Osteoarthritis (OA) is one of the most common joint conditions affecting adults. It can cause Pain, Stiffness, Swelling, Reduced mobility and Difficulty performing everyday activities.
When pain becomes difficult to manage, patients may be offered an intra articular injection. For some individuals, this can provide meaningful short term pain relief and make movement easier.
However, an important message for patients is:
- Reducing pain is not the same as treating or reversing osteoarthritis.
What is an intra articular injection?
- An intra articular injection involves delivering medication directly into a joint. Different substances may be used depending on the patient’s condition, including corticosteroids and other injectable therapies.
- This article focuses primarily on intra articular corticosteroid injections, which are commonly used to reduce pain and inflammation associated with osteoarthritis.
- The response varies between individuals. Some patients experience significant relief, while others may experience little or no benefit.
- The duration of pain relief is also variable. For corticosteroid injections, improvement is generally short term, often lasting from several weeks to a few months, although the duration differs between individuals and depends on factors such as the joint involved and severity of symptoms. Evidence suggests that the greatest benefit is usually seen in the short term and decreases over time.
- Therefore, an injection should ideally be viewed as one part of a broader management plan, rather than a permanent solution.
- Pain relief does not mean the joint has healed
- A patient may feel considerably better after an injection and consequently walk more easily, sleep better or perform daily activities with less discomfort.
However, the injection does not automatically:
➤ Restore lost cartilage
➤ Reverse established osteoarthritis
➤ Correct muscle weakness
➤ Improve overall physical capacity
➤ Restore normal movement patterns
The improvement in pain can instead provide an opportunity to restore movement, strength and function.
What can happen after an injection?
- Most injections are performed without serious complications, but patients should understand the possible effects.
- Some people may experience a temporary increase in pain or a “post injection flare” shortly after the procedure. Temporary swelling or irritation around the injection site may also occur.
- Corticosteroids can temporarily increase blood glucose levels, which is particularly important for people with diabetes.
- Although uncommon, infection is a serious potential complication. Increasing severe pain, Significant swelling, Redness, Warmth, Fever or feeling unwell following an injection requires prompt medical assessment.
- Repeated corticosteroid injections should also be considered carefully. Research has raised concerns regarding cartilage loss with frequent repeated injections. A clinical trial involving repeated corticosteroid injections every three months for two years found greater cartilage volume loss without a significant long term pain benefit compared with saline injections.
- This does not mean that a single corticosteroid injection will inevitably damage a person’s joint. It highlights why repeated injections should be based on careful clinical judgement rather than simply repeating them whenever pain returns.
- Understanding osteoarthritis is part of treatment
- Patient education is an important part of OA management.
- Many people believe that osteoarthritis simply means the joint is “Wearing out” and that movement will further damage it. This can lead to fear of exercise and reduced physical activity.
- Patients should understand that appropriate movement and exercise are generally important for managing osteoarthritis.
Education can help patients understand:
➤ What osteoarthritis is and how it can affect the joint
➤ Why pain and stiffness may fluctuate
➤ How to manage activity during painful periods
➤ Why maintaining muscle strength is important
➤ How to exercise safely and progressively
➤ How to manage flare ups
➤ When medical review is required
When patients understand their condition, they can participate more confidently in their own rehabilitation.
Why does weight management matter?
- For people who are overweight or living with obesity, weight management can be an important part of osteoarthritis care, particularly for weight bearing joints such as the knee and hip.
- Excess body weight increases the mechanical load placed on these joints. Weight reduction can help decrease joint loading and may improve pain, physical function and quality of life.
- Weight management should not be presented as blame or as the only treatment for OA. A supportive approach can combine healthy nutrition, appropriate physical activity, progressive exercise and realistic, sustainable goals.
- Even modest weight loss can be beneficial for people with osteoarthritis.
Where does physiotherapy fit?
- Physiotherapy is an important component of long term osteoarthritis management.
- A physiotherapist can help address several factors that an injection cannot directly address.
- Exercise therapy
- Progressive strengthening, mobility exercises, aerobic activity, balance training and functional exercises can be selected according to the patient’s symptoms, physical capacity and goals.
- Improving strength and physical capacity
- Pain often leads people to reduce their activity. Over time, this can result in muscle weakness and reduced physical capacity.
- Progressive strengthening can help patients regain confidence and improve their ability to perform everyday activities.
- Movement and functional rehabilitation
- Physiotherapy can assess walking, stair climbing, sit to stand movements, squatting and other activities that are important to the individual.
- Education and self management
- Patients can learn how to manage symptoms, remain appropriately active, modify activities when necessary and continue an appropriate home exercise programme.
- Supporting weight management goals
- Physiotherapists can help patients identify safe and achievable ways to increase physical activity and can work alongside other healthcare professionals when additional nutritional or weight-management support is required.
- An injection can be a bridge to rehabilitation
- An important way to view an injection is as a temporary window of opportunity.
- If pain is preventing a patient from exercising or participating in rehabilitation, short-term pain relief may make movement more achievable.
Instead of thinking:
- “The injection has fixed my joint.”
The patient should ideally think:
- “My pain has reduced enough for me to work on my strength, movement and function.”
- This change in perspective can influence long term outcomes.
- The goal is function, not simply pain elimination
- Pain is important, but it is only one part of osteoarthritis management.
- A successful treatment plan should also consider physical function, muscle strength, mobility, walking ability, participation in daily activities, physical activity and quality of life.
- A person may still experience some pain while becoming stronger, more active and more independent.
- Therefore, pain reduction should not be the only measure of treatment success.
- The key message
- An intra articular corticosteroid injection can have a role in osteoarthritis management, particularly when short term pain relief is clinically appropriate.
However:
- An injection is not a cure.
- The effect may be temporary.
- Repeated injections require careful consideration.
- Pain relief can create an opportunity for rehabilitation.
- Physiotherapy can help address strength, movement, physical capacity and long term self management.
- The aim of osteoarthritis management should not simply be to repeatedly suppress pain. The larger goal is to help the person move, function and participate in daily life with greater confidence and independence.
- An injection may provide a valuable period of symptom relief.
- Physiotherapy and active self management can help make that period count.
This article is intended for general health education and awareness and does not replace an individual medical or physiotherapy assessment. Treatment decisions should be made in consultation with an appropriately qualified healthcare professional.
Author:
Dr. Vasifa Juveria, Physiotherapist
