Hay Fever Treatment

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Hay Fever

The benefits of a steroid injection for Hay Fever

The injection is a single or double dose of corticosteroid (40mg / 80mg). This depends on the severity of symptoms or size of the person.
All hay-fever injections are administered in the gluteal muscle; this is confirmed by ultrasound to ensure optimal benefit.

Once administered the medication will suppress the excessive inflammatory response associated with hay fever. A single injection can provide relief for up to 3 months.

The total cost

The total cost of hay-fever treatment is £65 for 40mg / £95 for 80mg. There are no additional fees.

 

The risk

Under current Co-Vid 19 guidance patients must acknowledge that the use of steroids will decrease their immune response. This can make fighting the Co-Vid 19 virus more difficult. As a consequence, we strongly recommend you first try decongestants and minimise your exposure to pollen.

In keeping with current Co-Vid 19 guidance, any person who is shielding, high risk or presenting with Co-Vid symptoms is not eligible for injection.

Other exclusions include:

  • Under 18 or over 70 (Co-Vid 19 protocol)
  • If the person has or recently had cancer.
  • Glaucoma
  • Taking medication that could interfere with corticosteroid
  • If your diabetes is unstable or have poorly controlled  high blood pressure or other heart problems.
  • Diagnosed with Osteoporosis.

Check you have got Hay Fever!

Please do not mistake hay fever symptoms for corona-virus or the other way round.

The symptoms of corona-virus typically include a high temperature and a new, continuous cough.

Hay fever does not typically cause a high temperature and most people with hay fever do not feel unwell. Their symptoms will also fluctuate with changes in the level of pollen.

Please phone 0114 2671901 or 01924 654068  to make your appointment.

hay fever

Information on how coVID -19 is affecting clinical practice.
Please read the following. It contains information about Injection Therapy and the latest changes surrounding coVID-19.
Firstly, it has become standard practice to ask people with any symptoms to self isolate. The symptoms relate to fever, persistent cough and a sore throat. 
Anyone who has recently travelled or been in contact with someone who may be infected is also advised to self isolate.

Ultrasound scans to help confirm your diagnosis will continue as normal. Remember, there are lots of changes that can be made to manage your problem once diagnosis is established.

The use of injections such as Ostenil to assist with joint lubrication will also continue as normal. Please mention to the reception staff if you are considering Ostenil, just to make sure we have enough in stock.
What about the use of steroid injections
The use of Cortico-steroids does however need a bit more understanding. Cortico-steroids have a minimal effect on suppressing a persons immune system. This effect is not normally a problem, but with coVID-19, people at risk are having a difficult time in fighting off the viral infection. Therefore any compromise to their immune system is not advised.
The high risk group includes people:
  • Over the age of 70 years.
  • Any immunosuppressant disease; such as Lupus, Inflammatory Bowel Disease and Type 1 diabetes.
  • People with breathing problems such as Chronic Obstructive Pulmonary Disease (COPD) or asthma.
  • And anyone with cardiac problems such as hypertension (high blood pressure) or angina.

Please Note: There are diseases and pathology that prevent good health irrespective of an individuals actions. The advice in this blog is not a substitute for medical opinion. Always consult your healthcare professional for specific advice on your personal condition. But please remember, best health irrespective of condition will always be optimised if your chemistry is made as good as possible.

 

coVID-19 and injection therapy

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coVID-19

Information on how coVID -19 is affecting clinical practice.
Please could read the following. It contains information about Injection Therapy and the latest changes surrounding coVID-19.
Firstly, it has become standard practice to ask people with any symptoms to self isolate. The symptoms relate to fever, persistent cough and a sore throat. 
Anyone who has recently travelled or been in contact with someone who may be infected is also advised to self isolate.

Ultrasound scans to help confirm your diagnosis will continue as normal. There are however some restrictions on the use of Corticosteroids. Please phone for a telephone chat prior to booking to make sure you are suitable for steroid injection.

The use of injections such as Ostenil to assist with joint lubrication continues as normal. Please mention to the reception staff if you are considering Ostenil, just to make sure we have enough in stock.

What about the use of steroid injections
The use of Cortico-steroids does however need a bit more understanding. Cortico-steroids have a minimal effect on suppressing a persons immune system. This effect is not normally a problem, but with coVID-19, people at risk are having a difficult time in fighting off the viral infection. Therefore any compromise to their immune system is not advised.
The high risk group includes people:
  • Over the age of 70 years.
  • Any immunosuppressant disease; such as Lupus, Inflammatory Bowel Disease and Type 1 diabetes.
  • People with breathing problems such as Chronic Obstructive Pulmonary Disease (COPD) or asthma.
  • And anyone with cardiac problems such as hypertension (high blood pressure) or angina.
Consequently the Injection Clinic in conjunction with ActiveHealthcare advise against the use of steroid injections in this group of people for the time being.
Don't forget the benefits of Ostenil

Injections of Ostenil can be safely administered to any group!

Along with diagnosis and self management advice on joint degeneration, the use of Ostenil has proven benefits to assist joint lubrication and ease the symptoms of joint pain.

To read more about Ostenil please click on the link.

'Click here' to visit the Ostenil page.

 

medication-for-guided-injections

Now could actually be a good time to correct your muscle and joint problem.
The coVID-19 problem is now having a dramatic impact on health and finance.
It is difficult to find any positives, but if you are stuck in isolation then it does provide an opportunity to work on correcting your posture, strength and your movement pattern for daily tasks.

As with all problems, Injection Clinic recommends you first establish a diagnosis. Whether your fixing a car or your body, if you first identify whats wrong, your time in correcting the problem will be reduced.

Remember, shoulder and knee pain is not a diagnosis; shoulder impingement with bursitis or patella tendinopathy is!
To find out your diagnosis please book an appointment with Chris for a consultation and ultrasound scan. Then start your rehabilitation.

Once you have your diagnosis, try these home exercises

The links below provide an overview of the diagnostic process used at Injection Clinic and online exercises for self management.

Visit 'What to expect' to gain an insight into your diagnostic appointment

Visit 'QuickPhys' and Virtual Physio to see a range of exercises and video advice about your diagnosed problem.

virtual-physio-Quickphys

Please Note: There are diseases and pathology that prevent good health irrespective of an individuals actions. The advice in this blog is not a substitute for medical opinion. Always consult your healthcare professional for specific advice on your personal condition. But please remember, best health irrespective of condition will always be optimised if your chemistry is made as good as possible.

 

Spinal Injections

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Spinal Injections

What are Spinal Injections?

The term injection refers to the how medication or supplements are introduced into the body.
Most medication is administered via tablets or drinkable liquid formulas. There are however other ways to administered medication and this includes 'injections'.
Some injections are designed to go directly into the blood stream, others need to be injected into muscles or joints.

A Spinal Injection therefore refers to medication that is injected into the spine.
The key issue to understand is that there are many different medications that can be injected and many different spinal areas into which these injections can be administered to.

What are the most common Spinal Injections?

There are three main spinal injections; an epidural, nerve root block and facet joint injection.

Epidural

This is an injection administered into the spinal canal, the central part of the spine which protects the spinal cord and lumbar spinal nerve roots.
The injection can be administered at the base of the spine or  between vertebral bones around the mid-lumbar region.
Typically used for pain management of the lower limbs during surgery, pregnancy and for symptom relief of spinal stenosis (narrowing of the spine around the nerves).

These injections should be administered in hospital and research indicates that the steroid should be a non particulate solution in order to further minimise the risk of clots and damage to vascular tissue within the spine.

The forgotten facet joint injection

Facet joint injections often get over looked. One potential reason is the public's and healthcare workers perception that 'bad' back pain and 'referred pain' must arise from a 'trapped nerve' or a 'slipped disc'.
The reality is that as we get older the likelihood of back / leg pain from a facet joint irritation increases year on year.

Over time, with normal ageing , the discs between our vertebral bones loose height. This then positions the facet joints closer together and at risk of exposure to increasing compression. This mechanical force transmitted through facet joints is a very common cause of back and leg pain.

Facets joints are bony joints, just like any other joint in our body and like an arthritic knee, for example, they can respond well to injections of cortico-steroids.

The white marking 25.3mm shows the depth of a facet joint below the skin. Nerve roots and the spinal canal are deeper and can be seen under the numbers 26.7 and 33.2 (white oval areas).

Nerve Root Blocks

Nerve root blocks are often considered when the persons pain is thought to be attributed to the irritation of a specific nerve. For example a right sided L5 nerve root block is a consideration if someone has 'radicular' pain down their leg and into their foot.
An MRI scan can further provide some insight into the likelihood of nerve irritation based on the observation of a nerve being surrounded by displaced tissue or being deviated (moved) from its normal pathway.

A nerve root injection is more difficult to perform and again it is recommended that the injection is performed in a hospital setting under x-ray or CT guidance.

So what does the Injection Clinic think to Spinal Injections?

Firstly, at the Injection-Clinic we only perform facet joint injections. These are safe to administer under ultrasound and with the same medication as we use for all other joint injections.

The success of the injections varies from life changing to no effect. The main reason for this is due to the individuals specific diagnosis.
If the facet joint is inflamed and the chemical inflammatory changes are causing pain then a facet injection will have a good outcome. If the pain is due to mechanical compression on a nerve then the injection will have little benefit.

The problem is that we never fully know the complete diagnosis and consequently injections are administered for the purpose of diagnosis as much as they are administered for treatment.

Priced appropriately so you can find out.

An important consideration when thinking about spinal injections is the cost. There is no guarantee of the injection working, but because most spinal injections are administered in a hospital setting the cost is very high.
At the Injection Clinic, whilst the procedure is more complex than injecting a knee or shoulder joint, we do not charge a premium.
Facet joint injections are £80 each. Dependent on the findings from physical examination, a client normally has either two or four facet joint injections.

Best outcome, as always, isn't just an injection!

It is important to remember the underlying clinical principles of the Injection-Clinic that pain typically arises from both mechanical and chemical changes.
Whilst an injection will change the chemistry, it is the movement, posture and strength of supporting muscles around the spine that influence the mechanical strain.

As with all conditions aim to improve chemistry and your body's alignment, strength and pattern of movement.

Please Note: There are diseases and pathology that prevent good health irrespective of an individuals actions. The advice in this blog is not a substitute for medical opinion. Always consult your healthcare professional for specific advice on your personal condition. But please remember, best health irrespective of condition will always be optimised if your chemistry is made as good as possible.

 

Platelet Rich Plasma PRP

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Platelet Rich Plasma PRP

Please note: due to current changes in Medical Governing body, PRP is no longer available.
This does not mean the treatment is ineffective. It is due to the classification of the the PRP and how it is considered to be a medicinal product. As such, there is no license for practitioners to make a medicinal product and therefore, despite its success as a treatment, the InjectionClinic can no longer provide this service.

Hopefully this will change!

What is blood made from?

All mammals have a fluid called 'blood' that is pumped around their bodies in a network of blood vessels (arteries /veins).

Blood is made up of many different cells and a fluid called plasma.

Most people have heard of red and white blood cells. The red cells carry oxygen which is an essential element in energy production. White cells help us produce antibodies to fight infection. There are however other bits floating around in the blood plasma which are much smaller. These are called platelets.

What are Platelets?

Platelets contain many different 'factors'. These can plug areas of damage to the blood vessels and prevent leakage; they also stimulate growth and repair. Consequently, to improve healing potential Growth Factors have to be present.

Plasma itself, whilst mostly water, contains many different proteins, electrolytes, vitamins and nutrients such as glucose and amino acids. These too are needed to grow new tissue and generate tissue repair.

Platelet Rich Plasma could therefore be described as a collection of the 'bits' of blood needed for tissue repair.

Do we heal faster if we have more platelets at the site of tissue damage?

Firstly, we don't heal at all if Platelets are not present. So to make sure we heal as good as possible it would stand to reason that there exists a 'best amount'; an optimal level.

But what is this level and how do we know what our own level is?

It is unlikely that we will know our platelet count or what our levels of folate, B12, zinc and magnesium (just to name a few) are. But if we take what we have and concentrate it, then the levels in that sample will be higher.

Always remember to eat well and ensure your diet contains these essential nutrients!

Does the research support the use of PRP?

One of the largest research advice centres in the UK is the National Institute for Health and Care Excellence (NICE). NICE provides guidance to the National Health Service (NHS) with regard to which treatments it should deliver.

The current information provided by NICE states that "the evidence on platelet-rich plasma injections for knee osteoarthritis raises no major safety concerns. However, the evidence on efficacy (its success) is limited in quality."

Chris Creaghan has trailed the use of PRP in early to moderate degenerative joints. The patient feed back is favorable.

Not all PRP injections are the same and over the years Chris has found the best results are attained following a double spin method and the use of an Platelet activator.

Like all treatments, first a diagnosis must be established and the treatment administered needs to be appropriate for the condition.

So what does the Injection Clinic think?

Number one: eat well and make sure you have a diet that contains all the essential ingredients, as mentioned in the last blog 'Body Chemistry'.

Number two: move well. If you don't move well then you will continually irritate the tissues that need chance to repair.

Number three: normal and appropriate healing takes time. When cooking food it is not best practice to put everything on full heat; some things just take longer. Be patient.

Number four: When prepared correctly, PRP can boost your own healing capabilities. There is growing support from Injection Clinic patients that PRP is an effective treatment in the long term management of OA joints.

Please Note: There are diseases and pathology that prevent good health irrespective of an individuals actions. The advice in this blog is not a substitute for medical opinion. Always consult your healthcare professional for specific advice on your personal condition. But please remember, best health irrespective of condition will always be optimised if your chemistry is made as good as possible.

 

Body Chemistry

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Chemistry

The importance of chemistry

In the previous blog, we discussed how pain was initiated from chemical, mechanical and thermal changes.
This article provides a brief overview of how chemistry and chemical /cellular interactions are the foundation of all living things.

Such is the importance of our own chemistry, if we develop a chemical imbalance we get a warning in the form of an ache, a pain or a feeling of 'dis-ease'. As a result of this warning we then have a chance to take action and make necessary changes. Changes that could prevent tissue damage or the development of disease.

Changing your chemistry is easy.

You can change your chemistry in a matter of seconds, either with a thought or a drug. A single scary moment will initiate a cascade of chemical reactions that will change your blood pressure, digestive enzymes, heart rate and much more. A single cup of coffee will do similar things.

After these effects the body fights to regain normality, a balance; what is refereed to as homeostasis.
Unfortunately, sometimes it takes several hours, days or even months for the body to regain normal chemistry. Sometimes, normality cannot be re-attained because of a disease process or because essential ingredients are missing.

The importance of ingredients and the oven

You cannot bake a cake if your oven is broken, you can't make a cake if you don't have any eggs!

Our bodies are constantly cooking up new material and making new tissue. We have a digestive system to process food and extract key ingredients. We have a liver and kidneys to filter out toxins and waste products; the stuff we don't need. We have specialised cells to build new cells and construct new tissue.

For this process to work, we need a working 'oven' and a constant supply of the correct ingredients.
If any part of this process is missing or fails to work, we then have a health problem.

In most cases, if the problem reaches a stage were it could potentially cause damage, then our body will send us a warning. Not an email or a 'whats app' message, but quite often a 'pain'.

Interpretation of the chemical warning

The interpretation of a chemical initiated warning is difficult. How do you know if your painful and aching joints are related to a lack of vitamin D or mechanical wear and tear; or both?

What if you are low on iron, or if your kidneys aren't clearing out all your toxins?
What if your back pain is related to the chemical process that occurs when fighting an infection?
What if you are eating the right foods but your stomach fails to extract the key ingredients?

There are that many chemical reactions that the process of diagnosis is complex and confusing and sometimes seems endless. And, even if a test is positive there is still often another 'why?'.
For example, if a blood test shows your are low in iron; you then have to answer why?
Is it your diet? is it a failure to adsorb iron? or is it a problem in the bodies ability to make red blood cells etc?

What is the solution?

The first and most important thing to do is to have focus on what you have an ability to change.
Don't get caught up in too much specific detail. Firstly, are you putting the correct ingredients into your body??
Remember 'you can't bake a cake without eggs'

There are millions of people who are low in vitamins and minerals and people with highly toxic diets and thousands who are simply dehydrated.
Many people have low levels of exercise and activity and consequently their 'ovens' aren't fully fired up.
There are individuals who are sleep deprived and mentally stressed, anxious and full of negative thoughts.
And these people are still working and living, but feel unwell or tired or have general aches and pains.

The solution is definitely not to cover up this warning with pain medication, but to take action and improve all that is within an individuals control.

Can you make one change today that will improve your chemistry?

Please Note: There are diseases and pathology that prevent good health irrespective of an individuals actions. The advice in this blog is not a substitute for medical opinion. Always consult your healthcare professional for specific advice on your personal condition. But please remember, best health irrespective of condition will always be optimised if your chemistry is made as good as possible.

 

Understanding Pain

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Understanding Pain

The importance of pain

Pain affects us in many different ways, but it is important to remember that pain can only be initiated by changes to one or more of three things: temperature, mechanical force and chemical change.

Pain is our protector

The pain mechanism in all animals is designed to detect changes which could cause damage. We therefore understand, even as a child, that the mechanical impact from falling down or the heat from a fire and the sting of a nettle all result in a painful experience. We therefore learn and modify our behaviour. Pain helps to protect us from damage.

Pain can however become a real pain

The problem with this protection mechanism is highlighted when we develop changes to our body that cannot be healed. A very common problem is tissue degeneration simply from ageing. A worn knee joint for example, affects the mechanical function and stimulates an inflammatory response. Consequently both the mechanical and chemical changes are likely to initiate a pain experience.

This pain experience can be long lasting because the condition lacks the ability to recovery.

 

 

Pain can be deceiving !

Where we feel pain, how it feels, the words we use to describe pain and the impact it has on our life or not accurate in making a diagnosis !

The origin of pain lies within the chemical, mechanical or thermal changes within our body's tissues.

The first job of any examination is therefore to determine which tissues in the body are being affected.

Patient feedback; this could be you?

"Hi Chris

As requested, I wanted to give you feedback following my injection on the 25 August 2023.

Whilst i attended your clinic with an expectation that you would be injecting my knee you injected my hip through my groin.  The resulting decrease in my knee pain has been excellent.  Whilst I still have some discomfort in my right knee, I am able to get up and down stairs far more easily.  I have also been able to walk up to 5000 paces comfortably. I haven't been able to do that since September 2022.  My mobility has improved significantly."

 

How best to manage pain

The first step is to understand why you have a pain experience.

If, for example it is related to a worn joint, then the person needs to understand their problem in terms of mechanical and chemical changes.
Visit 'Your condition' page to see common problems explained in terms of  mechanical and chemical changes.
With this understanding the individual can search to find ways of decreasing the mechanical strain and improving their joint chemistry.

This may sound simple, but many people search to find whys of directly reducing their pain experience. And there is a difference!

The growing problem of pain

It is very tempting to hope for a solution that free's you of pain, takes very little time and is easy to do.
Because most people want this, pain mediation was developed. No need to alter the mechanical strain or improve joint chemistry, just take a tablet.

Unfortunately, this approach only works in the short term. The number of people with long term pain is now growing despite the fact that the amount of pain medication prescribed has increased.

 

What is the solution?

The solution involves education, understanding and appropriate expectations. With a focus on how to achieve best joint movement and the best living chemistry within our body's; we will attain our best health.

This does not mean we live a pain free life, it means we live our life as healthy as we can be.

But remember, as we attain better mechanical and chemical function then our pain mechanism does not have as much a reason to shout out its warning!

 

Please note this post, like all brief explanations only covers the basics for pain arising from muscle, bone, tendon and ligament structures. There are many other factors that influence the experience of pain and much research has been done on the emotional components of pain and the sensitisation of the pain mechanism. 

For more information and links to educational videos please visit 'virtual physio' on the QuickPhys website.

 

Movement-squat

The Importance of Movement

We have previously discussed how our experience of pain is generated by changes in temperature, chemistry and mechanical forces. See Pain, pain and more pain.
And how we move is the key factor in the mechanical strain placed upon our body's.

For many of us we repeat the same activities everyday; and the way we perform these activities is unique to us. No two people are the same or move the same. Consequently the strain on our joints and muscles is slightly different.

For some people their movement pattern is naturally good, they have balance, coordination and strength. For others, their movement is strained and this is either the cause of their injury or the result of injury.
In either case, their movement needs to be improved.

A Simple Forward Bend

Our spines are the same as every other animals, even a Giraffe has seven vertebral bones in its neck; the same as us but bigger. But unlike other animals we stand upright on two legs and therefore we frequently bend forward to pick things up.

Despite bending forwards throughout the day, how many of us actually practice the movement and analyse our movement pattern. Could we bend forward with a better technique?

The answer is yes 100%. Even the best athletes in the sport of weight lifting constantly practice their bending technique. They assess their foot position, distribution of body weight, pelvic tilt, movement at their hips and stability of their spine.
There are infinitive ways in which a person can bend forwards but as general observation, most of us move in-correctly.

 

If in doubt stick your bum out

The purists could pick fault with this statement 'if in doubt, stick your bum out', but as a starting point it helps correct one of the most common faults. People don't release their hip joints.

The lady in the picture demonstrates a simple squat. Her spine is held in neutral alignment and her hips and knees have released to allow the body to drop down.

This movement might look simple, but as a clinician of over 20 years, it is rare that I observe a client who moves like this. Consequently I see many people with knee, hip and back pain.

Remember, if we don't move well, the repeated mechanical strain on joints is likely to initiated a warning.

woman-squatting

How can I improve?

The first thing is to have awareness of your movement. The next time you bend forward stop at the end of the movement and ask yourself where do you feel the weight on your feet. Is it on your toes? maybe your heels. Do you have more weight on one foot than the other.

You can also check where your knees are in relation to your feet.

The video opposite demonstrates a wall squat. By first practising with your bum resting against a wall you can focus on alignment without worrying about balance. Once this movement has been mastered then progress to performing the movement in free standing.
Finally, make sure you then employ this movement during daily activities.

Please note this post, like all brief explanations only covers the basics for pain arising from muscle, bone, tendon and ligament structures. There are many other factors that influence the experience of pain and much research has been done on the emotional components of pain and the sensitisation of the pain mechanism. 

For more information and links to educational videos please visit 'virtual physio' on the QuickPhys website.

 

Pain, pain and more pain

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Pain is a real pain

 

I often get asked by patients, 'why am I in pain?'
Its a natural question, but the real answer might not be what the person was expecting!
As with most things they are many personal opinions and lots of research which can be interpreted in different ways.

I like the first part of the answer to refresh a basic understanding that changes in mechanical forces, temperature and chemistry can all generate a pain response. In summation, you can hit yourself, burn yourself and become poisoned. All these things really do hurt.

With muscle and bone pain, temperature is not really an issue, so most people have pain due to abnormal mechanical stress and strain and chemical changes such as inflammation.
To be more specific, a persons posture or movement pattern can elicit a mechanical strain on any joint, which if repeated for a long time, or performed with force or at speed, will result in the body tissues initiating a warning.

Mechanical

 

 

The video shows the difference in lifting techniques whilst getting the same job done.
The top video will only ever result in back pain. Notice how the spine is flexed and there is no use of leg muscles to make the lift.
It might takes years before this movement generates a warning stimulus, but the pain will come because the movement is wrong.

Inflammation

 

Chemical changes such as inflammation will also initiate a pain response. The next picture shows an inflamed bursa within the shoulder. The inflammatory process  makes the tissue bigger, which can cause further problems as the tissue can then become mechanically squashed.
This situation is a 'chicken and egg' scenario. The mechanical compression causes the bursa to become irritated and inflamed, the inflamed bursa is bigger and therefore gets squashed.

 

ultrasound-showing-shoulder-bursitis

So what is the answer?

 

The answer exists in a tissue based diagnosis.

What tissues are mechanically strained and which tissues are chemically inflamed.

You may experience pain because your shoulder movement is wrong resulting in an inflamed bursa. Or you may have joint irritation due to long term postural dysfunction and/or factors of ageing.

Sometimes 'pain' is more chemical than mechanical, as is the case with Gout.

In any situation, pain is a warning and the diagnosis is the determination of what tissues are mechanically strained or damaged and what tissues are inflamed.

A description of pain is not a diagnosis!

 

A description of pain will not determine what is strained and what is inflamed.

To determine a true diagnosis it requires observation, examination and investigation.
At the Injection Clinic we perform all three in one appointment for a set fee of £75.

If significant chemical changes are identified we can also administered medication. Price for a guided cortico-steroid injection is £75.

One visit: job done. Don't let your pain take over. Find out what is wrong and address the mechanical and chemical factors.

Please note this post, like all brief explanations only covers the basics for pain arising from muscle, bone, tendon and ligament structures. There are many other factors that influence the experience of pain and much research has been done on the emotional components of pain and the sensitisation of the pain mechanism. 

For more information and links to educational videos please visit 'understanding pain' on the QuickPhys website.

 

The error of chasing pain!

All too common problem
The error of chasing pain !
For over two years this person visited their GP with knee pain. Injections and physiotherapy did not improve the symptoms or the persons mobility.
The x-ray below shows the painful knee joint. There are no major changes seen on the x-ray, but because the experience of the pain remained around the knee, so did this persons treatment.

By staying focused on examining how joints and tissues are performing and not chasing the pain, we observed the whole person and in particular examined the joints above and below the knee.

The examination of the hip revealed significant changes. A loss of movement was quickly apparent and further investigation with x-ray highlighted the severe degenerative changes (bottom picture).

severe-oa-hip-joint

Its not uncommon for an experience of pain to mislead both patient and practitioner and therefore it is important not to be lead by an experience of pain alone.

Remember that an experience of pain is your body’s alarm, it is an essential warning mechanism, but the detail of your pain experience is not a reliable indicator of what the true nature of the problem is.

If in doubt get the problem checked out!

Examination and ultrasound scan to assist diagnosis £75. When indicated x-rays and MRI scans can be arranged.

 
 

Treatment for Knee Osteoarthritis

Knee osteoarthritis is not just mechanical wear and tear, it also involves cellular and chemical changes. These changes affect all the tissues that make up a knee joint (cartilage, bone, joint capsule, ligaments and muscle).

In the event of trauma and/or age related changes, the body will attempt to repair damaged tissue. However this process does not replace like for like. Consequently tissue repair can result in changes that further affect the normal function of the joint.

It is therefore essential that both mechanical and chemical changes are minimised.

patient review on treatment of knee pain and osteoarthritis

Mechanical Factors

In order to decrease abnormal mechanical stress on the knee joint there are three keys factors that a person should identify. Their joint alignment, strength and functional movement.

OA knee

The photograph shows a typical valgus alignment of the left knee and the x-ray shows what lays beneath the skin. You can clearly see the erosion of the left side of the knee joint. In this situation mechanical correction by surgery and a joint replacement is likely to provide the best outcome.

severe-oa-knee

Most are not that bad!

Fortunately, most knees with osteoarthritis are not that bad and therefore mechanical improvements can be made via exercises. The video shows good technique for a wall squat. You don’t have go very deep into the squat but it is important to get your hips, knees and feet in good alignment. The squat will improve knee joint strength.

Chemical Changes

The chemical changes within a knee joint can also vary. Many arthritic joints have inflammatory flare ups and at times the fluid within the joint needs to be aspirated. Other chemical changes include Gout. The video shows the technique for joint aspiration.

Chemical changes are not simply achieved by taking excessive fluid out, improvements can also be made by injecting medication directly into the knee. A common injection is a Corticosteroid. This will directly decrease inflammation and can often decrease the persons experience of pain.

Other injections can also be considered. These include viscosupplementation, such as Ostenil and Platelet Rich Plasma (PRP). Please click the button for more information on the different types of joint injection.

Diagnosis is critical for best treatment

For any treatment to be effective it must be tailored to the specific requirements of the individual. There are many other factors that affect knee osteoathritis including problems with the hip joint, foot and ankle. The pain experience itself is not diagnostic, it simply informs the person that they have a problem.

New patient examination and ultrasound scan £75

Please remember that the Injection Clinic provides a high quality service for all your joint aches and pains. Please visit the website for full details.