Well E1 Before and after treatment
Stem Cell Therapy vs. Physical Therapy: Complementary or Competing?
Contents: 6 sections
They are not equals. For knee and hip arthritis, exercise is the treatment the American College of Rheumatology strongly recommends, and it recommends against stem cell injections. Exercise and physical therapy come first. If you choose an injection anyway, it is an add-on to your exercise program, not a replacement for it, and it may be the part you pay for yourself.
The evidence for each
| Condition | Exercise and physical therapy | Injections |
|---|---|---|
| Knee arthritis | Guideline: strongly recommended, with "a strong body of literature supporting its use for almost all patients with OA" (ACR). Trials: compared with no exercise, right after the program, pain about 13 points better on a 100-point scale (low certainty) and function about 12.5 points better (moderate certainty) (Cochrane review, 2024) | Guideline: recommended against for stem cells and PRP (ACR, above). Trials: compared with a placebo injection, pain 1.2 points better on a 10-point scale at three to six months, low certainty (Cochrane review, 2025) |
| Hip arthritis | Guideline: strongly recommended (ACR, above) | Guideline: recommended against for stem cells and PRP (ACR, above) |
| Achilles tendinitis | "Physical therapy is very helpful in treating Achilles tendinitis," and surgery "should be considered only if the pain does not improve after 6 months of nonsurgical treatment" (OrthoInfo) | One PRP injection into the tendon did no better than a sham needle at six months in a trial of 240 people (Kearney, JAMA 2021) |
| Rotator cuff tear | Exercise is part of nonsurgical care, and "in about 80 to 85% of patients, nonsurgical treatment relieves pain and improves function in the shoulder" (OrthoInfo) | A cortisone injection gives pain relief "in about two-thirds (about 67%) of patients for a period of at least 3 months" (OrthoInfo, above) |
Sources for the table: ACR; <a href="https://www.cochrane.org/evidence/CD004376exercise-osteoarthritis-knee”>Cochrane review, 2024; <a href="https://www.cochrane.org/evidence/CD013342what-are-benefits-and-risks-stem-cell-injections-knee-osteoarthritis”>Cochrane review, 2025; OrthoInfo; Kearney, JAMA 2021; OrthoInfo.
The two knee numbers look similar, but they answer different questions. The exercise trials compared exercise with no exercise; the stem cell trials compared an injection with a placebo injection. Neither tells you what happens when you add an injection to a good exercise program. The knee trials in detail, and the other options beside them, are covered in knee arthritis options and what each one costs you.
Is physical therapy only for the muscles around the damage?
No. Physical therapy is sometimes described as working only on the muscles around a damaged joint or tendon. For tendon problems, exercise is a treatment for the tendon condition itself: OrthoInfo lists eccentric strengthening, a way of loading the calf muscle while it lengthens, among the treatments for the type of Achilles tendinitis in the middle of the tendon, away from the heel (OrthoInfo, above).
The matching claim about injections does not hold either. It assumes that a stem cell injection improves cartilage, so that the joint can then take harder training. No study in the Cochrane review measured whether the joint changed on X-ray (Cochrane, above), and the American Academy of Orthopaedic Surgeons says of stem cells and PRP for arthritis that “clinical studies have yet to confirm their value in treating osteoarthritis” (OrthoInfo).
If you do both, in what order?
Start with the exercise program. It is the treatment the guideline strongly recommends, it tells you whether you need anything more, and it gives you a starting point to measure against. Write down how far you can walk, how you sleep and how much pain medicine you take before you begin.
If exercise helped but did not go far enough, ask two questions before paying for an injection. Did you do the program long enough, with the load increased over time? Have you kept it going at home? A program that stopped is not the same as a program that failed. Someone whose walking improved but who still has pain on stairs has a narrower, measurable gap. The first thing to check is whether the program ever worked on stairs, with step-ups and the load raised over time. If it did and the gap remains, that gap is what an injection would have to close, and it is the thing to measure afterward.
If you then have an injection, ask the clinic for a written plan that says when you can restart exercise and physical therapy, what you may do before then, and the reason for each limit. None of the sources on this site sets a standard start date, so the plan should come from the person who treated you, and your physical therapist should see it. The signs that need a call are listed with what is normal in the weeks after an injection.
Keep exercising afterwards. An injection does not replace the strength and movement work, and the ACR’s recommendation for exercise applies whether or not you have had one. How injections fit among all your options is set out in a comparison of regenerative and conventional care.
How do the costs compare?
Medicare Part B covers “medically necessary outpatient physical therapy” with no yearly limit, and “after the Part B deductible, you pay 20% of the Medicare-approved amount” (Medicare.gov). Private plans set their own rules, so ask your insurer how many visits are covered.
Before paying for an injection, get your insurer’s answer in writing. A phone answer is not a coverage decision, which is why the steps for checking coverage before you pay for an injection end with a written reply.
When does adding an injection make sense?
Someone who has done a full exercise program, kept it going, and still has pain that limits their life has a reason to look further. Even then, the evidence for stem cell injections is a small average benefit on low-certainty evidence, the guideline recommends against them for knee and hip arthritis, and your insurer may not pay for them. That person should also hear what other options exist, including a surgeon’s view where the joint damage is advanced. A clinic that answers that person with urgency or a package deal is showing one of the warning signs in a stem cell clinic.
Which should you choose?
Exercise first, and keep it. An injection, if you add one, is an extra whose value you can only judge once you know what exercise alone does for you, and only if a written plan fits the two together.
This page is general information, not medical advice.