Try PT first! We can show you how to manage it!
In a systematic review, published in 2023 by Mo et. al, it was proven that the most effective treatment for knee osteoarthritis (OA) pain is aquatic exercise. The most effective treatment for improved functional outcomes is yoga, shortly followed by resistance training, stationary cycling, and traditional exercise.1
But your options do not stop there!
A randomized control trial conducted by Dunning et al. in 2018 showed clinically significant improvement in knee OA when dry needling (DN) was combined with manual therapy and exercise. Outcomes included complete discontinuation of pain medication and improved function versus manual therapy and exercise alone.2
What about PRP?
PRP (Platelet Rich Plasma) injection is the process of drawing a patient’s blood, putting it in a centrifuge to separate out the platelets which has enhanced human growth factor that can stimulate healing when re-injected into the patient. However, as of 2019, The American College of Rheumatology (ACR) and the Arthritis Foundation (AF) state that they strongly recommend against it, “as there is concern regarding the heterogeneity and lack of standardization in available preparations of platelet-rich plasma, as well as techniques used, making it difficult to identify exactly what is being injected.”3
How does cortisone work?
Cortisone injection is recommended by the ACR and AF for the treatment of knee OA.3 Cortisone, a type of corticosteroid shot, also known as a glucocorticoid shot (more specific component), is a synthetic version of cortisol that is beneficial with regard to its anti-inflammatory properties and subsequent pain relief.4 While this procedure is relatively safe, risks include temporary blood sugar spiking, immunosuppression, and increased risk of tendon rupture within first few days, as well as injection site discomfort. Also, if you are on blood thinners, you may not be appropriate for this intervention. Follow up with your provider.
Is a scope worth it?
According to J B Thorland et al, while patients may see an initial small change in pain up front from a little “clean out,” once post op pain has subsided, at one to two years post op, the pain and functional outcomes are the same for scope patients and patients that solely participated in PT. “Knee arthroscopy is associated with harms. Taken together, these fundings do not support the practice of arthroscopic surgery for middle aged or older patients with knee pain with or without signs of knee osteoarthritis.”5
Knee Replacement time?
For some people, your knee may have taken you as far as it can go. If, after physical therapy and more conservative treatment, you are noticing functional decline in your ability to ambulate, negotiate stairs, and participate in your usual life activities, it may be time to consult with your local orthopedic doctor for a total or partial knee arthroplasty. This will replace all of the “bone on bone” pieces with metal on metal, so you will no longer feel pain if this was your causative factor. After some healing and physical therapy, you can get back to living your fullest life with no restrictions. Rare but serious risks include infection, joint contracture, blood clots, and prosthetic failure so many choose to avoid these outcomes by keeping active and managing their knee OA with more conservative methods listed above.
If you are suffering from knee OA, and you “kneed” our help, contact us at Hampton PT and give us a try. We’d love to help you feel better and reclaim your active and pain free lifestyle!
References:
1. Mo L, Jiang B, Mei T, Zhou D. Exercise therapy for Knee Osteoarthritis: A Systematic Review and Network
Meta-analysis. Orthopaedic Journal of Sports Medicine. 2023;11(5). doi:10.1177/23259671231172773
2. Dunning J, Butts R, Young I, et al. Periosteal electrical dry needling as an adjunct to exercise and manual therapy for knee osteoarthritis. Clinical Journal of Pain. 2018;34(12):1149-1158. doi:10.1097/ajp.0000000000000634
3. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020;72(2):220-233. doi:10.1002/art.41142
4. Cleveland Clinic. Cortisone shots (Steroid injections). My.Clevelandclinic.org. https://my.clevelandclinic.org/health/treatments/cortisone-shots-steroid injections. Published February 5, 2024. Accessed April 5, 2025.
5. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350 (jun16 3):h2747. doi:10.1136/bmj.h2747
