Are steroids good for your knees?

Are steroid injections the answer for knee pain—or a shortcut that costs you in the long run? In this episode of The Talking Rehab Podcast, Dr. Fred Bagares unpacks the real story behind corticosteroid injections. You’ll learn why the quick relief they provide can sometimes accelerate joint breakdown, what the research actually shows about long-term effects, and how to think beyond short-term fixes.

Dr. Bagares also explores alternatives that support joint health—like PRP, vitamin D, and strength training—and shares the story of a patient who broke free from the “injection cycle” by changing his approach. If you’ve ever wondered whether steroid injections are truly helping or quietly harming, this episode will give you a clear, evidence-based perspective.

[00:00:00] The counterintuitive truth: the patients who benefit most from injections often need them the least.
[00:01:00] The quick-fix mindset: why pain relief doesn’t always equal healing.
[00:02:00] The 2017 RCT that revealed faster cartilage loss with repeated steroids.
[00:03:00] Upsides vs downsides: rapid pain relief versus long-term joint damage and systemic risks.
[00:04:00] Reframing the question: are you creating a protective or destructive joint environment?
[00:05:00] Evidence-based options that support cartilage health—PRP, vitamin D, chondroitin, hyaluronic acid.
[00:07:00] Safe adjuncts like glucosamine and collagen, plus their limits.
[00:08:00] Tom’s story: breaking the “injection cycle” through rehab, strength, and mindset shifts.
[00:09:00] Four takeaways: use interventions strategically, move consistently, treat strength as medicine, add safe supplements.
[00:10:00] The big picture: resilience, not just relief, is the goal for long-term knee health.

If you’re ready to start building a resilient joint environment instead of chasing short-term fixes, visit fredbagares.com to learn more.

Transcript

0:00

Are steroid injections good for your knees? Here's the counterintuitive truth. The patients who get the best long-term outcomes from knee injections are often the ones who need them the least. If you're looking for immediate pain relief, corticosteroids can deliver, However, Repeated injections create the exact environment that accelerates joint breakdown. It's like using a credit card to pay off debt Works today, but it costs you tomorrow. Here's the thing that people don't realize. Inactivity does the exact same thing. Poor movement patterns, ignoring early warning signs. All of these lead to. Degeneration of the joint. So the real question isn't about the injection, it's about the environment you're creating inside of the joint and what you expect out of the injection. This is what we're gonna explore today. I'm Dr. Fred Biris, and this is The Talking Rehab Podcast. Quick favor, before we dive in. If this podcast has changed how you think about your body or your recovery, hit that subscribe button. It's free. It takes two seconds, and it's how we keep bringing you these conversations every week. No fluff. Just real talk about what actually works. Thanks for being here. Now let's get into it. Picture this familiar scenario. You limp into a doctor's office, knee's been bothering you for several weeks. The conversation goes something like this. We could try physical therapy or we could do an injection to see if that helps. The needle goes in, the pain goes down, and for three months you feel great. It's almost like a magic bullet. Here's what's happening underneath the surface. Every intervention is either building resilience in your joint or contributing to its breakdown. There's really no neutral ground. The quick fix mindset says if it hurts less, it must be better. Your cartilage, your bone, and your entire movement system operates under a different set of rules. Let me share some data that might surprise you. In 2017, a randomized controlled trial tracked patients getting corticosteroid injections every three months for two years. The results they experienced no greater pain relief than the placebo group, but they lost cartilage at a faster rate compared to the placebo group. So think about this, the pain levels are roughly about the same between the two separate groups, but this group that received more steroid actually had more joint damage. This isn't about demonizing steroid injections, it's about understanding the true question. What are you doing to the long-term environment of your joint? Let's be honest about what we're dealing with. The upside is real. With steroid injections, you get rapid pain reduction. Even with low dose formulations, you have decreased swelling and also a decreased inflammatory response. Generally, if you're feeling better, your sleep improves along with your daily function, and you have more mobility because the pain is better controlled. However, what are the downsides? The downsides include. Repeated steroid injections lead to accelerated cartilage degradation, arthritis progression. There's also risk of subc chondral bone fractures, and tendon weakening. It is rare, but it is a serious complication. There's also systemic side effects. If you have diabetes, they can sometimes contribute to blood sugar spikes, adrenal axis suppression, and also bone density loss. That being said, I think we have to also understand the role of steroid injections. In this particular study, they did steroid injections every three months for two years, which is kind of a crazy game plan overall. We know that steroid injections have a role, but when it's your primary role, you do have to pay for the side effects. Here's where we reframe the question. Stop asking if these type of injections are good or bad, but start asking what creates a destructive joint environment and what builds a protective one. Destructive patterns include repeated high dose steroid exposure, prolonged inactivity, and muscle atrophy, all or nothing loading patterns, particularly when we work out. Ignoring early biomechanical warning signs. Protective patterns include consistent moderate activity that respects pain signals, strategic limited use of anti-inflammatory interventions, having a progressive strength training and movement optimization program. Also being proactive. When you start developing compensation patterns secondary to pain. Think of your knee like a thriving neighborhood ecosystem. Steroid injections, they're like calling it a heavy handed security force. They'll quiet things down quickly, but if you keep calling them back, eventually they start damaging the infrastructure, the streets, the buildings, the community itself. Now daily movement and activity. This is your essential maintenance crew. Keeping the sidewalks clean, the street lights working. The gardens tended to, nothing glamorous but absolutely critical. Now, supplements and other interventions, these are like the neighborhood volunteers. They're nice to have, but they won't save the neighborhood when the basics aren't being maintained. The ecosystem health matters more than any single intervention. Now, let's talk about what the research says about supporting cartilage volume. PRP or platelet-rich plasma. This is where the data gets interesting. Recent studies show that PRP treated knees gained an average of 295 cubic millimeters of cartilage over eight months while control groups lost cartilage. We're seeing measurable increases in cartilage thickness on ultrasound and even AI assisted MRI mapping, showing cartilage thickening in knee sub regions. With vitamin D optimization. Four year studies show consistent supplementation, significantly reduced cartilage meniscus, and bone marrow deterioration, The effect is dose dependent. At least 300 international units taken four to six days per week shows measurable benefits. The higher the vitamin D intake correlates with better cartilage thickness, volume across all knee compartments. Pilot studies have shown that chondroitin sulfate. Demonstrates a gain of 180 cubic millimeters of cartilage volume over 48 weeks compared to losses in placebo groups, while not always statistically significant due to measurability. The trend suggests genuine structure modifying effects. Hyaluronic acid injections, also known as gel injections for the knee, have shown that certain formulations demonstrate increases in type two collagen turnover and overall collagen volume in the osteoarthritic knee. Think of your knee like a thriving neighborhood ecosystem. Steroid injections, they're like calling in the heavy handed security force. They'll quiet things down fast, but if you keep calling them back, eventually they start damaging the infrastructure, the streets, the buildings, the community daily movement and activity. This is like your essential maintenance crew keeping the sidewalks clean, the street lights working, and the gardens tended to, nothing glamorous, but definitely essential supplements and other interventions. These are like the small community improvement grants. Nice to have, but they won't save a neighborhood when the basics aren't being maintained. A healthy joint ecosystem matters more than any single intervention. Let's talk about supplements and what the research supports glucosamine and chondroitin sulfate. There have been multiple systematic reviews that show modest, but consistent benefit for pain and function. The effect size isn't dramatic, but it's real and it is sustainable. Next we have collagen supplementation where emerging evidence suggests benefits for cartilage metabolism through optimal dosing and timing Vitamin D optimization is critical for bone health. However, the direct cartilage benefits are less established. That being said, these type of supplementations have a very low risk profile. They can be quite pricey, but at the end of the day, if it does support your overall healthy joint environment, it is a good adjunct to your overall game plan. Let me tell you about Tom. A 52-year-old office worker, weekend warrior basketball player. He came in to see me after two arthroscopic meniscus surgeries and years of intermittent steroid injections. His pattern was quite predictable. Injection would buy him three or four months of reduced pain, then it'd be back. Meanwhile, his cartilage was gradually thinning and his movement patterns were getting worse. Here's what we discovered. Tom's real problem wasn't his meniscus or his cartilage. However, it was the environment he created around his knee joints. We took a different approach. Yes, he got one more injection this time, but the overall goal is to decrease the acute pain. It's hard to implement a rehabilitation program if the pain is not well controlled. While the anti-inflammatory effect reset his pain cycle, we started to rebuild the fundamentals, hip strength, ankle mobility, and proper loading patterns. We added in an evidence-based support with supplementation of glucosamine, daily walking, in addition to progressive strength training. Most importantly, we changed the relationship with his knees, teaching him to distinguish between tissue damage and signals versus adaptation discomfort. Six months later, Tom wasn't pain-free, but he was still playing basketball. He felt stable, strong, and was no longer chasing injections. His joint environment changed fundamentally, but more importantly, his mindset and approach to how he moved his body had significantly changed as well. So here are some of the takeaways that will hopefully give you a practical framework for joint health. Number one, use interventions strategically, injections, physical therapy, medications, topical agents. These are all interventions, but they should be used as bridges to function better, not as crutches for poor habits. Number two, move consistently and intelligently. Cartilage thrives on regular and varied loading. That being said, too much or too little can contribute to cartilage loss. So be smart, but consistent. Treat strength as medicine. It is very well established in the literature that strong muscles absorb stress before it reaches your joints. Implementing a resistance training program is critical, not only for joint and muscle health, but also for your overall longevity. Using supplements don't replace the fundamentals, but they can be a very safe intervention. Again, these are adjunct treatments supplements can be helpful. Remember, your joint environment is being shaped every day by what you do and also what you don't do. So in closing, getting back to the primary question, are steroid injections good for your knees for short-term relief? They can be excellent, but as a long-term solution, they have long-term side effects. Therefore only use them if they are part of a comprehensive strategy. That being said, relying on injections alone can create a destructive joint environment, but so does inactivity. So, is ignoring biomechanical problems. So does the wait and see approach. From my standpoint, any intervention should build momentum in your rehabilitation program. The winning strategy isn't about avoiding interventions, it's also about building resilience step by step day by day. The real question is what kind of environment are you creating for your joints today? Because success isn't just getting out of pain. Success is building a joint environment that supports you for decades to come. If you're ready to build that resilient joint environment, please reach out to me@fredbiris.com. Thanks again for listening. I hope you have a great one. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.