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How Does Physical Therapy Compare With Steroid Shots?

A randomized study found that physical therapy resulted in more lasting improvement for people with knee osteoarthritis than steroid shots into the joint.
How Does Physical Therapy Compare With Steroid Shots?
Close-up Of A Cosmetologist Wearing Blue Surgical Gloves Makes Rejuvenation Beauty Injection On Woman’s Knee

People who see a doctor for knee pain due to arthritis may be offered steroid shots into the joint. Other physicians might make a referral for physical therapy first. Both treatments work, but how do they compare?

Comparing Physical Therapy With Steroid Shots:

Health care providers have long wondered about this question. Now scientists have designed a study to see which of these treatments works best (NEJM, April 9, 2020). The investigators assigned 156 patients with osteoarthritis of the knee to one of the treatments. They made the assignments using randomization software, but there were no placebo treatments. All the volunteers got one active treatment or the other, and they all knew which treatment they were getting.

Which Treatment Was Better?

After one year of follow-up, the clinicians reported that people who did physical therapy had less pain and better mobility than those receiving the steroid shots. Those getting physical therapy had up to eight sessions in the first month and a half. That’s not all, though. They also had the option of a few additional sessions at the 4-month and 9-month evaluations.

The steroid shots were triamcinolone with lidocaine.  These volunteers could also opt for an additional shot at the 4-month and/or 9-month reassessments.

On average, both groups got better. However, these researchers from the US military and their colleagues report that patients on physical therapy had significantly more improvement. Moreover, nearly one-fourth of those getting steroid shots reported no improvement or even worse symptoms at the end of the year. That compares with less than 10 percent of those in the physical therapy group reporting deterioration.

The investigators concluded:

“physical therapy for osteoarthritis of the knee resulted in better absolute scores on scales of pain and physical function than glucocorticoid injection at 1 year.”

Learn More: 

If you would like to know more about managing arthritis pain, you may be interested in our eGuide to Alternatives for Arthritis. This online resource provides information on medications as well as nondrug approaches to help you with this common health problem. 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Deyle GD et al, "Physical therapy versus glucocorticoid injection for osteoarthritis of the knee." New England Journal of Medicine, April 9, 2020. DOI: 10.1056/NEJMoa1905877
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