Treatment Options (General Info)

In this page:

Many Treatment Options
Exercises
Tools
Medications
Injections–”Cortisone Shots”
Surgery

A) Many Treatment Options

Most orthopaedic problems have several possible treatments that you can combine as symptoms come and go. Start simple, add more as needed; cut back when you have less pain. How much you’ll need, and how long it will take to feel better, depends on:

what’s causing your pain an how severe it is
your lifestyle and general health
how you expect your body to perform.

Learn the treatment plans we recommend for specific diagnoses by visiting those pages:

B) Exercises: to build strength, resilience and good body mechanics

Click here for info on Knee Exercises

Rehab exercises:

relieve pain and inflammation
restore range-of-motion
improve strength and endurance
return you to pre-injury activity level
correct unbalanced biomechanics that caused pain in the first place!

You have to be disciplined and consistent for the exercises to “work”. No matter what else is done to help your pain, it won’t work if you slouch or keep beating it up.

Don’t be afraid that physical activity will wear you out! On the contrary, joints are designed for motion, and motion helps circulation nourish your joints. Strong, resilient muscles support and protect their joints and prevent further injury. Start slowly; building strength and flexibility takes time. Be honest with yourself about your starting point and commitment to the program.

“Do I have to go to Physical Therapy?” You might get better on your own if you’re active and motivated, but you deserve the expertise of a Physical Therapist if:

You’re not better after 4-6 weeks on your own
You’re not an exerciser, and need instruction and coaching
You are an exerciser, but have pain from overuse
You need to build strength and endurance after surgery
Your only alternative is surgery and you really don’t want/can’t have it

Many patients don’t like the cost and inconvenience of “going to PT,” but you may need only a few visits to learn proper technique and ensure the time invested in your rehabilitation is worthwhile.

Choosing a PT/OT: We know where all the area PT/OT practices are located, and their special expertise. We usually recommend one that’s convenient to your home or work. Let us know if there’s one you prefer.

Learn the exercises we recommend for specific diagnoses by visiting those pages.

C) Tools: for support while you heal

Heat or Ice? The only time you must choose “ice” is for 48 hours after an injury or surgery. Otherwise, use whichever feels good.

Ice after activity cools inflammation from friction and strain. Cooling the area constricts nearby blood vessels; there’s less swelling, therefore less pain. Heat before activity warms up the joints by opening up the blood vessels, improving the flow of oxygen and healing: in with the good, out with the bad.

Use your ice/heat pack as often as you’d like; start with 20 minutes, three times a day. (Check your skin.) Most packs can be frozen or heated; buy two. Keep one in the freezer, pop one in the microwave you need it.

Braces, orthotics and other stuff: can provide support and stability. For minor problems, it’s OK to try one from the drugstore or sporting goods store. If you’ll need it for long-term use, or are hard to fit, then we’ll prescribe a fitting by an expert.
Complementary and Alternative Therapies like accupuncture, massage therapy, chiropractic, etc… might help your pain. We don’t provide referrals for such treatments, but let us know if you’re already using them.

Learn the tools we recommend for specific diagnoses by visiting those pages.

D) Medications: to relieve your pain and inflammation

Over- the-counter Medications
Over-the-counter (OTC) pain medications relieve joint, tendon and muscle pain. They are effective, serious medicine. Take only enough to relieve your pain. Once you feel better, take fewer pills or take it less often to minimize side effects. Keep track of what you take.

Non-Steroidal Anti-inflammatory drugs (NSAIDs)

Relieve pain by relieving inflammation
Aspirin, Ibuprofen, Advil, Motrin and Naproxen are NSAIDs
Tylenol is NOT an NSAID
Pick the ONE that’s most convenient and works for you; none of them are “better” than the others.
Common NSAID side-effects:
- DO NOT take NSAIDs if you’ve had a stomach ulcer, kidney disease, take blood thinners, or have another fragile health condition. Patients over 65 have to be especially cautious, and only take NSAIDs if followed closely by their Primary-Care Physician.
- Stomach upset, nausea—Eat frequent, small meals and healthy snacks throughout the day. Some prescription NSAIDs, like meloxicam or Celebrex®, are easier on the stomach than ibuprofen or naproxen, and might be a better choice for you.
- High blood pressure—Follow your blood pressure readings carefully. If it goes up, you may have to stop the NSAID.
- Kidney failure—if you have kidney problems, are dehydrated or have poor circulation, avoid all NSAIDs. If you retain fluid and your hands and feet swell, stop the NSAID.
Most healthy patients can handle NSAIDs without problems. If you are conscientious about using these drugs, you’ll feel better while you keep an eye out for side effects.

Examples:
- Ibuprofen = Advil® = Motrin® (they are the same thing!)
  - Each OTC pill = 200 mg, Prescription strength = 800 mg
  - Maximum dose/day = 2400 mg = 12 Advil
  - For severe pain take up to 4 pills, 3 times a day
  - For mild pain take 1-2 pills, 1-2 times a day
- Naproxen = Aleve® = Naprosyn®
  - Each OTC pill = 220 mg, Prescription strength = 500 mg
  - Maximum dose/day = 1000mg = 4 Aleve
  - For severe pain take 2 pills, 2 times a day
  - For mild pain take 1 pill, 1 a day

Acteminophen = Tylenol®

Acetaminophen is NOT an NSAID. It is pain reliever only.
It’s considered safer because it does not irritate your stomach, raise your blood pressure, damage your kidneys or interfere with blood clotting.
Maximum dose/day = 4000 mg
Each pill =
- 325 mg, Regular Strength (Up to 2 pills, 6 times a day)
- 500 mg, Extra Strength (Up to 2 pills, 4 times a day)
- 650 mg, Arthritis Strength (Up to 2 pills, 3 times a day)
Acetaminophen is found in many OTC and prescription pills; be careful and take less than 4000 mg/day. Read the labels and do the math!
Vicodin tablets = 5 mg hydrocodone (an opioid pain medication) and 500 mg acetaminophen, each.

Combine NSAIDs and Acetaminophen Safely

NSAIDs and Acetaminophen (Tylenol) work differently in your body for the same result: pain relief. Take both together to add up their benefits, but lower the risk of side effects by taking less of each.
Try these combinations with a small dose of each medicine. This leaves room to take more as needed for a flare up:

2 Advil + 2 Tylenol, up to 3x/day OR
1 Aleve + 2 Tylenol, up to 2x/day

★ NOTE: Do NOT mix different NSAIDs; be careful about cold-and-sinus remedies that also include aspirin, ibuprofen or acetaminophen!

When should I use over-the-counter (OTC) medications?

If you’re already using one, and it helps your pain without side effects
Pain is intermittent and you only need it a few times a week or with activity
You haven’t tried anything yet, have mild to moderate pain and tolerate NSAIDs

When do I need a prescription NSAID?

If you’re already taking one, and it helps your pain without side effects
If you have stomach problems from standard NSAIDs: try Mobic or Celebrex
If you’re on a blood thinner like Coumadin or Plavix: try Celebrex
If you’re taking consistent, high doses of OTC NSAIDs; prescription generics are cheaper

When do I need a stronger prescription pain pill like Vicodin, Codeine, or Percocet?

If you’re already taking one, and it helps your pain without side effects
If you’re unable to take NSAIDs and Tylenol isn’t enough
If you have severe, acute pain; up to 8/day short term
If you have moderate, chronic pain; up to 2-3 tabs/day is usually OK long-term
If you can’t sleep despite NSAIDs; 1-2 at bedtime is usually OK long-term

E) Injections: to cool inflammation or lubricate your joint

“Cortisone Shots” (Steroid Injections)send a strong anti-inflammatory medicine right to the scene, without the side effects of steroid pills or NSAIDs.
- Two drugs are injected at the same time, and fill the joint, tendon sheath or bursa: a local anesthetic, like novocaine and a corticosteroid, like DepoMedrol®.
- The novocaine numbs it immediately. The steroid will start to work in 2-7 days.
- Your pain will return in about an hour when the novocaine wears off. 1 in 5 patients experience “rebound pain”, and the area that was injected is more painful for 1-2 days until the steroid kicks in. Rest, apply ice, move gently…this too shall pass.
- Pain relief could last for months or years, when combined with good habits and basic medications. If your pain comes back, it might be time for surgery.
- There’s no hard-fast rule about how often you can have a cortisone shot. You may have heard that “you can only have 2 or 3 shots per year.” At this rate, you’re getting at least 4-6 months of relief. For patients who can’t have surgery, periodic steroid injections could be the answer.
It’s important to know…
- …unlike arthritis pills, cortisone shots don’t interact with other medicines. If you take a lot of pills, then a shot into a painful joint or two might be your safest option.
- …there aren’t many side effects from cortisone shots. Injecting steroid medication into an inflamed joint is not the same as taking steroids long-term by mouth.
- …that diabetic patients may have higher blood sugar level after the shot. Continue your usual diabetes medicine regimen and it will stabilize within a few days.
- …that steroid injections don’t cure arthritis; they quiet inflammation that is causing pain.
- …you can’t become or “hooked” on the shots. Inflammation from wear-and-tear happens at different rates in different patients. Joints with more wear have more friction and need stronger treatments.
- …your pain will come back if you don’t address the reason it started in the first place. Learn to use your joints and tendons properly; exercise to keep your muscles and ligaments strong and flexible.
Will it hurt?“Friends” may have told you the shots are painful. Please don’t let them frighten you!
- The whole process takes about 10 seconds. A very thin needle is used, so you only feel a slight prick.
- The needle goes into the space between the bones, not into the bone.
- The novocaine might burn as it fills the joint until it gets numb.
- About 2 teaspoons of medicine are placed into a knee or shoulder, less is used for smaller joints, like wrists and fingers.
- At first it may feel strange and full. Notice your immediate response–your pain will be gone and you’ll stride comfortably out of the office!
Synvisc and Euflexxa:are special injections that relieve pain and stiffness in arthritic knees by lubricating the worn surfaces.
- Why/how Dr. Siegrist uses Synvisc and Euflexxa
- Instructions after Synvisc and Euflexxa
- Visit Synvisc.com, Euflexxa.com

F) Surgery: to correct structural problems that won’t resolve otherwise

Learn about surgery for certain diagnoses by visiting those pages.