Steroid injections have been the standard for calming angry joints and tendons for decades. Platelet rich plasma injection therapy is newer, more biologic, and often discussed in the same breath as “healing” rather than “relief.” I use both in practice, sometimes for the same patient at different points in their recovery. They are not interchangeable. The right choice depends on tissue type, symptom trajectory, time horizon, and the patient’s priorities around risk, cost, and evidence.
This guide unpacks how PRP treatment and steroid injections actually work, what the science supports so far, where each tends to shine or fall short, and how I counsel patients making this decision for knees, tendons, shoulders, backs, and even hair and skin.
What actually gets injected
A corticosteroid injection usually combines a steroid such as triamcinolone or methylprednisolone with a local anesthetic. The steroid quiets the immune signaling that drives inflammation. Pain often eases within days, sometimes hours, because the anesthetic provides a preview and the steroid follows behind.
A platelet rich plasma injection uses your own blood. We draw a small tube, spin it in a centrifuge to concentrate platelets, then inject the platelet rich fraction into the target tissue. Platelets carry growth factors and cytokines that influence inflammation and tissue repair. Not all PRP injections are equal. The final product can be leukocyte rich or leukocyte poor, can vary in how many times it is spun, and can concentrate platelets anywhere from roughly two to eight times baseline depending on the system. Those details matter for certain problems.
Both are delivered through a needle. For deep structures, ultrasound guidance improves accuracy. For knees and shoulders, I recommend image guidance whenever possible. You want a PRP injection or a steroid delivered to the right compartment, not just near it.
Pain relief versus tissue repair
Corticosteroids primarily turn down inflammation. They do not rebuild collagen, restore cartilage, or repair tendon tears. In fact, repeated high dose steroid injections into weight bearing joints or tendons can impair matrix synthesis, thin cartilage over time, and weaken tendons in animal models and some human observational data. One injection, carefully spaced and dosed, is different from quarterly injections year after year. Used judiciously, steroid shots help people move, sleep, and participate in rehab.
PRP therapy aims to change the local biology in favor of regeneration. Think of it as nudging a stuck healing process forward. It does not fuse a meniscus tear back together or regrow a completely worn joint surface. It may, however, improve tendon structure on ultrasound over months, reduce pain, and enable progressive loading. In knees with osteoarthritis, platelet rich plasma injections often provide better symptom relief than placebo or hyaluronic acid in the six to twelve month window in several randomized trials. The magnitude of benefit varies, and advanced bone-on-bone arthritis responds less reliably.
If your top priority is immediate relief to get through a critical event, steroid still has a role. If your priority is longer horizon function and you can tolerate a slower onset, PRP therapy becomes attractive.
Where the evidence is reasonably strong
Knee osteoarthritis is the condition with the most published data for PRP treatment injections. Across multiple meta-analyses, PRP knee injections outperform saline and often hyaluronic acid for pain and function at 6 to 12 months. Higher platelet concentrations and leukocyte poor preparations tend to have slightly better outcomes with fewer flares. Younger patients and those with mild to moderate arthritis respond better than those with severe joint degeneration. A patient of mine in his early 50s with moderate medial compartment wear went from 20 minute walks to 5 mile hikes over four months after a series of two PRP knee injections, coupled with hip and quadriceps strengthening. Not every case looks like that, but the pattern matches the literature.
Chronic tendinopathies also fit PRP. Lateral epicondylitis, often called tennis elbow, has consistent RCTs showing PRP injection therapy beats steroid at 6 to 12 months for pain and grip strength, though the steroid frequently wins the first month. Patellar tendinopathy and plantar fasciitis show similar trends, especially when the PRP injection procedure is paired with progressive loading and technique changes. On ultrasound, tendons often look less thick and less hypoechoic months after PRP joint injections, which correlates with symptom improvement.
For partial thickness rotator cuff tears and gluteal tendinopathy, the signal is promising but more mixed. When patients commit to a rehabilitation plan and avoid repeat steroid exposure, the odds improve.
Hair and skin applications, like PRP hair restoration and PRP facial rejuvenation, are outside the musculoskeletal scope yet worth mentioning because patients ask. For androgenetic alopecia, PRP scalp injections can increase hair density and thickness in many men and women over 3 to 6 months, especially when combined with standard medical therapy. In aesthetics, PRP microneedling and PRP vampire facial approaches aim for collagen stimulation, fine line reduction, and better texture. Results vary widely based on technique and baseline skin.
Where steroid still makes sense
There are times when PRP is not the right move. A hot, swollen knee flare in severe osteoarthritis that prevents weight bearing responds reliably to a single corticosteroid injection paired with a short course of offloading, then a planned return to strengthening. An adhesive capsulitis shoulder during a freezing phase can loosen with a carefully placed glenohumeral steroid shot, buying range of motion so therapy can work. A severely inflamed bursitis at the hip or elbow that is disrupting sleep often settles with a one time steroid, which you then protect with targeted strengthening and ergonomic changes.
I still use steroid injections for cervical or lumbar radicular pain when nerve root inflammation dominates, although the evidence and procedural details differ from joint injections. Here we are talking about epidural steroid injections rather than intra-articular dosing, and those have their own risk profile. PRP injection for sciatica or PRP injection for herniated disc are active research topics, but most practices do not offer intradiscal PRP outside carefully selected cases.
Side effects and safety
Corticosteroid shots are generally safe but not benign. Short term blood sugar spikes occur in diabetics, sometimes for two to three days. Repeated steroid exposure within a joint may accelerate cartilage thinning according to some data, especially with frequent dosing. Soft tissue atrophy and skin depigmentation https://www.instagram.com/drv_aesthetics/ can occur at superficial sites. Tendon rupture risk is small but real when steroid is injected into or right next to a degenerated tendon. Some patients feel flushed or jittery for 24 to 48 hours.
PRP therapy is autologous, so allergy risk is minimal. The most common side effect is a post injection flare, a soreness that feels like a deep bruise for 24 to 72 hours. Infections are rare but possible. Bruising can occur. Because PRP injection treatment relies on your platelets, active infection, certain blood disorders, and platelet dysfunction are contraindications. Patients on strong anticoagulants can be treated, though the approach must balance bleeding risk. There is ongoing debate about whether to avoid NSAIDs around the time of PRP; I typically ask patients to skip them for 5 to 7 days before and after the procedure and to use acetaminophen and ice unless contraindicated.
How a PRP injection procedure actually unfolds
The day of a platelet rich plasma injection, you come hydrated and having avoided NSAIDs for a few days if possible. We draw blood, usually 15 to 60 milliliters depending on the target and the system used. The centrifuge run takes about 10 to 20 minutes. Meanwhile we prep the injection site, clean the skin, and set up ultrasound guidance. With tendons, I sometimes use a peppering technique or gentle fenestration to create a micro-injury pattern that encourages PRP distribution. For knees, we choose the suprapatellar pouch or medial approach and confirm intra-articular placement on ultrasound. Most people tolerate the process with local numbing; a few prefer mild oral anxiolytics.
On the back end, expect soreness, sometimes as much as the original pain, for a couple of days. Then a gradual easing. Structured rehab starts soon after. For tendons, relative rest for 2 to 3 days followed by a staged loading plan over weeks works best. For joints, low impact motion within comfort is fine right away, with progressive strengthening once pain allows.
Recovery time and expectations
Steroid injections can feel like a magic trick when they work. Relief may start the same day from the anesthetic and ramp up over 2 to 5 days. The effect can last weeks to months. In knees with osteoarthritis, a single steroid shot often helps for 4 to 8 weeks. Some people get three months. It tends to be shorter with each repeat.
PRP injection healing time is slower. Many patients notice a change around week two or three, with clearer gains by week six, and a plateau between three and six months. For tendinopathy, I usually plan a single session first, then reassess at 8 to 12 weeks. For knee OA, one to three injections spaced 2 to 4 weeks apart is common in studies and practice. The benefit curve for PRP injection results often keeps creeping up for months, which is why it suits people with patience and a willingness to do the rehab.
Cost and access
Steroid injections are typically covered by insurance in the United States and many other systems. Out of pocket cost is low. PRP injection cost is usually self-pay. Pricing ranges widely, often 500 to 1500 USD per site per session, higher in large urban centers. Quality of the PRP system and expertise of the clinician matter more than the fanciness of the waiting room. Ask about platelet concentration, leukocyte content, and ultrasound guidance. A clinic that can explain its protocol is a clinic that pays attention to details.
How I decide in real cases
A 38 year old recreational runner with chronic patellar tendinopathy who has already tried three months of heavy slow resistance training and activity modification is a good candidate for PRP therapy. We use leukocyte poor PRP, perform fenestration under ultrasound, and follow with a structured return to jumping over three months.
A 72 year old with severe knee osteoarthritis who has a family wedding in three weeks and can barely stand for photos often chooses a steroid injection now, with a plan to discuss PRP knee injections and long term strategy afterward. The quick relief helps her participate, then we reassess for a slower building option.
A 49 year old tennis player with recurring lateral epicondylitis who has had two steroid shots in the past with short term relief is better served by PRP injection for tennis elbow paired with eccentric forearm work and grip changes. The goal is fewer flares next season, not a short reprieve.
A 55 year old with shoulder pain and a partial thickness rotator cuff tear on MRI can go either way. If sleep is disrupted and range is limited by inflammation, a carefully placed subacromial steroid injection plus therapy can reset things. If he has failed a steroid previously or wants to avoid it, PRP injection for rotator cuff with tendon fenestration can be considered, knowing the payoff will be slower.
Special topics patients ask about
PRP injection for back pain: nonspecific low back pain is not a great PRP target. Some clinics promote PRP injection for facet joints, sacroiliac joints, or discs. Facet and SI joint injections with PRP have small studies suggesting benefit, but they are not mainstream yet. For herniated discs, intradiscal PRP is investigational and should be approached cautiously.
PRP joint injections versus hyaluronic acid: in knee OA, head to heads often show PRP outperforming hyaluronic acid at 6 to 12 months, especially in younger patients with less severe arthritis. Hyaluronic acid can still help a subset and is covered more often, but if a patient is paying cash and wants the best odds for durable relief, PRP often wins.
PRP injection for hair loss and PRP hair treatment: sessions are typically monthly for three months, then spaced out. Combine with minoxidil and finasteride or spironolactone when appropriate for better results. Expect improved hair caliber and density rather than a teenager’s hairline.
Aesthetics, including PRP facial injection, PRP injection for under eyes, and PRP injection for acne scars: technique and patient selection are everything. Under eye skin is thin and sensitive; post procedure swelling is expected for a few days. Results are subtle, usually measured in improved texture and fine lines rather than dramatic lifting. When patients understand that, satisfaction rises.
What about risks to tendons and cartilage
This question leads to honest talk about steroid. Injected into the tendon substance, corticosteroids can weaken collagen cross links and increase rupture risk, especially in weight bearing structures like the Achilles and patellar tendons. Around a tendon sheath or bursa, the risk is lower but not zero. In joints, repeated steroid dosing has been associated with cartilage thinning in some randomized data when given every three months for two years. That does not mean one or two shots will ruin a joint. It means frequent, routine steroid use without a broader plan is not wise.
PRP injection for tendon repair and PRP injection for cartilage damage sound ambitious. For tendons, PRP likely promotes better matrix organization and pain reduction when combined with mechanical loading. For cartilage, PRP does not regrow smooth hyaline cartilage. It can modulate the joint environment, reduce synovial inflammation, and help symptoms. Patients who expect symptom relief and functional gains do well. Patients who expect structural reversal of advanced degeneration are disappointed.
A practical comparison when choosing
Here is a concise snapshot to anchor the decision.
- Onset of relief: steroid is fast, often within days. PRP is delayed, usually weeks. Durability: steroid often lasts weeks to a few months. PRP, when effective, can last months to a year or more. Mechanism: steroid reduces inflammation. PRP modulates inflammation and may promote tissue healing. Risks: steroid carries small risks of cartilage and tendon weakening with repeated use and systemic effects like glucose spikes. PRP carries soreness flares and rare infection, with minimal systemic risk. Cost and coverage: steroid is usually covered. PRP is typically out of pocket.
Use this comparison as a starting point, then layer your specific diagnosis, goals, and timeline on top.
Conditions by condition
Knee osteoarthritis: PRP knee injections are a strong option for mild to moderate disease in active patients who want to delay surgery. Steroid helps acute flares or those needing short term relief. Combining either with strength, weight management, and gait mechanics changes multiplies the benefit.
Lateral epicondylitis: PRP injection for elbow pain is superior over time to steroid. Avoid repeated steroid directly into the tendon.
Plantar fasciitis: PRP injection for plantar fasciitis is a good choice for stubborn cases beyond three months of night splints, calf lengthening, and load management. Steroid can calm a hot flare but carries a small risk of plantar fascia rupture if repeated.
Rotator cuff tendinopathy: for partial tears, PRP injection for rotator cuff may help when therapy alone stalls. Subacromial steroid eases impingement symptoms and can jump start motion. Decide based on prior response and goals.
Hip and gluteal tendinopathy: PRP has promising data. Steroid can quiet bursitis but recurrences are common if biomechanics are not addressed.
Wrist, ankle, and smaller joints: PRP injection for wrist pain or ankle pain can be useful for chronic tendinopathies. For small joint arthritis, the evidence is thinner; individual trials and clinician experience guide use.
Ligament and muscle injuries: for grade 1 to 2 sprains and strains, PRP injection for ligament injury or muscle injury can shorten time to return in some athletes, particularly when delivered early and combined with a clear return to play plan.
Back and neck: PRP injection for back pain or PRP injection for neck pain remains selective. Consider it only in a clinic that performs image guided procedures routinely and has a clear protocol and follow up plan.
The role of rehab and load management
Neither therapy is a replacement for good mechanics. PRP injection for tissue repair does not absolve you from progressive loading, sleep, and nutrition. Steroid injection for pain management without a rehab plan is a short story that often ends the same way, with recurring symptoms. I give patients a simple framework: reduce peak load briefly, keep moving within comfort daily, begin targeted strengthening within a week based on tissue tolerance, and progress volume or intensity by 10 to 20 percent per week. A therapist who understands tendons and joints is worth their fee.
Common questions I answer in clinic
How long does PRP injection last? If you respond, six to twelve months is common for knees and tendons, with some patients reporting a year or more. For hair, maintenance is needed.
Is PRP injection painful? The draw is easy. The injection ranges from uncomfortable to moderately painful for a minute or two. Post injection soreness is expected for two to three days.
What is the PRP injection success rate? It depends on condition. For tennis elbow, success defined as meaningful pain reduction and function at six months is high, often above 70 percent in studies. For knee OA, response rates vary from roughly 50 to 80 percent depending on severity. For advanced arthritis, rates drop.
Are there side effects of PRP injection? Soreness, swelling, and bruising are common, infection is rare, and allergic reaction is extremely rare because it is your own blood.
What about PRP injection vs stem cell? Most so called stem cell injections in clinic settings are not true stem cell therapies. PRP is better studied, safer, and more standardized. If you are considering cell based products, ask detailed questions and be cautious.
Red flags and poor candidates
A patient with uncontrolled diabetes and recurrent infections is not a great candidate for either therapy until sugars are steady. An acutely ruptured tendon needs surgical evaluation, not PRP injection for tendinitis. A joint with mechanical locking from a loose body likely needs a procedural solution. Patients on dual antiplatelet therapy after a recent stent must coordinate with cardiology before any injection. And anyone expecting an injection to fix months of underloading or overloading without changing habits should reset expectations.
The bottom line I share with patients
Steroid injections excel at short term relief. They are tools, not plans. Platelet rich plasma treatment is a strategy to nudge healing and function over months. It costs more, takes longer, and demands participation in rehab. For knee osteoarthritis in the mild to moderate range and for chronic tendinopathies like tennis elbow or plantar fasciitis, PRP therapy has credible evidence and real world traction. For acute flares, adhesive capsulitis, and situations requiring fast relief, a well placed steroid injection can be the right call.
Choose the tool that fits your tissue, timeline, and tolerance for risk and cost. Ask your clinician whether the injection will be guided by ultrasound, how many injections are typical, what recovery looks like day by day, and how it integrates with therapy. Good outcomes rarely hinge on the needle alone. They come from matching the right intervention to the right problem at the right time, then following through.