Melissa had been going from doctor to doctor for years trying to get relief from her knee pain. Each doctor told her something different: it’s the meniscus, it’s arthritis, it’s tendinitis… and to do injections for it. She did that for years. 3 injections a year for what felt like ages. They worked well enough that she could keep doing her normal thing: she was exercising and jogging a few days a week. Then the injections stopped working. Melissa was too young for a replacement so her doctors just told her to keep taking the pills and wait it out until she was old enough for a knee replacement. But to not wait too long because if the joint is too damaged the replacement doesn’t do well. She was stuck between a rock and hard place. She had to get older, and her arthritis had to get back enough for her to be eligible for the replacement, but not so bad that the replacement wouldn’t work. 

What Melissa didn’t know was why the cortisone injections stopped working. The ibuprofen was working, that helps inflammation, cortisone helps inflammation.

Why didn’t the cortisone get rid of my knee pain?

Why doesn’t the cortisone work anymore?

The cortisone wasn’t working for Melissa anymore because cortisone injections help the inflammation that is localized to the area she was getting the injection: so in her case her knee. So what’s the issue? Well, if the cortisone isn’t working when it’s injected into her knee, but the ibuprofen pill is working when she takes it… then the inflammation she has isn’t localized to the knee. It’s systemic, it’s going through the whole body. This happens when acute inflammation isn’t completely resolved.

Do NSAIDs help with knee pain?

Then as the months went on the ibuprofen stopped working for Melissa.

She was taking 2 ibuprofen a day for months (maybe even years) and it was working nicely. Then all of a sudden the ibuprofen doesn’t work anymore. Now what was she going to do? This was the point where she was introduced to me and we worked together in the step-by-step program to get her feeling better. What she didn’t know was that the body gets used to the dosage of the pills… she builds a tolerance to it and she needs to take more and more to get the same effect. So 2 pills no longer worked, maybe she would need to take 3 or 4 pills, I’m not sure I don’t prescribe medications, I leave that to my clients’ physician. 

Anti-inflammatory diet for knee pain

How to get rid of inflammation when cortisone and pills don’t work.

When Melissa found me she was frustrated. She had pain, she couldn’t run anymore and she felt like she was going to get worse if she just sat around doing nothing. She ate a normal American diet and didn’t think much of it. One of the first things we worked on (after finding her a pain relief modality to use at home) was her diet. The typical American diet involves a lot of sugar, and a lot of saturated fats and trans fat. None of these serve the body well when there is pain and inflammation. Sugar, saturated and trans fats contribute to inflammation, making it worse. Melissa worked for the first 6 weeks or so to reduce and eliminate sugar, saturated fats and trans fats from her diet, and switch them out with unsaturated fats. Not only did she start feeling better, she even had more energy.

Strength exercises for knee pain

Taking advantage of a strength routine after cortisone injections

One thing that Melissa didn’t do (and honestly she didn’t know to do) was when she was getting the cortisone injections she wasn’t taking advantage of that time to strengthen her legs.

When I lived and worked in Rhode Island I worked closely with a pain management physician and he would do injections or other procedures and send the patients to me for PT. We coordinated the round of PT to match up with the injections, typically starting the day after the injection.

The patient and I would work together to find comfortable exercises to do while the injection is just kicking in and things are still sore. Then once the injections get rid of the pain we work to find exercises that will strengthen the muscles at the knee, at the back/core, at the hip and at the ankle so the whole lower half of the body is supported. This makes it much less likely to have problems in the future.

My favorite exercise that I do when my knee feels tight and sore is the heel slide.

My favorite exercise to do for strength when it hurts too much to use the knee is the straight leg raise.

If you’re looking for knee pain relief check out this free guide I created just for you