Short answer
Many people with knee pain can improve without surgery, and the best-supported options are the unglamorous ones: exercise, and weight loss when it applies. The main U.S. guideline for knee osteoarthritis makes strong recommendations for exercise and weight loss.
Injections and devices are where the evidence is thinner and less settled. The same guideline strongly recommends against PRP and stem cell injections, and a large 2021 trial found PRP no better than saline. Reviews of shockwave and laser report pain benefits, but the studies differ a lot in method.
At Charleston Pain Relief Center in North Charleston, SC, we tell you which options have stronger evidence, which are newer, and what each is likely to do for your knee.
This article is general information, not medical advice for your situation. Do not stop or change a prescribed medication on your own — talk with whoever prescribed it first.
Pain Relief · North Charleston
What is actually causing your pain?
Text yourself the answer: what we would look at, what it costs, and this week’s openings. One tap, and the message is already written for you.
★ Your first 15 minutes are free
Prefer to talk? Call 843-604-2276
Scan it with your phone camera
The message is already written. Send it and we reply with the details.
On your phone right now? Call 843-604-2276
Where the research in this article comes from
We would rather you check our numbers than take our word for them. The basics on osteoarthritis come from the Mayo Clinic patient guide. The treatment recommendations come from the 2019 American College of Rheumatology/Arthritis Foundation guideline, summarized for family doctors in American Family Physician, and from a 2015 American Family Physician review on non-surgical knee pain. On specific treatments, the key studies are a 2021 randomized trial of PRP versus saline published in JAMA, two meta-analyses of shockwave therapy in knee osteoarthritis, a 2022 meta-analysis of laser therapy, and a 75-patient randomized trial of A2M injections. Full citations are at the end. From here on we will refer to them as the patient guide, the guideline, the PRP trial and the reviews.
Common causes of knee pain
Knee pain has many causes. Two that are usually managed without surgery are osteoarthritis and patellofemoral pain syndrome (pain around or behind the kneecap). Others include meniscus and ligament injuries, tendon irritation from overuse, and pain referred from the hip or back. An exam matters, because the best treatment depends on the cause.
Osteoarthritis and cartilage wear
Osteoarthritis (OA) happens when the cartilage that cushions the ends of the bones gradually wears away. It affects the whole joint, not only the cartilage. Symptoms often develop slowly and worsen over time, and they can usually be managed even though joint damage cannot be reversed. That last point is worth keeping in mind when you evaluate any treatment that claims to regrow cartilage.
The foundation: exercise, movement and weight
This is the least exciting part and the best supported. The guideline strongly recommends exercise for knee osteoarthritis, along with weight loss for people who are overweight and tai chi. No single type of exercise came out on top, though most studies used aerobic exercise. Active approaches (stretching, strengthening and exercise programs) work better for knee pain and function than passive treatments such as therapeutic ultrasound, electrical stimulation or cryotherapy. And pain in knee OA is related to weight: even a 5% weight loss brings notable improvement in knee pain. Any plan we build with you should include this foundation.
Medications and cortisone injections
Oral anti-inflammatory medicines (NSAIDs) provide temporary improvement in knee pain and function, and the guideline also strongly recommends corticosteroid (cortisone) injections into the knee. A cortisone injection can calm a flare, but the research on repeated injections is less comfortable, and we covered it in Cortisone Shots and NSAIDs: What the Research Actually Says.
Braces, supports and walking aids
The guideline makes strong recommendations for assistive devices such as canes and tibiofemoral knee braces, which reduce pain and improve walking speed. They are low-risk, and a good place to start if your knee gives you trouble with daily activities.
Shockwave therapy
SoftWave and other shockwave therapy sends acoustic waves into the tissue around the joint. A 2020 meta-analysis of randomized trials in knee osteoarthritis found reduced pain at 4, 8 and 12 weeks and concluded shockwave was efficacious and safe. A larger review of 50 trials (4,844 patients) also found benefit, with big differences in results between studies. Devices and doses vary, so a result from one machine does not automatically carry over to another. These trials measured pain and function, not cartilage regrowth.
Laser therapy
Class IV laser therapy is called high-intensity laser therapy in much of the research. The 2022 meta-analysis found that high-intensity laser plus rehabilitation exercise improved knee pain, stiffness and function compared with control, and noted that a direct comparison with low-level laser is still needed. The trials in that review added laser to exercise, so they support laser as an add-on to exercise, not a replacement for it.
PRP, A2M and other regenerative injections
This is where the evidence is thinnest and where we want to be most direct. PRP therapy concentrates platelets from your own blood and injects them into the joint. The guideline strongly recommends against PRP and stem cell injections for knee osteoarthritis. The PRP trial gave 288 adults with mild-to-moderate knee OA three weekly PRP injections or saline and found no significant difference in knee pain or cartilage volume at 12 months. Its authors noted that most guidelines did not recommend PRP because of a lack of high-quality evidence. PRP preparations differ, so one formulation’s result does not automatically apply to another.
Alpha-2-macroglobulin (A2M) is a protein in blood plasma that blocks cartilage-degrading enzymes in laboratory and animal studies. In people, the only randomized trial we found followed 75 patients with knee OA for 12 weeks after an injection of A2M, PRP or a cortisone drug. A2M gave modest improvement in pain and function at 6 weeks, inconsistently across measures and to a similar degree as PRP and cortisone. That is early, short-term evidence.
If you choose a regenerative option, treat it as an experiment: agree beforehand on what improvement you are looking for and by when, and what you will do if it does not come.
When surgery is the right call
For advanced osteoarthritis, joint replacement is a legitimate option. Artificial joints can wear out or come loose and may eventually need to be replaced, so timing matters. If knee pain is limiting your life and non-surgical care is not helping, ask for an orthopedic consultation. It does not commit you to surgery. See a doctor promptly if you have knee pain after an injury with an inability to bear weight or visible deformity, or a hot, swollen knee with fever.
What a knee evaluation at CPRC may look like
- History and exam, including where it hurts, what makes it worse and what you have already tried.
- A review of any imaging you have, such as X-rays or an MRI.
- A plan that starts with the basics (movement, strength, weight when relevant) and adds other options only where they fit.
- A reassessment partway through, so you and your provider can see whether it is working, with a referral if it is not.
Frequently asked questions
What is the best treatment for knee pain without surgery?
For knee osteoarthritis, the strongest evidence is for exercise and, when it applies, weight loss. Other treatments are best seen as add-ons, chosen to fit your knee, your goals and your health.
Does PRP regrow cartilage?
The PRP trial found no significant difference in cartilage volume between PRP and saline at 12 months, and the guideline strongly recommends against PRP for knee osteoarthritis.
Is shockwave therapy good for knee arthritis?
Meta-analyses of randomized trials report reduced knee pain over the first 12 weeks, though the studies vary widely and none of them show cartilage regrowth. It is reasonable to try with a clear checkpoint, not a promise.
What is an A2M injection?
A2M is a protein found in blood plasma that blocks cartilage-degrading enzymes in laboratory studies. The one small randomized trial we found, with 75 patients followed for 12 weeks, showed modest, inconsistent improvement similar to PRP and cortisone.
Can knee arthritis be reversed?
Osteoarthritis symptoms can usually be managed, but the damage to the joint cannot be reversed. Be cautious about any treatment that promises to regrow cartilage.
Where can I get knee pain treatment near North Charleston?
Charleston Pain Relief Center is at 2294 Otranto Rd, North Charleston, SC 29406, serving North Charleston, Hanahan, Goose Creek, Ladson, Summerville, Park Circle and the wider Lowcountry. Call or text 843-604-2276.
Knee pain holding you back? Find out your options.
Tell us what hurts and what you have already tried. Our North Charleston team will text you back with a straight answer about whether we can help — and what it would involve.
Sources
- Mayo Clinic Staff. Osteoarthritis: Symptoms and causes. Mayo Clinic. mayoclinic.org
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020;72(2):149–162.
- Buelt A, Narducci DM. Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation. Am Fam Physician. 2021;103(2):120–121. aafp.org
- American Family Physician. Nonsurgical Management of Knee Pain in Adults (2015). aafp.org
- Bennell KL, Paterson KL, Metcalf BR, et al. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA. 2021;326(20):2021–2030. doi:10.1001/jama.2021.19415. PMC
- The efficacy and safety of extracorporeal shockwave therapy in knee osteoarthritis: a systematic review and meta-analysis. Int J Surg. 2020;75:24–34. PubMed
- Clinical efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a systematic review and meta-regression of randomized controlled trials (50 trials, 4,844 patients). PEDro record
- Ahmad MA, Hamid MSA, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy. 2022;114:85–95. PEDro record
- The Effectiveness of Alpha-2-Macroglobulin Injections for Osteoarthritis of the Knee (single-center randomized trial, 75 patients, 12-week follow-up). Icahn School of Medicine record
Charleston Pain Relief Center · 2294 Otranto Rd, North Charleston, SC 29406 · 843-604-2276 · Last updated 3 October 2026. This article is educational and is not a substitute for individual medical advice. Do not start or stop any medication without speaking to your prescriber.