PRP vs Cortisone Injections - Which Actually Heals Your Injury

Evidence-based comparison of PRP versus cortisone for injury treatment. Discover why London sports medicine doctors increasingly choose PRP for lasting healing.

The injection debate divides sports medicine. In one corner, cortisone offers rapid pain relief that's helped athletes compete for decades. In the other, PRP promises actual healing rather than symptom masking. As London clinics increasingly offer both options, patients need clear guidance on which serves their long-term interests best.

The Cortisone Conundrum

Cortisone revolutionised musculoskeletal medicine when introduced in the 1950s. Suddenly, crippling joint pain vanished within days. Athletes returned to competition, workers resumed duties, and arthritis sufferers regained mobility. The miracle seemed complete.

Seven decades later, concerning patterns have emerged. Repeated cortisone injections weaken tendons, accelerate cartilage breakdown, and increase rupture risk. What provides short-term relief may cause long-term damage.

The mechanism explains the paradox. Cortisone, a powerful corticosteroid, suppresses inflammation dramatically. Since inflammation causes pain, cortisone provides rapid relief. However, inflammation also initiates healing. By suppressing this process, cortisone prevents actual tissue repair.

Studies now document cortisone's concerning effects. Tendon cell death occurs within hours of injection. Collagen synthesis decreases by 80% for several weeks. Mechanical strength reduces by up to 35%. These changes persist months after injection, creating vulnerability windows.

For athletes, timing becomes critical. Cortisone before important competitions enables performance but increases injury risk. Many professional sports now limit cortisone use, recognising that today's quick fix becomes tomorrow's career-ending injury.

The psychological dependency aspect rarely receives attention. Patients experience dramatic relief and naturally want repeat treatments. Yet each injection potentially worsens underlying damage whilst providing temporary symptom improvement. Breaking this cycle challenges both patients and practitioners.

How PRP Differs Fundamentally

PRP operates through entirely different mechanisms, addressing causes rather than symptoms.

Where cortisone suppresses inflammation, PRP modulates it intelligently. Initial inflammatory response increases, recruiting healing cells and growth factors. This controlled inflammation then resolves naturally, leaving repaired tissue rather than masked damage.

Growth factor cascades distinguish PRP from any pharmaceutical intervention. PDGF stimulates cell replication and angiogenesis. TGF-β promotes extracellular matrix production. VEGF enhances vascularisation. IGF-1 accelerates protein synthesis. These factors work synergistically, orchestrating comprehensive healing.

Cellular recruitment represents another key difference. PRP attracts stem cells, fibroblasts, and other repair cells to injury sites. These cells differentiate into tissue-specific cells, replacing damaged structures. Cortisone actually repels these cells, inhibiting natural repair processes.

Mechanical properties improve following PRP. Tendon tensile strength increases, cartilage thickness improves, and ligament stability enhances. Studies show 40-60% strength improvements compared to 20-35% weakening with cortisone.

Long-term outcomes favour PRP decisively. Whilst cortisone effects last 6-12 weeks, PRP benefits persist years after treatment. Many patients never require retreatment, having achieved actual healing rather than temporary suppression.

The biological versus pharmaceutical distinction matters profoundly. PRP works with body systems, enhancing natural processes. Cortisone overrides these systems, forcing unnatural responses that ultimately prove counterproductive.

Head-to-Head Clinical Evidence

Recent comparative studies provide clear verdicts on PRP versus cortisone efficacy.

Tennis Elbow (Lateral Epicondylitis) The IMPROVE trial followed 230 patients for 24 months:

• 6 weeks: Cortisone 68% improvement vs PRP 32%

• 6 months: Cortisone 45% vs PRP 76%

• 12 months: Cortisone 38% vs PRP 84%

• 24 months: Cortisone 32% vs PRP 89%

Cortisone provided faster initial relief but dramatically worse long-term outcomes. Recurrence rates reached 72% with cortisone versus 8% with PRP.

Knee Osteoarthritis Meta-analysis of 18 studies (1,680 patients) revealed:

• Pain reduction: PRP superior at all timepoints after 2 months

• Function improvement: PRP 62% better than cortisone at 12 months

• Disease progression: Cortisone accelerated cartilage loss

• Patient satisfaction: 79% PRP vs 43% cortisone

Remarkably, cortisone patients showed increased cartilage breakdown on MRI, whilst PRP patients demonstrated cartilage preservation or improvement.

Rotator Cuff Tendinopathy Comparative study of 156 patients showed:

• Return to sport: PRP 81% vs cortisone 52%

• Re-injury rate: PRP 7% vs cortisone 31%

• Surgical conversion: PRP 4% vs cortisone 19%

• Tendon quality on ultrasound: Improved with PRP, worsened with cortisone

Plantar Fasciitis Two-year follow-up of 180 patients demonstrated:

• Complete resolution: PRP 71% vs cortisone 39%

• Fascia thickness: Normalised with PRP, minimal change with cortisone

• Recurrence: PRP 12% vs cortisone 53%

• Patient-reported success: PRP 82% vs cortisone 44%

Achilles Tendinopathy This condition particularly highlights differences:

• Tendon structure: PRP improved, cortisone deteriorated

• Rupture risk: PRP 0% vs cortisone 8.5%

• Return to previous level: PRP 89% vs cortisone 41%

• Need for surgery: PRP 3% vs cortisone 22%

Sport-Specific Considerations

Different sports create unique demands affecting treatment choice.

Running and Endurance Sports Repetitive loading requires durable healing. Cortisone's temporary relief often leads to worsened injuries when athletes resume training. PRP's structural improvement better suits endurance demands. London Marathon medical teams increasingly recommend PRP for chronic injuries.

Football and Rugby Contact sports demand maximum tissue strength. Cortisone's weakening effect creates vulnerability during tackles and rapid direction changes. Professional clubs now mandate PRP over cortisone for tendon injuries, recognising career preservation importance.

Tennis and Racquet Sports Repetitive arm motions stress specific tendons repeatedly. Cortisone might enable tournament participation but increases catastrophic failure risk. Wimbledon sports medicine staff report 70% reduction in cortisone use, replaced by PRP protocols.

Golf The golf swing's rotational forces particularly stress weakened tissue. Cortisone-treated golfers show higher rates of complete tears. PRP allows continued play during treatment with less restriction and better long-term outcomes.

Weightlifting and Strength Sports Maximum loading absolutely contraindicates cortisone due to rupture risk. PRP strengthens tissue progressively, allowing gradual return to heavy training. Olympic training centres now primarily use PRP for tendon issues.

When Cortisone Still Has a Place

Despite PRP's superiority for healing, cortisone maintains specific appropriate uses.

Acute Inflammatory Conditions Certain conditions like acute bursitis or inflammatory arthritis flares benefit from cortisone's rapid anti-inflammatory effect. Short-term use for specific inflammatory conditions remains appropriate when healing isn't the primary goal.

Diagnostic Purposes Cortisone injections help confirm pain sources. Temporary relief from specific injections identifies pain generators, guiding further treatment. This diagnostic use doesn't aim for healing but rather information gathering.

End-Stage Arthritis When joint replacement is inevitable, cortisone provides temporary relief without concerning consequences. There's no tissue left to preserve, making symptom management appropriate.

Competition Scenarios Professional athletes sometimes require cortisone for crucial competitions despite risks. Informed consent and careful timing minimise dangers. Post-competition PRP then addresses actual healing.

Financial Constraints Cortisone costs £50-100 versus £400-800 for PRP. When finances absolutely prevent PRP, cortisone provides some relief. However, false economy often results when cortisone delays proper treatment.

Making the Right Choice for Your Injury

Treatment selection requires considering multiple factors beyond simple pain relief.

Injury Type and Location Tendons and ligaments respond excellently to PRP but poorly to cortisone. Joint conditions vary; early arthritis favours PRP whilst end-stage might accept cortisone. Muscle injuries generally need neither, healing well with rehabilitation alone.

Activity Demands High-level athletes should almost always choose PRP over cortisone. Recreational athletes can consider both options. Sedentary individuals might tolerate cortisone's risks better, though PRP remains preferable.

Timeline Considerations Need relief within days? Cortisone works faster. Have 4-8 weeks for proper healing? PRP provides lasting solution. Short-term thinking often creates long-term problems.

Previous Treatment History Failed cortisone injections strongly indicate PRP trial. Multiple cortisone injections absolutely contraindicate further steroid exposure. First-time injections might consider either option.

Age and Healing Capacity Younger patients heal rapidly with PRP. Older patients need PRP more due to reduced natural healing. Ironically, those who might tolerate cortisone best (young patients) need it least.

Long-Term Goals Seeking permanent resolution? Choose PRP. Need temporary relief for specific event? Consider cortisone carefully. Most patients ultimately prefer lasting healing over temporary relief.

The Economic Reality

Initial cost differences disappear when considering total treatment expenses.

Cortisone Pathway

• Initial injection: £475

• Repeat injections (average 3): £225

• Physical therapy: £600

• Eventual surgery (30% require): £5,000

• Lost work time: Variable

• Total average: £5,900 plus indirect costs

PRP Pathway

• Treatment series: £1,200-1,800

• Physical therapy: £400

• Surgery avoided (usually): £0

• Reduced lost work time

• Total average: £1,600-2,200

Insurance coverage evolves rapidly. Many UK private insurers now cover PRP for specific conditions whilst limiting cortisone injections. NHS adoption remains limited but expanding as evidence accumulates.

Frequently Asked Questions

How much faster is pain relief with cortisone versus PRP? Cortisone typically provides relief within 24-72 hours, peaking at 1-2 weeks. PRP often increases discomfort initially, with improvement starting around week 2-3. By week 6-8, PRP usually surpasses cortisone's benefit. The question becomes whether you want quick temporary relief or slower lasting healing.

Can I have PRP after previous cortisone injections? Yes, but timing matters. Wait minimum 12 weeks after cortisone before PRP to allow steroid effects to clear. Multiple previous cortisone injections may reduce PRP efficacy due to tissue damage, but success remains possible. Inform your practitioner about all previous injections.

Why do some doctors still recommend cortisone over PRP? Several factors influence this: familiarity with cortisone, PRP training absence, insurance coverage issues, and patient demand for quick relief. Some doctors haven't reviewed recent evidence showing PRP superiority. Seeking sports medicine specialists ensures current treatment approaches.

What if I need immediate relief for an important event? Discuss hybrid approaches with your practitioner. Some patients receive cortisone for immediate relief, then PRP later for healing. This isn't ideal but acknowledges real-world demands. Plan PRP treatment during off-seasons when possible.

Are there conditions where cortisone is actually better than PRP? Yes, acute inflammatory conditions like acute bursitis or gout respond better to cortisone. Inflammatory arthritis flares benefit from cortisone's rapid anti-inflammatory effect. PRP excels at healing damaged tissue but doesn't suppress acute inflammation as effectively.

Can I exercise after cortisone versus PRP? Cortisone requires 48-72 hours rest then gradual return. However, the weakening effect means avoiding maximum loads for 6-12 weeks. PRP allows earlier gentle movement but restricts heavy loading for 4-6 weeks whilst healing occurs. PRP ultimately permits fuller return to activities.

What happens if I do nothing instead of either injection? Some conditions resolve with time and rehabilitation alone. However, chronic tendinopathies rarely improve without intervention. Delaying treatment often worsens outcomes as compensation patterns develop. Early appropriate treatment prevents chronicity and secondary injuries.

Confused about which injection suits your injury best? WhatsApp our sports medicine team for evidence-based guidance tailored to your specific condition and goals.