Knee Injections for Arthritis

Injection for knee arthritisWhat is the best injection for knee arthritis?

A new study has shown the benefits of combining an injection with physiotherapy for the treatment of knee arthritis. Historically, injections alone have only provided a small level of relief for only a small percentage of patients suffering from knee osteoarthritis.
Common injections include cortisone (steroidal anti-inflammatory), hyaluronic acid (lubricating substance found in cartilage), dextrose (stimulates tissue healing) and stem cells.


The Knee Injection Study

The paper published this year (2023) was titled “Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials.”


The paper was a Systematic Review comparing 3 different groups.
1) Physiotherapy only
2) Injection only
3) Injection combined with Physiotherapy


What were the results?

The authors found that for pain reduction, dextrose injection PLUS physiotherapy yielded the best results.  For enhancing walking capacity, mesenchymal stem cell injection PLUS physiotherapy was the most effective.

Adding physiotherapy to any injections, yielded better results that the injection alone, so the recommendation is, regardless of what injection you may receive, the results will always be superior if some rehabilitation is undertaken in conjunction with the injection.

Effective physiotherapy treatment of knee osteoarthritis after you have had an injection should be designed to treat your assessable impairments. For example, if you are found to have reduced range of motion of your knee, then some hands on manual therapy may be useful to help restore your the flexiblity of your knee.

More of then not, we find their are weaknesses with strength testing of the quadriceps and hip abductor muscles so these will commonly be strengthened over an 8-12 week period.

With regards to the stem cell injection, Sydney University are currently undertaking a randomised, placebo controlled study at the moment. If you wish to be part of this study, you can read more at

OR contact us here.

Hypermobility Tests – Conduct your own Beighton Score.

Are you worried you are Hypermobile?

Hypermobility is estimated to affect between 10-20% of the total population. It occurs on a sliding scale from mild hypermobility to advanced, clinical hypermobility. It is measured with the Beighton Score.

The Beighton Score is a simple scale of 0-9 based on 5 different tests. A point is given for each joint that is hypermobile. The joints and movements tested are:

  1. Little finger extension x 2
  2. Thumb extension x2
  3. Elbow elbow extension x2
  4. Knee extension x2
  5. Hamstrings x1



Studies on the prevalence of generalised Hypermobility

A large study conducted in the UK on 6000 children in 2011 found that 27% of girls and 10% of boys aged 13 had some form of hypermobility (a score of >3 on the Beighton Score).

Another study, this time on American College students in 2019, found 12.5% of the student population scored >4.

Clinical Hypermobility (a score >7) is rare and commonly only occurs in those with Ehlers Danlos syndrome which affects about 1 in every 5000. You can find out more about Ehlers Danlos here.


What can I do if I am Hypermobile?

Fortunately, there has not been any evidence to date that those with hypermobility are more likely to suffer an injury. There is, however, evidence that when those with hypermobility do suffer an injury, the severity can be worse.

It therefore makes sense to choose sports where severe injury, such a joint dislocations and fractures, are less common, which might involve avoiding contact sports.

There is emerging evidence that heavy strength training may play a protective role for joint hypermobility, so a well-programmed weight training program may be of benefit.