When Physical Therapy and Steroid Injections Don’t Seem to Matter

I came across an interesting study not long ago – not about knees, but tennis elbow (it's no longer up, so I can't link to it).

It turned out that about three-quarters of people with tennis elbow (who have damage to tendons in their forearm) recovered on their own after about a year.

Okay, maybe not surprising. The next part is though:

There was no significant difference between people who received no medical intervention and spontaneously got better and those who had both steroid shots and physical therapy sessions.

After a year, both groups were doing roughly the same.

The study involved 157 people, from ages 18 to 70. One group received six weeks of physical therapy and two steriod injections (the second group had the therapy and placebo injections). Then the third group got no special treatment.

The most aggressive combo, of physical therapy and steroid injections (to knock down the inflammation), showed a marked benefit at six weeks, no improvement at 12 weeks, and worse symptoms at 26 weeks.

Then, at the one-year mark, this article tells us:

Overall, improvement with physical therapy plus placebo injection or steroid injection was about the same as with no treatment at all.

Okay, now here’s my take.

First, steroid injections are dangerous. I really believe these are a deal with the devil: a quick “ah” sensation of relief, at the cost of leaving damaging chemical residue in your joint that weakens it.

As for physical therapy, good physical therapy can be a life saver, but all too often we get bad physical therapy. For example, I recall my own experience when I had knee pain and along the way developed tendinitis diagnosed as golfer’s elbow (which is similar to tennis elbow).

Here’s some of what was done and prescribed:
(1) electrical stimulation (worthless for me, I’m quite sure – but others have had success with this)
(2) stretching exercises (may have damaged the tendon further – how much sense does it make to stretch a cold tendon? Doing so may have created a few microtears in the tissue.)
(3) exercises that were probably too low repetition to stimulate constructive tendon healing.

If that’s similar to the physical therapy that someone gets for tennis elbow, then I wouldn’t be in the least surprised to find out it’s basically ineffective.

However, the right physical therapy can change your life. I devised a program of eccentric exercises, thanks to Doug Kelsey and other sources online, that I’m pretty sure helped me rescue the tendons in both arms. That program I bet would’ve changed some outcomes in this study.

Anyway, for knee pain the right move is not to do nothing and hope it resolves. Don’t take away that message. The point is rather that the solutions we’re directed to, such as conventional physical therapy and high-powered anti-inflammatories, may not be good solutions at all.

A Bike Is a Bike Is a Bike -- Or Is It?

Here’s a short post in reaction to something I read in the comments. Someone was frustrated about how his knees reacted badly to a session on a stationary bike but were okay on a real bike, out on the road. Which makes no sense at all, right?

After all, a bike is a bike is a bike. Right?

Ten years ago, before my experience with knee pain, I would have said reflexively, “Sure. No appreciable difference.”

But once you have knee pain ... well, I’m not so sure. Your knees in this state are more tender and more easily disturbed. You start to appreciate subtleties, slight differences between Activity A and Activity B that actually can matter.

Personally, I’ve noticed differences in how my knees react to riding a stationary bike versus a bike on the open road.

The stationary bike has certain advantages. It’s easier to control the force exerted. You can simulate an 18-mile stretch of easy, flat road if you want to. Hell, you can even spin backwards.

But what I find more interesting is that riding on the open road may have certain advantages too. It’s easier for my knees to ride hard on the road than on a stationary bike. Why? Maybe because I’m shifting my body around, moving on the seat more, slightly altering the way that my joints take the pedaling force. Or maybe because sometimes I’m slowing (or even stopping for traffic lights), other times accelerating. Or maybe because occasionally I’m standing up on my pedals. I don’t know.

Then there are the bike setups to consider. Chances are very good that your stationary bike and road bike aren’t configured exactly the same way, in terms of distance from seat to pedal, for example. Does that matter? If you’ve got great knees, probably not. If you don’t, it might.

Anyway, this is just my way of urging you to stop and think a bit if you’re doing two things that you think are basically the same and one bothers your knees and one doesn’t. Maybe they aren’t really the same. And maybe that slight difference is actually important.