Written by Kevin Liu
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In a randomized, single-blinded, multicenter Chinese study, physical therapy was superior to glucocorticoid injections over one year for subjective knee pain and function.
Don’t knee-glect your physical therapy
Physical therapy (PT) and glucocorticoid injections have been used for decades to manage knee osteoarthritis (KOA). Historically, glucocorticoid injections are considered for short-term pain relief with concerns for promoting cartilage loss and limited long-term benefits, while PT has demonstrated long-term effects in pain reduction, functional improvement, and quality of life.
This multicenter, single-blinded, randomized trial conducted in China confirmed the existing literature that PT provided superior long-term improvement in pain and function among 273 adults 50-70 years old with KOA and meniscal injury when compared to glucocorticoid injections at one year. 62% had an excellent outcome at 1 year with PT vs. 36% with injection, NNT = 4. The 2019 American College of Rheumatology and Arthritis Foundation guidelines strongly recommend exercise and PT as first-line therapy for KOA, with adjunctive intraarticular glucocorticoid injections for short-term relief.
How does this change my practice?
As a hospitalist and occasional primary care doctor, my goal is to get patients to move as much as possible, and I don’t see this as one or the other. Glucocorticoid injection can be a bridge to more PT participation. The more active my patients are, the more robust their outcomes. Like PT, the cliche of “use it or lose it,” is true for knee pain and function.
Source
Physical therapy vs. glucocorticoid injection in patients with meniscal tears and knee osteoarthritis: a multi-center, randomized, controlled trial. BMC Med. 2025 May 9;23(1):277. doi: 10.1186/s12916-025-04113-y. PMID: 40346599
