Shots: Cortisone / Steroids and Prolotherapy

[Guest guest]

Dear Community,

I have previously written some on myself on this forum, but let me just briefly

lay out the context of my worries and inquiries. I hope I could find someone

with a similar condition, although I believe many here have more severe

consitions:

I was a frequent runner (many miles, several times a week, laid back running

with heavy heal strokes, you name it, probably combined with too low an intake

of good fat and lack of some hormones) until last October when I started having

pain in one knee during and after running. Since two weeks after this, I have

not run or biked, done PT constantly according to all the rules and

recommendations, tried Aleve and weaker anti-inflammatories without success and

have not found bracing helpful.

A sports medicine doctor and an orthopedist both gave me basically the same

message from looking at my MRI: Chondromalacia, 40 % into the cartilage. Mild,

probably no loose parts in there that an orthroscopy would pick up, but it might

not hurt to do one. But the bottom line is: Your cartilage wear is not that bad,

so just live with it, and you should be able to do, at least low impact, sports.

With a small implication that I am probably a girl who is just complaining

excessively.

I saw another orthopedist the other day who gave me the message I suspected

after reading abou him: Cartilage does not hurt itself. Yes, my CP is minor but

there is no statistical correlation between CP and knee pain. Good: The pain

should be curable. Bad: You cannot tell what is really wrong. I have a lot of

pain behind my knee, often on the side, sometimes it changes to the other side,

and after walking, the pain is often under the kneecap. My last doctor said that

the whole area is probably " irritated " , which is aggrevated if you work with it,

and which just does not heal as the area just keeps irritating itself back and

forth.

While being clueless about what actually causes knee pain, I assume most people

do not actually know, try various things and may find something that works.

Now to the shots: Cortisone / steroids: Dampens inflammation. If an area is

" irritated " I guess that it may make sense to take it all away and hope it does

not come back again and the whole area calms down. Prolotherapy: Exactly the

opposite, starts an inflammation in order to start a healing reaction.

So depending on if an " irritation " or whatever causes the knee pain implies

inflammation or that something is " broken " that should be " healed " one will be

right and not the other. I should add that I am a bit afraid of cortisone,

reading a lot of scarty stuff about side effects, while reading good stuff on

prolo, so I am biased.

If anyone out there has had similar inquiries, or could supply me with any input

on what shot to go for, I would be very grateful

Best,

Lotta

[Guest guest]

Lotta,

I've read a number of your posts and sympathize with what you're going through.

I had a long struggle with this same condition, which I gradually overcame (and

wrote a book about the experience later, because there is so much bad advice out

there -- there is a tendency as you've no doubt observed for doctors to simply

shrug or say " listen to your knees " in some glib way and not put a patient on a

long-term track for healing -- and healing is, unfortunately, long-term, say

over a year or two).

Just a few quick things before I head off to work (I have a blog too and a

website where I share my thoughts -- the nice thing about this forum is you'll

find a diversity of opinions and experiences, and a lot of empathy all around).

The degree of chondromalacia maps imperfectly to the pain felt. There is a

correlation, but it's faulty. When you injure your cartilage, if it's not a

sudden, traumatic tear for example (I did a lot of reading on this), the first

changes are deep in the tissue and I suspect they're not even detected on MRI.

You might want to look into the " pain transmission belt, " if you will, for

injured cartilage. There are a couple of main ways that, it's theorized, bad

cartilage leads to pain sensations. The tissue itself has no nerve endings. All

this is very significant for any healing plan.

Doug Kelsey at Sports Center in Austin has a lot of writings on his blog (he's a

PT) that are VERY smart about healing knees with chronic pain. Another member of

this forum, Lawrence, went through the Kelsey program and may want to chime in.

I followed a lot of Kelsey's principles in crafting my own recovery.

Yes, I'd be a bit wary too of going the cortisone route. I think cortisone may

leave a chemical residue in the joint. Maybe not an issue for one shot -- or

even 2 or 3 -- but if you have to keep going back, there could be. Kelsey

believes in prolo, I think, and that's natural-based, so may be worth looking

into. Just don't expect any quick fixes.

A few thoughts! Gotta run. Best of luck!

www.savingmyknees.com

>

> Dear Community,

> I have previously written some on myself on this forum, but let me just

briefly lay out the context of my worries and inquiries. I hope I could find

someone with a similar condition, although I believe many here have more severe

consitions:

>

> I was a frequent runner (many miles, several times a week, laid back running

with heavy heal strokes, you name it, probably combined with too low an intake

of good fat and lack of some hormones) until last October when I started having

pain in one knee during and after running. Since two weeks after this, I have

not run or biked, done PT constantly according to all the rules and

recommendations, tried Aleve and weaker anti-inflammatories without success and

have not found bracing helpful.

>

> A sports medicine doctor and an orthopedist both gave me basically the same

message from looking at my MRI: Chondromalacia, 40 % into the cartilage. Mild,

probably no loose parts in there that an orthroscopy would pick up, but it might

not hurt to do one. But the bottom line is: Your cartilage wear is not that bad,

so just live with it, and you should be able to do, at least low impact, sports.

With a small implication that I am probably a girl who is just complaining

excessively.

>

> I saw another orthopedist the other day who gave me the message I suspected

after reading abou him: Cartilage does not hurt itself. Yes, my CP is minor but

there is no statistical correlation between CP and knee pain. Good: The pain

should be curable. Bad: You cannot tell what is really wrong. I have a lot of

pain behind my knee, often on the side, sometimes it changes to the other side,

and after walking, the pain is often under the kneecap. My last doctor said that

the whole area is probably " irritated " , which is aggrevated if you work with it,

and which just does not heal as the area just keeps irritating itself back and

forth.

>

> While being clueless about what actually causes knee pain, I assume most

people do not actually know, try various things and may find something that

works.

>

> Now to the shots: Cortisone / steroids: Dampens inflammation. If an area is

" irritated " I guess that it may make sense to take it all away and hope it does

not come back again and the whole area calms down. Prolotherapy: Exactly the

opposite, starts an inflammation in order to start a healing reaction.

>

> So depending on if an " irritation " or whatever causes the knee pain implies

inflammation or that something is " broken " that should be " healed " one will be

right and not the other. I should add that I am a bit afraid of cortisone,

reading a lot of scarty stuff about side effects, while reading good stuff on

prolo, so I am biased.

>

> If anyone out there has had similar inquiries, or could supply me with any

input on what shot to go for, I would be very grateful

> Best,

> Lotta

>

[Guest guest]

Dear ,

Thank you so much for your reply. I sure do recognize the " listen to your knees "

comment. It is a bit frustrating when you are paying docs to be experts, it

would be better if they could just say " I do not have a clue, sorry. "

A doctor told me that cortisone is basically the stronger form of taking

anti-inflammatory: it severely recudes inflammation. If anti-inflammatories seem

to work but not enough, he claimed, that would be worth trying. Well, Aleve is a

painkiller and I have been feeling much better taking it for a week, but it is

probably most the pain-killing effect that I am enjoying. It does seem there are

some downsides to cortisone /steroids, which I take out just from hear-say from

different people with other conditions, in addition to your comment.

It seems there are not downsides (except for a thinner wallet) in trying

prolotherapy, however, at least I have not heard of it. So seeking in the blind

for remedies, I believe that is what I will try out first, give it a shot, in

other words, if you appreciate the pun.

I hope that anybody who has heard bad things about prolo would give me a wink.

" pain transmission belt " - I cannot find the concept by Googling. Perhaps you

could send me a link?

Again, thank you so much for your reply.

Best,

Lotta

> >

> > Dear Community,

> > I have previously written some on myself on this forum, but let me just

briefly lay out the context of my worries and inquiries. I hope I could find

someone with a similar condition, although I believe many here have more severe

consitions:

> >

> > I was a frequent runner (many miles, several times a week, laid back running

with heavy heal strokes, you name it, probably combined with too low an intake

of good fat and lack of some hormones) until last October when I started having

pain in one knee during and after running. Since two weeks after this, I have

not run or biked, done PT constantly according to all the rules and

recommendations, tried Aleve and weaker anti-inflammatories without success and

have not found bracing helpful.

> >

> > A sports medicine doctor and an orthopedist both gave me basically the same

message from looking at my MRI: Chondromalacia, 40 % into the cartilage. Mild,

probably no loose parts in there that an orthroscopy would pick up, but it might

not hurt to do one. But the bottom line is: Your cartilage wear is not that bad,

so just live with it, and you should be able to do, at least low impact, sports.

With a small implication that I am probably a girl who is just complaining

excessively.

> >

> > I saw another orthopedist the other day who gave me the message I suspected

after reading abou him: Cartilage does not hurt itself. Yes, my CP is minor but

there is no statistical correlation between CP and knee pain. Good: The pain

should be curable. Bad: You cannot tell what is really wrong. I have a lot of

pain behind my knee, often on the side, sometimes it changes to the other side,

and after walking, the pain is often under the kneecap. My last doctor said that

the whole area is probably " irritated " , which is aggrevated if you work with it,

and which just does not heal as the area just keeps irritating itself back and

forth.

> >

> > While being clueless about what actually causes knee pain, I assume most

people do not actually know, try various things and may find something that

works.

> >

> > Now to the shots: Cortisone / steroids: Dampens inflammation. If an area is

" irritated " I guess that it may make sense to take it all away and hope it does

not come back again and the whole area calms down. Prolotherapy: Exactly the

opposite, starts an inflammation in order to start a healing reaction.

> >

> > So depending on if an " irritation " or whatever causes the knee pain implies

inflammation or that something is " broken " that should be " healed " one will be

right and not the other. I should add that I am a bit afraid of cortisone,

reading a lot of scarty stuff about side effects, while reading good stuff on

prolo, so I am biased.

> >

> > If anyone out there has had similar inquiries, or could supply me with any

input on what shot to go for, I would be very grateful

> > Best,

> > Lotta

> >

>

[Guest guest]

Lotta,

Yes, that is something that annoyed me too. Why don't doctors just say, " I don't

know and frankly I don't consider it important to know the cause of your pain. "

Then at least you'd have honesty! There is instead the pseudo-diagnosis of

" patellofemoral pain syndrome " that some make. This diagnosis, when broken down

to its constituent parts, when all the impressive-sounding medical words are

demystified, simply says you have ... knee pain (around the kneecap)!

Sorry if I threw you off balance with my personal colorful idiom. " Pain

transmission belt " is just a phrase I coined (probably badly) to make the point

that with cartilage damage the pain sensation is not transmitted directly from

the injury, in a simple manner, as when you bang your thumb with a hammer.

Here is what I wrote in my book (about the two main sources of knee pain with

such damage):

" The first culprit: the bone lying under the cartilage (for example, the femur

or tibia). It happens to be nerve rich. Normally cartilage protects the bone

from excess pressure, such as from long periods of bent-knee sitting. When

healthy, the rubbery tissue transfers load agreeably. When not healthy, look

out. The adjacent bone is exposed to more stress and responds by firing off pain

sensations. "

" The second culprit: something called the " synovium. " It's a membrane that lines

the knee's joint capsule and seals in the synovial fluid. For a knee pain

sufferer, the synovium can become irritated through a multi-step process that

may begin with something as simple as a brisk trot across the parking lot. "

" Inside the joint, the force from that act of running shears off fragments of

soft cartilage. Along with related debris, they float about in the synovial

fluid. (Doug Kelsey colorfully likens the fluid at this point to a snow globe.)

Eventually they reach the synovium (which, like bone, has plenty of nerves

unfortunately). It absorbs the cartilage remnants and the assorted cellular

detritus and becomes inflamed and possibly swollen, communicating a dull aching

to your brain. "

Anyway that's all from my research (which I did a lot of; journalism training

does have its uses). Cheers.

www.savingmyknees.com

> > >

> > > Dear Community,

> > > I have previously written some on myself on this forum, but let me just

briefly lay out the context of my worries and inquiries. I hope I could find

someone with a similar condition, although I believe many here have more severe

consitions:

> > >

> > > I was a frequent runner (many miles, several times a week, laid back

running with heavy heal strokes, you name it, probably combined with too low an

intake of good fat and lack of some hormones) until last October when I started

having pain in one knee during and after running. Since two weeks after this, I

have not run or biked, done PT constantly according to all the rules and

recommendations, tried Aleve and weaker anti-inflammatories without success and

have not found bracing helpful.

> > >

> > > A sports medicine doctor and an orthopedist both gave me basically the

same message from looking at my MRI: Chondromalacia, 40 % into the cartilage.

Mild, probably no loose parts in there that an orthroscopy would pick up, but it

might not hurt to do one. But the bottom line is: Your cartilage wear is not

that bad, so just live with it, and you should be able to do, at least low

impact, sports. With a small implication that I am probably a girl who is just

complaining excessively.

> > >

> > > I saw another orthopedist the other day who gave me the message I

suspected after reading abou him: Cartilage does not hurt itself. Yes, my CP is

minor but there is no statistical correlation between CP and knee pain. Good:

The pain should be curable. Bad: You cannot tell what is really wrong. I have a

lot of pain behind my knee, often on the side, sometimes it changes to the other

side, and after walking, the pain is often under the kneecap. My last doctor

said that the whole area is probably " irritated " , which is aggrevated if you

work with it, and which just does not heal as the area just keeps irritating

itself back and forth.

> > >

> > > While being clueless about what actually causes knee pain, I assume most

people do not actually know, try various things and may find something that

works.

> > >

> > > Now to the shots: Cortisone / steroids: Dampens inflammation. If an area

is " irritated " I guess that it may make sense to take it all away and hope it

does not come back again and the whole area calms down. Prolotherapy: Exactly

the opposite, starts an inflammation in order to start a healing reaction.

> > >

> > > So depending on if an " irritation " or whatever causes the knee pain

implies inflammation or that something is " broken " that should be " healed " one

will be right and not the other. I should add that I am a bit afraid of

cortisone, reading a lot of scarty stuff about side effects, while reading good

stuff on prolo, so I am biased.

> > >

> > > If anyone out there has had similar inquiries, or could supply me with any

input on what shot to go for, I would be very grateful

> > > Best,

> > > Lotta

> > >

> >

>