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Knee Injections

Knee pain, inflammation, arthritis and swelling can be treated with knee injections. Injections are very effective and unlike other medications that have side effects, injections have very few side effects. There are two types of injections used for knee pain:

Corticosteroid Knee Injections

The body produces the hormone cortisol. This hormone is released by the adrenal glands in the body when you are stressed. The effect from this hormone doesn’t last long. Steroid injections like cortisone imitate the effect from this hormone but are improved so it has more of a lasting effect.

Cortisone injections are mixed with a local anaesthetic. They help reduce inflammation and ease knee pain. The cortisone helps reduce the inflammation and the local anaesthetic delivers immediate pain relief. When other treatments like physical therapy and medication do not work then steroid injections are given for knee pain.

Cortisone knee injections are beneficial as the area that needs relief from inflammation can be targeted unlike taking anti-inflammatory medication. They have fewer side effects and the results can be felt within days and last for months. Fluid may have to be taken out of the joint before the joint is injected. This is so that it can be tested to discover the cause of the inflammation in the knee. Steroid injections should only be given by experienced medical professionals.

Many causes of knee pain can be treated by a cortisone injection. Some of these causes are gout, arthritis, tendonitis and bursitis. This injection is a good way to reduce pain whilst the cause is being treated. Injections are generally used alongside other treatments like taking medication, using equipment to help walking and carrying out knee exercises.

Are there any side effects to steroid injections?

There are some side effects connected to cortisone injections for knee pain. Some may last for a few days and some longer but side effects are rare. The side effect that is most common with cortisone injections is a brief rise of symptoms which may last for a few days. It roughly happens in about 5% of patients and a flare up can be eased by using a cold compress.

Some other side effects are:

Up to three cortisone injections can be given in one place and each injection should be spaced out at three months apart.

Qualified health professionals can only administer cortisone knee injections. If you are taking medication to thin the blood like warfarin or aspirin then you may have to stop taking them for a couple of days before the knee injection is given. The doctor will discuss this with you as they are aware of your medical history. After the injection avoid being too active for the next 48 hours to reduce the risk of injury.

Prolotherapy Injections

This is a safer form of treatment which involves injection of an irritant solution (often a form of sugar called dextrose) into joints, ligaments, and tendons. We generally recommend a course of 3 injections every 10 days.

What Are Studies Showing?

In the randomized controlled trial, Dr. Rabago and his team placed 90 people with knee OA into one of three groups: the first group received prolotherapy, the second received inactive salt-water shots and the third was given a pamphlet of knee exercises to be done at home, For the first two groups, doctors injected a solution into the knee joint and in up to 15 surrounding tender areas targeting points of pain and swelling. This procedure was performed on three occasions, four weeks apart (with the possibility of two extra treatments, if needed). The study was "blinded," meaning no one involved knew who got prolotherapy sugar-water versus salt-water injections. Dr. Rabago says his team included the exercise comparison group to rule out the possibility of mistaking a placebo effect (in either injection group) for a true therapeutic response, a problem seen in less well-designed trials.

The researchers used what's known as a WOMAC score to compare participants' levels of pain, stiffness and physical function before treatment and a year after they received their first series of shots or started the exercise program.

The WOMAC score of those who received prolotherapy improved 24 percent, compared with an 11-percent improvement in the salt-water group and a 12-percent improvement in the exercise group. The changes in the prolotherapy group versus the comparison groups were great enough that researchers could rule out the possibility of chance findings. More importantly, says Dr. Rabago, the changes were large enough to make meaningful differences in patients’ daily lives.

Other research on prolotherapy for knee OA has also noted some benefits. A small trial of 13 patients with thumb or finger OA published in the Journal of Alternative and Complementary Medicine in 2000 compared the injection of a mixture of dextrose and lidocaine (a pain reliever) with lidocaine alone. Researchers found that patients who received the dextrose combo injections had less pain when moving their fingers compared with those who got only lidocaine.

A trial of 38 knee OA patients published in 2000 in Alternative Therapies in Health and Medicine also compared dextrose plus lidocaine with lidocaine alone. This study showed that the people who got dextrose had substantially better outcomes than their lidocaine-only counterparts in terms of pain, swelling, knee buckling and knee flexibility.

Trameel and Zeel Injections

A combination of two homoeopathic remedies has been shown to relive the pain of knee osteoarthritis. Traumeel and Zeel given by intra-articular (IA) injections – injected directly into the joint space of a painful, inflamed arthritic joint – were shown in a recent study to be safe and effective treatments for moderate to severe pain associated with knee osteoarthritis when compared to a placebo injection.

Traumeel (TR14) and Zeel (ZE14) are American FDA approved homoeopathic treatments used together for the treatment of inflammatory and degenerative conditions of the musculoskeletal system, including osteoarthritis and/or rheumatic joint diseases, and for the relief of symptoms including pain, swelling and joint stiffness.

These medicines have a long history of safe and effective use throughout the world in the treatment of joint and musculoskeletal pain.They are considered good alternatives to traditional NSAIDs.


Clinical data released at the 2015 European League Against Rheumatism (EULAR) congress show Traumeel® and Zeel® T co-administered intra-articular (IA) injections provide a new first line injection treatment option in the management of moderate to severe osteoarthritis of the knee, where oral pain management failed.

Key clinical point: The degree of pain control achieved with the homeopathic product combination was consistent with that seen with other injected anti-inflammatory drug.

Major finding: Effect sizes for Tr14&Ze14, compared with injected placebo, using the WOMAC pain subscale were 0.26 on day 15 and 0.25 on day 99, showing sustainability of the response.

Data source: Phase III, randomized, double-blind, placebo-controlled trial of 232 patients with moderate to severe pain from knee OA.

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