Are Corticosteroid Injections Worth a Shot?
Corticosteroid injections, often called cortisone shots, are a popular conservative treatment for pain and inflammation. They're given directly into the affected area and are considered minimally invasive. Patients often ask whether they're right for them and how well they really work. As we often say in physical therapy: it depends. Here's how cortisone shots work, their benefits, the potential risks, and when they may be the right choice.
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 get significant pain relief after a cortisone shot typically have high levels of inflammation in the targeted area. Responses vary, though: some patients improve a lot at first, while others notice the effect diminishing with repeated injections.
How long do cortisone shots last, and should you still do physical therapy?
Even when they work, the pain relief from 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 cortisone shots can reduce pain enough to let patients take part in rehabilitation more effectively.
If pain is stopping you from doing your exercises or progressing through therapy, an injection may offer enough relief to move forward. But physical therapy remains essential for long-term recovery and prevention.
Potential side effects and risks
Cortisone shots are widely used, but 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
Injections and surgery
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.
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. If you're weighing surgery for a rotator cuff tear, see our post on surgery vs. physical therapy for rotator cuff tears.
Are cortisone shots worth it?
Corticosteroid injections can be a helpful short-term pain relief option, especially when inflammation is high or when pain limits your ability to take part in physical therapy. Their success depends on several factors:
- Level of inflammation
- Number and frequency of injections
- Injection site
- Stage of healing
- Timing relative to planned surgeries
An open conversation with your healthcare provider is essential to fully understand the benefits and risks and decide whether an injection is an appropriate choice for your condition.
Not sure whether a cortisone shot fits your recovery plan? We can help you build a rehab plan for the long term.
book a sessionthe takeaway
Cortisone shots offer short-term relief, not a fix. They work best alongside physical therapy, and if surgery is on the horizon, talk to your surgeon about timing first.
Frequently asked questions
How do cortisone shots work?
They mimic cortisol, a naturally occurring anti-inflammatory hormone, reducing inflammation by limiting prostaglandin activity and reducing interaction between white blood cells.
How long does a cortisone shot last?
Even when effective, the pain relief is usually short-term. Injections may improve symptoms quickly, but they don't resolve the underlying problem.
Should I still do physical therapy after a cortisone shot?
Yes. A study on plantar fasciitis found that combining physical therapy with corticosteroid treatment produced the best short- and long-term outcomes, and physical therapy remains essential for long-term recovery.
What are the risks of cortisone injections?
Potential risks include delayed soft tissue healing, weakened tendon structure, reduced tendon load tolerance and diminished effectiveness with repeated injections.
Can I get a cortisone shot before surgery?
Discuss timing with your surgeon. Research has linked two or more shoulder injections in the year before rotator cuff surgery to a higher risk of revision surgery, and an injection within four weeks of total knee replacement to a higher infection risk.
References
Abate M, Salini V, Schiavone C, Andia I. Clinical benefits and drawbacks of local corticosteroids injections in tendinopathies. Expert Opinion on Drug Safety. 2017;16(3):341-349. doi:10.1080/14740338.2017.1276561
Bhattacharjee S, Wallace S, Luu HH, Shi LL, Lee MJ, Chen AF. 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. 2021;29(14):e714-e721. doi:10.5435/JAAOS-D-20-00850
Desai VS, Camp CL, Boddapati V, Dines JS, Brockmeier SF, Werner BC. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy. 2019;35(1):45-50. doi:10.1016/j.arthro.2018.07.043
Johannsen FE, Herzog RB, Malmgaard-Clausen NM, et al. Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training. Knee Surg Sports Traumatol Arthrosc. 2019;27:5-12. doi:10.1007/s00167-018-5234-6
