What to Know Before Getting a Cortisone Injection

While cortisone injections can be an important tool in treating joint inflammation and pain, they do have limitations. Many of these limitations are described below.

A Cortisone Injection Is Part of a Larger Treatment Plan

These injections provide temporary relief. Patients who are seeking long-term relief are typically advised to:

1. Participate in physical therapy. Stretching and strengthening muscles and other soft tissues help relieve pain and other arthritis symptoms. In fact, one study¹Deyle GD, Allen CS, Allison SC, Gill NW, Hando BR, Petersen EJ, Dusenberry DI, Rhon DI. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. 2020 Apr 9;382(15):1420-1429. doi: 10.1056/NEJMoa1905877. PubMed PMID: 32268027 comparing cortisone injections to physical therapy reported that physical therapy provided better long-term relief.

   See Ways to Get Exercise When You Have Arthritis

2. Lose excess weight. Shedding excess pounds can reduce stress on a joint. Another reason to lose excess weight: cortisone injections may be less effective in relieving knee osteoarthritis pain in patients who are obese.²Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. J Am Acad Orthop Surg. 2017 Oct;25(10):703-714. doi: 10.5435/JAAOS-D-16-00541. PubMed PMID: 28953085.
3. Make lifestyle changes. Simple changes, such as changing footwear, can reduce the number of micro-traumas a joint experiences daily.

These steps can improve a joint's biomechanics and possibly decrease or eliminate the need for additional cortisone shots.

Without other treatments, joint pain will probably worsen over time
Patients who have repeated cortisone shots may notice that the period of pain relief becomes shorter and shorter over time. This is not necessarily because the patient has built up a tolerance to the medication but because the joint is degrading. Again, physical therapy, weight loss, and changes in day-to-day lifestyle can help slow down or stop joint degradation.

Activity Should Be Increased Gradually

It may take a few days for the benefits of the cortisone medication to take full effect. During this time, patients are usually told to rest and cut back on normal activities.

Once the joint pain is relieved, a well-intentioned patient may be tempted to jump right into an exercise routine. However, in order to avoid injuries or possibly making the condition worse, a doctor typically advises a patient to resume normal activities gradually and add intensity over time.

Repeated Injections Can Affect Soft Tissue

Too many injections over a short period of time can cause damage to the tendons, ligaments, and articular cartilage at the injection site.³McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283 For this reason:

• If more than one injection must be given in the same joint, they should be spaced several weeks apart.⁴Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002 Jul 15;66(2):283-8. PubMed PMID: 12152964. Many doctors prefer waiting longer—at least 3 to 4 months.⁵Martin SD, Conaway WK, Lei P. Use of Intra-Articular Corticosteroids in Orthopaedics. J Bone Joint Surg Am. 2018 May 16;100(10):885-891. doi: 10.2106/JBJS.17.00289. PubMed PMID: 29762289.
• Patients are advised to have no more than 3 or 4 injections in the same place per year.⁴Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002 Jul 15;66(2):283-8. PubMed PMID: 12152964.
• A surgeon will typically require a 3-month waiting period after a cortisone injection before operating on the affected joint.

Tendons are particularly prone to degeneration and injury after a cortisone injection. Because of this risk, a doctor will not inject cortisone medication directly into a tendon, even if a tendon is suspected to be the root of the pain. Because cortisone works locally, an injected placed near a tendon can still reduce its inflammation.

In fact, the Achilles and patella tendons are particularly prone to injury post-injection, even if an injection is directed near, rather than in, the tendon. For this reason, doctors avoid cortisone injections for Achilles and patella tendinopathies.⁴Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002 Jul 15;66(2):283-8. PubMed PMID: 12152964.