Can strength training and Platelet Rich Plasma (PRP) injections reduce pain in individuals with knee arthritis when going up and down stairs?

Strength Training and PRP for Knee Arthritis Pain

Yes, strength training will significantly reduce your knee pain when going up and down stairs, but PRP injections should not be your first choice and offer no additional benefit when combined with exercise. 1

Strength Training: Your Primary Treatment

Quadriceps strengthening exercises are strongly recommended and will reduce your stair-climbing pain with robust evidence supporting their effectiveness. 2

Pain and Function Benefits

• Strength training produces significant pain reduction with an effect size of 1.05 when compared to control groups 2
• Two-thirds of studies examining quadriceps strengthening showed significant improvements in functional activities like stair climbing 2
• Benefits persist long-term, with improvements lasting 6-18 months 2
• Lower limb strength training reduces pain (effect size 0.29-0.53) and improves physical function (effect size 0.24-0.58) 3

Exercise Prescription Specifics

• Perform strengthening exercises at least 2 days per week 3
• Use moderate to vigorous intensity (60-80% of your one repetition maximum) 3
• Complete 8-12 repetitions per exercise 3
• Supervised sessions produce better outcomes than unsupervised exercise 3
• Twelve or more directly supervised sessions are more effective than fewer sessions for improving pain (effect size 0.46 vs 0.28) and function (effect size 0.45 vs 0.23) 3

Types of Exercise

• Both quadriceps-specific strengthening and general aerobic fitness training are equally effective over 18 months 2
• Dynamic strengthening exercises are more commonly recommended than isometric exercises 3
• Exercise programs do not require constant professional supervision once learned 2

PRP Injections: Limited Role

PRP injections are not recommended as first-line treatment and provide no additional benefit when combined with exercise. 4, 1

Guideline Positions

• The American College of Rheumatology/Arthritis Foundation strongly recommends against routine PRP use due to preparation heterogeneity and lack of standardization 5, 4
• The American Academy of Orthopaedic Surgeons provides only a "limited" strength recommendation, meaning you should exercise caution and clinical judgment 5, 4

Evidence Against PRP

• The highest quality 2024 randomized controlled trial found PRP combined with exercise was no better than exercise alone for pain at 24 weeks (pain improvement: 1.4 points with PRP+exercise vs 1.9 points with exercise alone, neither reaching the clinically important difference of 2 points) 1
• Exercise alone was clinically superior to PRP alone for function and quality of life 1
• PRP did not improve pain compared to exercise alone at 24 weeks in patients with mild-to-moderate knee osteoarthritis 1

When PRP Might Be Considered

• Only after failing first-line treatments including physical therapy, weight management, and NSAIDs 5, 4
• Only in mild-to-moderate knee osteoarthritis (Kellgren-Lawrence grades II-III), as severe disease (grade IV) shows worse treatment response 5
• If used, multiple injections are favored over single injections 5
• PRP may reduce pain more than placebo or hyaluronic acid at 6 months, but this evidence comes from older, lower-quality studies with high risk of bias 6

Comprehensive Treatment Algorithm

First-Line (Start Here)

1. Quadriceps strengthening exercises - 2+ days/week, supervised initially 2, 3
2. Weight reduction if overweight - reduces risk of symptomatic knee OA 2, 3
3. Education about self-management 2, 3
4. Oral or topical NSAIDs as appropriate 4

Second-Line (If First-Line Insufficient)

• Intra-articular corticosteroid injections for acute pain exacerbations, especially with knee swelling 4

Third-Line (If Previous Treatments Failed)

• Consider PRP only after exhausting above options, understanding limited evidence 5, 4
• Avoid oral narcotics including tramadol - they increase adverse events without improving pain or function 4

Refractory Cases

• Joint replacement surgery for severe, disabling pain with radiological deterioration 2

Critical Pitfalls to Avoid

• Do not start with PRP - it adds cost and effort without proven benefit over exercise alone 1
• Do not skip supervised exercise sessions - supervision significantly improves outcomes 3
• Do not expect PRP to work in severe arthritis - it performs poorly in Kellgren-Lawrence grade 4 disease 5
• Do not use PRP as monotherapy - if considering it at all, ensure you're also doing strengthening exercises 1