Treating knee osteoarthritis is, basically, we can break it down into two components. There's reducing the inflammation within the knee, and then there's getting all of the muscles and the biomechanics right to take the pressure off of the knee so that the same forces aren’t going through it so the inflammation doesn’t re-accumulate.

When the pain’s not getting better with physical therapy, or if the pain is interfering with the person's ability to participate with physical therapy, one, there are oral medications to help with the pain—they’re not going to fix anything but they can certainly help with the symptoms. And also there are different kinds of injections that one can do in order to take away the pain and inflammation from the arthritis.

The two broad categories. One is steroids. You can put steroids into the knee, which are certainly not going to fix the arthritis in the knee but they will open up a window of opportunity during which a person can take advantage of not having the pain in the knee in order to stretch, and strengthen, and be more active, lose the weight, and tweak the biomechanics, in essence, so that the pain doesn’t come back in three or six months because the mechanics have been shifted so the same forces aren’t going through the knee.

The other broad category of injections are hyaluronic acids. This is basically like putting an oil change into the knee, right? Hyaluronic acid is basically joint fluid. What happens in arthritis of the knee is that you start to lose some of the joint fluid. And what the pharmaceutical companies have done is they've created a synthetic joint fluid that you can put back into the knee through a series of injections. Depending on the brand that you use, it’s either one, or three, or four, or five injections series that you do.

What this is sort of like, it’s sort of like paving the potholes in the road. If you think of arthritis as sort of potholes in the road, this just puts a coat over it, it lubricates it. Again, you’re not fixing the arthritis; the injections do wear off over a period of typically six months. But if you use that time, if you use the time when the pain is better and the inflammation is down again as a window of opportunity during which you can stretch, and strengthen, and affect the biomechanics, then ideally as the medications wear off, the pain won’t come back because the mechanics have been tweaked.

Dr. Grant Cooper is a physiatrist with several years of clinical experience, specializing in the non-surgical treatment of spine, joint, and muscle pain. He is the Co-Founder and Co-Director of Princeton Spine and Joint Center and the Co-Director of the Interventional Spine Program. Dr. Cooper has authored and edited 15 books.