Steroid Injections, PRP, and Surgery: Addressing pain or fixing the problem?
When someone has persistent knee, hip, low back, or shoulder pain, it is common to eventually hear about steroid injections, platelet-rich plasma (PRP), or surgery.
These treatments can absolutely have a role in musculoskeletal care. The important question, however, is what problem are we actually trying to solve?
Is the goal simply to decrease pain? Or are we trying to restore the person's ability to move, load, strengthen, and perform without repeatedly irritating the same area?
The research suggests that these treatments are not interchangeable—and in many common musculoskeletal conditions, their benefits can be temporary.
Steroid Injections: Effective Pain Relief, But Often Temporary
Corticosteroid injections are designed primarily to decrease inflammation and pain. They can be useful when pain is preventing someone from moving or participating in rehabilitation.
For knee osteoarthritis, the American Academy of Orthopaedic Surgeons recognizes corticosteroid injections as providing short-term pain relief.
The same pattern appears at the hip. A 2026 systematic review and meta-analysis of 14 studies involving 3,235 patients found large improvements in hip pain and function during the first three months following corticosteroid injection, but the pain benefit was no longer significant at 6–12 months.
Shoulder research shows a similar story. A randomized trial involving 708 people with rotator-cuff-related shoulder pain found that corticosteroid injections produced modest short-term benefits, but those advantages did not translate into superior long-term outcomes.
And the evidence is even less encouraging for chronic low back pain. A 2025 BMJ clinical practice guideline found little to no important benefit from spinal injections compared with sham procedures for chronic axial or radicular spine pain and recommended against routine epidural steroid injections for these conditions.
The pattern is worth noticing: steroids can sometimes create a window of reduced pain, but that does not necessarily mean the underlying problem has been corrected.
PRP: More Interesting, But Not a Magic Fix
PRP is different from corticosteroids because the goal is not simply to suppress inflammation. PRP uses concentrated components of a person's own blood and has been investigated as a way of influencing the local healing environment.
The strongest evidence among the four areas discussed here currently appears to be for knee osteoarthritis.
A 2024 meta-analysis of 35 randomized controlled trials involving 3,348 patients found that PRP produced better WOMAC outcomes than corticosteroid injections at short-, medium-, and long-term follow-up, with clinically meaningful differences at the medium- and long-term points.
Another network meta-analysis involving 48 studies and 9,338 knees found that PRP improved pain and function compared with placebo at a minimum of six months.
That does not mean PRP "regrows cartilage" or permanently fixes knee arthritis. The research is still heterogeneous, with different PRP preparations, injection protocols, patient populations, and stages of arthritis.
The evidence for PRP in the hip and shoulder is considerably less definitive. A systematic review of randomized trials in hip osteoarthritis concluded that PRP remains a potentially useful treatment but that its effectiveness and protocols require further study.
For rotator-cuff-related shoulder problems, a 2025 network meta-analysis of 20 randomized trials involving 1,479 people found that no injection maintained a meaningful pain-relief advantage beyond three months, although PRP and some combination treatments showed improvements in certain measures of function.
So PRP may be a useful tool for certain patients—but "biologic" does not automatically mean "cure."
Surgery: Sometimes a Perfect Solution, Other Times Misguided
Surgery deserves a different discussion because some conditions genuinely require structural correction.
For example, when someone has severe end-stage hip osteoarthritis, total hip replacement can be extremely effective. In a randomized trial of 109 patients with severe hip OA who were already considered candidates for surgery, hip replacement produced a 15.9-point improvement in Oxford Hip Score at six months compared with 4.5 points with resistance training. Seventy-five percent of surgical patients achieved at least an 8-point improvement.
Total knee replacement can also produce substantial improvements in patient-reported function. A systematic review of 72 high-quality studies involving more than 19,000 patients found clinically meaningful improvements in self-reported function during the first 3–6 months after knee replacement. However, performance-based measures did not consistently demonstrate clinically meaningful improvement.
A successful surgery can reduce pain without automatically restoring optimal movement or athletic performance.
In fact, a 2025 systematic review estimated that approximately 12–15% of people still experience long-term pain up to two years after total knee replacement, while approximately 14% reported unfavorable pain outcomes 6–12 months after total hip replacement.
And some common orthopedic surgeries are much less compelling.
For example, evidence comparing arthroscopic partial meniscectomy with exercise therapy for degenerative knee disease found essentially no difference in pain or function at 12 months in the reviewed trials.
Similarly, the evidence surrounding surgery for degenerative rotator-cuff conditions is mixed, and recent research has not demonstrated that adding PRP to rotator-cuff surgery consistently improves outcomes.
Understanding the Site of Pain Is Not Always Where Treatment Should Be Targeted
This is where I think the conversation needs to change.
An injection may reduce pain.
PRP may provide longer-lasting symptom improvement in certain conditions.
Surgery may be the appropriate answer when there is severe structural disease or a clearly defined surgical problem.
But none of those automatically answers the question:
Why did this person become painful in the first place?
If someone has limited hip rotation, poor single-leg control, inadequate strength, restricted ankle mobility, poor thoracic movement, or an inability to tolerate the demands being placed on a joint, simply making the area less painful does not necessarily change those factors.
For an active person—especially a golfer—that distinction matters.
The objective should not simply be "How do we make this hurt less?"
It should also be:
"How do we make this person capable of handling the demands that caused the problem?"
That may involve improving mobility, building strength, changing loading strategies, improving movement quality, modifying activity temporarily, and progressively returning the person to the activities they care about.
Injections and surgery may have an appropriate place within that process.
But perhaps the better question is not whether they are "good" or "bad."
It is whether they are being used to create an opportunity for rehabilitation—or being used as a substitute for rehabilitation.
-Dr. Nick DC, MS, TPI, CSCS
If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.
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Bibliography
Busse, J. W., Genevay, S., Agarwal, A., et al. (2025). Commonly used interventional procedures for non-cancer chronic spine pain: A clinical practice guideline. BMJ, 388, e079970. https://doi.org/10.1136/bmj-2024-079970.
Cheng, H. Y., Beswick, A. D., Bertram, W., Siddiqui, M. A., Gooberman-Hill, R., Whitehouse, M. R., et al. (2025). What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis. BMJ Open, 15(5), e088975. https://doi.org/10.1136/bmjopen-2024-088975.
Frydendal, T., Christensen, R., Mechlenburg, I., Mikkelsen, L. R., Varnum, C., Graversen, A. E., et al. (2024). Total hip replacement or resistance training for severe hip osteoarthritis. New England Journal of Medicine, 391, 1610–1620. https://doi.org/10.1056/NEJMoa2400141.
Belk, J. W., Houck, D. A., Littlefield, C. P., Kraeutler, M. J., Potyk, A., Mei-Dan, O., Dragoo, J. L., Frank, R. M., & McCarty, E. C. (2022). Platelet-rich plasma versus hyaluronic acid for hip osteoarthritis yields similarly beneficial short-term clinical outcomes: A systematic review and meta-analysis of Level I and II randomized controlled trials. Arthroscopy, 38(6), 2035–2046. https://doi.org/10.1016/j.arthro.2021.11.005.
Medina-Porqueres, I., Ortega-Castillo, M., & Muriel-Garcia, A. (2021). Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: A systematic review and meta-analysis. Clinical Rheumatology, 40(1), 53–64. https://doi.org/10.1007/s10067-020-05241-x.
Palmer, J. S., Monk, A. P., Hopewell, S., Bayliss, L. E., Jackson, W., Beard, D. J., & Price, A. J. (2019). Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database of Systematic Reviews, 2019(7), CD012128. https://doi.org/10.1002/14651858.CD012128.pub2.
Jang, et al. (2025). Effect of platelet-rich plasma versus placebo or corticosteroid for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Orthopaedics and Trauma, 62, 102870. https://doi.org/10.1016/j.jcot.2024.102870.
[GRASP Trial Collaborative Group]. (2021). Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: The GRASP factorial randomized controlled trial. The Lancet, 398(10298), 416–428.
Jawanda, et al. (2024). Comparative effectiveness of intra-articular treatments for knee osteoarthritis: A systematic review and network meta-analysis of randomized controlled trials. Arthroscopy.
Note: The network meta-analysis included 48 studies and 9,338 knees; the search results I found did not expose the complete author list and DOI, so I would verify this citation before putting it into a published book or article.Cheng, H. Y., et al. (2025). What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis. BMJ Open, 15(5), e088975. https://doi.org/10.1136/bmjopen-2024-088975.
