Are Corticosteroid Injections Worth a Shot?
Corticosteroid injections—often known as cortisone shots—are a popular conservative treatment for pain and inflammation. These pain relief injections are administered directly into the affected area and are considered minimally invasive. Patients often ask whether corticosteroid injections are right for them and how effective they truly are.
As we often say in physical therapy: it depends.
Below, we’ll explore how cortisone shots work, their benefits, potential risks, and when they may be the right choice for your condition.
How Do Corticosteroid Injections Work?
Corticosteroid injections mimic cortisol, a naturally occurring anti-inflammatory hormone. Cortisol helps reduce inflammation by:
Limiting prostaglandin activity
Reducing interaction between white blood cells
People who experience significant pain relief after a cortisone shot typically have high levels of inflammation in the targeted area. However, responses vary: some patients experience strong initial improvement, while others may notice diminishing effectiveness with repeated injections.
How Long Do Cortisone Shots Last? Should You Still Do Physical Therapy?
Even when effective, the pain relief provided by corticosteroid injections is usually short-term. They may improve symptoms quickly, but they don’t resolve the underlying problem.
A study by Johannsen et al. showed that combining physical therapy with corticosteroid treatment for plantar fasciitis produced the best short-term and long-term outcomes. This suggests that cortisone shots can reduce pain enough to allow patients to participate more effectively in rehabilitation.
If pain is preventing you from performing exercises or progressing through therapy, a corticosteroid injection may offer enough relief to move forward. But physical therapy remains essential for long-term recovery and prevention.
Potential Side Effects and Risks of Corticosteroid Injections
While cortisone shots are widely used, they are not without risks. Research has raised concerns about their impact on soft tissue, healing, and surgical outcomes.
Potential risks include:
Delayed soft tissue healing
Weakened tendon structure
Reduced tendon load tolerance
Diminished effectiveness with repeated injections
A 2019 study by Desai et al. found that patients who received two or more shoulder corticosteroid injections in the year before rotator cuff surgery had a higher risk of needing revision surgery.
Additionally, a 2021 study in the Journal of the American Academy of Orthopaedic Surgeons found that receiving a corticosteroid injection within four weeks of total knee replacement increases the risk of infection. Other studies advise avoiding injections within three months of joint replacement surgery.
If you’re preparing for surgery, it’s critical to discuss injection timing with your surgeon to minimize these risks.
Are Cortisone Shots Worth It? The Bottom Line
Corticosteroid injections can be a helpful short-term pain relief option, especially when inflammation is high or when pain limits your ability to participate in physical therapy. However, their success depends on several factors:
Level of inflammation
Number and frequency of injections
Injection site
Stage of healing
Timing relative to planned surgeries
Having an open conversation with your healthcare provider is essential to fully understand both the benefits and risks of corticosteroid injections and to determine whether they are an appropriate choice for your condition.
References:
Abate, Michele, Salini, Vincenzo, Schiavone, Cosima, Andia, Isabel. Clinical benefits and drawbacks of local corticosteroids injections in tendinopathies, Expert Opinion on Drug Safety, 16:3, 341-349 (2017). DOI: 10.1080/14740338.2017.1276561
Bhattacharjee, Sarah BS; Wallace, Sara MD; Luu, Hue H. MD; Shi, Lewis L. MD; Lee, Michael J. MD; Chen, Antonia F. MD, MBA. Do We Need to Wait 3 Months After Corticosteroid Injections to Reduce the Risk of Infection After Total Knee Arthroplasty?, Journal of the American Academy of Orthopaedic Surgeons, July 15, 2021 - Volume 29 - Issue 14 - p e714-e721. DOI: 10.5435/JAAOS-D-20-00850
Desai, Vishal S., Camp, Christopher L., Boddapati, Venkat, Dines, Joshua S., Brockmeier, Stephen F., WernerIncreasing, Brian C. Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 35, Issue 1, 2019, Pages 45-50, ISSN 0749-8063. https://doi.org/10.1016/j.arthro.2018.07.043.
Johannsen, F.E., Herzog, R.B., Malmgaard-Clausen, N.M. et al. Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training., Knee Surg Sports Traumatol Arthrosc 27, 5–12 (2019). https://doi.org/10.1007/s00167-018-5234-6
