Do you have Osteoarthritis and Knee/Hip Pain? Prolotherapy and Other Treatment Options
Arthritis is defined as inflammation (-itis) of the joints (arthro). There are two forms of arthritis: One type is inflammatory arthritis which is includes joint pain and inflammation from autoimmune conditions like lupus and rheumatoid arthritis. The second type is osteoarthritis (OA). Osteoarthritis is also known as degenerative joint disease or degenerative arthritis. The Arthritis Foundation states osteoarthritis is the most common chronic condition of the joints and affects approximately 27 million Americans (1).
Our joints, under normal conditions, have cartilage that cover the ends of bones so that the bones can glide against each other smoothly. Cartilage also acts as a shock absorber. In an osteoarthritic joint, this cartilage has broken down hence the reason why OA is commonly referred to as degenerative arthritis. This reduction in cartilage leads to pain and difficulty with moving the joint. Inflammatory chemicals are also secreted which then further damage the cartilage. If this process is not stopped, eventually the cartilage erodes leading to the bones rubbing against each other. This results in the grinding or cracking of joints, joint stiffness, and significant pain. This can often be when joint replacement surgery may be recommended. The most common joints to be affected for OA are the hips, lower back, neck, knees, finger joints, and the big toe, although, any joint can be affected (1).
- Stiffness, especially morning stiffness
- Swelling around the joint
- Stiffness can be better with movement but worse with joint overuse
- Clicking or cracking within the joint
- Excess weight: being overweight can add extra pressure on the joints, especially the hips and knees, and leads to the cartilage having the ability to wear away faster. Also, fat tissue is considered inflammatory and can produce inflammatory chemicals which can create inflammation in the body and assist in joint pain, inflammation, and degeneration.
- Overuse: Standing for long periods of time can put additional strain and pressure on the joints as well as heavy lifting and bending.
- Injuries: Injured joints that have not received adequate treatment can add stress to the joint. These include injuries such as ligament and tendon tears, fractures, and surgeries to the joint or area around the joint. For example, injuries to knee ligaments can progress to intraarticular injury and degenerative joint disease. This is why when you have an injury it is important to seek out chiropractic or physiotherapy or other care to help heal the injury properly and strengthen the ligaments and tendons involved.
Conventional and Holistic Treatments:
The most common treatments that are recommended for OA if it doesn’t qualify for joint replacement surgery are:
- EXERCISE to help with weight loss. Seeking out physiotherapy or chiropractic care can provide you with the right exercises to do to strengthen the muscles and ligaments around the joint that create less pressure on the joint. Exercises can also be recommended to help with range of motion and stretching.
- PAIN RELIEVING AND ANTI-INFLAMMATORY MEDICATION is another treatment your family doctor will often recommend such as Tylenol, ibuprofen (Naproxen, Advil), and/or Aspirin.
- CORTISONE INJECTIONS reduce pain in the short-term through suppressing inflammation. Cortisone shots can increase cortisol in the body and are only recommended a maximum amount of 4 injections per year due to long-term side effects of cortisol. Furthermore, reducing the inflammation may weaken the tendon/ligament/cartilage in the long-term and may not necessary stop the cartilage from wearing away and can continue to degenerate the tissue involved.
- NUTRITIONAL SUPPLEMENTS such as collagen, boswellia, fish oil, glucosamine and chondroitin, turmeric, and MSM are most commonly recommended. In terms of glucosamine, it has shown to be more efficacious if taken together with chondroitin and the glucosamine sulphate form has shown a greater benefit for mild to moderate knee OA verses glucosamine chloride but doses are typically quite large at about 1500mg/day (2) and have to be taken long-term. Fish oil, boswellia, turmeric, and MSM are anti-inflammatories.
- ACUPUNCTURE also can help relieve the pain associated with arthritis.
Prolotherapy is another treatment option that can help build the cartilage. Dextrose (sugar) injected into the joint creates a controlled inflammatory response bringing inflammatory chemicals and platelet-derived growth factors to the site to stimulate and in essence, speed up tissue repair, an otherwise normal process that occurs in tissue healing due to an injury. This builds the connective tissue matrix within cartilage which is the basis for using prolotherapy in OA to help with maintenance of the cartilage. The dextrose injected will also help to strengthen ligaments and tendons in the area.
In a study involving participants with knee osteoarthritis, prolotherapy was done at 4 week intervals with 3-5 treatments and those who received prolotherapy, scores on the osteoarthritis index improved more compared to those that received exercise and saline injections and there was sustained improvement in pain, stiffness, and function compared to those that received saline injections and at-home exercises (2). Another study found that after 12 months of administering 6 treatments of dextrose prolotherapy to subjects with knee osteoarthritis, pain and swelling decreased while the range of flexion increased and non-significant improvements were seen after 6 months (3 treatments) (4). This study also showed statistically significant improvements in cartilage thickness and a slight increase in femur width while some of the knees were completely void of cartilage in one compartment prior to receiving treatment (4). When using prolotherapy for arthritis, it is generally recommended at least 4-6 treatments depending on the severity of the arthritis and sustained improvements may range from 6 to 12 months but relief of pain may be seen within the first couple of treatments. Prolotherapy may also be effective in arthritis of the hip joint by strengthening the ligaments and helping to repair the articular cartilage.
For more information on prolotherapy offered at Ascent, click here to learn more.
Arthritis Foundation. Osteoarthritis. Retrieve on October 31st 2018 from https://www.arthritis.org/about-arthritis/types/osteoarthritis/causes.php
Jean-Yves Reginster, Neuprez A, Lecart MP, Sarlet N, Bruyer O. Role of glucosamine in the treatment of osteoarthritis. Rheumatol Int. 2012 Oct;32(10):2959-2967.
Rabago D MD, Patterson JJ DO, Mundt M PhD, Kilowski R MD, Grettie J BS, Segal NA MD MS, Zgierska A MD PhD. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013 May;11(3):229-237.
Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000 Mar;6(2):68-74, 77-80.