Navigating Non-surgical Knee Pain Treatment Options

By Debra K. Brinker, RN

The most common causes of chronic knee pain include osteoarthritis, bursitis, tendonitis, chondromalacia patella and meniscal injury, all of which can lead to disability and decreased quality of life. Taking action against knee pain does not have to include surgical intervention. This article focuses on which types of treatments are regenerative in nature and which are degenerative and more likely to become a fast track to replacement surgery.

Oral medications and supplements
When you have joint aches, do you reach for a bottle of ibuprofen? Did you know that aside from the widely known GI-related side effects, NSAIDs block the body’s ability to heal? (See Figure 1.) For this reason, their use should be cautioned for ligament and soft tissue injuries, instead of being promoted as we often see on television. NSAIDs can provide short-term pain relief, but also shut down the healing cascade. They promote increased wear and tear on the joint and are degenerative when continuously used.

Figure 1
Figure 1

Conversely, natural supplements can be used to promote joint lubrication and have been shown to help with the symptoms of osteoarthritis. These include glucosamine, chondroitin, omega-3 fatty acids, and bromelain, among others. When choosing supplements for joint health, quality varies greatly. Supplements purchased through a healthcare practitioner are often more potent, and of a purer and higher quality, than those commercially available at drug and wholesale stores.

Are Cortisone Injections Really That Bad?
Shortly after doctors started injecting cortisone and other steroids into knee joints in the 1950s, reports of terrible arthropathies, or joint diseases, began to surface, an indication that all was not well with this treatment choice. Corticosteroid injections inhibit blood flow to the injured area, new blood vessel formation, protein synthesis, fibroblast proliferation and ultimately collagen formation. They accelerate cartilage degeneration and weaken collagenous tissues, including ligaments and tendons, contributing to the development of conditions such as osteoarthritis, and fast-tracking a recommendation for joint replacement. (See Figure 2.) Today, despite the dangers, cortisone use is widespread.

Figure 2
Figure 2

Hyaluronic Acid Injections
A popular conservative treatment for knee pain is hyaluronic acid (and its derivatives, such as the Synvisc family). Hyaluronic acid is a substance naturally found in the body that provides cushion and lubrication to the joints. It is frequently used as an intraarticular injection for the relief of knee joint pain. The drawback of hyaluronic acid is its lack of long-term clinical effectiveness.  A systematic review of 89 studies comparing hyaluronic acid injections to a sham treatment, or non-intervention, in over twelve thousand patients, found that hyaluronic acid supplementation to the knee produced minimal to non-existent results when it came to pain relief and function in knee osteoarthritis patients.  That means thousands of patients received no relief at all, and if they did find relief, it was not much. Hyaluronic acid has become a way for some people to delay a joint replacement. However, there are other regenerative injection treatments that have prevented the need for replacement altogether.

Regenerative injection therapy
Prolotherapy is a regenerative injection therapy that uses natural substances that stimulate joint repair. It is also known as Stem Cell Therapy or Platelet Rich Plasma when the solution used in the injection includes a person’s own cells from their blood, bone marrow, or fat. These tissues contain large quantities of growth factors and stem cells. They are injected into and around damaged joints, such as injured and arthritic knees. Prolotherapy stimulates the normal reparative mechanisms of the body: laying down new collagen, strengthening the tendons and ligaments, repairing meniscal tissue, and boosting cartilage growth. Prolotherapy can be combined with various other non-invasive options for knee pain, such as supplements and exercise to further promote repair and joint lubrication. But it is the only stand-alone treatment that can induce joint repair directly at the source of the tear or degeneration in the joint. (See Figure 3.)

Figure 3
Figure 3

Other non-invasive options for knee pain
Our joints need motion to stay lubricated and heal. Being sedentary worsens joint pain. It is important to keep moving, but without the use of NSAIDs. Trainers and therapists can teach the proper form and introduce new techniques for strengthening muscles around the knees. There are cases of knee pain that improve just from adding in a regular, low-impact exercise that puts the joint through the full range of motion, such as cycling, water aerobics, and tai chi.

If you are becoming more limited because you suffer from knee pain, get moving! Take action against developing degenerative joint disease. There are so many options available to rejuvenate joints that do not require surgery, cortisone, or ibuprofen. If joint disease is already developing, a consultation with a regenerative medicine specialist can prove helpful for combining the most efficacious options for your specific needs.

Regenerative Medicine Specialists
with locations in Fort Myers and Chicagoland

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