Had a cortisone injection? What to expect in the first days, how much to rest, when to start exercising, and how to make the relief last longer.
You have just had a cortisone injection for your shoulder, hip, knee, elbow or foot. Maybe the local anaesthetic has already taken the pain away, and you feel better than you have in weeks. The temptation is to get straight back to everything — the gym, the garden, the long walk you have been missing.
How you use the next few weeks makes a real difference to how long the relief lasts. In our earlier article we explained where cortisone injections help and where they can backfire. This guide is the practical follow-up: a physiotherapist's step-by-step plan for the days and weeks after an injection.
Always follow the specific instructions from the doctor who gave your injection. Advice can differ for different sites, and for injections into tendons compared with joints.
At a glance
- First 24–48 hours: relative rest — normal light activity, but avoid heavy use of the injected area
- A short pain flare in the first day or two is common and usually settles
- Days 3–14: gentle movement and gradual return to normal activity
- From about 2 weeks: the "window" — start or resume a progressive strengthening programme
- Diabetes: blood sugar may rise for a few days — monitor closely
- Urgent: increasing redness, heat, swelling, fever or severe pain needs prompt medical review
What happens after the injection
- Minutes to hours: if a local anaesthetic was used, the area may feel numb or pain-free. This wears off after a few hours.
- Day 1–2: some people have a "steroid flare" — increased pain as the anaesthetic wears off and before the steroid takes effect. Ice and simple pain relief usually help.
- Days 2–7: the steroid starts to work, and pain usually eases progressively.
- Weeks 1–6: the period of greatest relief for most people. How long it lasts varies widely.
The first 48 hours: relative rest
"Relative rest" means doing normal light activities while avoiding heavy or repetitive load on the injected area.
- Shoulder: everyday tasks are fine; avoid heavy lifting, overhead work and the gym.
- Elbow or wrist: avoid forceful gripping, lifting and repetitive tool use.
- Hip or knee: walk normally around home and work, but avoid long walks, running, stairs-heavy days and heavy lifting.
- Foot and heel: keep walking modest; avoid running and long periods on your feet.
Use ice for 15–20 minutes at a time, wrapped in a cloth, if the area is sore. Keep the injection site clean and dry for the rest of the day, following your doctor's advice about showering and swimming.
Days 3 to 14: ease back in
- Return gradually to your usual daily activities.
- Start gentle range-of-movement exercises — the movements your physio has given you, within comfort.
- Keep walking or cycling at a comfortable level for general fitness.
- Avoid big jumps in load, even if the area feels completely normal. This is the most common mistake we see.
Sleep and work in the first fortnight
Good sleep helps pain settle, so set yourself up for it: for a shoulder, a pillow under the arm and avoiding lying on that side; for a hip, a pillow between the knees; for a knee, a pillow under or between the knees. At work, most people can continue with light duties straight away. If your job is physically heavy or repetitive, talk to your employer about lighter tasks for a week or two, and build back up gradually rather than returning to full duties on day three because the pain has gone.
Why "feeling great" can be a trap
The steroid reduces pain and inflammation, but it does not make a tendon or joint stronger overnight. If you go straight back to the activity that caused the problem — at the same level, with the same muscles — the tissue meets the same demands it could not cope with before. That is one reason trials of injections for tendon pain have found high rates of relapse.
From about two weeks: use the window
This is the most important part. While pain is lower, you can do the strengthening work that was too painful before. Research supports exercise as the treatment that lasts:
- For outer hip pain, an Australian trial in the BMJ found education plus exercise did better than an injection alone at 8 weeks and at one year.
- For knee osteoarthritis, a trial in the New England Journal of Medicine found physiotherapy gave less pain and better function at one year than injections.
- For tendon pain, a review in The Lancet found injections worked in the short term but often less well over months, which is exactly the gap a strengthening programme is meant to fill.
A typical approach:
- Start with controlled strengthening — for tendons, often isometric (static) holds, then slow, heavier movements.
- Progress steadily every week or two — more weight, more repetitions, harder positions.
- Add functional work — the lifting, walking, gripping, running or overhead movements you need for work, sport and life.
- Keep going after the pain has gone. Strength takes 8 to 12 weeks or more to build. Stopping when the pain disappears is a common reason it returns.
“We think of the weeks after an injection as the best time to get stronger. The pain is lower, so you can train properly — and that strength is what's still there when the injection wears off.”
— UpPlus Physiotherapy team
Examples by area
Shoulder
Band rotations with the elbow at your side, rows, and lifting the arm in a slightly forward position, progressing to light weights and overhead work. See our guides to supraspinatus tears and rotator cuff tendinopathy.
Elbow (tennis or golfer's elbow)
Isometric wrist holds, then slow wrist curls and extensions with a light weight, gradually increasing, plus grip work. See our tennis elbow and golfer's elbow articles.
Outer hip
Isometric hip presses, bridges, sit-to-stands and side steps, while avoiding positions that compress the tendon. See our gluteal tendinopathy guide.
Knee
Sit-to-stands, step-ups, straight leg raises and walking or cycling, building towards a full strengthening programme. See our knee osteoarthritis guide.
Heel
Calf and plantar fascia stretches and slow, loaded heel raises. See our plantar fasciitis guide.
A sample six-week plan: shoulder injection
Every plan should be tailored, but here is what a typical programme might look like after a cortisone injection for shoulder pain from rotator cuff tendinopathy.
| When | Focus | Examples |
|---|---|---|
| Days 1–2 | Relative rest | Normal light tasks; no gym, no overhead work; ice if sore. |
| Days 3–14 | Movement | Gentle range-of-movement exercises; walking; light daily tasks. |
| Weeks 2–3 | Start strength | Isometric presses against a wall; band rotations with the elbow at the side; rows. |
| Weeks 4–5 | Build strength | Heavier bands or light dumbbells; lifting the arm forwards and out to the side; shoulder blade work. |
| Week 6 and beyond | Function | Overhead work, carrying, return to gym or sport; maintenance two to three times a week. |
Progress depends on how the shoulder responds. Mild discomfort during exercise that settles by the next day is fine. Pain that is worse the next morning means the step was too big, and it is fine to drop back for a few days.
How long will my relief last?
There is no single answer. Some people have relief for weeks, some for months, and some find it is the start of a lasting recovery. The difference often comes down to what happens in the weeks after the injection:
- Relief tends to fade sooner when people return to heavy activity straight away, or do no strengthening.
- Relief is more likely to hold when the injection is followed by a gradual, consistent exercise programme and sensible load management.
- Underlying factors — advanced arthritis, a large tendon tear, or ongoing heavy work demands — can shorten the relief, and may need a different plan.
If the pain returns, it does not mean you did something wrong. It is a signal to review the diagnosis, the load you are putting through the area and the rehab plan, rather than to simply book another injection.
Questions to ask your physio
- Which exercises should I start with, and when?
- What activities should I avoid, and for how long?
- How will I know if I am doing too much?
- How should I progress over the next six to twelve weeks?
- What is the plan if the pain comes back?
Special situations
If you have diabetes
A systematic review found that blood glucose levels rise after joint injections in people with diabetes, usually for a few days. Check your levels more often, follow your diabetes plan, and contact your GP or diabetes team if readings are much higher than usual.
If you have surgery planned
Surgeons often prefer a gap between a joint injection and joint surgery because of infection risk. Tell your surgeon about any recent injection.
If the injection did not help
It can take up to two weeks to work. If there is no improvement after that, the diagnosis may need rethinking — the pain may be coming from somewhere other than the injected structure. A review with your doctor or physio is worthwhile.
If you are thinking about another injection
Repeated injections into the same area carry increasing risks for tendons and cartilage, and a review in Radiology described uncommon but serious joint complications after hip and knee injections. If you are relying on injections to stay comfortable, it is a good time to look at the bigger plan.
When to seek medical help
Contact your doctor promptly, or go to an emergency department, if you have:
- Increasing redness, heat or swelling around the injection site after the first day or two
- Fever, chills or feeling unwell
- Severe or rapidly worsening pain
- A sudden pop or new weakness, especially after an injection near a tendon
- Blood sugar readings that stay very high
Common mistakes after a cortisone injection
- Going straight back to heavy activity because it feels great.
- Doing nothing and waiting for the injection to fix it.
- Stopping exercises as soon as the pain goes.
- Booking the next injection as soon as the pain returns, without changing anything else.
- Ignoring warning signs of infection.
How UpPlus Physiotherapy helps after an injection
- A rehab plan timed around your injection, following your doctor's instructions
- A staged strengthening programme, progressed regularly
- Advice on returning to work, sport and daily activities safely
- A long-term maintenance plan to reduce the chance of the pain returning
Read more about our exercise rehabilitation and gym-based rehab.
Finding a physio near me after an injection
When searching for the best physio after a cortisone injection, look for someone who times your rehab around the injection, progresses your strength week by week, and helps you plan beyond the relief rather than waiting for the next shot.
Our clinic is at 177 Trimmer Parade, Seaton, a short drive from Woodville, Findon, West Lakes, Grange and Beverley. No referral is needed, and you can claim on the spot with private health cover.
Physio take-home message
- Relative rest for 48 hours, then ease back into normal activity.
- Do not jump straight back to heavy load, even if it feels great.
- Use the window: start progressive strengthening from about two weeks.
- Keep going for 8–12 weeks or more — strength is what lasts.
- Watch for infection signs and, if you have diabetes, monitor blood sugar.
If you have just had an injection, or have one coming up, our physiotherapists can build a plan to make the relief count. Book online or call 0403 907 587.
This article is general information, not medical advice about any particular medicine or procedure. Follow the instructions of the doctor who gave your injection, and contact them if you are unsure about your recovery.
