nSTRIDE treatment offered at the Midland Knee Protect Clinic mentioned in Daily Mail article< Back to the news
As an explorer, adventurer and lover of endurance sports, a stint on Strictly Come Dancing should have been a breeze for Steve Backshall.Yet the BAFTA-winning television presenter faced an endurance battle, as he jived and quick-stepped with partner Ola Jordan in 2014, as a result of agonising pain in his right knee; pain which would subsequently be diagnosed as osteoarthritis. ‘It was just awful,’ recalls Steve, 48, who lives in Berkshire with wife Helen Glover, the Olympic gold medal rower, and their three children, Logan, three, and twins Kit and Willow, one. ‘My knee had been giving me a bit of trouble ever since I broke my left ankle in a climbing accident in 2010. It took 11 operations to try and fix the ankle but I never let up on my expeditions and adventures. ‘Throughout that time, to compensate for the weakness on my left, I was putting pressure on the opposite side of my body — and my right knee was absorbing all that. ‘The pain in my knee started slowly, but by the time I was on Strictly it was agony.’
Yet now, thanks, he believes, to a new treatment, he’s had a pain-free 18 months. ‘I remember getting out of my hammock on an exploratory expedition in the jungles of Borneo, with giant rainforest trees high as skyscrapers overhead and gibbons singing over the canopy, and thinking: “I can really do this again.” ‘Equally, the sheer joy of running around the garden with the kids has been fantastic. Before I’d throw the ball and let them do the running. Now I’m with them and I’m not grimacing in pain.’
Osteoarthritis affects around a third of people in the UK aged 45 and over. It’s typically age-related as a result of general wear and tear, but other risk factors include obesity, family history and previous injuries. The joints become stiff and painful partly because inflammatory proteins outnumber anti-inflammatory ones and attack the cartilage. Treatment is typically non-steroidal anti-inflammatory (NSAID) drugs such as ibuprofen, or steroid injections into the joint to reduce inflammation. However steroids are not effective long term, says Vikas Vedi, a consultant hip and knee surgeon at Hillingdon Hospitals NHS Trust and BMI Bishops Wood Hospital. ‘Steroids tend to become less effective each time they’re used. There is some evidence that suggests repeated steroid injections soften and damage the cartilage. ’For the most severe form of osteoarthritis, a joint replacement may be needed.
The treatment Steve had, called nStride, uses extracts from the patient’s own blood to target the inflammation. In the 20-minute procedure around 55ml of blood is taken from the patient and is then put into a centrifuge to remove around 7ml of plasma — which is rich in platelets and some white blood cells. This is then put through a second centrifuge spin to separate out the anti-inflammatory proteins, producing about 3ml of fluid. ‘This fluid is rich in anti-inflammatory proteins known as cytokines and interleukins,’ says Mr Vedi. ‘When injected into the knee, these bind to the cartilage to stop the inflammatory proteins in the inflamed joint causing further breakdown of the cartilage cells, and reducing pain.’ According to the manufacturer the treatment can delay the progression of osteoarthritis and may reverse its effects in some cases. It cites small studies (some sponsored by the manufacturer) that have shown its effectiveness, including a trial involving 46 patients with knee osteoarthritis. Those who received nStride saw a 65 per cent improvement after one year compared to 41 per cent in those who received placebo.
In a follow-up study, published last year in the American Journal of Sports Medicine, the patients who had the injection experienced significant improvement in pain for three years afterwards. Mr Vedi suggests it’s suitable for ‘gap patients’ — whose condition isn’t bad enough to need joint replacement but who have significant symptoms. The nStride is not the first injectable approach for osteoarthritis. Platelet-rich plasma (PRP) therapy also involves injecting the patient’s own platelets, taken from a blood sample, into the knee joint. PRP has been around since the late 1980s and, like nStride, it uses growth factors in the blood to promote healing. However, the newer treatment has a higher concentration of white blood cells.
Following his climbing accident, Steve had been managing his pain with medication. But, as it worsened, a scan in 2014 showed that he had cartilage damage as well as a cyst in the kneecap caused by pressure on the joint. He had a procedure to trim the torn cartilage and cyst but the pain continued. ‘I admit I was pushing myself,’ says Steve. ‘We were doing high-altitude ascents in the Himalayas and white water des-cents in New Guinea and jungle peaks in Venezuela. ‘I was under the care of a physiotherapist and was doing things such as yoga and stretching. But my consultant said I had osteoarthritis in the knee and, since it was a degenerative condition with no cure, it wasn’t going to go away, which was disheartening. ‘By January 2020 I was really struggling. It was clear something had to be done as I couldn’t live on painkillers.’
Then Steve’s consultant told him about a colleague who was providing a new treatment at his private clinic. The treatment itself was straightforward, says Steve. ‘I was told to take it easy for the first couple of days afterwards and build up activity slowly. The release from pain started kicking in about five days later. Over the coming weeks the pain reduced dramatically. I remember going out with the kids one morning — it had been snowing and we’d been sledging and wandering around the fields — and I thought: “This feels fantastic.” My knee was about 90 per cent back to what it had been before I’d first started having problems.’ The treatment costs £1,800, which Steve paid for himself. Eighteen months on, the effect has ‘worn off’ and Steve is considering having another treatment. ‘I just want to get back to where I was again.’ Yet some experts are not convinced by nStride. Philip Conaghan, a rheumatologist and professor of musculoskeletal medicine at the University of Leeds told Good Health: ‘nStride, in my view, lacks good evidence to recommend widespread uptake. ‘Results of large trials in Australia should be out early next year. Until then it would not be something to recommend spending money on. Not because of safety concerns but because of whether it would actually work.’ He says the best way to manage early osteoarthritis is to have strong thigh muscles to support the load on the knee joint. ‘Multiple studies show strengthening them reduces pain.’ He says walking laps in a swimming pool is particularly good for this.