Knee pain is one of the most common issues that we see here at Pro Active Physio & Pilates. Whether your symptoms are due to knee osteoarthritis, overuse, or a recent flare‑up, it can be difficult to know which treatment option is right for you.
Two of the most widely discussed options are corticosteroid (steroid) injections and hyaluronic acid (HLA) injections. Both can help reduce pain, but they work differently, last for different lengths of time, and suit different types of knee symptoms. This guide breaks down the pros and cons, based on NICE guidelines, CSP recommendations, and our clinical experience delivering safe, effective injection therapy. Both options are available here on site at our Tewkesbury clinic (just a short distance from Worcester, Evesham, Pershore, Bredon and Cheltenham).
What are steroid injections?
Steroid injections reduce inflammation inside the knee joint. NICE recognises them as a short‑term option for managing knee osteoarthritis when pain or swelling is limiting your movement or preventing rehabilitation. Read more about knee arthritis and your options here.
Benefits of steroid injections:
- Fast pain relief – often within a few days
- Ideal for inflammatory flare‑ups
- Helps restore movement quickly so rehab can progress
- Useful when pain is stopping you from general exercise and losing weight
- Can be combined with physiotherapy for better long‑term outcomes
Limitations to consider
- Relief is short‑term only
- Not recommended too frequently as can lead to deterioration of the joint surface and can leave you prone to needing surgery in future.
- Temporary post‑injection soreness is possible
- May temporarily affect blood sugar in people with diabetes
- Not suitable if infection is present or surgery is planned soon
What are Hyaluronic Acid (HLA) injections?
Hyaluronic acid is a naturally occurring gel‑like substance that helps lubricate and cushion the knee joint. HA injections aim to improve joint glide and reduce stiffness. Many people do experience significant benefit – especially when other conservative treatments haven’t helped enough.
You can learn more about our full range of options on our Injection Therapy page here.
Benefits of Hyaluronic Acid injections
- Longer‑lasting relief – often 6-12 months and no limit to how many you may have. Less destructive to the joint.
- Improves joint lubrication and shock absorption – helps kick start natural processes within the joint.
- Helpful when steroid injections are unsuitable and is less destructive to the joint itself.
- May delay the need for more invasive interventions such as knee replacement surgery.
- Useful for chronic stiffness and “grinding” sensations
Limitations to consider
- Relief is gradual, not immediate
- More expensive than steroid injections (See our price list here)
- Not everyone responds
- Mild temporary swelling or aching can occur
Steroid vs Hyaluronic Acid: A clear comparison
| Feature | Steroid Injection | Hyaluronic Acid Injection |
|---|---|---|
| Onset of relief | Fast (days) | Gradual (weeks to months) |
| Duration | Short-term | Medium-term |
| Best for | Flare-ups, inflammation, severe pain | Stiffness, chronic OA, reduced cushioning |
| Cost | Lower | Higher |
| NICE stance | Supported for short-term relief | Not routinely recommended but used selectively and early evidence to suggest benefits. More research is needed. |
| Role in rehab | Helps settle pain to allow exercise | Supports longer-term comfort and mobility |
What do NICE and CSP guidelines say?
NICE NHS Guidelines:
- Supports steroid injections for short‑term relief in knee osteoarthritis.
- Does acknowledge that HLA injections may help some individuals but further research and evidence is needed.
Chartered Society of Physiotherapy:
- Emphasises that injections should be part of a broad rehabilitation plan, not a standalone fix.
- Encourages combining injections with strengthening, mobility work, and lifestyle modification for the best long term benefits
If you’re unsure which option suits your symptoms, our clinicians can guide you further during a Physiotherapy Assessment.
Our clinical approach: Injections followed by rehabilitation
Whether you choose Steroid or HLA, we believe that it is essential that you combine your injection with a personalised physiotherapy plan. This might include strength and conditioning tailored to your knee, load‑management and activity guidance, diet and lifestyle advice, pilates‑based control work and ongoing support to prevent flare‑ups.
We work closely with both NHS and private knee surgeons, so, if we can’t help then we may consider referring you on for further scans, blood tests or potential surgery. All of our specialist physiotherapy team here on site are qualified to assess and refer onwards for further imaging as well. We may also refer you to Lewis Brand Orthotics who can recommend an offloader brace to prevent further flare ups and help manage your symptoms further following your injection.
Is an injection right for you?
You may benefit from an injection if you are experiencing:
- Persistent knee pain affecting daily life
- A flare‑up that is stopping you from exercising
- Stiffness or grinding from osteoarthritis
- Pain that has not improved with physiotherapy alone and you are keen to avoid surgery
- Difficulty walking, climbing stairs, or standing for long periods
Ready to take the next step?
If knee pain is holding you back, our clinicians can assess your symptoms and guide you through the most effective treatment options – including steroid injections, hyaluronic acid injections, and evidence‑based physiotherapy. Our team at Pro Active Physio & Pilates is here to help you move better, feel stronger, and get Back into Action doing the activities that you love most.
Read more here on the DUROLANE website and please do not hesitate to contact us with any further questions. We can’t wait to here from you!
