Alternatives to cortisone injections for knee pain include Hyaluronic Acid (Gel) Injections (viscosupplementation) for lubrication, Platelet-Rich Plasma (PRP) from your own blood to promote healing, and Prolotherapy, using dextrose to stimulate repair, with other options like physical therapy, regenerative medicine (stem cells, peptides), and procedures like genicular artery embolization also available for managing osteoarthritis and joint pain, depending on severity and cause.
Hyaluronic Acid Injections (Viscosupplementation)
Unlike cortisone shots, hyaluronic acid injections don't just suppress the feeling of pain being experienced, they reduce friction in the joints and help protect your cartilage and bone from further damage.
In a study published in The American Journal of Sports Medicine, researchers found that adding PRP to a cortisone injection can actually preserve the anti-inflammatory effects of cortisone while reducing its harmful effects on tendon cells—specifically in tendinopathic conditions.
The University of Chicago Medicine began a pilot study in 2022 on genicular artery embolization (GAE), a unique treatment designed to delay or even prevent knee replacement surgery. The procedure works by sealing off problematic arteries that grow into the knee joint, causing inflammation or compression.
Common side effects
The most common side effect of hydrocortisone injections is intense pain and swelling in the area where the injection was given. This usually gets better after a few days. You may also get some bruising where the injection was given. This should go away after a few days.
Areas with dense nerve endings or tight spaces, such as the sole of the foot (plantar fascia) or small joints in the hand, tend to be more uncomfortable. In contrast, larger joints like the knee, shoulder, or hip are generally less painful due to more room for the injection and fewer surface nerves.
Unexplained bruising on your legs can be caused by vitamin deficiencies, liver disease, autoimmune conditions, or blood disorders that affect clotting. Certain medications like blood thinners, NSAIDs, and even some supplements can also increase bruising.
1. You aren't moving enough. One of the biggest mistakes we see patients with knee pain make is to begin using their knees less.
One of the most promising options is platelet-rich plasma (PRP) therapy. In 2025, new research continues to support PRP as a safe and effective treatment for knee osteoarthritis, offering real hope for patients who want to delay or avoid surgery.
Knee pain treatments
There's really no “bad time” to get PRP, but there is a perfect time. PRP works best when your injury is fresh, and inflammation is at its peak. The healing factors actively seek out inflammatory and injury markers in your body that tell them where to work, so it's best to start treatment as soon as possible.
The length of cortisone pain relief varies
Generally, a cortisone shot can suppress pain for anywhere from six weeks to six months.” Cortisone provides pain relief by reducing inflammation. If you have pain caused by inflammation, cortisone can make you feel really good.
In some cases, knee pain relief can be achieved without surgical intervention. Sometimes, knee injuries or pain are effectively addressed with bracing, medication, and lifestyle changes. For those with arthritis, physical therapy or steroid shots may help relieve symptoms.
nSTRIDE® is the only single-injection therapy where the benefits are sustained for up to 3 years.
Cortisone is a naturally occurring, mostly inactive pregnene (21-carbon) steroid hormone. In the body, cortisone is produced as part of the Cortisol-Cortisone shunt, which protects vulnerable organs like the kidneys from cortisol.
How to avoid a knee replacement: Nonsurgical treatment for bone-on-bone knee pain. You may be surprised to learn that surgery isn't always the best option. Often, nonsurgical options are very effective at treating knee pain from arthritis, injury or another condition.
If you're dealing with a fresh knee injury—especially one with knee swelling or sharp pain—it's important to give your knee a break. Rest doesn't mean total inactivity, though. It just means avoiding high-impact movements or weight-bearing exercises for a few days.
Vitamin D deficiency is linked to knee pain. Adequate nutrition is essential for maintaining healthy knees. Knee pain can be managed and prevented through dietary adjustments. Understanding the link between nutrition and knee health is critical.
With an ACL tear, in young people or active older adults, surgical repair is typically necessary after an ACL tear. The biggest issue with a surgical repair is that it takes about 9 months to rehabilitate afterwards. Most people would agree that the ACL ligaments is the worst ligament to tear in the knee.
If there's any evidence that an underlying condition could be causing bruising, you should see a hematologist to have your blood evaluated for clotting proteins. Remember, easy bruising can occur naturally in some people and may not be connected to any medical problem.
Poor circulation is a common cause of unexplained bruising on legs, particularly when there are issues with the veins, such as varicose veins. Varicose veins occur when blood pools in the veins due to faulty valves, which increases pressure in the veins, making them more prone to rupture.