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:
- Participate in physical therapy. Stretching and strengthening muscles and other soft tissues help relieve pain and other arthritis symptoms. In fact, one study1 comparing cortisone injections to physical therapy reported that physical therapy provided better long-term relief.
- 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.2
- 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.
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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.3 For this reason:
- If more than one injection must be given in the same joint, they should be spaced several weeks apart.4 Many doctors prefer waiting longer—at least 3 to 4 months.5
- Patients are advised to have no more than 3 or 4 injections in the same place per year.4
- 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.4