Training & Nutrition - To any Docs around, what about cortisone shots?

This looked like the best forum to post my question in.

I'm a 34 yr old woman, and since high school I've mainly worked in jobs where I'm standing on hard floors for the better part of the day. I started cycling a few months ago, and while I'm losing weight and getting in better shape, I still have alot of trouble with my knees.

I'm sure weight has been a factor, since I've never been considered anywhere near skinny in my adult life. Right now I'm down to the same weight I was when I met my hubby four years ago; I've lost 35 pounds and deffinitely gained some muscle; I've also dropped two "X's" on my clothing labels :D

My knee problems have been developing gradually over the years, from pops and creaks to occasional flareups of pain. The word "occasional" doesn't come into the picture anymore; my knees are only NOT in pain when I'm sitting down and not exerting any pressure on them. If I have to even bend over to pick something up, suddenly I feel like I'm 80 years old.

Kneeling and standing again, or getting up and down off the floor, is getting to be downright impossible - the pain from pushing myself up is really very bad. And there have been times when I've done something like climb into the bed of a pickup truck and basically stepped up into it on one foot, only to find myself laying in the bed of the cab sobbing. That has only happened a couple of times, thank God, but I don't think I've ever felt such pain in my life. :(

I had hoped cycling would improve things, and as I said there have been deffinite physical improvements, but the knees don't seem to be improving. I've used ibuprofen now and then (I don't like to use medicines any more than I have to, and they aren't all that effective on me anyway). I've also been using Aspercream, but it doesn't do alot for me either. I take a Magnesium suppliment (I have a mag defficiency) and oyster shell calcium; I keep forgetting to buy more MSM with Glucosamine, but I take that when I have it, too.

Does anyone know if cortisone shots might be the answer? I have thought about it in the past (I have some arthritis in my hips, as well, but that actually HAS improved since I started getting more exercise and cycling). I'm so ready to just hop on my bike and ride ride ride, and I have been riding about 30-50 miles a week, but the results - some swelling to the left side of my left kneecap, alot of stiffness for an hour or two afterward, and ALOT of pain after standing 4-5 hours in one place at my other job (which ends Saturday, I gave notice) makes me cringe at the thought of cycling much more than that.

Anyone have some advice for me? :(

PS, does anyone know how much cortisone shots actually cost?

Hopefully you have insurance as I'd recommend seeing an orthopedist. I went through a lot of pain in my right knee a couple of years ago. Both knees bothered me but the right got really bad. Finally saw the doctor, got the knees MRI'ed, and found out what the problems are. After arthroscopic surgery on the right knee, it's about 1000% better. Not perfect — neither knee is, nor will they ever be — but no longer constant pain and swelling. The surgery was well worth the time and trouble. (And thank God for insurance.)

Knees wear out. Genetics, sex (M/F), weight and extent of prior injuries (serious injuries resulting in several months recovery or surgery) are the major influences on how fast they wear out. Women have smaller bones hence the cartilage is subject to greater pressure and wears out faster. Excessive body weight, especially starting in adolescence, does the same. Family history of degenerative joint diseases (lots of family with total knee replacements) suggests a genetic factor that will probably apply to you. Prior injuries increase the rate of development of degenerative joint disease.
A fractured bone that involves a joint surface on a weight bearing joint is almost certain to be a future problem regardless of the quality of the original repair. Cartilage tears (menisceal tears), ACL and collateral ligament injuries likewise tend to increase the rate of decay of knee function. A lot of high school athletes find this out in when they get into the late '30s to '40s age bracket. Cortisone shots are a temporary treatment for relatively acute inflammatory processes, they might help for a time frame of weeks to months. Chronic progressive problems such as you seem to be having suggest the need for orthopedic or rheumatologic evaluation which will probably culminate in MRI which is the best way to evaluate soft tissue problems.
Realistically you need to lose a LOT of weight. It is not easy, it will be the most difficult thing you have ever done. You have made a start though and having done this you know you can do it. Exercise is important and bicycling has relatively low stress on the knees, not no stress, but lower than most aerobic activities. If surgery is suggested it might be prudent to get two opinions, surgery also accelerates degenerative joint disease, and cartilage surgery can only be done a few times before you end up with no cartilage at all. I am not saying don't have surgery if needed, but that it should really be needed.

Addendum: Costs, can't be specific but joint injection is likely to be in the $75 to 250 range, depending on where you get it. Orthopod and ED will go at the high end of the range (may be a lot more than that)
and walkin clinic at the low end. Injectable steroids used to be in the $5-10 range just for the medication but now I see prices of 3-5x that as the basic cost for the medication alone. To get one under $150-200 is going to be difficult. MRI will run $1200 to 2500 depending, per joint. Dedicated small MRI machines would be cheaper a bit maybe $800 but are not very common.
Steve

It may be as simple as needing orthotics. Standing a lot is hard on the arches. Even the $25 Superfeet insoles should help, also Spenco and others make them. Any kind of foot problem can cause knee pain because mis-alignment drastically affects the knees since they connect it all together.

An othopedist and/or podiatrist should be able to help you determine the cause. Also, Glucosamine and chondoitin taken long term, help rebuild the cartilage and relieve swelling. I would avoid Cortisone shots for now until you find out what is really wrong first. They will be only temporary relief anyway.

It wasn't clear from your message if the cycling has worsened your problem, but if it has - stop immediately until you find out what is wrong. If you have an injury it will just exacerbate the problem.

I congratulare you on the weight loss, but as mtnroads said, I would avoid the cortizone shots. And DEFINATELY take Glucosamine, chondoitin and MSM, every day to help rebuild the cartlilage. I had problems with my knees a few years ago and had Arnica injected into them and helped reduce the swelling and pain. My acupuncture Doc recommended Arnica ove cortizone and I read that you should never have the same area injected more than twice with Cortizone. Hope this gives you something to think about.

Okay. I'll skip the cortisone, especially if it's not a long-term solution. I'll get more MSN and Glucosamine as soon as I have the funds (probably next weekend), and make sure I stick to it. I haven't had any knee injuries, so I'm sure it's just built up over time; and both of my parents have rheumathoid arthritis, so it's possible genetics do play a big part in it for me. I also have fallen arches (for about 10 years now), so that's probably a good clue, too.

As I said, I've given notice at the cashier job, and Saturday is the only day I have left to work. The biking has not worsened my problem, it's just not gotten better; I had hoped building up the muscles in my legs would help alleviate the stress on my knees.

And yes, I intend to work even harder at losing weight. I've already lost two inches each up top and at the hips, and about four at the waist. Now it's time to dust off the Windsor Pilates dvds and get busy :rolleyes:

As far as those costs go, it's not likely I'll ever be able to afford an MRI. My cashier job is/was part-time and there's no health insurance as an independent contractor delivering newspapers (only accident insurance). My mother goes to a clinic in a nearby city that takes uninsured and low-income patients and gives treatment and prescriptions at little or no cost, so if need be I can try going there.

Thank you to everyone who posted, I'm really glad I asked before jumping in too deep! I'll keep cycling, start pilate-ing and increase my healthy eating habits (glad I didn't buy those Doritos tonight :lol: ), and keep up with the suppliments, and I'll see what happens.

Zee