Joint Pain Treatment in Young Adults: Steroids, PRP, GFC

Joint pain treatment in young adults follows a ladder: physiotherapy and a short course of anti-inflammatories first, then a steroid injection if pain keeps rising after about three weeks, and regenerative therapy with platelet-rich plasma (PRP) or growth factor concentrate (GFC) only once the problem has become chronic, at around three months. Complete tears go to surgery.

That sequence is the practice of Dr. Rakesh Mahajan, Vice Chairman & HOD - Orthopedics, BLK-Max Super Speciality Hospital, New Delhi, India. Its logic rests on one distinction. Early in an injury, pain is driven by inflammation and responds to anti-inflammatory treatment. Months later, inflammation has usually subsided and the problem is tissue that has failed to heal, which needs a different approach. Treating each stage with the right tool, and not jumping ahead, is the core of his method. This article walks through each rung: physiotherapy, medicines and nutraceuticals, steroid injections, PRP and GFC, and the point at which surgery takes over. The causes and the diagnostic pathway are covered in the complete guide to joint pain in the younger population, and prevention in the article on preventing joint pain in young adults through diet and training.

Acute or chronic: the first decision in joint pain treatment

Before choosing a treatment, Dr. Mahajan establishes how long the problem has lasted. He places the boundary of chronicity between 6 and 12 weeks and labels a problem chronic at three months. Most patients who reach him have already consulted several doctors and taken many treatments, and arrive beyond six weeks, which in his view already means the problem is chronic.

The implication is practical:

• A patient who comes early starts with NSAIDs and conservative care, not with regenerative therapy.
• A patient whose tests rule out acute inflammation and whose problem is chronic can go straight to regenerative therapy.
• Between 6 and 12 weeks, regenerative therapy is considered only if a steroid has also failed to reduce the inflammation. The ideal point, in his view, is three months.

Physiotherapy for joint pain: matching the modality to injury depth

Physiotherapy is the first active treatment, and Dr. Mahajan selects the modality according to how deep the injured tissue lies. Five centimetres is his dividing line.

Preventing fibrosis matters because a muscle that heals with scar tissue stays weak and can lead to deformity. TENS works on the gate control theory of pain: stimulating nerve fibres that carry touch and pressure signals reduces the transmission of pain signals in the spinal cord.

Exercise is part of the physiotherapy plan. For tennis elbow, for example, it means eccentric exercises (strengthening the muscle while it lengthens under load) for the extensor carpi radialis brevis (ECRB), the forearm muscle whose tendon is affected. For the shoulder, it means shoulder exercises alongside ultrasonic therapy, TENS and cold packs. Typical prices are on the physiotherapy and rehabilitation cost page.

How long to take NSAIDs for joint pain

Dr. Mahajan gives non-steroidal anti-inflammatory drugs (NSAIDs) for short periods only: his usual course is two to three weeks. He chooses the drug according to the patient's tolerance and any history of allergy to a drug group.

His rules are specific:

• Three weeks is the maximum. He does not give NSAIDs beyond three weeks.
• Taper early. If the patient is more than 50% better after two weeks, he tells them they can reduce the full dose, and adjust to what the body needs.
• Step down to paracetamol. After that, the most he allows is paracetamol, or a combination of tramadol with paracetamol, which he regards as safe for the kidneys, the heart and the gut.

The reason is the side-effect profile. NSAIDs can cause cardiovascular, kidney and gastrointestinal problems, and drugs such as ibuprofen have long been associated with gastrointestinal and kidney toxicity. Tramadol is an opioid, so it carries its own risks, including dependence, dizziness and interactions with some antidepressants, and is best used for short periods under medical supervision.

The underlying question, as he frames it, is when to stop treating pain and tell the patient to consider surgery. Analgesics cannot be continued indefinitely. If a patient is not responding and would benefit from a surgical approach, the doctor should recommend it.

Collagen and other nutraceuticals: type 2 versus types 1 and 3

Nutraceuticals (food-derived products taken for a health benefit) form the next part of his medical treatment. Dr. Mahajan uses collagens, boswellia and several other natural compounds intended to support healing of muscle, ligament and articular cartilage, the smooth layer that covers the ends of bones in a joint. His choice depends on the tissue involved, because different tissues are built from different collagens:

• Articular cartilage is rich in type 2 collagen. For cartilage problems, he prefers collagen type 2, derived from chicken or fish sources. In his experience it helps in cartilage loss up to stage 1 or 2, and in some cases stage 3, and it has to be taken for a long time.
• Ligaments and tendons are rich in types 1 and 3 collagen. For partial tears of ligaments and tendons, he uses collagen types 1 and 3, which are available separately from type 2.

Clinical evidence for collagen and other nutraceuticals in joint and cartilage repair is limited, and they are not among the treatments recommended in major osteoarthritis guidelines such as those of the American College of Rheumatology (2019) and NICE (2022).

DMARDs for inflammatory arthritis

For young patients whose joint pain is autoimmune, Dr. Mahajan uses disease-modifying anti-rheumatic drugs (DMARDs), which act on the immune process driving the inflammation rather than only on the pain. He uses both the conventional and the newer synthetic DMARDs, which are required in rheumatoid arthritis and psoriatic arthritis. In ankylosing spondylitis, conventional DMARDs help only arthritis of the peripheral joints; spinal disease that does not respond to NSAIDs is treated with biologic or targeted synthetic DMARDs. He sometimes gives them for a period even in seronegative arthritis, where blood tests show no abnormality, to modulate the immune response so that the joints start to improve.

Steroid injections: when to give them and when to wait

A steroid injection is the anti-inflammatory step on the ladder, and timing decides when Dr. Mahajan uses it.

Which steroid

He uses two injectable steroids: triamcinolone and methylprednisolone. He previously used methylprednisolone in the bigger joints (the knee and the shoulder) and triamcinolone in the smaller joints. Research published two to three years before the session showed that triamcinolone is also effective in the bigger joints, and he is now shifting to using triamcinolone in most cases.

Tennis elbow treatment: when a steroid injection fits

Tennis elbow (lateral epicondylitis) shows how he times an injection:

1. In the first week, no steroid. A patient who presents within a few days of the injury starts with conservative treatment: cold packs, a tennis elbow band, and physiotherapy with ultrasonic therapy or TENS and eccentric ECRB exercises.
2. Give conservative care up to six weeks. He is prepared to wait up to a maximum of six weeks.
3. Escalate if pain keeps rising. If the pain is increasing without response to NSAIDs and conservative treatment even after three weeks, he gives a steroid injection, because its role is anti-inflammatory and the other measures are not working.
4. Relabel at three months. If the pain persists at three months despite the steroid and everything else, the condition is chronic tennis elbow. It is no longer an inflammatory problem: the ECRB tendon is not healing, the patient has weakness in every activity, and the line of treatment changes to regenerative therapy.

Randomised trials have found that steroid injection relieves tennis elbow pain in the short term but is associated with more recurrence at one year than physiotherapy or a wait-and-see approach, which supports reserving it for patients who fail conservative care.

In the shoulder, he does not repeat a steroid injection before three months, as the bilateral shoulder pain case in the complete guide illustrates.

PRP vs GFC: regenerative therapy for chronic tendon and ligament injuries

Regenerative therapy is reserved for the chronic stage, when the tissue has stopped healing on its own. Dr. Mahajan uses two options: platelet-rich plasma (PRP) and growth factor concentrate (GFC). Both are prepared from the patient's own blood and are injected into or around a ligament, muscle or tendon to promote healing of a partial tear or a partially healed injury. A complete tear is different: it needs a surgical approach.

PRP has been in use for more than a decade. GFC has been available for the past few years, and Dr. Mahajan describes it as a next generation of PRP without the platelets: what clinicians wanted from PRP was the growth factors, and GFC kits deliver those growth factors directly.

PRP needs more injections than GFC because of the platelet content, and it is more painful. With GFC, he has observed that three to four injections hold good in most conditions. He keeps a gap of two weeks between injections with both, to promote healing and get the maximum benefit.

How PRP is prepared and injected

The preparation is done with a commercial kit and a centrifuge machine:

1. About 10 to 14 ml of the patient's blood is drawn into a vial supplied with the kit, which contains an anticoagulant.
2. The blood is centrifuged to separate the platelet-rich plasma.
3. From 12 to 14 ml of blood, about 4 to 5 ml of PRP solution is obtained.
4. The solution is injected all around the tendon or ligament in multiple pricks, not at a single point, to achieve the maximum result.

How growth factors promote healing

Platelets promote healing at the cellular level through the growth factors they carry. These include platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta) and vascular endothelial growth factor (VEGF). Dr. Mahajan's summary of the principle is that some growth factors increase vascularity, bringing new blood supply to the tissue, while others increase cellular activity and regeneration.

Clinical evidence for PRP in tendon and ligament injuries is mixed, and guidelines treat it as an option for selected chronic cases rather than a standard of care; evidence for GFC is more limited still.

Can PRP and a steroid be given together?

No. Dr. Mahajan is clear that the two should not be used concurrently, because they do different jobs. A steroid, like an NSAID, reduces inflammation, and he gives it at the stage when pain and inflammation are present. PRP is for regeneration, and is given only once the problem has been labelled chronic and inflammation has been excluded. Once it is clear that the tissue will not heal within its normal healing period, treatment shifts from steroid to PRP.

Is there an age limit for PRP?

Dr. Mahajan sets no age limit for PRP, and it can be given to patients up to 60 or 70.

When joint pain needs surgery: ligament tears and arthroscopy

Surgery is needed for complete ligament tears and for shoulder problems that fail injection and physiotherapy. The ladder ends where a structural problem cannot heal without repair. Chronic ankle sprain is his example. Where the anterior talofibular ligament (ATFL), the ligament most often injured in an ankle sprain, is weak on clinical examination, an MRI decides between a complete and a partial tear, and he urges doctors not to hold it back when in doubt. A complete tear needs ATFL reconstruction, as do complete ligament tears elsewhere; costs for this kind of surgery are on the foot and ankle reconstruction surgery cost page. A partial tear can be treated with PRP or GFC, depending on what is available at the centre.

In the shoulder, failure of injection and physiotherapy leads to arthroscopy (keyhole surgery), in which the inflamed bursa is debrided (cleared of inflamed tissue) and the tendons and acromioclavicular joint are assessed. Shoulder and knee ligament surgery is covered in Dr. Vipin Maheshwari's articles on rotator cuff repair and shoulder instability and knee and shoulder arthroscopy.

How joint pain treatment in young adults differs from arthritis care

Dr. Mahajan's regenerative ladder is aimed at soft tissue: partial tears and chronic tendinopathy in young, active people. Established arthritis in an older joint is a different problem, and Dr. Mannu Bhatia's article on non-surgical arthritis treatment explains why he does not use PRP once the cartilage is gone. When arthritis reaches its end stage, Dr. Mahajan's own masterclass on robotic knee replacement takes up the story. The questions doctors asked during this session, on PRP preparation, timing and growth factors, are collected in the Live Discussion for this masterclass.