6 Joint Pain Treatments Your Doctor May Not Have Mentioned
Not all treatment options get equal airtime in a 15-minute appointment. Here are evidence-based alternatives for knee and shoulder arthritis that often go undiscussed.
By Joint Pain Authority Team
What This Article Covers
A standard doctor’s appointment is 15-20 minutes. In that window, your provider needs to review your history, examine you, discuss findings, and outline next steps. Some treatment options inevitably don’t make the conversation.
This is not about doctors hiding information. It is about system constraints that limit what gets discussed. The treatments in this article are all evidence-based, often Medicare-covered, and could make a meaningful difference in your quality of life.
You deserve to know all your options.
Why Some Treatment Options Never Come Up
Before we cover the six treatments, understanding why certain options get overlooked helps you become a more effective advocate for your own care.
Time Constraints Are Real
The 15-Minute Reality
The average primary care visit lasts 15-20 minutes. In that time, your doctor must:
- Review your medical history and current medications
- Conduct a physical examination
- Discuss symptoms and concerns
- Order any necessary tests
- Explain the treatment plan
- Document everything for medical records
With osteoarthritis, the default path is often: try over-the-counter pain relievers, maybe cortisone, then consider surgery when those stop working. There simply is not time to explore every alternative.
Specialty Training Creates Blind Spots
Different specialists learn different treatment approaches:
- Orthopedic surgeons are trained to operate. They may view non-surgical options as “buying time” before inevitable surgery.
- Primary care physicians see every condition. They may not have specialized training in advanced joint treatments.
- Rheumatologists focus on inflammatory and autoimmune conditions, which may differ from degenerative osteoarthritis.
None of these providers are wrong. They are simply working from their training and experience. But it means you may get different recommendations depending on who you see first.
Guideline Conflicts Create Confusion
Professional medical organizations sometimes issue conflicting recommendations. When the American Academy of Orthopaedic Surgeons says one thing and the Osteoarthritis Research Society International says another, doctors often default to the most conservative recommendation or the one from their primary professional body.
This directly affects which treatments you hear about. Learn more in our article on why doctors may not mention gel injections.
The 6 Treatments Worth Asking About
1. Gel Injections (Viscosupplementation)
The Basics
- FDA approved since 1997 for knee osteoarthritis
- Medicare covered for nearly three decades
- How it works: Hyaluronic acid supplements your natural joint fluid, providing cushioning and lubrication
- Typical results: 51% reduction in pain scores, relief lasting 6-12 months
Viscosupplementation (commonly called gel injections or HA injections) replaces the degraded hyaluronic acid in arthritic joints. Your joints naturally contain this substance, but osteoarthritis breaks it down faster than your body can replace it.
Why doctors may not mention it:
- The AAOS recommends against it, while OARSI, ACR, and VA/DoD guidelines conditionally recommend it
- Some providers are unfamiliar with the evidence supporting its use
- Insurance prior authorization requirements can be time-consuming
Who might benefit:
- Patients with mild to moderate knee osteoarthritis
- Those who want to delay or avoid surgery
- People who have had limited relief from cortisone or can no longer take NSAIDs safely
2. Fluoroscopy-Guided Injections
The Accuracy Problem
Research shows that 20-30% of “blind” joint injections miss the joint space entirely. When medication lands in surrounding fat, bursae, or tendons, it cannot work as intended.
| Injection Method | Accuracy Rate |
|---|---|
| Blind (landmark-guided) | 70-80% |
| Ultrasound-guided | 96-100% |
| Fluoroscopy-guided | 100% |
If you have had a joint injection that “did not work,” the problem may not be the medication. It may be that the injection never reached your joint in the first place.
Fluoroscopy uses real-time X-ray imaging to confirm needle placement before any medication is injected. The provider can see exactly where the needle tip is and verify it is inside the joint space.
Why doctors may not mention it:
- Not all facilities have fluoroscopy equipment
- Many providers were trained in blind injection techniques
- It takes longer than a blind injection
Who might benefit:
- Patients whose previous injections “failed”
- Those with obesity, significant swelling, or altered anatomy
- Anyone who wants certainty that their treatment reaches the right place
Learn more about why injection accuracy matters for joint pain relief.
3. Comprehensive Physical Therapy
Beyond “Do Some Exercises”
Comprehensive physical therapy is NOT the same as:
- A handout with stretches
- A verbal recommendation to “stay active”
- Three sessions when you need twelve
True comprehensive PT includes:
- Individualized assessment and treatment plan
- Manual therapy techniques
- Progressive strengthening protocols
- Gait and movement retraining
- Education on long-term self-management
When your doctor says “try physical therapy,” what do they mean? Too often, patients receive a few sessions, a sheet of exercises, and a pat on the back. That is not comprehensive physical therapy.
Evidence-based PT for osteoarthritis involves:
- 8-12 weeks of supervised sessions (not 3-4)
- Manual therapy including joint mobilization and soft tissue work
- Progressive resistance training that builds over time
- Functional movement assessment to identify and correct compensations
- Home exercise programming with clear progression guidelines
Why doctors may not go into detail:
- Referral to PT seems self-explanatory
- Details about what makes PT effective take time to explain
- Insurance coverage varies significantly
Who might benefit:
- Nearly everyone with joint osteoarthritis
- Those who had unsuccessful PT in the past (incomplete protocols are common)
- Patients preparing for or recovering from any procedure
Our physical therapy treatment page covers what to look for in a comprehensive program.
4. Medical Weight Management Programs
The 4-to-1 Multiplier
Every pound of body weight creates approximately 4 pounds of force on your knees with each step. This means:
| Weight Change | Force Reduction on Knees |
|---|---|
| 10 pounds lost | 40 pounds less pressure |
| 20 pounds lost | 80 pounds less pressure |
| 30 pounds lost | 120 pounds less pressure |
Research shows that losing just 10% of body weight can improve knee pain and function significantly.
Weight management is frequently mentioned in passing (“losing weight would help”) but rarely discussed as a structured treatment with professional support. The difference matters.
Structured weight management programs include:
- Medical supervision and monitoring
- Nutritional counseling from registered dietitians
- Behavioral support for sustainable habit change
- Sometimes medication assistance when appropriate
- Regular follow-up and accountability
This is different from generic advice to “eat less and move more.” Structured programs have significantly better outcomes because they address the complex factors that make weight management difficult.
Why doctors may not go deeper:
- Weight is a sensitive topic
- Detailed nutrition counseling requires specialists
- Time constraints prevent comprehensive discussion
Who might benefit:
- Patients carrying extra weight who have joint osteoarthritis
- Those who have tried to lose weight on their own without lasting success
- Anyone interested in addressing root causes of joint stress
5. Unloader Braces
Mechanical Relief
Unloader braces (also called offloader braces) physically shift weight away from the damaged compartment of your knee to the healthier side.
Key facts:
- Medicare covered when prescribed appropriately
- Provide immediate mechanical relief
- Can be worn during activities that aggravate pain
- Non-invasive and reversible
- Often overlooked in favor of medication-based approaches
If you have osteoarthritis primarily affecting one side of your knee (medial or lateral compartment), an unloader brace can be remarkably effective. These devices use a three-point pressure system to open up the damaged side of the joint, reducing bone-on-bone contact.
Types of knee braces:
- Sleeve braces: Provide compression and warmth but no mechanical offloading
- Hinged braces: Add stability but limited offloading
- Unloader braces: Specifically designed to shift weight off the damaged compartment
The distinction matters. A generic knee brace will not provide the same benefit as a properly fitted unloader brace prescribed for your specific pattern of arthritis.
Why doctors may not mention it:
- Fitting requires time and expertise
- Not all providers are familiar with unloader technology
- Patients may resist wearing a brace
Who might benefit:
- Patients with unicompartmental knee osteoarthritis (one side worse than the other)
- Those who want to remain active while managing symptoms
- People seeking non-pharmaceutical pain relief
6. Lifestyle Modification Coaching
Beyond General Advice
Lifestyle modification coaching provides personalized guidance on:
- Activity pacing: How to stay active without triggering flare-ups
- Ergonomic adjustments: Workplace and home modifications
- Sleep optimization: Position, mattress selection, pain management at night
- Stress management: Chronic pain and stress create a feedback loop
- Adaptive strategies: Alternative ways to accomplish daily tasks
“Stay active but don’t overdo it” is advice that sounds reasonable but is nearly impossible to follow without more specific guidance. What counts as overdoing it? How do you pace activities? What modifications actually help?
Lifestyle modification coaching, often provided by physical therapists, occupational therapists, or specialized health coaches, gives you actionable strategies rather than general principles.
Examples of specific guidance:
- Activity pacing: If you can walk 20 minutes before pain increases, walk 15 minutes, rest, then walk again. Build tolerance gradually.
- Ergonomics: Raising your chair height by 2 inches may reduce stress on your knees. Using a footrest in bed may take pressure off your hips overnight.
- Adaptive tools: Long-handled reachers, lever-style door handles, cushioned grip tools in the kitchen.
Why doctors may not mention it:
- Lifestyle coaching requires specialized training
- Insurance coverage is inconsistent
- It is not a prescription that can be written quickly
Who might benefit:
- Patients struggling with flare-ups related to activity
- Those who want to maintain independence despite joint limitations
- Anyone seeking practical strategies rather than just symptom management
How to Ask About These Options
Having information is one thing. Getting your doctor to discuss it is another. Here are scripts that work.
Conversation Starters
For gel injections:
“I have read that viscosupplementation has been covered by Medicare since 1997 and shows about 51% pain reduction in studies. Would I be a candidate for this before considering more invasive options?”
For imaging-guided injections:
“I understand that blind injections miss the joint 20-30% of the time. Is fluoroscopy or ultrasound guidance available for my injection to ensure accuracy?”
For comprehensive physical therapy:
“Could you refer me to a physical therapist who specializes in osteoarthritis for a comprehensive 8-12 week program, not just a few sessions?”
For weight management:
“Are there structured medical weight management programs you could refer me to? I am interested in professional support rather than trying to manage on my own.”
For unloader braces:
“My arthritis is worse on one side of my knee. Would an unloader brace be appropriate to shift weight off the damaged compartment?”
For lifestyle coaching:
“I am struggling with knowing how much activity is too much. Is there a specialist who could help me develop activity pacing strategies?”
Tips for Productive Conversations
-
Bring printed information. Doctors respect patients who do research. Print relevant studies or articles.
-
Ask about the why. If a doctor recommends against something, ask: “What specific concerns do you have about this treatment for my situation?”
-
Request referrals. If your current provider does not offer a treatment, ask: “Who in the area specializes in this approach?”
-
Get it in your chart. Ask the doctor to document your request and their response. This creates a record.
-
Consider a second opinion. Especially for surgical recommendations. Different specialists may offer different perspectives.
Your Right to Know All Options
You Have the Right To:
- Know all evidence-based treatment options for your condition
- Understand why certain treatments are or are not recommended for you
- Ask questions until you understand
- Seek second opinions
- Choose the approach that aligns with your goals and values
Informed consent means informed about ALL options, not just the ones that fit into a 15-minute appointment.
The treatments in this article are not fringe alternatives or unproven therapies. They are evidence-based options that have helped millions of patients manage joint pain without surgery or with delayed surgery.
If you have been told that medication and eventual surgery are your only options, you have not heard the whole story. The question is not whether these treatments exist. It is whether anyone has taken the time to explain them to you.
Now you have that information. What you do with it is up to you.
Frequently Asked Questions
Why don’t doctors mention all treatment options?
Time constraints, specialty-specific training, conflicting medical guidelines, and insurance complexity all contribute to some treatments being discussed less often than others. A 15-minute appointment does not allow for comprehensive review of every option.
Are these treatments covered by Medicare?
Many are. Viscosupplementation (gel injections) has been covered since 1997. Physical therapy, unloader braces, and imaging-guided injections are also typically covered when medically appropriate. Coverage details vary, so verify with your specific plan.
What if my doctor dismisses these options?
Ask why specifically. If the reason is guideline-based, know that different professional organizations have different recommendations. You have the right to seek a second opinion from a specialist who may interpret the evidence differently.
How do I find providers who offer fluoroscopy-guided injections?
Ask directly when scheduling. Pain management specialists, interventional radiologists, and some orthopedic and rheumatology practices use imaging guidance routinely. If a provider does not offer it, ask for a referral.
Should I try all conservative options before surgery?
For most patients, yes. Surgery is irreversible and carries risks. Ensuring you have truly tried comprehensive conservative care, not just brief attempts, is reasonable before considering surgical options.
Can I combine these treatments?
Absolutely. In fact, combining approaches often provides the best outcomes. For example: gel injections for cushioning, physical therapy for strength, an unloader brace for mechanical support, and lifestyle coaching for activity management.
Stay Informed About Your Treatment Options
Get weekly evidence-based updates on joint pain treatments, Medicare coverage changes, and strategies for living well with arthritis.
Join 10,000+ readers. No spam.
References
- Altman RD, et al. Analysis of a large US claims database to determine if TKR is delayed by viscosupplementation. Osteoarthritis and Cartilage. 2015.
- Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage. 2019.
- Messier SP, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: Is more better? Arthritis Care & Research. 2018.
- Jackson DW, et al. Accuracy of needle placement into the intra-articular space of the knee. Journal of Bone and Joint Surgery. 2002.
- Henrotin Y, et al. Physiological effects of oral supplementation with collagen, hyaluronic acid, and Boswellia serrata. Applied Sciences. 2021.
- Fransen M, et al. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2015.
Enjoyed this article?
Get more insights like this delivered to your inbox weekly.
Join 10,000+ readers. No spam.