In clinical practice, patients with stiff, sore joints seem to prefer use of warm, moist heat. Patients with swollen, inflamed joints, or joint injuries prefer ice.

The best medical guidance we can give is to avoid causing problems with heat or ice. If you have any impairment in sensation or feeling, like diabetics with neuropathy, you should probably avoid using heat or ice to prevent burns and tissue injury. Electric heating pads can cause severe burns. Do not use a heating pad when you may fall asleep.

Ice can freeze tissue, and cause damage if left on too long. A general rule of thumb is to apply ice for about 20 minutes, allowing the skin to return to normal temperature before re-applying the ice.

Physical Therapy :
Physical therapy (PT) is an important part of both surgical and non-surgical care for joints. Physical therapists are specially trained in techniques to improve muscle tone, decrease stiffness, improve walking and preserve remaining joint function. Physical therapy may include:
   - Exercise to strengthen muscles
   - Stretching to decrease stiffness
   - Ultrasound / modalities to stimulate healing
   - Gait training – improve your ability to walk.
   - Braces or splints to stabilize deformities
Your physical therapist will evaluate your condition, and work with your doctor to design a program specifically for you. During the initial phase, you may work with or under the supervision of the therapist, later progressing to work on your own.

Exercise:
Regular exercise has many health benefits. Exercise helps people with arthritis stay active longer. It can improve balance, and is beneficial for osteoporosis. If you have health problems, consult your doctor before starting an exercise program. If you already have joint problems, a physical therapist can design a program to get you started.

For patients with significant hip and knee arthritis, exercise in water is a good option. Water exercise provides resistance to strengthen muscles, while buoyancy decreases pressure on the joints. The Princeton Health and Fitness Center is a great resource for year round exercise in the Bluefield / Princeton area. The fitness center’s therapy pool is ideal for patients with arthritis.

Joint fluid supplementation:
Joint fluid supplements like Synvisc and Hyalgan are injected directly into the joint once each week for 3 to 5 weeks. These medications claim to supplement the lubricating function of normal joint fluid. They do not cure arthritis.

Some studies report 85% of patients with moderate arthritis will experience significant temporary relief of pain and stiffness. In our practice, only 5-10% of patients respond.

The medication for 3 shots costs roughly $1,000.00. Medicare and many insurances cover joint fluid supplements, but require documented trial of at least 2 other treatments first.

In our practice, we recommend a trial of joint fluid supplements for a select few patients due to the high cost of the medication and the low number of patients that respond to the medication.

Cortisone Shots:
Cortisone or steroids are potent anti-inflammatory medications. Cortisone may be injected directly into joints, or the soft tissues around joints to decrease pain and swelling. Injection may be coupled with aspiration, or drawing fluid off of the joint. Injection may provide rapid onset of temporary relief of arthritis or inflammatory joint pain.

The response to joint injection depends on the patient and the condition. For gout, injection of the joint at the base of the toe, or other inflamed joint can provide almost miraculous improvement. For OA, a large percentage of patients achieve temporary relief lasting from a few weeks to 6 months. Eventually, the shots lose effectiveness for most people.

Side effects / risks of joint injection: Many patients may experience facial flushing (hot flashes), irritability and restlessness at night for a few days. Patients with diabetes may experience a temporary increase in blood sugar readings. A small percentage of patients may retain fluid for a few days as well. Infection has been reported, but is fortunately rare.

In most cases, joint injection should be limited to 3 injections per joint per year. Excessive joint injection can lead to softening of the cartilage and weakening of tendons about the joint.