For many years, principal physio Paul Hattam, has been using injections alongside physiotherapy for the treatment of arthritis.
Injections are a common therapy for arthritis and other musculoskeletal conditions. In our recent blog, Hyaluronic acid – can it help my arthritis?, we discussed an injection therapy called hyaluronic acid which is the chief constituent of natural synovial joint fluid. We are increasingly using this therapy for the treatment of arthritis as we have noted a consistent reduction in pain which leads to progressive increases in function and mobility.
Traditionally steroid injections have been given for many musculoskeletal problems, however, steroid injections are now used very cautiously for certain conditions like injuries to tendons because of fear of damaging the tissue further, particularly when repeated. There are no such concerns for many other conditions such as tenosynovitis, bursitis and arthritis as these respond very well to steroid. ‘Gold standard’ practice is use ultrasound guidance to target these structures accurately and this is standard practice at The Physios.
So it is all a bit confusing, begging the question:
Which injection is right for me?
1) Steroid injections
Steroid injections have been widely used in the treatment of inflammatory conditions affecting the joints including osteo and rheumatoid arthritis. The inflammatory process of arthritis causes pain, swelling and loss of function and is dampened down by the powerful anti-inflammatory effect of the steroids. There is good evidence that shows its benefit in the short term (somewhere between 3 weeks and 3 months) but this sometimes does not provide a satisfactory treatment option as repeated injections of steroid, can be harmful to the joint. Some people do report longer term benefit but this is by no means a given.
2) Hyaluronic acid injections
Hyaluronic acid is a natural constituent found within the joint structure and helps to provide viscosity and elasticity to the joint fluid – important features of a healthy joint. Arthritis adversely affects the normal conditions within the joint and injecting HA helps to restore this, thereby reducing the symptoms associated with the condition. There is increasing evidence to show that its effect is longer lasting than steroid and that side effects are minimal making this an attractive choice for both clinicians and patient. We use a product called Ostenil here at The Physios, check out their guide to Hyaluronic acid.
3) Combined steroid and hyaluronic acid injections
Combined hyaluronic and steroid injections can be efficacious in cases where the short term benefits of steroid and the longer lasting effects of the hyaluronic acid are needed. This might be an option where the joint is very irritable and inflamed as the steroid is invariably the best way of treating this and the addition of HA helps to ensure that the longer term health of the knee is addressed too.
A recent patient had a combined injection as she had a swollen and irritable knee alongside an ongoing achy knee from previous sporting injuries. She comments:
The good news is that my knee is much improved since the injection three weeks ago. The pain is much reduced, I can move faster and better and even managed to run quite a long way for a bus! Hope this continues as life is much better. Thank you so much for your combined help and hope to see you in a year’s time for another injection to keep me away from the surgeon’s knife…..
A holistic team approach
Here at The Physios, we are strive for ‘gold standard’ outcomes for our patients. This influences everything we do, from investment in the latest technology to best practice specialist services, such as, injection therapy.
We also approach each clinical case as a team. This starts with a comprehensive clinical assessment and diagnosis from one of our experienced team. From here your physio can arrange anything else you might require, for example, a prescription for an injection or a scan to confirm the diagnosis. Part of this team approach is to ensure optimum recovery after your injections. This can include some ‘hands-on’ treatment to restore the movement in your joint and conditioning exercises to strengthen the muscles affected by your injury. It is important to note that the injection is only the start of your recovery as the rehabilitation ensures a solid, comprehensive recovery.
Do feel free to get in touch if you have any queries regarding our injection therapy service. Alternatively you can book an appointment with one of your experienced team online.