A steroid shot calms inflammation quickly but wears off. A gel shot (hyaluronic acid, such as ORTHOVISC) adds lubrication to a knee with osteoarthritis. PRP uses platelets from your own blood and is given as a short series. Which one makes sense depends on what is actually causing your knee pain, so the honest first step is an examination.
People often come to us having heard about all three from a friend, a sister-in-law and a television ad, and they want to know which is “best.” There isn’t a single best. Each one is a tool for a slightly different problem.
What is actually wrong with my knee?
This matters more than which needle goes in. Knee pain in adults usually comes from one of a handful of places: worn cartilage (osteoarthritis), an irritated tendon, an inflamed bursa, a ligament or meniscus injury, or tight thigh muscles pulling on the joint. Sometimes the knee is fine and the pain is coming from the hip or the lower back.
When you see Dr. Donna D’Alessio, she asks when it started, what you were doing, and what makes it better or worse. Then she examines the knee for swelling, tenderness, range of motion, strength and stability. If something above the knee could be involved, she checks that too. You can read more about how she works on our knee pain treatment page.
An injection chosen for the wrong cause is a wasted appointment. A steroid in a knee whose pain is really from the back won’t do much.
What does a steroid (cortisone) shot do?
A steroid injection puts a strong anti-inflammatory medicine directly where the inflammation is. For an arthritic knee that has flared up, or for an inflamed bursa, it can bring pain down fairly quickly, often within days.
We give these with ultrasound guidance, so the medicine goes inside the joint or into the bursa rather than somewhere near it.
The trade-off is that the relief is temporary. A steroid quiets inflammation. It doesn’t change the cartilage. In general medicine, doctors also space steroid injections out and limit how many a knee gets, because repeated doses over a long time may not be good for the joint. It works well as a bridge: to get you through a bad flare, to let you start physical therapy, or to get you to an event without limping.
What is a gel injection, and who is it for?
The “gel” is hyaluronic acid. Your knee already makes it. It’s part of the fluid that lets the joint surfaces glide. In a knee with osteoarthritis, that fluid tends to thin out.
A hyaluronic acid injection such as ORTHOVISC adds a lubricating gel back into the joint. It’s used for knee osteoarthritis specifically, not for tendon or bursa pain. It doesn’t act as fast as a steroid. Some people notice their knee moving more easily and hurting less over the following weeks.
If you have arthritis and steroid shots have stopped lasting, or you’d rather not keep having them, this is usually the next conversation.
What is PRP, and how is it different?
PRP stands for platelet-rich plasma. We draw a small sample of your blood, spin it in a centrifuge to concentrate the platelets, and inject that concentrate into the knee. Platelets carry growth factors, and the idea is to support the joint’s own repair response.
Because it comes from your own blood, there is no drug in it.
PRP is a slower process than the other two. The course we recommend is three injections spaced four to six weeks apart, then a maintenance injection every six months. Most people notice improvement within four to six weeks after the first one, and some feel better after a single injection. We use it for knee osteoarthritis and for tendon problems around the knee. The details are on our PRP joint injections page.
One thing people don’t expect: after PRP you’re asked to skip ice and anti-inflammatory painkillers like ibuprofen. Those work against the inflammation PRP relies on. Your knee may be sore, bruised or a little swollen for a few days. You can usually go back to normal activity as you tolerate it, though you might be told to take it easier for the first 72 hours.
So which one should I get?
Here’s roughly how the thinking goes, though your exam decides it.
If your knee is in a painful flare and you need relief soon, a steroid is often the quickest way to get it.
If you have osteoarthritis and want something aimed at how the joint moves, a gel injection is worth discussing.
If you’d like to try a treatment made from your own blood and you’re willing to come back for a short series, PRP may suit you. It’s also an option for tendon pain, where gel isn’t used.
These aren’t always either-or. A plan might use one now and another later. Some knees also do better with work on the surrounding muscles, through trigger point injections or massage, alongside an injection.
And sometimes the answer is that an injection isn’t right yet, or that you need imaging or a surgeon’s opinion first. If that’s the case, we’ll tell you.
Do knee injections hurt?
Most people feel brief pressure or a pinch. Afterwards, some soreness, bruising or swelling where the needle went in is common and usually settles by itself. PRP adds a blood draw at the start, the same as a routine blood test.
Does insurance cover knee injections?
It depends on your plan and on which injection you have. Montville MedSpa & Pain Center is an out-of-network provider for pain management, and you don’t need a referral. If you call with your insurance card, the team checks your out-of-network benefits and tells you what to expect before anything is scheduled. We’d rather you know before you come in.
Frequently asked questions
How long does a knee injection appointment take?
Most injections are done during a short office visit, and many people go back to their usual day soon afterwards. A PRP visit takes a little longer because the blood has to be drawn and prepared first.
Can I have PRP if I’ve already had a steroid shot?
Often, yes. Tell Dr. D’Alessio when your last steroid injection was and how long it helped. That history is useful when choosing what comes next.
Will an injection fix my arthritis?
No injection reverses arthritis. The aim is less pain and better movement so you can stay active. How much relief you get, and for how long, varies from person to person.
When is knee pain an emergency?
Get urgent care if you can’t put weight on the leg after an injury, the knee looks deformed, or it’s hot, red and swollen and you have a fever. A swollen, painful calf also needs to be seen promptly, because it can be a sign of a blood clot.
Book a knee evaluation in Montville
If your knee has hurt for more than a few weeks, or keeps coming back, come and see Dr. Donna D’Alessio at Montville MedSpa & Pain Center, 624 Main Rd in Towaco, Montville Township. She’ll examine the knee, tell you what she thinks is behind the pain, and explain which injection, if any, fits it. Call (973) 794-3958 to book.
Can a Massage Help Tension Headaches?
That band of pressure around your head often starts in your neck and shoulders. What a massage can do about it, how to time it, and the headaches that need a doctor first.
Can I Get a Massage If I Have Sciatica?
Massage can ease the muscles that clench around an irritated sciatic nerve, if the pressure goes in the right place. When it helps, when to wait, and what to say first.
How to Use Out-of-Network Benefits for Pain Management in New Jersey
Plenty of people carry out-of-network benefits for years without using them. What the terms on your plan mean, what to ask, and how we check your coverage before you book.
