Cortisone injections allow doctors to deliver potent medicine directly to sites of inflammation with minimal side effects. Depending on the patient and the condition being treated, a successful cortisone injection can suppress localized inflammation for anywhere from 6 weeks to 6 months.
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
Cortisone injections typically provide temporary relief. Most patients seeking better, long-term relief are advised to participate in physical therapy to stretch and strengthen their joints, muscles, and other soft tissues. Patients may also be advised to lose weight or make other lifestyle changes, such as changing footwear. These steps can improve a joint's biomechanics and possibly decrease or eliminate the need for additional cortisone shots.
Patients who do 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. For this reason:
- Injections should be spaced at least 4 to 6 weeks apart, and patients are advised to have 4 or fewer injections in the same place per year.
- A doctor will not inject cortisone medication directly into a tendon, even if a tendon is suspected to be the root of pain. Because cortisone works locally, an injection 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.3
The Initial Injection Usually Works
For most people, the initial corticosteroid injection will reduce inflammation and pain. If the patient's pain is not adequately relieved, the doctor may recommend trying a second injection. To protect a joint's soft tissue, injections should be at least 4 to 6 weeks apart.3 If the patient gets limited or no relief from the second injection, then a third injection is unlikely to provide relief and is not recommended.
- Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002 Jul 15;66(2):283-8. PubMed PMID: 12152964.