Non-Biologic Injections in Sports Medicine

PURPOSE OF REVIEW: Non-biologic injection therapies are among the most commonly utilized interventions in sports medicine. Yet, the evidence supporting their use varies widely across injectates and clinical indications. This review provides an overview of the most broadly used non-biologic injectates in musculoskeletal care, including corticosteroids, local anesthetics, non-steroidal anti-inflammatory drugs (NSAID), normal saline, dextrose prolotherapy, hyaluronic acid, and botulinum toxin. For each agent, we discuss the mechanism of action, adverse effect profile, and current clinical evidence across a range of sports medicine conditions. RECENT FINDINGS: Corticosteroids are the most extensively studied injectate and demonstrate consistent short-term analgesic benefit; however, data highlights dose-dependent risks to articular cartilage and tendon with implications for long-term outcomes. NSAID injections have shown comparable efficacy to corticosteroids across several indications, representing a viable alternative in appropriately selected patients. Hyaluronic acid has shown benefit in knee osteoarthritis, but guideline recommendations remain divided on its use. Dextrose prolotherapy and botulinum toxin exhibit condition-specific promise, each supported by a limited but growing evidence base. The therapeutic effects observed in saline control groups underscore the complexity of interpreting injection-based research. While several traditionally employed injectates have demonstrated efficacy for short-term pain relief and functional improvement, concerns regarding long-term tissue effects and variable clinical outcomes have prompted increasing interest in alternative therapies. Accordingly, treatment selection requires careful consideration of the underlying pathology, therapeutic goals, safety profile, and available evidence. This review synthesizes the current literature to provide clinicians with a practical, evidence-based framework for the use of non-biologic injections in sports medicine.