PRP vs. Prolotherapy vs. Cortisone
PRP vs. Prolotherapy vs. Cortisone: Which Joint Injection Is Right for You?
If you have joint pain and you've started looking into injections, you've probably run into three options: cortisone, PRP, and prolotherapy. They're often compared as if they're three versions of the same thing. They aren't.
They use different substances, and they're usually injected in different places with different goals. That's why there's no clean head-to-head comparison, and why the right choice depends on what you need right now.
I'm Dr. Smriti Singh, an emergency medicine physician and osteopath (DO) in San Francisco. Here's how I explain the differences to patients.
The short version
Cortisone calms inflammation fast. It's useful when you need relief quickly, or when surgery is already on the horizon.
PRP triggers inflammation on purpose to call in healing. It's slower, sorer, and aimed at longer-term change.
Prolotherapy works on a similar idea with a milder, more affordable solution. It usually takes more sessions.
Cortisone (steroid) injections
How it works: Cortisone is a strong anti-inflammatory. It quiets the body's immune response where it's injected, so swelling and pain come down, usually within a day or two.
When it makes sense:
You need the pain down for something specific, like a trip or an event, and don't have time to wait.
You already have bone-on-bone arthritis and surgery is likely down the road. Cortisone can keep you more comfortable in the meantime.
The catch: Relief typically fades within weeks to a few months, and it doesn't repair anything. In a 2017 study in JAMA, people with knee arthritis who got cortisone every three months for two years lost more cartilage than people who got saline, without better pain scores. That's why most doctors limit how often they give it.
Where it goes: Cortisone shouldn't be injected into ligaments or tendons, because it can weaken them. So a cortisone shot generally goes inside the joint only, not into the structures that hold the joint together.
PRP (platelet-rich plasma)
How it works: I draw a small amount of your blood, spin it to concentrate the platelets, and inject that concentrate. PRP does the opposite of cortisone: it's pro-inflammatory. It signals your body to send help to the area, bringing in growth factors and proteins involved in laying down new collagen.
What it's good for: Mild to moderate arthritis and tendon or ligament injuries. Several reviews have found PRP gave better pain and function scores than hyaluronic acid ("gel") injections for knee arthritis at 6 to 12 months.
Where it's injected matters: When I do PRP, I don't only inject the inside of the joint. I also treat the ligaments and tendons that stabilize it, and the needle itself adds a dry-needling effect at those spots. How much PRP helps depends a lot on whether the person injecting targets these structures.
The catch: Because it's inflammatory, PRP can be painful and leave you sore for several days, especially in the knee or shoulder. It's also slow. You may notice early changes around four weeks, but it takes about three months to know whether it worked. The research is mixed: a 2021 JAMA trial found PRP injected only inside the knee joint did no better than saline at 12 months. PRP isn't covered by insurance.
Prolotherapy
How it works: Prolotherapy uses dextrose (a sugar solution) instead of your own blood. Like PRP, it's injected into the joint and at the spots where ligaments and tendons attach to bone, to trigger a healing response that strengthens them.
What it's good for: Arthritis and chronic ligament or tendon pain, especially when a joint feels loose or unstable. A 2013 randomized trial in the Annals of Family Medicine found dextrose prolotherapy, injected inside the knee and at the surrounding ligaments and tendons, improved knee arthritis scores at one year compared with saline and with exercise alone.
Why it's a good place to start: It's less inflammatory than PRP and costs less per session. That makes it a reasonable way to find out whether your joint responds to this kind of treatment before investing in PRP.
The catch: It usually takes more sessions than PRP, spaced a few weeks apart. Responses vary: some people feel less pain right away, while others are sore for a few days first. It isn't covered by insurance.
Why you can't compare them head to head
These three options aren't just different substances. They're usually different techniques.
Cortisone goes inside the joint. PRP and prolotherapy, done well, treat the joint and the ligaments and tendons around it. So comparing them often means comparing a joint-only injection with a treatment of the whole joint. And PRP studies that inject only inside the joint aren't testing the way many physicians actually use it.
Where osteopathic care fits in
Conventional care tends to focus only on the inside of the joint. But a joint is more than bone and cartilage. Its ligaments and tendons give it both stability and range of motion, built around the way we actually move.
Joint pain also usually has company: a tight hip, a weak glute, a stiff upper back, or a foot that collapses inward. As a DO, I pair injections with osteopathic manipulation (OMT) and a strengthening plan so the joint isn't fighting the same forces that caused the problem.
Who isn't a good fit for PRP or prolotherapy
Severe, bone-on-bone arthritis where surgery is likely. Cortisone may be the better bridge, along with a surgical opinion.
An active infection, certain blood disorders, or some cancers.
Anyone who needs fast relief for a trip or event soon. Cortisone works faster.
Patients with underlying metabolic disease where the body's own healing capacity is limited due to systemic inflammation
The bottom line
Cortisone fits when you need quick, short-term relief or are heading toward surgery. Prolotherapy is an affordable first try at strengthening the joint structures. PRP fits when you want a stronger healing response and can handle more soreness and a longer wait.
Whichever you choose, ask whether the injector treats the ligaments and tendons, not just the inside of the joint.
If you're in San Francisco and want to talk through your options, you can book a consultation or read more about joint injections at Trailhead Wellness Medicine. Trailhhead Wellness Medicine does not offer cortisone injections.
This article is for general education and isn't medical advice. Talk with your own physician about your situation.
