Cortisone injections have gotten a bad rap in recent years as a treatment for arthritis pain, because steroids are known to damage cartilage and could potentially cause the joint to further deteriorate.
But a new study suggests that if used wisely, cortisone shots are as safe as another type of injection used to treat knee arthritis.
Occasional cortisone shots don’t appear to cause knees to deteriorate any faster than injections of hyaluronic acid, a substance injected to lubricate joints stiffened by arthritis, the researchers said.
“Knee replacement rates were, if anything, a little bit less in the group that got the cortisone injections,” said senior researcher Dr. David Felson, a professor of medicine and epidemiology at Boston University School of Medicine.
However, Felson added that the study only looked at people who’d gotten infrequent cortisone shots to their knee, and shouldn’t be interpreted as giving the green light to regular injections for years to come.
“What we know from the study that we can trust is that a few cortisone injections won’t really cause much trouble,” Felson said. “It’s conceivable that repeated injections every three months for years won’t cause any trouble, but you can’t say that.”
Steroids are known to be toxic to cartilage, the connective tissue that keeps your bones from rubbing against each other, explained Dr. Melissa Leber, director of the Emergency Department’s Division of Sports Medicine in the Icahn School of Medicine at Mount Sinai in New York City.
“If you use it enough, it will damage the cartilage,” said Leber, who had no role in the study.
A 2019 study reported a threefold increased risk of knee arthritis progression in people who’d received repeated cortisone injections, compared with people who’d never gotten the shot, Felson and his colleagues said in background notes.
Comparing two types of shots
However, no clinical trials had ever compared the two most common types of knee arthritis injections, cortisone jabs and hyaluronic acid shots, Felson said.
The two types of shots do different things in the joint, and are sometimes used in combination, Leber said.
Cortisone shots are anti-inflammatory and help reduce pain, while hyaluronic acid injections are like a gel that provides lubrication in the ailing joint.
“You’re injecting WD40 almost into the knee. That acts to allow smoother gliding in the joint,” Leber explained.
The latest study looked at nearly 800 people with knee arthritis, of whom 4 out of 5 reported getting cortisone shots for their knee pain. The rest had reported receiving hyaluronic acid injections.
After seven years of follow-up, researchers found that those who got steroid injections had no greater cartilage loss than those treated with hyaluronic acid.
In fact, people who got cortisone shots were about 25% less likely to need a total knee replacement than those who got hyaluronic acid.
The message to knee arthritis patients regarding cortisone shots is simple, Felson said: “Don’t be scared.”
“There’s nothing bad that’s going to happen with one shot or even a few shots,” Felson said. “People should be reassured. They shouldn’t avoid getting an effective treatment.”
Wise use is crucial
The findings bolster the approach orthopedic specialists already take in handing out cortisone shots to treat knee arthritis, Leber said.
“If someone already has a ton of damage to the cartilage in their knee, a lot of arthritis, then we don’t worry as much about using a steroid to help with pain control because they already have a lot of arthritis in the knee,” Leber said. “Damaging it a touch more just to give them good pain control is a very minor thing. It’s not as risky.
“In someone who’s young, in their 20s to 40s, who has very little cartilage damage but has pain, we try to use it sparingly,” she continued. “Would you use them on occasion in a young person? Yes. That’s only as a one-time thing. You don’t want to use it repetitively.
“Steroid is bad for cartilage, but that doesn’t mean it’s bad for every patient,” Leber concluded. “It’s a case-by-case situation.”
Regardless, you wouldn’t expect any patient to receive frequent cortisone injections, whatever their condition, added Dr. Jeffrey Schildhorn, an orthopedic surgeon with Lenox Hill Hospital in New York City.
“If you give someone a shot in January and they come back in April saying they want another one, and they come back in August and want another one, how well are they working?” said Schildhorn, who was not part of the study. “They’re not working, if you’re only getting two or three months of relief.”
SOURCES: David Felson, MD, professor, medicine and epidemiology, Boston University; Melissa Leber, MD, director, Emergency Department’s Division of Sports Medicine, Icahn School of Medicine at Mount Sinai, New York City; Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; Arthritis and Rheumatology, Dec. 1, 2021
Though it’s tempting to hang up your shoes for the winter season and wait for spring, there are plenty of benefits to running in the cold.
Cold weather jumpstarts a runner’s metabolism by preventing the body from preserving fat stores. That means it’s easier to burn calories and get rid of fat. Simply put, running in the cold is a great way to fight winter weight gain.
It also helps runners impacted by seasonal affective disorder (SAD). Endorphins released in exercise are shown to increase positive moods and decrease depression symptoms. Plus, running outdoors helps increase energy and motivates runners to repeat workouts.
Most importantly, cold weather is the ideal running condition. It puts less stress on the body, which means it’s easier to run and allows for greater efficiency. That’s why the ideal temperature for marathoners is 45 degrees.
While it makes for perfect conditions, going on a winter run still needs to be done safely to avoid common injuries. Before making a winter running plan, consider these tips.
How to safely go running in the winter
Dress for the weather
Knowing how to dress correctly for running in the winter is simpler than one might imagine and doesn’t involve bulky layers.
A few key things to remember:
Dress like it’s up to 20 degrees warmer than it is.
Choose clothes suitable for temperatures 10 to 20 degrees higher than the current conditions. Doing so might seem counterintuitive, but remember that the body begins to warm the second it starts to move. Too many layers of warmth make for sweat, which could lead to a chill post-run.
Outfits should consist of three layers: synthetic base, insulative middle, and weatherproof top layer.
A proper synthetic base layer consists of technical fabrics to regulate body temperature. It extends down to the feet, which should be encased in wool or technical fabric to avoid moisture and trap warmth. It’s easy to skip a base layer, but important not to. They’re just as effective as bulky jackets but far less cumbersome.
In addition, don’t forget a weatherproof jacket such as a windbreaker or raincoat to keep the elements at bay.
Good running shoes are also important and should have strong traction in winter conditions.
Protect the extremities.
Winter runs come with an increased risk of damage to extremities. This could be as minor as dry skin or as serious as hypothermia.
Avoid these risks by wearing a moisture-wicking hat, running gloves, and a face mask. Skin balm is a great way to keep skin healthy and prevent frostbite.
Still not sure what to wear for today’s run? Runner’s World recommends the following:
10-19 degrees: 2 shirts, tights, gloves, hat, windbreaker jacket/pants
20-29 degrees: 2 shirts, tights, gloves, hat
30-39 degrees: long-sleeve technical fabric shirt, shorts or tights, gloves, hat
40-49 degrees: long-sleeve technical shirt, shorts or tights (gloves and hat optional)
Don’t skip your warm-up or cooldown
It’s often tempting to skip a warm-up or cooldown, but it’s important to do so when running outside in the cold.
Taking the time to warm up properly for a run will help to loosen the body and avoid potential injuries. Doing so will also help ease the body back into running after potential muscle atrophy due to lack of activity during Covid-19.
We recommend working through a variety of dynamic warm-up stretches and movements. Pick a set of five to six exercises such as lunges and jumping jacks for about 30 seconds each. Once the warm-up is complete, the heart rate should be elevated and the skin should feel warm.
Cooling down after jogging in the cold will help to relax muscles, lower heart rate, and alleviate future muscle soreness. Simply put, runners who cool down feel better.
There are three important elements of a cooldown:
Changing clothes immediately after the run to avoid chills and regulate body temperature.
Replace the used running hat with a fresh, warm one.
Consume a hot drink or soup to raise body temperature.
Plan runs carefully
Take some time to sit and plan each run.
Plan a route that won’t take longer than 60 minutes. Even in ideal conditions, longer runs increase the risk of compromising the immune system.
Once active, runners should stay within their aerobic zone (typically 40-70% of their maximum heart rate). It will feel slow for some runners but decrease bodily stress while still conditioning and maintaining the muscles.
Determining the aerobic zone can easily be done per the CDC’s guidelines. First, calculate the maximum heart rate by subtracting the age of the runner from 220. Then, multiply that number by the target number within the aerobic zone.
For instance: A 35-year-old runner wants to maintain an aerobic zone of 50% of their maximum heart rate. Their maximum heart rate comes to 185 bpm after subtracting 35 from 220. To stay within a 50% zone, they should aim for 92.5 bpm (.5 x 185).
The finish should be fast. Minimize the distance from the end of a run to a warm place in order to avoid falling body temperatures. If a run takes place in a neighborhood, finish at the end of the driveway. Likewise, if a run takes place in public, finish as closely as possible to a mode of transportation.
Lastly, hydrate before, during, and after a run. In dry winter air, the body actively works to keep itself warm. A good rule of thumb is to drink half of the body weight in ounces every day. For example, runners weighing 150 pounds should aim for 75 ounces of water.
How to stay injury-free when running in the cold
It’s just as easy to sustain an injury during the winter months as it is in the spring or summer. These could stem from an increase in mileage, old or improper gear, and treacherous terrains such as snow and ice.
The most common running injuries include plantar fasciitis, shin splints, and Achilles tendinitis.
While most running injuries can be helped with ice, stretching, and rest, some call for more extreme measures such as knee surgery if runners don’t listen to their bodies. Don’t hesitate to slow down or stop at any sign of swelling or sharp pain.
Here are some tips to stay injury-free for great runs:
Get a full night’s sleep
Warm-up and cool down
Use ice on inflamed areas
Plan to gradually increase mileage
Running in the winter is great for runners of all kinds, including beginners. Just remember that in order to stay as safe and healthy as possible, warm up consistently, upgrade your gear, and listen to your body.
Dr. Kim Huffman, an avid runner, gets a fair amount of guff from friends about the impact that her favorite exercise has on her body.
“People all the time tell me, ‘Oh, you wait until you’re 60. Your knees are going to hate you for it’,” Huffman said. “And I’m like, ‘That’s ridiculous’.”
Next time the topic comes up, Huffman is well-armed: An extensive British analysis of prior study data has found no link between a person’s amount of exercise and their risk for knee arthritis.
The research team combined the results of six clinical trials conducted at different places around the globe, creating a pool of more than 5,000 people who were followed for 5 to 12 years for signs of knee arthritis.
In each clinical trial, researchers tracked participants’ daily activities and estimated the amount of energy they expended in physical exertion.
Neither the amount of energy burned during exercise nor the amount of time spent in physical activity had anything to do with knee pain or arthritis symptoms, the researchers concluded.
“This helps dispel a myth that I’ve been trying to dispel for quite a while,” said Huffman, an associate professor at the Duke University Medical Center’s division of rheumatology.
“If you add up the amounts of activity that people do and also the duration of activity, neither of those is associated with knee arthritis,” added Huffman, who wasn’t involved in the analysis.
Dr. Bert Mandelbaum is chief medical officer of the Los Angeles Galaxy soccer club and team physician for the U.S. Soccer Men’s National Team.
He agreed the study “further corroborates the fact that levels of exercise in one’s personal life do not increase the risk, the onset or progression of osteoarthritis.”
So where did this misconception come from?
Huffman thinks it’s because people mistake exercise-related injuries for the effect that exercise itself has on your joints.
“Right now, the clear risks for knee arthritis are genetics, injuries and female sex,” Huffman said. “People who exercise more may be more likely to injure their knee. That’s where I think the myth comes from.”
In fact, exercise can help ward off knee arthritis in several ways, Huffman said:
Flexing and extending the knee during exercise promotes the diffusion of fluid into the joint, promoting better nutrition.
An elevated metabolism created by exercise helps control inflammation in the knee joint.
Weight loss reduces the amount of load placed on the knee.
Exercise strengthens the muscles surrounding the knee, stabilizing it and reducing the risk of injury.
“I don’t think we’re finding that simple overuse or using your joint is a problem. It’s more an association with injuries and perhaps in the setting of obesity or high genetic risk,” Huffman said.
Your best bet is to choose an exercise that poses the least risk of a knee injury, Huffman said.
“If you want to go snow skiing, I don’t think that’s a huge problem but you’re probably going to be more likely to injure yourself downhill skiing than, say, walking in your neighborhood or training for a marathon,” Huffman said. “It’s not soccer or football or skiing itself. It’s just the risk for injury during those activities.”
On the other hand, exercise provides benefits that go far beyond healthy joints, said Mandelbaum, co-chair of medical affairs at Cedars-Sinai Kerlan-Jobe Institute at Santa Monica, Calif. He played no role in the research review.
“Physical activity is essential to optimize both physical and mental health and plays a central role in facilitating life’s quality and quantity,” Mandelbaum said. “The list of benefits includes decreased anxiety, better mood, decreased levels of coronary disease, hypertension, diabetes and obesity, and therefore a longer life.”
The analysis was published recently in the journal Arthritis and Rheumatology.
The Arthritis Foundation has more about knee osteoarthritis.
SOURCES: Kim Huffman, MD, PhD, associate professor, Duke University Medical Center, division of rheumatology; Bert Mandelbaum, MD, co-chair, medical affairs, Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, Calif.; Arthritis and Rheumatology, Nov. 3, 2021
It may look like bad news, but a new study says it’s not: The number of people younger than 21 who had total hip replacement surgery in the United States jumped from 347 in 2000 to 551 in 2016.
The increase wasn’t due to a rise in the number of children with inflammatory arthritis, which often prompts a hip replacement in the very young. That suggests that non-surgical treatments to control that painful condition are effective, said senior study author Dr. Bella Mehta, a rheumatologist at the Hospital for Special Surgery in New York City.
For the study, the researchers analyzed data on total hip replacement in U.S. patients younger than 21 from about 4,200 hospitals in 46 states. The mean age of patients was 17.
Osteonecrosis (the death of bone cells due to lack of blood supply), osteoarthritis and juvenile idiopathic arthritis (JIA)/inflammatory arthritis were the most common reasons for total hip replacement.
Over the study period, total hip replacement for osteonecrosis rose from 24% to 38% of patients, but it fell from 27% to 4% for arthritis, likely due to recent improvements in drug treatments for arthritis, according to the study.
The findings were scheduled for presentation Tuesday at the American College of Rheumatology annual meeting and recently published in The Journal of Arthroplasty.
“Our study shows that although THA [total hip arthroplasty] procedures are increasingly being performed in young people, we aren’t seeing more of these patients seeking surgery for inflammatory arthritis,” Mehta said in a hospital news release.
“We’re doing a better job at treating these individuals so they don’t develop end-stage joint damage,” Mehta added. “Twenty years ago, we didn’t have access to effective pharmacologic treatments for these conditions, and now we’re using them well and helping these patients live a better life.”
Improvements in implant technology and materials have also made them far more durable than they were 20 years ago, so surgeons now feel more comfortable offering hip replacement surgery to young patients because their implants are likely to hold up under the wear and tear of decades of activity, noted study co-author Dr. Mark Figgie, chief emeritus of the surgical arthritis service at the hospital.
Mehta said the findings could be of value both to clinicians and young patients.
“I would use these results to say to a young person: ‘There are a lot of people who get these procedures; you’re not alone,'” Mehta said. “I find that, especially for young patients, knowing they’re not the only ones to experience something really helps. And it’s a life-changing procedure for them.”
Feeling achy and stiff in the morning? Try these seven techniques to ease into the day.
Nothing is more restorative than a good night’s sleep. You wake up refreshed and ready to take on a new day. Yet, for some people, the early morning hours bring unwelcome neck and back pain.
Movement during the day promotes fluid secretion from your tissues, which in turn keeps your joints mobile. When you’re asleep, however, you’re not moving for an extended period of time, which can cause your joints and muscles to stiffen up.
For some people, morning pain and stiffness go away as the day goes on. For others, the pain lasts all day. If you find yourself waking up constantly in pain, try these seven tips for a pain-free morning:
When you wake up, do some simple stretches to unlock your joints and muscles. Here are two to try:
Knee to Chest Stretch: Remain on your back in your bed, and pull both knees toward you until your feet are flat on the bed. Grab your right knee with both hands and pull toward your chest. Do the same with the left knee. Hold for about 30 seconds. Repeat two to three times.
Shoulder/Upper Back Stretch: Stand up and hold your right elbow with your left hand. Stretch your right arm across the front of your body, keeping your arm straight. Do the same with your opposite arm. Hold for 30 seconds, and do two to three repetitions.
2. Change Your Mattress and Pillow
Your morning pain and stiffness could be caused by your bed or pillow. Be sure to choose a pillow that aligns your neck parallel to the mattress so it isn’t bent up or down. As for your mattress, it should be firm, but not too firm.
3. Change Your Sleep Position
Sleeping on your stomach may be the root of your pain. If so, switch to your back and prop up your knees with a pillow to keep your spine in a neutral position. Side-sleepers can try inserting a pillow between their knees.
4. Exercise Regularly
An intense workout just before you slip under the covers is not advisable. However, a brisk walk or relaxing yoga during the day can loosen up your muscles and joints, setting you up for a pain-free morning. Typically, thirty minutes of exercise a day will tire you out so you can fall asleep faster.
5. Stay Hydrated
During the night, you lose water when you sweat, which can lead to dehydration. Dehydration stiffens your muscles and joints as your tissues are deprived of fluids. So instead of going for that cup of morning coffee, drink two glasses of water first to rehydrate your body.
6. Take Vitamin D
Most people don’t get enough vitamin D in their diet. But the vitamin is essential for bone and muscle health. Have your doctor test your vitamin D levels, and if you are deficient, take a vitamin D supplement regularly.
7. Visit a Physical Therapist
Lingering morning pain should be checked out by a physical therapist. Keep a log of where the pain is strongest and which actions seem to aggravate it. Your physical therapist can show you how to adjust your sleeping position to prevent pain and improve your posture. He or she can also recommend the right pillow and mattress for a restful night’s slumber.
Don’t Live With Pain
If you’re experiencing pain and stiffness in the morning, the orthopedic specialists at Comprehensive Orthopaedics can review your symptoms to determine the source of your discomfort.
Many American arthritis sufferers aren’t getting any exercise despite its benefits for reducing pain and improving their quality of life, new research shows.
Sixty-seven percent of U.S. adults with arthritis engaged in physical activity in the past month, most often walking, according to a new data analysis by the U.S. Centers for Disease Control and Prevention. The findings were drawn from national health surveys from 2016 through 2018.
“With 33% of U.S. adults with arthritis who are not physically active, there is still room for public health action,” said lead researcher Dana Guglielmo of the CDC’s National Center for Chronic Disease Prevention and Health Promotion.
And that action starts with frank talk between arthritis patients and their health care providers, she said.
Guglielmo suggested patients ask their doctors about arthritis-friendly physical activities and self-management programs to help ease symptoms such as joint pain.
“Providers should check in with patients about their physical activity levels and talk to them about physical activity and arthritis self-management programs,” she added.
Arthritis is the most often reported cause of disability among Americans over age 15.
U.S. National Health Interview Survey data showed that 71% of respondents got their exercise through walking, 13% from gardening and 7% by lifting weights.
Guglielmo urged anyone with arthritis to walk.
“Walking is an ideal physical activity for adults living with arthritis, because it is low-cost, convenient and adaptable to various settings,” she said.
To get the most benefit, however, adults with arthritis should engage in an activity that combines aerobic, muscle-strengthening and balance exercises, Guglielmo said.
“Any activity is better than none,” she added. “Evidence-based physical activity programs can support adults with arthritis in getting and staying active by helping them overcome common barriers to physical activity. These programs can even improve their mental and physical health and quality of life.”
Dr. Jeffrey Schildhorn, an orthopedic surgeon at Lenox Hill Hospital in New York City, said everyone with arthritis pain should be encouraged to be active.
“People with arthritis ask me what can I do, and I tell them … you want to move your body,” he said. “When people stop moving their bodies, they get stiffer, they start quitting, they get fat.”
The best way to prevent these consequences is to be active, Schildhorn said. Even people who suffer the most pain can benefit from walking. Being physically active helps keep joints lubricated, he explained.
“Most people with arthritis wake up stiff, and sometimes they wake up in more pain, and as they get going, joints tend to lubricate, they get more mobile and the pain is less,” he noted. “So, walking or anything that gets your body moving actually helps.”
Schildhorn emphasized that he’s not talking about deep squats, but about keeping the body going. Plus, getting outside, getting sunshine and socializing can keep people healthy, he said.
Being inactive can become its own self-defeating loop, Schildhorn said: If you aren’t active, you feel worse, and feeling worse makes it less likely that you’ll exercise.
“People stop working out, they get stiffer because they spend so much time sitting on a chair with a pillow behind them because it feels better. To me, that is the opposite of health,” he said.
Being active can extend the time before a knee or hip replacement is needed.
“What people don’t understand is just how valuable physical activity is,” Schildhorn said. “It’s good for your immune system, it’s good for your attitude, it won’t wear out the joints faster, and you can cope with the symptoms longer.”
When you reach a point when you can’t walk as far as you once did because of the pain, then it might be time for surgery, he added.
The study was published Oct. 8 in the CDC’s Morbidity and Mortality Weekly Report.
SOURCES: Dana Guglielmo, MPH, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention; Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; Morbidity and Mortality Weekly Report, Oct. 8, 2021