The more we put our bodies through—whether through competitive sports or just aging—the more joint pain we can expect. But when joint pain interferes with your life, it’s time to find an alternative solution to over-the-counter pain relievers.
Joint injections may be another option, says Joanne Borg Stein, MD, a Mass General Brigham physical medicine and rehabilitation and sports medicine specialist.
Joint injections insert a variety of helpful substances directly into your joints or the surrounding ligaments and tendons. They can reduce inflammation, manage your pain, and may have the potential to heal supporting structures.
“Injections shouldn’t be viewed as standalone treatments, but rather a means to an end,” says Dr. Borg Stein. “You have to also do the work of rehab, meaning physical or occupational therapy, to get results.”
Whether you have pain in one joint from an injury (or just wear and tear), or you’ve developed osteoarthritis in multiple joints, injections could help. Injections may be appropriate for joints throughout your body, including your knee, hip, shoulder, ankle, sacroiliac (SI) joint, and facet (spine) joints.
“You have to start with the basics of adequate rest, exercise, and nutrition,” says Dr. Borg Stein. “If we've maximized your health through other avenues and you still have pain, then we start to think about injections.”
The decision to get a joint injection starts with a thoughtful and honest conversation with your doctor. More often than not, insurance doesn’t cover this expensive treatment. Insurance coverage may not be available because some of these injections are still experimental and not FDA-approved. When you pay out of pocket, you want to make sure you fully evaluate your options with your physician.
“We sit and talk with you for a while,” says Dr. Borg Stein. “Have you exhausted other means, especially ones that would be covered by insurance? Would you be better served by having surgery? What are your expectations for recovery?”
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Your doctor will recommend a type of injection based on your needs. The available injectables range from the well-known corticosteroids to cells collected from your own body.
You’ll likely receive a cortisone shot, also called a steroid injection, as a first-line treatment. Cortisone shots are effective for many patients in quickly reducing inflammation and pain directly inside the joint, but they come with a few precautions.
“Steroids may be somewhat toxic to the cartilage in your joint and may cause side effects throughout your body over time,” says Dr. Borg Stein. “I save them for times when you need a really quick fix. On a long-term, repeated basis, we should come up with another plan.”
Insurance often covers cortisone shots. If you have a minor injury, relief may last indefinitely. But for chronic (long-term) pain, you’ll only feel the steroid’s effects for about 3 months.
Gel injections are made of hyaluronic acid, a thick substance that mimics the normal cushioning fluid inside your joints. Some insurance plans may cover gel injections, but only for your knee (and sometimes your shoulder).
Knee gel injections work well for most knee pain, especially if you have mild to moderate arthritis. The effects generally last 6 to 12 months.
“We’ll often use a gel injection if you’ve tried other treatments like medication, exercise, or steroid injections without success, but you’re not yet a candidate for a knee replacement,” says Dr. Borg Stein.
Prolotherapy injections use concentrated sugar water (dextrose) and aim to relieve joint, ligament, and tendon pain. These injections, rarely covered by insurance, may help reduce pain from osteoarthritis as well as chronic tendon and ligament injuries, such as ankle sprains.
“Prolotherapy has some strong research evidence for helping knee arthritis and tennis elbow, in particular,” says Dr. Borg Stein.
Orthobiologics, sometimes called regenerative medicine, refer to a newer category of injectables made from your own blood or tissue. While research hasn’t proven that this therapy truly restores missing tissue, and such products are not FDA-approved to treat arthritis or other joint conditions, in some studies orthobiologics have shown the potential for promoting healing in tissue.
Not usually covered by insurance, these injections target arthritic joints and chronic tendon problems pretty much anywhere in your body. “Arthritis in your ankle, hips, knees, shoulders, elbows, wrist,” lists Dr. Borg Stein. “Tennis elbow, tendinopathy of your hip, or hamstring, or Achilles—you name it, we can do it.”
She adds that orthobiologic injections can be especially helpful for SI joint pain. The SI joint connects your pelvis to your lower spine. The ligaments that link over your bones in the SI joint are easily sprained, but in Dr. Borg Stein’s experience can be very responsive to regenerative injection treatment.
The most common and best studied orthobiologic is called platelet-rich plasma (PRP). The process of PRP injections involves taking your blood, isolating and concentrating the platelets, and injecting billions of platelets into your joint, ligament, or tendon.
Some newer injectables, called cell therapies, use cells and tissues collected from your own body like bone marrow or fat tissue. The cells are collected, cleansed, and carefully injected into your joint, ligament, or tendon.
“Cell therapies have reduced chronic inflammation in many of my patients and research suggests that cell therapies may have the potential to stimulate a healing response in the tissue over time,” says Dr. Borg Stein.
“The difference between most of these treatments is time,” says Dr. Borg Stein. “In a month, you’re going to feel better with a steroid. In the long run—6 months later— I have seen patients feel better for months or years with platelet-rich plasma or prolotherapy.”
There’s a lot of false advertising and hype around the success of joint injections, so you want a doctor you can trust. Ask your doctor what the research shows for your specific diagnosis and how long pain relief might last. Be diligent about where you get orthobiologic injections and question the doctor’s or clinic’s safety protocols.
Lastly, Dr. Borg Stein emphasizes the importance of the whole picture. "Make sure you're in it as a true participating partner, both before and after joint injection. Get yourself in the best physical and mental state possible,” she says. “If you’re investing, you really want to get the most out of your procedure and your rehab.”