The answer could be viscosupplementation and here’s why…

Many are trying to stay out of the surgery room while maintaining the most natural state of the joint. Those who have explored these alternatives have most likely landed on joint injections. But, not all joint injections are created equal. Steroids help reduce pain and inflammation, but do not treat the cause of the issue. They are a great first line of defense, but they simply help make life more bearable as the cartilage breaks down. Other injections like Synvisc or other thicker gels are often administered in lower series of treatments and are dense gels that can help provide cushion for a short period of time, but are a much more foreign feeling substance for your body to react to. These do not mirror the body’s natural synovial fluid close enough to help stimulate regeneration. Viscosupplementation is called just that because it mimics the viscosity of your body’s naturally occurring synovial fluid, that gets depleted over your lifetime.

The viscosupplementation treatments offered at Essence Med Joint Injection Clinic in Council Bluffs are focused on long term results by leveraging medical advancements to optimize the results. It involves injecting that natural gel-like fluid into your knee joint via a precise process utilizing a fluoroscope, a live video x-ray device. Because this gel is much like the naturally occurring hyaluronic acid found in the synovial fluid that normally surrounds your joints, it is important to have exact placement into the space it once was. Joint injections that are done without this technology are not getting to the exact location necessary for treatment.

The Hyaluronan in the injections acts like a shock absorber and lubricant. This lubricant can help make painful joints move more smoothly, reducing discomfort and helping improve function. It has been shown after a series of five or more injections, this type of injection can stimulate the natural production of fluid in the body. With proper bracing, allowing space for the injection to settle, the program is further optimized for successful outcomes.

Read on to learn if this is a treatment you should talk to us about trying.

“HA is a cushion or a buffer against inflammatory cells in the joint,” Caitlin Carlson, NP, says. “In some cases, it can stimulate the knee to start producing more natural HA.” Some physicians also believe that HA helps reduce pain by coating nerve endings within the joint.

A single treatment program, which may consist of up to five injections, usually offers relief for five to six months, but sometimes up to one year or longer and have seen greater success by building on eachother. However, pain and stiffness will return as the fluid breaks down and gets metabolized by the body. It should be done on a very specific schedule within a period of a few weeks and more than one injection is usually required to improve efficacy of the medication. Most insurance companies approve viscosupplementation injections every six months.

Essence Med, Council Bluffs’ Premier Joint Injection Clinic, offers a risk-free consultation. If you have not had a total knee or shoulder replacement and are suffering from osteoarthritis pain or stiffness, you could be a prime candidate for viscosupplementation.thi

What is PRP?

Platelet Rich Plasma. Plasma is the body’s regeneration powerhouse, packing a punch in your body’s natural ability to heal. It is the liquid part of your blood, mostly made of water and protein. It lets red and white blood cells and platelets move through your bloodstream. Platelets are a type of blood cell that makes your blood clot. They also play a major role in healing. You may have heard about athletes like Tiger Woods getting platelet-rich plasma (PRP) injections to help heal an injury. It is becoming more and more common as a leading natural option to repair and put the healing process into hyperdrive. Which is why it has been labeled the “accelerator” for recovery treatment programs. Doctors may use platelet-rich plasma (PRP) on injuries or damage to tendons, ligaments, muscles, joints, and skin.

 

How much does PRP cost? Will my insurance cover PRP?

PRP injections are a newer treatment that have been tested extensively in large-scale trials, especially for osteoarthritis.  These trials demonstrate both the safety and the efficacy of PRP for knee arthritis and arthritis symptoms occurring in other joints throughout the body. PRP can also be beneficial in treating certain tendon injuries including partial tears of the patellar tendon, plantar fasciitis, and elbow tendinitis.  However, insurance plans will not yet cover this type of new treatment. We provide affordable PRP injections, averaging $400 per treatment at Essence Med in Council Bluffs.

 

What should I expect at my PRP appointment?

To collect plasma, our medical team draws blood from your body and uses a machine to separate the platelet-rich plasma from the rest of the blood. The platelets are known to contain anti-inflammatory and growth or healing factors.  PRP has anti-inflammatory capacity, which makes it good for arthritis management.  The centrifuge process of concentrating the plasma and platelets is performed right in our office at your appointment. The area of your body being treated (the site of pain, injury or osteoarthritis) is numbed with a local anesthetic. Once you’re numb, a small needle is used to inject your plasma into the area of your body being treated

Once platelets are in the area that is being treated, they break down and release growth factors, which are compounds that help cells repair and renew. This is thought to trigger your body’s healing process. 

At Essence Med we use live video fluoroscopy during injections to ensure we are getting into the precise location to maximize results of your treatment program. Many providers do not use anything to navigate the needle or use ultrasound to help them guide the needle for treatment. PRP injections can be done this way, but we have a saying in our office, “to see is to know, and to not see is to guess”, and we want to make sure every drop is going into the exact location that will benefit your treatment area the most. We use leading medical technology to pinpoint the most ideal needle endpoint to release the plasma using clear x-ray imagery. PRP injections usually take about 30-45 minutes, though it depends on the area you’re targeting.

 

Is there downtime with PRP treatment?

There is no downtime for PRP treatments. The injections may cause a temporary local irritation for up to 30 minutes following treatment. Ice packs or over-the-counter pain medication should suffice for treating any irritation. Arthritis pain improvement occurs typically within a few days. It is not necessary to stop aspirin or other nonsteroidal anti-inflammatory medicines before or after PRP injections. It is recommended to wait 2 weeks between PRP treatments and 3 weeks before starting any additional injections such as viscosupplementation.

Why Knee Braces?
Custom-fitted knee braces not only help relieve pressure on your knee joint, they also properly shift the knee into it’s intended alignment from years of imbalance.  We get the question, what do knee braces really do? The unloading brace that we custom fit for our patients during this treatment series allows proper spacing in the joint for the medication to settle in without being compressed by the natural pressures of walking and other daily activities. Reducing the pressure on the joint space not only improves the efficacy of the medication, but it also reduces pain due to bone on bone rubbing because it helps mildly separate and evenly distribute the load on your knees, this is why the braces we use are called “unloading braces”. By opening the joint, these knee braces can relieve bone on bone pressure when the leg is extended and the most pain relief is needed.

What can I expect when wearing my knee braces?
Unloader braces are an effective treatment for unicompartmental knee osteoarthritis. They can significantly improve the patient’s quality of life and potentially delay the need for surgery.  Because these braces are custom fitted, they are tailored to the patient in order to best address the current state of their joint. This is done by shifting stress away from the affected side and evening out the pressure put on specific points of the knee. By providing a net varus or a net valgus force for weight redistribution based on the affected area, the femur and tibia are re-aligned for better support, stability, and overall comfort to the patient.

Because this is shifting the alignment, it is common to feel a bit of soreness in the soft tissue surrounding the joint. Similar to shifts while wearing braces to realign your teeth, this is transitioning joint alignment which can release pressure from the bones and joint space, but cause mild muscle fatigue from this transition as the body adapts. You should not experience severe pain and should check your braces regularly for proper fit and placement. Improper use can further injure the joint.

When do I wear my knee braces?
How often you continue to wear your braces is up to you, but it is recommended that patients start out wearing their braces two hours per day in the first week, and by the second week, up to four hours per day. By week three, you can wear your brace for six to eight hours a day, or as needed. We also recommend patients wear their braces through the duration of their treatment program and post-program as needed. Continuing to wear braces while doing strenuous activities or performing tasks that may create added pressure on the joint is beneficial for both the longevity of the joint and can reduce pain during and post-activity.