Saturday, July 29, 2017

The Latest Reason to Skip That Steroid Shot for Knee Pain

If you’re trying to fight inflammation in a bad knee by using drugs, opt for the milder, non-steroidal stuff.

That’s the takeaway from a study published this year in JAMA.

There were 140 subjects, average age 58. They had pain and inflammation because of knee osteoarthritis. For every three months over two years, the subjects received knee injections that consisted of either the corticosteroid triamcinolone or a placebo.

What researchers then found was rather surprising.

Knee pain declined slightly in both groups, but by about the same amount – so the steroid didn’t even outperform a saline placebo. However, those who got the corticosteroid injections had “significantly greater cartilage volume loss.”

The researchers’ conclusion doesn’t mince words: These findings do not support this treatment for patients with symptomatic knee osteoarthritis.

Controlling inflammation is good, but it’s probably a good idea to take a pass on steroids.


  1. Thanks for posting this, Richard. It has reinforced my earlier decision to avoid cortisone injections.

  2. Yes, I have had two -- one in my elbow and one in my foot -- and both times I was quite reluctant. Hopefully those two will be the last! I hear very little good about the long-term effects of steroid injections.

  3. Richard,
    Just discovered and read your book yesterday, after doing my own research to find non-surgical answers to knee pain. One Ortho said it's actually worn cartilage in the hip and said just replace your hip, it's easy. I was doing a web search for the answer to the question, are these docs right when they say your cartilage can't be regenerated, it will just continue to deteriorate, make the best of it. I don't accept that, and of course I was happy to read your experience. What I don't find in your book is whether you had a subsequent MRI or X-ray to confirm whether there was cartilage repair/regrowth? Are you basing everything on how your knee feels, or is there objective evidence of a change in your cartilage? My second question is whether you investigated stem cell injections and prolotherapy? These injections are highly promoted out here in Lala-land.
    As a final question, have you read the books by John Sarno,M.D. out of NYU HOSPITAL? It's very possible your recovery may be supported or partially explained by his theories.

    1. On the objective proof that my cartilage has improved: I wrote a post about this, as the question has come up a number of times. See here:

      I certainly understand the curiosity. But as to whether cartilage can repair/regrow -- I don't think you'd want my MRI anyway. Just look at the clinical studies in the book! I cite a couple of studies where cartilage filled in where there was none before. In my opinion, that's much more powerful than just my case anyway (for my story, sample size = one).

      Never looked into stem cell injections or prolotherapy, but I think others on this blog have.

      I know little about Sarno, but it appears that he believes a lot of chronic pain traces back to psychological anxieties in some way. I would be very skeptical of that -- at least in my case. It may be true for someone else


  4. Andando de Bicicleta
    Monday, August 07, 2017
    Catastrophic Injuries Seem to Be the Rule
    So in 2015 I was playing soccer with the kiddos and felt a sensation (not a good one) in my left knee, my non-kicking leg. My doc looked at it, osteoarthritis he said, you know you're getting older you can't do the things you used to do. I could not get the nagging injury to go away and leave me the heck alone.

    Fast forward to May of 2017, our new (to us) SUV had a leak that finally had to be taken care of and caused it to die. My wife and I discussed how we were too old for this and we should call a tow truck. Alas, I now know better, but I couldn't see spending a bunch of money for something I could do myself. My buddy Joe and I towed it to the dealership a couple of miles away. Once there and off the chains, we still had to put it in a parking spot because the bay was chained up. Fact: Parking lots have slight inclines to alleviate runoff. Fact: An SUV weighs much more than a sedan or pick-up truck. I attempted to push that SUV into the spot all by myself at first. My strong gams from cycling helped, but my weak knee was not happy. This time both knees were affected or strained! I tried taking it easy all the while still going to work. I tried carrying a staff to support myself. The pain was intense and at times my knee would give out. I tried to stay off of them. I tried taking the ramp down and I had to stop mid ramp. Stairs were better, because with the staff and the banister I was able to help myself. But with the staff my employer forced me to get a prescribed staff (one month with the staff). That month was over at the beginning of July. I decided to give it an extra month just to be safe before I started back to exercise. That month was over at the beginning of August. My wife and I had tried to restart our walking regime, but the first time it was still painful and the second time we over-did it. Meanwhile in South Texas temperatures have been way too high. Ambient temp was at 120° F. This is not the desert! These are the coastal plains. So here it is Aug and I didn't have plan!

    How do I fix my knee?! I landed on a site that pushed quad strengthening that even brought up the fact that quad strengthening aggravates your knees, but did not answer the main question. Next I tried to learn what I could about the knee from WebMD etc. I presented with pain in the Medial Meniscus and the Medial Cruciate Ligament in the right knee. In my left knee the one that clicks there was pain at the back at the joint capsule. Doctor prescribed a series of anti-inflammatories that started its work immediately plus the staff. I was good to go! I had four or five days till I closed out the year with my middle schoolers and then I could just rest until it was time to move to another house this summer. Still no plan. I was going ahead blindly anyway.It wasn't until I found your site that I felt like I had some hope for getting rid of the pain. I was hoping to post a plan that's based on your blog writings. I don't want to overstep your authority. They are your ideas with some ideas added to transitioning to more exercise based on common practice like the 10% rule that you also posted to your blog. Feel free to say no. I have totally enjoyed reading your blog and I have hope thanks to you! God bless you and your family! (Condensed from a blog-post).

    1. Hi Bobster, not quite sure what you're asking here -- but if you want to post a plan for healing bad knees, that makes mention of some ideas that I believe in, my first reaction would be to say: go for it. I assume you're not just ripping out word-for-word chunks of the book or blog. Good luck.

  5. Someone I know recently told me about "Low Dose Naltrexone." I thought Richard might enjoy sleuthing this. I haven't tried Naltrexone and took the long "hermetic" road to curing my knees, but often torture myself wondering if what I did to reverse my inflammation and/or arthritis and degeneration is repeatable by another person?

    Anyway, here's a link ,to an overview-

    Here's a peer reviewed study-

    My body and knees are going strong. I still have mysterious and infrequent bouts with inflammation which doesn't reduce my ability to cycle or function. I have my theories as to why, but they are too rabbit holed to share here.

    Good luck to all healing their knees, R-X

  6. I have recently taken the knee warming that Richard suggests is so important in Winter in to my routine at the height of Summer. As I try to recover from my exercise bout or as I try not to let any pain take hold of my knee, keeping them covered with a lite blanket seems to do wonders. I am considering that my short purchases from now on should be knickers. Knickers are shorts that go past the knee. Interesting! Thoughts?

  7. Richard, I'll post it here and see what you think. Thanks for the opportunity!

    Training Variables:
    Only you know what you can do. Tenet: Less is more. Caution is better than grit!

    This year with much analytical concentration and caution: fall '17

    Paradigm Shift:
    Not just patience, but you're dealing with soft-tissue time. (Richard's Pitch Experiment). Weeks -n- months although you'll know the next day you did something wrong.
    Remember, do not ramp up too fast or like old times. No accelerations, never out of the saddle, no hills, no kidding!

    Good Knee Care Habits: After a bout of exercise 1 to 1.5 hour rest before next thing. (Cycle).
    Below 60 degrees embrocation or knee warmers.

    10 minute rest half way on long walks in order to not start hurting.(2k steps @ a mile) 4k steps per day maintenance

    Beginning 70 steps several times a day walking the dog, going back to the car.

    101 steps around X every 10 minutes (Richard started at the pool, I have started walking the dog.

    10% increase every two weeks. As a runner this was the rule of thumb. In marathon running it moved to one week, but then on the fourth week you go back to where you were at the beginning of the month. Remember: less is more.

    Minutes before 15 : now 5, 7, 13 - Primes

    80 rpm @ first for 15 min. 1200 revs
    Build time in the saddle up to thirty minutes 2400 revs. Once you can do two sets of thirty then you're adding thirty to what you can already do. 15/16/17/18/19/20/21/22/23/24/ 25/26/27/28/29+30+30+30+30+30

    4th year with cautious optimism:

    Saturday ride - long, strenuous, hilly up to three hours 40 miles Fast and 20 miles easy

    Sunday-60 minutes flat or trainer easy pedaling

    Tue. -N- Thurs. 45 minutes on trainer or flats 10 easy warm up and 35 minutes faster, but still not intense

    Mon. Wed. Fri. Walk 2 miles each day

    Eventually - eventually:
    After a year of cautious progress:

    Less is more keep three steady and change one to improve

    Duration - how long - 2hrs conversational pace

    Frequency - #of rides per 10 daze

    Volume - combo of dur. N freq.

    Intensity . Ride 4 60-90 mins warm-up n cool-down . 6x6mins w/4mins recovery (recovery equals easy cheesy

    Reco : 45 mins whistleride (a whistle ride is one where you're going slow enough to whistle) not as easy as it sounds!

    5-20 minutes in the pool adding minutes as you get better trained.

    1. Bobster/sharpner: This is really your program, with a nod to a few things I mention doing. I don't see any problem with your posting this. Hope the knees are good!