PRP vs. Cortisone: What I Tell My Patients Before They Choose

I have had this conversation numerous times. A patient comes in with a sore knee, a nagging shoulder, or a hip that has been bothering them for months. They have heard about PRP. They have also been offered a cortisone shot by another provider. They want to know which one to choose.

My answer used to be more nuanced than it is today.

The research has caught up with what many of us in sports medicine have suspected for years: cortisone offers fast, temporary relief, but for most patients dealing with chronic joint pain or soft tissue injury, PRP produces better outcomes over the long run. And in some cases, cortisone may actually be making the underlying problem worse.

Here is what I tell my patients before they decide.

What Cortisone Actually Does (and Does Not Do)

Cortisone is a corticosteroid. When injected into a joint or around a tendon, it reduces inflammation quickly and effectively. For many patients, the relief is noticeable within 24 to 48 hours. It feels like a solution.

The problem is that inflammation is not the disease. In most cases, it is the symptom. Cortisone suppresses the inflammatory response, but it does not repair the tissue that is causing the problem in the first place.

Over time, repeated cortisone injections can actually weaken tendons and cartilage. There is now solid evidence that cortisone may accelerate cartilage loss or lead to tendon weakening, which means that the injection providing short-term relief could be contributing to long-term joint or soft tissue deterioration.

I am not saying cortisone is never appropriate. There are situations, particularly when a patient needs immediate pain relief before a significant event, or when inflammation is so severe it is preventing rehabilitation, where a well-timed cortisone injection has a role. But for most patients who come to me with a chronic injury or degenerative joint condition, cortisone is not the best long-term strategy.

What PRP Does Differently

Platelet-rich plasma therapy works on a fundamentally different principle. Instead of suppressing your body's response to injury, PRP harnesses it.

The process starts with a simple blood draw. We concentrate the platelets from your own blood, which are rich in growth factors, and inject them directly into the injured area. Those growth factors signal your body to begin the repair process: building new collagen, regenerating tissue, and restoring function at the source of the problem.

PRP typically does not provide the same overnight relief as cortisone. Most patients notice gradual improvement beginning two to four weeks after treatment, with results continuing to build over three to six months. For someone in acute pain, that timeline can feel frustrating.

But here is the important distinction: PRP is not just managing symptoms. It is working toward resolution. That is a different goal, and for many of my patients, it is the right one.

What the Research Shows

The evidence base for PRP has grown substantially, and the direction of the data is consistent. Multiple large-scale reviews comparing PRP to corticosteroids for knee osteoarthritis have found that while cortisone may provide faster initial relief, PRP produces superior outcomes at 3, 6, and 12 months, with some studies documenting benefits extending to 18 to 24 months.

A 2024 systematic review analyzing over 35 randomized controlled trials found that PRP outperformed cortisone at every follow-up point beyond the initial window, and that those differences were clinically meaningful, not just statistically significant. Patients were experiencing real improvements in pain and function that made a difference in their daily lives.

For tendon injuries, including rotator cuff, patellar tendon, elbow extensor tendons (“tennis elbow”, and gluteal tendons, the data is similarly favorable for PRP. Tendons are notoriously slow to heal on their own because of limited blood supply. PRP addresses that directly by delivering concentrated growth factors to tissue that otherwise receives very little.

The science is not perfect, and I don’t want to overclaim. We still need larger, more standardized studies to fine-tune how to maximize the benefits of PRP. PRP works best for mild to moderate osteoarthritis and soft tissue injuries. Though it may provide pain relief, it is not a cure for severe bone-on-bone arthritis or a replacement for surgical intervention when that is genuinely what is needed. But for the majority of patients I see with chronic injuries, the evidence supports PRP as a strong option.

The Question I Always Ask First

Before recommending any injection therapy, I ask my patients what they are trying to accomplish.

If the answer is "I need to get through a race in two weeks," that changes the conversation. Short-term relief has real value in the right context, and we can talk about how to manage the situation responsibly without compromising long-term outcomes.

But if the answer is "I have had this pain for a year and I want it to stop," then masking the problem with cortisone is not a plan. It is a delay. And depending on how the tissue responds to repeated steroid injections, it may be a delay that costs you.

Most of my patients want the second thing. They want to get better, not just feel better temporarily. That is where PRP has more potential for the patients I treat.

Why Physician-Led Care Matters for PRP

Not all PRP is created equal. The concentration of platelets, the number of platelets, the preparation method, and the precision of the injection all affect outcomes. In my practice, PRP is performed by me, using ultrasound guidance when appropriate, with a protocol designed for the specific injury and patient.

I also take the time before any injection to understand the full picture: imaging, history, activity level, resources, and goals. That conversation shapes the treatment plan. The plan almost always includes physical therapy paired with what I offer, as there is clear data supporting rehab protocols. 

At Leeward Health + Wellness, you do not need a referral to see me, and I do not work with insurance, which means your care is not filtered through a coverage decision made by someone who has never met you. You come in, we talk through your options honestly, and we build a plan that makes sense for your injury and your life.

The Bottom Line

Cortisone is fast. PRP is restorative. For short-term, situational relief, cortisone has a role. For patients who want lasting results from a treatment that works with the body’s natural healing processes, PRP is the stronger choice.

If you have been living with joint or soft tissue pain and wondering whether there is a better option than a cortisone shot, I would be glad to talk through what PRP could look like for your specific situation.

No referral needed. No insurance required. I’ll take time to discuss all of it.

Schedule a consultation directly at leewardhealth.me.