As a physical therapist, I’m often asked by patients about steroid injections for knee arthritis pain. I’ve worked with many who’ve received them, only to find mixed results. For some individuals they’ve been a lifesaver, the pain-relieving effects lasted for months. Others may have noticed improvement for several days, only to have the same pain return within a week. And for others, they noticed absolutely no difference. So what gives? Why such mixed results?
Research on steroid injections for chronic pain due to arthritis reveals less than stellar results. One study even found the use of injections accelerated the breakdown of healthy cartilage in the knee and had no impact on reported pain levels in those who received the injections.
Interpreting the Results
Understanding what’s happening here requires us to take a step back and look at the big picture of the human body. And the way our medical system views the body and the healing process.
Your body is amazing and resilient. Your body is equipped with amazing healing capacity, without you even being aware it’s happening. Just knowing that the body has these systems is empowering and leaves you more in control of your health than you realize.
The medical system places an emphasis on passive interventions to alleviate symptoms, which often causes us to overlook the root causes of those symptoms.
In our example today, knee pain is the symptom. But it’s not the root cause of the problem, it’s just an indicator. Pain is part of the immune system’s inflammatory response for healing. It’s a sign of damage, either to the knee itself or the nervous system.
We view pain as a negative, but it performs a positive role in healing. We are so averse to pain in the US, we now have an entire aspect of healthcare devoted to managing and reducing pain. But treating pain in this way is very topical, with little emphasis on long term or sustainable management.
This isn’t to say those living with chronic pain just need to suffer through it. People in pain truly need help, guidance, and validation of their pain experience. To start this process, we need to take a big step back and look at the whole person and their lifestyle.
Going back to our example, using an injection is a targeted, specific intervention to alleviate pain. It doesn’t address some of the biggest risk factors for chronic pain which include other lifestyle factors such as stress and lack of sleep. These are much less glamorous to address as there is no quick fix. They involve deep introspection, a slower approach, and hard work.
We’ll discuss this further in a moment, but first a closer look at the immune system.
How the Immune System Promotes Healing
Your immune system has amazing healing powers. When part of you sustains damage, like the cartilage of your knee, your immune system kicks into full gear in that area of the body. It signals cells to enter the area to start the healing process, initiating an inflammatory response. We know this is happening when we notice swelling, redness, and pain. We’ve been taught these are symptoms we should immediately mitigate, but these are a sign your body is starting to heal itself.
In the case of steroid injections, the medication is being directly administered to the joint in order to suppress this inflammatory response. It’s simple in theory, stop the inflammation which will stop the pain.
But what’s really happened is that we overlooked the cause of the inflammation in the first place, stopping our healing mechanism in its tracks. One side effect found in this particular study was the breakdown of remaining healthy cartilage in the knee following the use of steroid knee injections. Yikes.
This means the suppression of the inflammatory response with the use of a steroid accelerated the process of joint breakdown and arthritis. Probably not the outcome intended.
The Complexity of Healing and Pain
The fact that pain remained unchanged reminds us that pain is much more complex than just the tissue damage in the area we are feeling pain. A real healing process from pain involves a holistic approach.
Is there a time injections might be the answer? Yes. But remember, these are best used as a short term approach to manage pain while allowing you to make changes to get the situation under control.
The danger lies in becoming dependent on the injections to function.
So what can you do instead? Start by taking inventory of these four aspects of your life.
When is the last time you can honestly say you had a good nights sleep? In the clinic, we tend to see disrupted sleep in conjunction with chronic pain. It’s a vicious cycle, pain keeps you up at night and the lack of sleep, in turn, amplifies pain. Getting quality rest is the lowest hanging fruit for your overall health and well-being.
2. Stress Management
One of the strongest risk factors for chronic pain, among many other health conditions, is chronic stress. No amount of physical work will impact your pain unless you learn to identify and manage stressful factors in your life. Simple activities like keeping a gratitude journal, or meditating (we love the Headspace app) can go a long way in lowering your stress levels over time. Focus on incorporating movement-based activities into your lifestyle that are also stress-relieving, like yoga, tai chi, gardening, etc. The possibilities here are endless.
3. Inflammatory Lifestyle Factors
Both sleep deprivation and stress are among the risk factors for chronic pain because they contribute to an inflammatory state in your body. The other biggest risk factors for pain are lifestyle factors including highly processed diets, smoking, and excessive alcohol use. Take inventory of other aspects of your life and see if you can reduce inflammatory factors over time. A great way to work toward this is to start by learning how you form meaningful habits and how to set appropriate health goals. You don’t have to change your life overnight, but take small steps to work toward a healthier lifestyle every day.
4. Make a Habit of Studying and Improving Your Movement
Most of us have heard the phrase “wear and tear” when it comes to arthritis. It’s a bit of a misguided statement that scares people with arthritis away from a movement-filled lifestyle. Arthritis is actually indicating that unfavorable forces have been placed on the knee for a prolonged amount of time. The damage within the joint is more of an indication of under-use or inappropriate use over time.
Not all movement is created the same, so if you have arthritis it’s vital that you start incorporating high-quality movement into your lifestyle. By changing the forces through the knee, you can use movement to promote the calming of inflammation and healing.
Start by identifying how you tend to move throughout the day. Become a student of yourself. How much of your day do you spend sitting? Getting on and off the floor? How are your feet angled when you walk?
These questions will guide you through making gradual changes in your alignment, positively impacting the health of your joints for years to come. For more on the impact of movement on your health, we recommend picking up a copy of Katy Bowman’s Move Your DNA.
Above all else, remember that your body is resilient in its ability to heal itself. There will be a time for medical interventions, but thoroughly research any choice you need to make to understand the positives and negatives. And never stop seeking active solutions.