisting with easy, free movement (viscosity). You could consider HA much the same as hydraulic fluid which not only lubricates but also accepts pressure and load. In the arthritic joint, the composition of synovial fluid changes. Swelling invades the joint and viscoelastic properties are reduced. Not only that, but it is thought that the HA provides a barrier to the inflammatory process which is the main feature of osteoarthritis.

So do I really have to keep taking the painkillers and just manage as best I can?


The hyaluronic acid we inject is synthetically produced in laboratories but has the same properties as the version produced in your own joints. What we invariably see is a consistent reduction in pain which leads to progressive increases in function and mobility. The beauty of the treatment is that there are no harmful side effects and at a time when the medical profession have become more cautious about the use of repeated steroid injections (rightly so) or long term use of anti inflammatory medication, this treatment provides an effective, safe and repeatable solution for joint conditions including arthritis. The only downside is that HA is not readily available on the NHS but, for comparatively little cost, the prospect of reduced pain, improved function and a return to normal activities are all within reach.

Physio Paul Hattam remarks, “I’ve seen the impact the treatment has had with many people now especially when the injection is combined with physiotherapy and exercise. The evidence supports its use mainly in early arthritis but I have also had notable successes with people who have more advanced arthritis unwilling or unable to consider joint replacement. It is certainly a treatment option we didn’t have at the beginning of my career and has provided a much better solution for anyone with osteoarthritis”

But don’t just take our word for it – here is what Jane recently had to say:

Hi Paul,
We had an exciting summer – where quite a bit of physical activity wasn’t held up by my leg issues. We walked 600 miles from Land’s End to Hadrian’s Wall and cycled 600 miles up the west coast of France (and camped in a very small tent!)
Thanks again for all your help with understanding what was and is going on with my knee, encouragement and wisdom, and the (possibly magic) Hyaluronic mixture. In that order.


Time and again we have seen excellent results using HA with many people returning to sports and hobbies that they had long since written off. Do get in touch to see if HA could help you.


Paul Hattam is one of the team of physiotherapists at The Physios and also tutor’s on post-graduate courses for Physiotherapists & Medical Practitioners learning injection therapy.