Chiropractor Chandler AZ

KNEE INJECTIONS FOR OSTEOARTHRITIS

Osteoarthritis is the most common joint disease. It is a slowly progressing disease which affects the joints and causes pain and stiffness. The surface of the joints become damaged so the joint does not move as smoothly as it should. The condition is sometimes called arthrosis, osteoarthrosis, degenerative joint disease, or wear and tear. These may occur as a result of an imbalance in the equilibrium between the breakdown and repair of the joint tissue. In 2005, it was estimated that over 26 million people in the US had some form of osteoarthritis. The incidence of knee osteoarthritis increases with age, and women have higher rates than men, especially after the age of 50. The prevalence of knee osteoarthritis is 1% in people aged 25-34 and it increases to nearly 50% in those 75 years and above. Osteoarthritis of the knee tends to cause the greatest burden to the population as the pain and stiffness often lead to significant disability, requiring surgery. The burden of osteoarthritis is physical, psychological, and socioeconomic.

SYMPTOMS OF KNEE OSTEOARTHRITIS

1. Pain and stiffness in the knee which get worse when the knee is moved or at the end of the day
2. Knee joint can be swollen, especially after physical activity
3. Limited range of motion
4. Clicking or cracking sound when joint bends
5. Swelling around the joint. Swelling can be hard or soft around the knee

These symptoms make it difficult for the patient to do daily activities like standing, sitting, and walking.

RISK FACTORS FOR KNEE OSTEOARTHRITIS

There are many factors that increase the risk of knee osteoarthritis and it is often a combination of these factors:

1. Age: Onset of Osteoarthritis is from the late 40s onwards. The reason is not fully understood, but it can be due to the weakening of the muscles, the decrease in the body's ability to heal itself, or gradual wearing out of the joint with time.
2. Gender: Osteoarthritis of the knee is twice more common in women as compared to men. It is more common in women above the age of 50.
3. Obesity: Being overweight is another factor that can cause knee osteoarthritis and worsen the symptoms.
4. Knee injury: Normal physical activity and exercise do not cause knee osteoarthritis, but very hard, repetitive physical activity or injury can increase the risk. Injuries to the knee in early life often lead to osteoarthritis in later life. A common cause is a torn meniscus or ligament, which can result from a twisting injury.
5. Genetics: Genetics play the most important role in knee osteoarthritis. If a person has a parent, brother or sister with knee osteoarthritis, he has a greater chance of developing it. A particular group of genes is involved in developing the disease rather than a single gene.
6. Other knee joint diseases: Osteoarthritis in the knee can also be caused by some other knee disease such as gout that occurred in earlier years.

COMPLICATIONS OF OSTEOARTHRITIS

1. Osteoarthritis with crystals: It occurs when chalky deposits of calcium crystals form in the knee joint cartilage. It can happen in any joint, with or without osteoarthritis, but it's most likely to occur in a knee that's already affected by osteoarthritis, especially in older people. It can cause sudden pain and noticeable swelling of the joint. The crystals may show up on x-rays and they can also be seen under a microscope in samples of fluid taken from the joint. Crystals make osteoarthritis more painful.
2. Baker's Cyst: Baker's cysts can form when extra synovial fluid is produced and it becomes trapped in a pouch sticking out of the joint lining. They're often painless. Sometimes a cyst can cause aching or tenderness with exercise. Occasionally, a cyst can press on a blood vessel, which can lead to swelling in the leg, or the cyst may burst and release joint fluid into the muscle, which can be very painful.

DIAGNOSIS OF OSTEOARTHRITIS

Osteoarthritis is usually diagnosed by physical examination and the symptoms can include tenderness over the joint, creaking or grating of the joint, bony swelling, excess fluid, restricted movement, joint instability, weakness and thinning of the muscle. There are no blood tests for osteoarthritis. X-rays are used to evaluate the severity of the disease. Rarely, MRI is used which shows soft tissues and changes in the bone.

TREATMENT OF OSTEOARTHRITIS

There is no cure for osteoarthritis. Only the symptoms can be treated and improved. Self-help measures are important to relieve pain and stiffness, and to reduce the chances of osteoarthritis becoming worse. Self-help methods include:

1. Weight management: Being overweight can not only cause osteoarthritis in the knee but can also make it worse. Therefore, keeping the weight within a healthy range is an important method.
2. Exercise: Research has shown that exercise can result in a short-term reduction of pain and improvement of physical function in patients with knee osteoarthritis.

Conventional treatment methods include:

1. Painkillers and non-steroidal anti-inflammatory drugs: Painkillers and NSAIDs help with pain and stiffness, but they do not affect arthritis or repair the damaged joint. Paracetamol is usually the best and well-tolerated painkiller.
2. Steroid injection: It is given in the case of extreme pain. The injection can start to work within a day or so, and it may improve pain for several weeks or even months. But steroid injections can't be given frequently or indefinitely.
3. Surgery: Surgery is recommended when the pain gets worse and affects mobility. Surgery gives significant pain relief when other methods fail to relieve the pain.

Complementary treatment methods include:

1. Homeopathy: Homeopathy is used to treat knee osteoarthritis, but there is no evidence of its effectiveness.
2. Acupuncture: Some researches have shown that Acupuncture is effective in reducing pain from osteoarthritis, but its effects are short-term. There's also some evidence that electroacupuncture may be effective for pain associated with osteoarthritis of the knee. This technique is similar to conventional acupuncture except that an electrical impulse is applied via the needles.

PLATELET-RICH PLASMA (PRP) PROLOTHERAPY FOR KNEE OSTEOARTHRITIS

PRP Prolotherapy is an alternative treatment method that uses the patient's own blood to treat osteoarthritis. This method manipulates the self-healing mechanism of the body. In this method, blood composition is reversed and the healing property of platelets is used to repair the injury. To prepare the PRP injection, the patient's own blood is drawn and centrifuged to separate different blood components. The layer containing platelet-rich plasma is separated and the rest of the material is discarded. When this PRP is injected at the site of injury, these platelets get activated and release alpha granules which activate the patient's own growth factors which then trigger epithelial growth factors (EGF). EGF induces the cell migration and replication at the site of damage, stimulating damaged tissue to heal through the following stages:

1. INFLAMMATION PHASE that lasts for 2-3 days. In this phase, growth factors are released.
2. PROLIFERATION PHASE that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
3. REMODELLING which lasts over a year. In this phase, collagen is matured and strengthened.

Side effects associated with this method are minimal. There is no risk of blood-borne disease transfer and allergic reaction since the patient's own blood is used. The only risks involved are an infection, no relief of pain, neurovascular injury, and scar tissue formation. The loss of a limb or death is rare, but possible.

PRP Prolotherapy works by healing the damaged knee structure which relieves the pain, increases the mobility, and protects the knee. Researchers have shown that PRP was more effective than other treatment options and led to improvements in patients' functions and quality of life. A study demonstrated that PRP injection led to significant functional improvement in patients with knee osteoarthritis, whose effects last at least 12 months. There were also better results among those patients with milder forms of osteoarthritis than advanced ones.

Another research conducted on patients who were resistant to conventional treatments showed that knee injections of PRP can decrease joint pain and stiffness and improve patients' quality of life in the short term.

A study examined previously published studies and concluded that PRP injections are a sustainable treatment for knee osteoarthritis and have the potential to lead to symptomatic relief for up to 12 months.

PRP Prolotherapy repairs the structure of the joint by activating and accelerating the body's healing machinery. Thus it is thought to protect the joint along with pain relief.

In a research published in May 2015, doctors expressed concerns over the lack of standardization of PRP Prolotherapy. The research done in the past 10 years acknowledged that the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration is very promising, but some controversial results have also arisen.

PRP intra-articular injections of the knee may be an effective alternative treatment for knee osteoarthritis. However, current studies are at best inconclusive regarding the efficacy of the PRP treatment. A large, multicentre randomized trial study is needed to further assess the efficacy of PRP treatment for patients with knee osteoarthritis.

Conservative Treatments to Combine with PRP

While PRP and stem cell treatments are enhancing the tissue repair and regeneration, conservative treatments can enhance healing, strengthen the muscles, and stabilize joint movements to maximize your recovery.

Cold Laser Therapy Treatments

1. ACCELERATED TISSUE REPAIR AND CELL GROWTH

Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.

2. FASTER WOUND HEALING

Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.


3. REDUCED FIBROUS TISSUE FORMATION

Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.

4. ANTI-INFLAMMATION

Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.

5. PAIN RELIEF

Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.

Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensations. Overall, laser therapy reduces painful nerve signals and reduces your perceived pain.

6. INCREASED BLOOD FLOW

Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.

7. INCREASED REPAIR AND REGENERATION

Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.

8. NERVE FUNCTION AND REPAIR

Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.

9. INCREASED ENERGY PRODUCTION - ATP

ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have the ability to heal and repair.

Soft Tissue Treatments:

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.

Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries are common because of weakness and poor stabilization of the leg and hip muscles. The combination of muscle weakness, poor coordination, and altered gait mechanics produce excessive strain on the soft tissues.

The lower extremities works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.

Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments foot pain and exercises.

Bibliography:

Heidari, B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med, 205–212.

Litwick, A., Edwards, M., Dennison, E., & Cooper, C. (2013). Epidemiology and Burden of Osteoarthritis. Br Med Bull, 185–199.

Raeissadat, S. A., Rayegani, S. M., Babaee, M., & Ghorbani, E. (2013). The Effect of Platelet-Rich Plasma on Pain, Function, and Quality of Life of Patients with Knee Osteoarthritis. Pain Research and Treatment, doi:10.1155/2013/165967.