Knee pain, like all other types of joint pain, can appear suddenly or become an ongoing, chronic condition. The most common cause of chronic knee pain and disability is arthritis, which frequently results in knee replacement. Knee pain can also be caused by conditions like bursitis, tendonitis, sports injuries, degenerative joint disease, chondromalacia patellae and meniscal injury, all of which very often lead to the eventual surgical recommendation or intervention.

<h6>Knee Pain Treatments</h6>
Before surgery, other more conservative therapies are usually attempted to bring relief from the knee pain. NSAIDs (non-steroidal anti-inflammatory drugs like Ibuprofen or Naprosyn) and steroid (cortisone) injections might be included in those initial recommendations. Are these treatments a good choice? Although steroid injections and NSAIDs have been shown in studies to be effective in decreasing inflammation and providing pain relief in the short-term, they unfortunately have also been shown to change the properties of ligaments and other soft tissue, which ends up slowing down the healing process. Because these medications inhibit soft tissue healing, their use is cautioned in those who have ligament and soft tissue injuries. Therefore, their use in ligament injuries should be used for the shortest period of time, if used at all. Instead, Regenerative Orthopedic techniques, such as Stem Cell Therapy, PRP and Prolotherapy, which have been shown to strengthen and resolve ligament injuries, repair meniscal injuries, and rebuild cartilage in the knee, should be sought.

<h6>The RICE Protocol</h6>
So what about the RICE (rest, ice, compression and elevation) protocol? Everyone knows about the RICE protocol, and most people are quick to put it into action. However, an interesting point is that the RICE protocol has been rescinded by its author due to its detrimental effect on healing. Why? Because it hinders blood supply to the injury, and blood brings the healing factors to an injury. Remember…The river does not flow when it is frozen; and that ‘river’ is your blood.

<h6>What about Hyaluronic Acid Injections?</h6>
Hyaluronic acid injections, such as Synvisc or Hyalgen, are some of the most popular conservative treatments for knee pain. Hyaluronic acid is a substance naturally found in the body that provides cushion and lubrication to the joints. It can be used as an oral supplement and as an injection that is given directly into the knee joint for the relief of knee pain. Are there drawbacks to the use of hyaluronic acid? 

If relief is experienced with hyaluronic acid injections, it is generally only for a short period of time. Studies have shown this treatment to actually lack clinical effectiveness. In fact, a systematic review of 89 studies that included over twelve thousand patients comparing hyaluronic acid injections to a sham treatment or to no intervention at all, found that hyaluronic acid supplementation to the knee produced minimal to non-existent results when it came to pain relief and function in knee arthritis patients. That means thousands of patients in these studies received no relief at all, and if they did find relief, it was not much. Unfortunately, those that do find some pain relief with the use of hyaluronic acid, only experience results for a short period of time, and the treatment frequently becomes only a delay for the inevitable knee replacement, because all it does is lubricate a dysfunctional joint, and does not fix anything.  

<h6>Other Non-Surgical Treatments</h6>
Even though the goal of many non-surgical treatments such as weight loss, exercise, physiotherapy, bracing, and orthotics, is to decrease pain and improve function, they are unable to repair the source of the pain, the ligament or soft tissue injury. Why is it so important to repair the ligaments and other soft tissue? Because the long-term consequence of ligament and soft tissue injuries that are left unhealed is arthritis. Is it any wonder why the treatments mentioned above including hyaluronic acid do not last, and why they are unable to prevent the eventual knee replacement! You see, these treatments are unable to get to the root cause of the problem. The road to arthritis can only be remedied when the problem of ligament injury is addressed. None of the above treatments address this problem. Regenerative Orthopedics does.

<h6>Are Cortisone Injections Really All That Bad?</h6>
Steroids are used to provide anti-inflammatory relief in affected areas of the body. They lessen swelling, redness, itching and allergic reactions, and, in addition to their use for pain, are often used as part of the treatment for a number of different diseases, such as severe allergies or skin problems, asthma, or arthritis. In many of these cases, steroids are lifesaving! The discovery that steroids could be injected into joints was received with enthusiasm, and led to widespread use. However, 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. There was an obvious indication that all was not well with this treatment choice. Way back then, the researchers discouraged the use of steroids being injected into the joint, due to their side effects and cell death in the bone.

Steroid injections accelerate cartilage degeneration and joint destruction. Cortisone has a deleterious effect on soft tissue healing by inhibiting blood flow to the injured area, new blood vessel formation, protein synthesis, fibroblast proliferation and ultimately collagen formation. Cortisone weakens collagen and therefore soft tissue such as ligaments and tendons, which contributes to the development of conditions such as arthritis, which as we know, leads to the eventual joint replacement. Today, despite the dangers, cortisone use is widespread and has become the standard of care. 

<h6>Surgical Repair</h6>
Elimination of knee pain by arthroscopic shaving, cutting, or removal of tissue just delays the pain for a few years until the remaining tissue becomes degenerated. The athlete or any knee pain patient must realize that with each procedure and each shaving or cutting of tissue, NSAID prescription, or steroid injection, the risk of developing long-term arthritis and the eventual knee replacement is greatly increased. The key to keeping the knee strong is to stimulate the area to heal. Remember, once surgery is done, it cannot be undone!

<h6>Regenerative Orthopedics</h6>
Regenerative Orthopedic therapies such as Stem Cell Therapy, PRP and Prolotherapy stimulate, rather than interfere with, the normal healing process. The treatments stimulate the normal inflammatory-reparative mechanisms of the body, boosting cartilage growth, strengthening the tendons and ligaments, and repairing the meniscus in a knee or the labrum in the hip or shoulder. These regenerative treatments offer hope to those suffering from various types of knee pain and provide an effective, non-surgical option for those trying to avoid knee replacement.
As we say at OrthoRegen:
Regenerate First; Surgery Last!
