By Dr. Mercola
Knee osteoarthritis (OA) is a disease characterized primarily by a loss of cartilage in your knee joint. As it progresses, OA can be marked by the gradual onset of pain, swelling, stiffness and loss of joint mobility. When treating knee OA, most conventional doctors focus on pain relief and reducing inflammation. The underlying assumption seems to be that if you are experiencing less pain you may be more likely to move around and put weight on your knee.
Unfortunately, alleviating pain as a primary focus of treatment may result in further structural changes to your knee, including bone and joint damage, and cartilage loss.
While cortisone injections, also known as corticosteroid shots, have been a standard treatment approach for knee OA for decades, the science behind their effectiveness continues to be questioned. Now, the results of a rigorous two-year study1 published in the Journal of the American Medical Association (JAMA) present convincing evidence that use of corticosteroid injections:
• Causes your body to gradually lose knee cartilage over time
• Seems to be no more effective than placebos in terms of relieving your knee pain
If you are considering steroid shots for knee OA, or are currently receiving shots, you'll want to continue reading.
Knee Steroid Shots Shown to Be No More Effective Than Placebos
In the JAMA study,2 a group of 140 men and women, ages 45 or older who suffered from painful knee OA, were randomly assigned injections of either a corticosteroid or a saline placebo. Those receiving a corticosteroid were injected with 40 milligrams (mg) of triamcinolone acetonide.
The intra-articular injections were administered every three months during a period of two years. According to The New York Times,3 the effects of the shots were tracked via pain questionnaires and physical ability tests, as well as annual bone and joint magnetic resonance imaging (MRI).
Neither the study participants nor the staff administering the shots knew which patients were receiving placebos. At the conclusion of the study, there was no noticeable difference between the two groups in terms of joint pain and stiffness. Both groups performed equally well in terms of standing from a seated position and walking. Based on the results, the study authors said:4
"Among patients with symptomatic knee OA, two years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support [steroid shots] for patients with symptomatic knee OA."
Placebos Have Been Shown to Be as Good as Pills, Shots and Surgeries
Research suggests there is healing power in placebos. Some studies into this phenomenon have even concluded many conventional treatments "work" due to the impact of the placebos, and little else. The documentary above, "Placebo: Cracking the Code," addresses the profound effects of placebos.
As you may know, a placebo (i.e., a dummy pill or sugar pill) has no active medicinal ingredients. It's designed to fool you into thinking you have received the real thing, to compare the efficacy of a medicine that has active ingredients. Scientific research has proven it's possible for you to react as well, or even more favorably, to a placebo as compared to pharmaceutical medications or medical treatment, even surgery.
Placebos have been shown to produce dopamine release and other chemical responses, mimicking the effects of drugs without actually possessing an active ingredient. The reality characterized by a patient believing he or she is getting an actual drug and subsequently improves despite the absence of an active substance has become known as the "placebo effect."
The placebo effect also works with surgical procedures. Just like drugs, placebo or "sham surgery" has been shown to produce results equal to actual surgery. Because sham surgery involves nothing more than skin incisions, it's amazing to think your body would respond favorably to it even though your physical ailment has not even been addressed.
Improvement Following Sham Knee Surgery Is Due to Placebo Effect
Arthroscopic surgery of the meniscus continues to be a common orthopedic procedure in the U.S., where about 750,000 of these procedures are carried out annually, at an estimated cost of $3 billion.5 An unusual experiment featured in the documentary referenced above was performed by Dr. Bruce Moseley, an orthopedic surgeon at Baylor College of Medicine in Houston. In an attempt to document the effect of placebos, Moseley performed fake surgeries for patients suffering from knee OA.
Moseley's findings were documented in the New England Journal of Medicine,6 including the stunning realization his medical skills and the procedures performed had virtually no bearing on the recovery of patients undergoing arthroscopic knee surgery. Moseley's patients who underwent fake surgeries recovered as well as those receiving standard treatment!
Said Moseley, "The entire benefit for arthroscopic surgery for OA of the knee was a placebo effect." Another study,7 published in 2013, also found arthroscopic knee surgery for degenerative meniscal tears had no more benefit than sham surgery. At the postoperative one-year mark, all patients, regardless of whether they had real or sham surgery, reported equal amounts of pain reduction. This outcome led the researchers to conclude real knee surgery offers no better outcome than sham surgery.
The results of these studies underscore the role your brain plays in producing the healing you believe should be happening in your body as a result of a surgical procedure, regardless of whether the procedure was real or imagined. Given this data, it seems best to avoid knee surgery at all costs, and instead use your mind to address the pain you are experiencing. I'll provide more suggestions on how to do that later in this article.
Physical Therapy or Surgery: Which Is The Better Choice?
Two studies demonstrated the effectiveness of using a structured physical therapy program to either eliminate the need for surgical repair or to improve outcomes by performing the therapy prior to surgery.
In the first study, researchers followed participants for five years who had suffered an injury to their anterior cruciate ligament (ACL). The researchers found results were nearly identical between those who underwent ACL surgical repair and those who were treated with rehabilitation alone.8
A second study9 released in 2016, followed middle-aged participants for two years who had suffered a meniscal tear in their knee. Again, researchers found exercise and physical rehabilitation to be as effective as surgical repair. Of the 140 patients involved in the research, half underwent an intensive 12-week exercise program.
The other half received arthroscopic surgery followed by a home-based rehabilitation program. No clinical difference between the two groups was noted as it related to pain levels, performance of daily activities or ability to participate in sports. The study authors stated:10
"Supervised exercise therapy showed positive effects over surgery in improving thigh-muscle strength, at least in the short term. Nineteen percent of participants allocated to exercise therapy crossed over to surgery during the two-year follow up, with no additional benefit.
Our results should encourage clinicians and middle-aged patients with degenerative meniscal tear and no radiographic evidence of OA to consider supervised, structured exercise therapy as a treatment option."
Many Doctors Claim Steroid Shots Are Still a Valid Treatment for Knee OA
Dr. Timothy McAlindon, chief of rheumatology at Tufts Medical Center and leader of the two-year study which concluded steroid shots are no more effective than placebos for addressing knee pain, says he still believes cortisone shots can play a role in treating knee OA. "You have to weigh the risks and the benefits," he noted.11
According to WebMD,12 Dr. David Felson, professor of medicine at Boston University, "worries that the study results will discourage people from using an effective treatment that helps many get pain relief."
Felson speculates administering higher levels of corticosteroids than those provided during the study may help reduce inflammation even more. He told WebMD,13 "Though researchers said they followed practice guidelines to set the dose of steroids used in the study, many of [my] colleagues use double that amount with their patients."
Dr. Wellington Hsu, professor of orthopedic surgery at Northwestern University's Feinberg School of Medicine, believes cortisone injections for short-term pain relief are useful particularly ''when knee arthritis flares up so badly you can't walk."14 Hsu also mentioned other treatments, such as platelet-rich plasma and stem cells, as potential methods which may be effective in bringing about pain relief from knee OA.
Platelet-Rich Plasma Therapy May Help Injured Knees
In the past decade, medical professionals have been using platelet rich plasma (PRP) therapy to release growth factors that help heal and strengthen areas of the human body, including knee joints.
As you may know, platelets are an important part of your body's healing process — they're responsible for blood clotting and are among the "first responders" to an injury site. By forming a clot, platelets stop bleeding. In the process, platelets open up and spill out the growth factors held inside.
These growth factors act as signaling molecules, issuing the instructions needed to call forth your body's resources to repair damaged tissue. Research published in the American Journal of Sports Medicine15 investigated the effects of PRP when applied to 78 patients with OA in both knees. Each of the 156 knees received one of three treatments: one PRP injection, two PRP injections or one saline-placebo injection. Researchers evaluated the knees at six weeks, three months and six months after the injections, and concluded:16
• At six weeks and three months, the knees treated with one or two PRP injections saw a reduction in pain and stiffness, and experienced improved function
• At the six-month mark, positive results from PRP diminished, but knee pain and function were still better than before treatment
As with any treatment approach, clinical studies providing evidence that PRP effectively alleviates OA symptoms have been mixed. According to Arthritis-health.com:17
"In several clinical studies, PRP injections were no better than a placebo treatment. Even in studies that do provide evidence PRP works, not all patients benefit … It may be that PRP therapy, like other OA treatments, works for some people but not for others, or works best in conjunction with other treatments, such as physical therapy."
Exercise Is a Great Way to Take Care of Your Joints
If you are looking for some relief from joint stiffness or pain in your knees, you might consider trying exercise. Exercise not only can significantly improve your joint function and mobility, but also lessen any discomfort you may be experiencing.
Be advised there is no evidence supporting the belief that exercise is detrimental to your joints. The myth you can "wear down" your knees, for example, is just that, a myth. Barring injury, your body is designed to tolerate average levels of exercise and normal activities of daily living throughout your lifetime.
Even if you maintain a healthy weight, exercise can have a positive impact on your joints. For sure, low-impact cardio exercise such as bicycling, swimming or using an elliptical machine can boost joint health. In addition, taking a walk around the block is also beneficial, especially if you are just beginning to exercise or are getting back to exercise after some time off.
Setting a goal of taking at least 10,000 steps a day, which is just over 5 miles, or 9 kilometers, keeps your focus on getting more movement in your life. Ideally, I recommend you move toward 15,000 steps a day. If possible, you should add this over and above your existing fitness regimen. If it's too overwhelming to think of doing anything more than walking, start there. You can always add more activity later.
How Exercise Will Help You, Especially if You Have OA
Though you may think exercise will aggravate your joint pain and stiffness, that's typically not the case. In fact, the opposite is true: Lack of exercise can make your joints even more painful and stiff.
According to the Mayo Clinic, exercise is especially crucial if you have knee pain. Exercise not only increases flexibility and strength, but also reduces joint pain and fatigue. Even moderate exercise can soothe weary joints and give you a sense of control over your OA pain and discomfort. Some of the benefits you'll receive from exercise include:18
✓ Enhancing your quality of life
✓ Maintaining bone strength
✓ Having more energy to get through the day
✓ Making it easier to get a good night's sleep
✓ Helping you control your weight
✓ Strengthening the muscles around your joints
✓ Improving your balance
By exercising, you are keeping your muscles and surrounding tissue strong, which is crucial to maintaining support for your bones. The absence of exercise weakens your supporting muscles, creating more stress on your joints. A good way to avoid achy joints is to get up and move as much as possible during the day, says Dr. Kim Stearns, a board-certified orthopedic surgeon at the Cleveland Clinic:19
"We say motion is lotion — the more you move, the more your body lubricates itself. When you've been sitting or lying around, fluid in the joints doesn't move. The more active you are, the more your joints lubricate themselves."
Cautions to Note When Exercising With Joint Pain
If you have joint pain, there are a few factors to consider with respect to exercise. Particularly if your pain worsens with movement, you want to take care to not strain a significantly unstable joint. Pain during movement is one of the most common and debilitating symptoms of OA.
If you've already developed knee OA, you'll most certainly want to incorporate exercises that strengthen the quadriceps muscle at the front of your thigh. Instead of running or other high-impact exercise, you will more likely enjoy and benefit from non-weight-bearing exercises such as bicycling or swimming.
Should you experience pain for more than one hour after exercising, you either need to slow down or choose a different form of exercise. As needed, you may want to work with a physical therapist or qualified personal trainer who can help develop a safe set of activities for you.
Whatever you choose, be sure your program includes a range of activities. I recommend core training, high-intensity cardio, stretching and weight training. My favorite exercise is peak fitness, and this program can be safely used by nearly everyone.
Diet, Weight and Exercise Affect the Health of Your Joints
Because diet accounts for about 80 percent of the health benefits you reap from a healthy lifestyle, it makes sense to look to your diet with respect to joint health. I've said it many times before — the best diet is one that involves eating real food.
I recommend replacing processed foods with whole, organic foods as much as you can. It is especially important to avoid processed vegetable oils and sugars. If you hope to optimize your health, you must have a regular source of high-quality, unprocessed fats. Check out my latest book "Fat for Fuel" for more tips on how to incorporate more healthy fats into your diet.
If you are overweight, consider pairing exercise with a healthy diet to bring some relief to your joints. A 2013 study20 revealed overweight and obese adults with knee OA who followed an intensive diet and exercise program experienced less pain and better function than those who pursued just diet or exercise alone.
Dr. Aman Dhawan, an orthopedic sports-medicine specialist at Penn State Health Milton S. Hershey Medical Center, suggests any loss of weight will translate into tremendous improvements in your joint pain and function:21
"There is good data to support getting rid of excess weight because it does improve pain in the joints of the lower extremities, as well as decreases your risk of getting arthritis, or of having it progress. The joints carry the weight of our bodies, so the less stress you put on them, the longer they will stay healthy."
Final Thoughts About Addressing Knee Pain
As always, the best way to handle knee pain is to act now to prevent it or at least minimize it as much as possible. While steroid shots may be useful as a short-term solution, and certainly seem preferable to a knee surgery, I recommend you derive all of the benefits you can from the natural solutions presented in this article. As always, another helpful tool is the Emotional Freedom Techniques. In the video below, Julie Schiffman demonstrates how you can effectively tap away knee pain.