Kellie K. Middleton, MD

When Physical Therapy Doesn’t Improve Your Pain, Try Orthopedic Injections

Apr 08, 2024
When Physical Therapy Doesn’t Improve Your Pain, Try Orthopedic Injections
Pain can send you to the sidelines whether you’re an athlete or not. If your joints hurt or an acute injury isn’t healing, you can’t focus or move freely, and your quality of life suffers. Orthopedic injections may help.

When you injure yourself or suffer the degradation of tissues with age, such as that which comes with arthritis, it’s hard to get on with your daily life. Even if you’re not an athlete, you need to be able to move freely and painlessly to get through your day and maintain your quality of life (QOL).

It’s always best to start with supportive therapies, such as rest, massage, and physical therapy, when treating injuries or arthritis. However, if that doesn’t significantly improve your pain, you may have to move on to the next level of treatment.

Kellie K. Middleton, MD, is an orthopedic expert in Lawrenceville, Georgia. She always recommends physical therapy (PT) for joint pain and injuries. However, when PT isn’t enough to control pain and restore mobility and QOL, she may advise orthopedic injections. 

Would orthopedic injections help your pain and help you heal? Read below to find out if you may be a candidate for the following types of injections.


When you need a quick fix for pain, an injection with corticosteroids may be the solution. Cortisone, a type of corticosteroid, quickly reduces both pain and swelling.

However, steroids can have negative long-term effects on your cartilage. If you have arthritis or want to avoid it, you should only use cortisone over the short term.

A single injection can completely eliminate acute mild to moderate pain. Severe or chronic pain may be relieved for up to three months. If your pain persists, you may benefit from other therapies.

Hyaluronic acid

Healthy, young joints produce plenty of a natural lubricant called hyaluronic acid (HA). Your synovium, which is tissue that protects your joints, produces HA to ease friction and help your joints move smoothly.

If you’re older or have osteoarthritis, you may have no to low levels of HA. We inject synthetic HA directly into your joints to replenish the synovium. The HA injections are a cushioning gel that should last about 6-12 months. 

Platelet-rich plasma (PRP) 

If you’re relatively young and healthy, you may have healing powerhouses in your own blood. Platelet-rich plasma (PRP) is a serum that we create by withdrawing blood from your arm and then spinning it in a centrifuge two times to isolate healing cell fragments called platelets.

PRP injections involve taking platelets from your blood, concentrating them in a centrifuge, and then injecting them directly into your inflamed soft tissues. The injections provide each injection site with billions of platelets. 

Platelets help heal wounds and also provide your body with materials to rebuild tissues, such as proteins and growth factors. You can use PRP to improve joint pain and accelerate healing in other types of tissues, including muscle, tendon, and bone.

Mesenchymal cells

Mesenchymal cells are “blank slate” cells that we either take from your bone marrow or obtain from donated tissues after healthy, live births, such as placenta or umbilical cords.

Mesenchymal cells signal your own body to create progenitor cells, which you use to rebuild injured tissues. Like PRP, these cells can help repair damaged tissues of all sorts and promote healing to alleviate pain. 


ReNu is made from donated amniotic tissue and fluids from healthy cesarean births. These tissues, which would otherwise be disposed of, contain powerhouses of cell-building and renewal, such as cytokines and regenerative growth factors. 

The constituents of amniotic tissues have been used safely and effectively in medical care for more than 100 years. In addition to healing proteins, ReNu contains HA for its lubricant abilities.

Almost 70% of knee arthritis patients respond to ReNu injections. In fact, 63% experienced pain reduction after just one injection. Pain relief can last for up to one year. 

After any injection, we recommend continuing PT until your pain is resolved. If you’re an athlete or a very active adult, we advise keeping PT part of your regimen.

Are you frustrated with the limited relief PT and other first-line therapies have given you? Contact us today for an orthopedic injections appointment by phone or the online form.