Knee Injections for Arthritis

by | Jun 25, 2023 | Chronic Conditions, Knee

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 https://www.sydney.edu.au/research/volunteer-for-research-study/other/the-sculptor-study.html

OR contact us here.

Ankle dorsiflexion knee to wall measure for squat

How to Treat and Manage Stiff Ankles

If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.

  • Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.

Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:

  • Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.

Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!

Hip Range of Motion

How Much Flexibility Do I Need and How Do I Test It?

For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:

  1. Lie down on your back with your legs extended.
  2. Place the inclinometer length-ways on your thigh,
  3. Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.

     

    measuring hip flexion

    How to Treat and Manage Stiff Hips

    The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.

    For the rest of the population, here are some effective strategies for improving hip mobility:

    • Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
    • Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
    • Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.

    Conclusion

    Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.

    By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!