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CONSERVATIVE CARE · EVIDENCE-BASED · FRANKLIN, TN

Nonsurgical Joint Pain Treatment
in Franklin, TN

Medications · Injections · Physical Therapy · Bracing — Dr. Cory Calendine, MD

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Call (615) 791-2630

If you’re looking for joint pain treatment without surgery, that’s exactly where I start. Before recommending joint replacement, I pursue every conservative option appropriate for your condition at the Bone and Joint Institute of Tennessee in Franklin — medications, corticosteroid and hyaluronic acid injections, physical therapy, weight management, and bracing. This is not a box to check before moving on to surgery: many of my patients achieve lasting relief from conservative treatment and never need a joint replacement.

SURGERY LAST

CONSERVATIVE CAREFULLY CONSIDERED

700+

HIP & KNEE PROCEDURES/YEAR

FELLOWSHIP TRAINED

HIP & KNEE REPLACEMENT SPECIALIST

UNDERSTANDING JOINT PAIN TREATMENT WITHOUT SURGERY

Nonsurgical Hip & Knee Pain Treatment — Conservative-First Approach

Joint replacement surgery is not the first conversation at the Bone and Joint Institute of Tennessee. It is the last one — after conservative treatments have been given a genuine trial and assessed honestly. Many patients who arrive having expected to be immediately recommended for surgery leave with a non-surgical treatment plan that provides meaningful relief for years. Others confirm, through that evaluation process, that their joint damage has progressed to the point where surgery is the correct path. Either outcome serves the patient’s best interest.

The treatments below are not a standard checklist. They are selected and individualized based on which joint is affected, the severity and character of arthritis, prior treatment history, overall health, activity level, and the patient’s goals for their hip or knee function. Not every option is right for every patient — and the consultation is the starting point for determining which combination is appropriate for your specific situation.

TreatmentBest ForWhat to Expect
Medications (OTC + Rx)Mild to moderate pain; inflammatory arthritisRelief within hours (NSAIDs); weeks to months (DMARDs)
Corticosteroid InjectionsSignificant joint inflammation and swellingDays to 1 week for full effect; lasts weeks to months
Hyaluronic Acid (Gel) InjectionsKnee osteoarthritis; inadequate cartilage lubricationFull effect over several weeks; lasts 6 months or longer
Physical TherapyAll stages of arthritis; improving strength and functionStructured program; benefits build over 4 to 8 weeks
Exercise ProgramAll stages; weight management; functional maintenanceOngoing; best results with consistent routine
Weight ManagementPatients with BMI contributing to joint load3 to 5x reduction in joint load per pound of weight lost
PRP / Biologic InjectionsSelected cases; discussed individually at consultationEvidence still developing; discussed individually at consultation
Knee BracingMedial or lateral compartment arthritis; instabilityImmediate unloading effect; most effective for unicompartmental disease

ORAL AND TOPICAL MEDICATIONS FOR ARTHRITIS PAIN

Medications for Hip and Knee Arthritis Pain

Over-the-Counter & Prescription Anti-Inflammatories

For mild to moderate arthritis pain, over-the-counter pain relievers are often first-line treatment. Acetaminophen (Tylenol) reduces pain without targeting inflammation. Non-steroidal anti-inflammatory drugs or NSAIDs — ibuprofen (Motrin, Advil) and naproxen (Aleve) — reduce both pain and the inflammation that contributes to joint stiffness. When OTC options provide inadequate relief, prescription-strength NSAIDs may be recommended. These are prescribed based on your specific condition, medical history, and response to prior treatment.

DMARDs for Inflammatory Arthritis

For patients with rheumatoid arthritis or other inflammatory joint conditions, a different class of medication is used. Disease-modifying anti-rheumatic drugs (DMARDs) — including methotrexate and biologic agents such as etanercept (Enbrel) — work by targeting the immune mechanisms driving inflammation rather than simply reducing pain. Unlike NSAIDs, which provide relief within hours, DMARDs require weeks to months to achieve their full effect. They are typically managed in coordination with a rheumatologist, and require regular monitoring for safety.

CORTICOSTEROID AND HYALURONIC ACID JOINT INJECTIONS

Joint Injection Therapies for Hip and Knee Arthritis

Corticosteroid (Cortisone) Injections

Corticosteroid injections deliver powerful anti-inflammatory medication directly into the affected hip or knee joint, reducing swelling and pain in a way that oral medications often cannot match. They are most effective when inflammation and swelling are significant components of the pain. Hip joint injections require image guidance (ultrasound or fluoroscopy) due to the depth and anatomy surrounding the joint; knee injections can typically be performed in the office. Corticosteroid injections work quickly — patients often notice improvement within a few days to one week. Relief typically lasts from several weeks to several months, depending on the severity of arthritis and individual response.

There are recommended limits on how frequently corticosteroid injections should be administered — typically no more than three to four times per year per joint, as frequent injections may contribute to cartilage degradation over time. This frequency guideline is discussed at each evaluation.

Hyaluronic Acid (Viscosupplementation) Injections

Hyaluronic acid injections — also called viscosupplementation or gel injections — introduce a lubricating fluid into the joint that supplements the natural synovial fluid diminished by arthritis. The treatment is most studied and approved for knee osteoarthritis; hip viscosupplementation is available but less commonly performed. Several formulations are available, including Synvisc (hylan G-F 20), Orthovisc, Supartz, and Hyalgan, administered as a single injection or a series of weekly injections depending on the specific product.

Hyaluronic acid injections typically take longer to reach full effect than corticosteroid injections — most patients notice gradual improvement over several weeks. When effective, relief can last six months to a year or longer. Coverage by insurance varies by plan and diagnosis; confirm with your insurer before scheduling.

What to Expect from Joint Injections — Timeline and Frequency

Injection TypeOnset of ReliefDurationFrequency Limit
Corticosteroid (Cortisone)Days to 1 weekWeeks to months3 to 4x per year, per joint
Hyaluronic Acid (Gel)Gradual, over weeks6 to 12 months+Varies by product

STRENGTHENING YOUR HIP AND KNEE — EXERCISE AND PHYSICAL THERAPY

Exercise and Physical Therapy for Arthritis Management

Why Exercise Matters — and Why It Does Not Make Arthritis Worse

The most common misconception about exercising with hip or knee arthritis is that it will accelerate joint damage. For most patients, the opposite is true. Weight-bearing exercise — particularly low-impact activities like walking, cycling, and swimming — provides the cartilage with the fluid exchange it needs to maintain health. Strengthening the muscles around the hip and knee reduces the mechanical load that the joint itself must bear, functioning as a natural shock absorption system that decreases daily wear and pain.

The right exercise program for arthritis is one that is calibrated to your current joint status and overall fitness. For mild to moderate arthritis, exercise often provides excellent pain reduction and functional improvement for knee stiffness. For more advanced arthritis with bone-on-bone changes, certain exercises may cause discomfort — and the program is designed around avoiding aggravating activities while maintaining the strengthening work that matters. Dr. Calendine coordinates with physical therapists throughout the Franklin and Nashville area to develop programs appropriate to each patient’s specific condition.

Structured Physical Therapy Programs

Physical therapy for arthritis management is more targeted than general exercise. A structured PT program typically includes: range-of-motion work to prevent progressive joint stiffening; targeted strengthening of the quadriceps, hip abductors, and surrounding musculature; gait training; and manual therapy techniques that reduce pain and improve joint mobility. For patients recovering from an injection, PT can extend and enhance the injection’s effect by building functional strength during the window of reduced pain.

The physical therapy team Dr. Calendine works with understands the goals of conservative arthritis management and designs programs that address current limitations while building toward long-term functional independence. PT is particularly valuable as a transitional treatment — either as a standalone approach for patients with early-stage arthritis, or as preparation for patients who are heading toward surgery to optimize their pre-operative conditioning.

WEIGHT MANAGEMENT AND JOINT SUPPORT

Weight Management and Knee Bracing

Weight Management | Mechanical Relationship

Body weight has a direct, mechanical relationship to hip and knee joint load. Published biomechanical data consistently shows that the knee joint bears approximately 3 to 5 times body weight during normal walking, with higher multiples during stair climbing and other loaded activities. For a patient who is 20 pounds overweight, the compressive load increase on the knee during walking is approximately 60 to 100 pounds per step. Conversely, even modest weight loss produces a measurable reduction in daily joint load that many patients notice as improved walking comfort. Weight management is most meaningful as a complement to other conservative treatments rather than a standalone intervention. For appropriate patients, Dr. Calendine's team can connect you with nutritional resources and weight management support that complement injection and PT programs, maximizing the overall conservative treatment effect.

Knee Bracing — Unloading Arthritis Pain

Unloader knee braces are designed for patients with arthritis concentrated in one compartment of the knee — typically the medial (inner) compartment. These braces work by applying a three-point pressure system that shifts the mechanical load away from the arthritic compartment, reducing the bone-on-bone stress that drives pain during walking and activity. For appropriately selected patients, a well-fitted unloader brace can provide meaningful activity improvement without injections or surgery. Knee bracing is most appropriate for single-compartment arthritis in patients who are active and motivated to wear the brace consistently. It is less effective for patients with arthritis affecting multiple compartments. Dr. Calendine evaluates arthritis pattern, alignment, and activity level to determine if bracing is appropriate. Fitting is handled by orthotics specialists familiar with orthopaedic bracing for arthritis

WHEN CONSERVATIVE TREATMENT IS NO LONGER ENOUGH

When Conservative Treatment Has Run Its Course

Recognizing When Surgery Becomes the Right Conversation

Conservative treatment for hip and knee arthritis is not indefinitely postponable. There is a point at which the joint damage is advanced enough, and the relief from non-surgical options has become limited enough, that joint replacement surgery becomes the more appropriate next step. Reaching that point is not a failure of conservative treatment — it is what conservative treatment is designed to confirm: that surgery is now the right intervention, and not before. 

 

The signs that conservative treatment has reached its limits are generally recognizable: injections that once provided several months of relief now providing only weeks; physical therapy improvements that plateau without further gains; pain that is limiting daily activities despite medication; imaging that shows significant joint-space narrowing or bone-on-bone changes. When these signs align, the conversation about joint replacement surgery begins — and it is a different conversation from the one that happens when surgery is raised prematurely. 

What That Conversation Looks Like with Dr. Calendine

The consultation for joint replacement at BJIT is for patients who have been through conservative treatment and are evaluating whether surgery is appropriate and when. Dr. Calendine will review your imaging, your prior treatment history, and the current character of your pain and functional limitations. He will explain which procedure is appropriate for your joint, what the technique involves, what recovery looks like, and why he recommends it specifically for your situation. There is no pressure to decide at the consultation — it is an information appointment that gives you everything you need to make a considered decision.

 

Our practice performs hip and knee replacement at the BJIT Ambulatory Surgery Center and Williamson Medical Center in Franklin, TN. Most patients who are appropriate candidates for surgery can return to unrestricted daily activities within six to twelve weeks of their procedure. Dr. Calendine completed his joint replacement fellowship at the Anderson Orthopaedic Research Institute in Alexandria, Virginia, one of the country’s leading hip and knee fellowship programs focused exclusively on joint replacement and revision surgery.

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FREQUENTLY ASKED QUESTIONS

FAQ — Nonsurgical Hip and Knee Pain Treatment

Q1. What are the nonsurgical treatment options for hip and knee arthritis?

The evidence-based nonsurgical treatments for hip and knee arthritis include: oral medications (acetaminophen, NSAIDs, and DMARDs for inflammatory arthritis); corticosteroid (cortisone) injections; hyaluronic acid (gel/viscosupplementation) injections; structured physical therapy; a therapeutic exercise program; weight management; and knee bracing for single-compartment disease. Acupuncture is a complementary referral option supported by some clinical evidence. The appropriate combination of treatments depends on which joint is affected, arthritis severity, prior treatment history, and individual health factors. The most effective approach is individualized at the consultation — not selected from a standard protocol.

Cortisone (corticosteroid) injections for hip and knee arthritis typically produce full effect within a few days to one week after the injection. Duration of relief varies significantly between patients and depends on arthritis severity, which joint is injected, and individual response. Most patients experience relief lasting from several weeks to several months. For many patients, the first injection produces the longest-lasting relief; subsequent injections may provide shorter benefit as the underlying joint condition progresses. There is a recommended limit of approximately three to four cortisone injections per year per joint to avoid potential cartilage effects from frequent steroid exposure. 

Cortisone injections deliver a corticosteroid — a powerful anti-inflammatory medication — directly into the joint. They work fastest (days to a week) and are most effective when inflammation and swelling are prominent. Gel injections (viscosupplementation/hyaluronic acid) introduce a lubricating fluid that supplements the natural synovial fluid depleted by arthritis. They take longer to reach full effect (several weeks), but relief when it comes tends to last longer — six months to over a year in good responders. Gel injections are most studied for knee osteoarthritis; they are less commonly used for hip arthritis. The two treatments work differently and are not interchangeable — one or both may be appropriate depending on your joint condition. 

Yes — and the evidence is strong. Physical therapy for hip and knee osteoarthritis consistently demonstrates meaningful improvements in pain and function in clinical studies. The mechanism is primarily muscle strengthening: the quadriceps (for knee) and the hip abductors and external rotators (for hip) act as natural shock absorbers. Stronger muscles reduce the mechanical load the joint must bear with each step, which directly reduces pain. PT also addresses gait patterns, range-of-motion limitations, and movement compensations that develop in response to chronic joint pain. The benefits are most significant when PT is started before arthritis is bone-on-bone and continued consistently. PT after injections is particularly effective, since injections provide the pain relief that makes exercise possible. 

For some patients, yes — particularly those with early-to-moderate arthritis and significant excess body weight contributing to joint load. Weight loss reduces the compressive load on the hip and knee with every step, which can produce meaningful pain reduction and functional improvement. Published data shows that a 10% reduction in body weight is associated with approximately 50% improvement in knee pain scores in some patient groups. 

 

However, weight loss does not repair damaged cartilage or reverse structural joint changes. Patients with advanced bone-on-bone arthritis will typically continue to progress regardless of weight loss, though reduced weight improves surgical outcomes and recovery if joint replacement eventually becomes necessary. Weight management is most powerful as a preventive and palliative measure in earlier-stage disease. 

The transition from conservative treatment to joint replacement surgery is indicated when: conservative treatments are no longer providing meaningful, lasting relief; joint pain is significantly limiting daily activities that matter to you; imaging shows advanced joint-space narrowing or bone-on-bone changes consistent with your symptoms; and you are medically appropriate for surgery. There is no arbitrary age requirement or time requirement — the decision is based on your specific joint condition, how pain affects your life, and a realistic assessment of what conservative treatment can still offer versus what surgery would provide. 

 

The consultation with Dr. Calendine is specifically designed for patients at this decision point — when you are evaluating whether surgery is the right next step and when. Call 615-791-2630 or schedule online. 

FRANKLIN, TN · SERVING ALL OF MIDDLE TENNESSEE

Not Sure What Your Hip or Knee Needs?
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Whether you are exploring nonsurgical options, evaluating whether surgery is appropriate, or ready to schedule your procedure — the consultation at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067, is the starting point. No referral required.

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