Cortisone injections can ease pain fast, but the relief does not always last. Where they help, where they can backfire, and how to decide.
"Just get a cortisone shot." For a painful shoulder, elbow, hip or knee, it is one of the most common suggestions people hear — from friends, from the internet, sometimes from health professionals. And for good reason: cortisone injections can reduce pain quickly, sometimes dramatically, within days.
But the research tells a more complicated story. For some conditions, an injection gives useful short-term relief that helps people get moving. For others, especially tendon problems, the early relief can be followed by worse results months later than if you had done nothing at all. This guide, written from a physiotherapist's point of view, explains what cortisone injections are, where the evidence supports them, where it does not, the possible side effects, and the questions worth asking before you have one.
Physiotherapists do not give cortisone injections — they are given by doctors, often under ultrasound guidance. Our role is to help you understand the options and to make the most of your recovery either way.
At a glance
- What it is: a strong anti-inflammatory steroid medicine, often mixed with local anaesthetic, injected into or around a painful joint, tendon or bursa
- Strength: often good short-term pain relief, from days to several weeks
- Weakness: for many tendon problems, worse outcomes and more relapses at 6–12 months than exercise or even waiting
- Joints: can help an arthritis flare, but repeated knee injections have been linked with more cartilage loss
- Best use: as a short-term aid that lets you exercise, not a standalone fix
- Side effects: usually mild, but include a short pain flare, raised blood sugar, skin changes, and rarely infection or tendon damage
What is a cortisone injection?
"Cortisone" is the everyday name for corticosteroids — synthetic versions of a hormone your body makes naturally. They are powerful anti-inflammatories. Injected directly into a painful area, they deliver a high dose where it is needed with fewer whole-body effects than steroid tablets.
Common sites include:
- Joints — knee, hip, shoulder, thumb base, facet joints of the spine
- Around tendons — tennis elbow, shoulder (subacromial), outer hip, plantar fascia
- Bursae — the fluid-filled cushions near tendons
- Tendon sheaths and tunnels — trigger finger, De Quervain's, carpal tunnel
The injection usually includes a local anaesthetic, so pain may ease within minutes, wear off after a few hours, and then improve again over the next several days as the steroid takes effect.
What having an injection is like
If you have never had one, knowing what to expect takes away a lot of the worry.
- Before: the doctor confirms the diagnosis, explains the benefits and risks, and asks about diabetes, blood thinners, allergies, infections and any planned surgery.
- During: the skin is cleaned and, for many sites, an ultrasound probe is used to guide the needle. The injection itself usually takes a minute or two. You may feel pressure or a brief sting.
- Straight after: you may be asked to wait 15–30 minutes. If local anaesthetic was used, the area may feel numb and pain-free for a few hours.
- Driving: numbness after a shoulder, hip, knee or foot injection can affect your control of the car. Arrange a lift if you are unsure, and follow the clinic's advice.
- Afterwards: most people go back to light normal activity the same day, with heavier use reduced for a day or two. Our companion guide covers this in detail.
How long does the relief last?
It varies enormously — from a few days to several months — depending on the condition, the site, and what you do while the pain is lower. Relief is often shorter for tendon problems than for conditions like trigger finger, and shorter for advanced arthritis than for a flare-up of milder arthritis. If an injection gives no relief at all after two weeks, it is worth asking whether the pain is really coming from the structure that was injected.
Where cortisone injections can help
- Trigger finger and De Quervain's tenosynovitis, where they are often an effective first-line treatment.
- Carpal tunnel syndrome, for short-term symptom relief and as a guide to whether surgery is likely to help. See our carpal tunnel guide.
- Flare-ups of osteoarthritis in the knee, hip or thumb, where a short period of relief can help you get back to exercise.
- Frozen shoulder in its early, painful stage.
- Shoulder pain from rotator cuff disease, where a Cochrane review found a small short-term benefit from injections around the rotator cuff.
- Inflammatory arthritis, such as rheumatoid arthritis, where injections into an inflamed joint are a well-established treatment.
Where they can backfire: tendons
The strongest warning in the research is about tendon pain. A major review of randomised trials, published in The Lancet in 2010, found that corticosteroid injections reduced tendon pain well in the short term — but for tennis elbow in particular, people who had injections did worse at 6 and 12 months than those who had other treatments or simply waited, and relapse was more common.
Two trials show this especially clearly:
- In a Dutch trial in The Lancet, people with tennis elbow who had an injection were the most improved at six weeks. By one year, those who had physiotherapy or simply waited had better results, and many in the injection group had relapsed.
- In an Australian trial in JAMA, people with tennis elbow who received a cortisone injection had worse one-year outcomes and much higher recurrence than those given a placebo injection.
Other tendons tell a similar story. For outer hip pain from gluteal tendinopathy, an Australian trial in the BMJ found education plus exercise worked better than an injection at both 8 weeks and one year. See our gluteal tendinopathy guide, and our existing article on tennis elbow.
“An injection can turn the pain down, but it does not make a tendon stronger. If the injection is used to start exercising, it can be useful. If it replaces exercising, the pain often comes back.”
— UpPlus Physiotherapy team
Cortisone and knee arthritis
For knee osteoarthritis, injections can settle a painful flare. But two studies give reason for caution about using them repeatedly:
- A two-year trial in JAMA gave people with knee osteoarthritis an injection of steroid or saline every three months. The steroid group had more loss of cartilage on MRI, and no less pain than the saline group.
- A trial in the New England Journal of Medicine compared physiotherapy with steroid injections for knee osteoarthritis. At one year, the physiotherapy group had less pain and better function.
A review in Radiology also highlighted uncommon but serious joint complications after hip and knee injections, such as rapidly progressing arthritis and small fractures under the cartilage. These are rare, but they are another reason to think carefully about repeated injections. Read more in our knee osteoarthritis guide.
Possible side effects
Most people have no significant side effects. The ones to know about:
- Post-injection flare: increased pain for a day or two, usually settling with ice and rest.
- Raised blood sugar: a systematic review found blood glucose rises in people with diabetes after joint injections, typically for a few days. If you have diabetes, monitor more closely and speak with your doctor beforehand.
- Facial flushing and, for some, temporary changes in sleep, mood or menstrual cycle.
- Skin thinning or lightening, or a small dent from loss of fat, at the injection site — more likely with superficial injections.
- Tendon weakening or rupture, particularly with injections directly into tendons or repeated injections.
- Infection — rare, but important. Seek medical help urgently for increasing redness, heat, swelling, fever or severe pain in the days after an injection.
Does ultrasound guidance matter?
Many injections in Australia are given under ultrasound guidance, which helps the doctor place the needle precisely. For shoulder pain, a Cochrane review found no clear evidence that image guidance improved pain or function compared with injections guided by landmarks alone, although the evidence was limited. Guidance may matter more for deep joints like the hip, and for avoiding injecting directly into a tendon.
How many injections are too many?
There is no single agreed number, but most doctors limit injections to the same area to a few a year, spaced at least several weeks to months apart. If you find yourself needing injections repeatedly to stay comfortable, that is a sign the underlying problem has not been addressed — and a good reason to review the plan.
Questions to ask before you have one
- What exactly is causing my pain, and is it a tendon, a joint or a bursa?
- What does the evidence say about injections for this condition?
- How long is the relief likely to last?
- What should I do afterwards to make the most of it?
- What are the alternatives, and what happens if I do not have it?
- Do I have diabetes, an infection, or a planned surgery that changes the timing?
The physio view: use the window
The most useful way to think about a cortisone injection is as a window of opportunity. While pain is lower, you can do the strengthening and movement work that addresses the reason the area became painful in the first place. Used that way, an injection can be a helpful part of a plan. Used on its own, the relief often fades and the problem returns.
We have written a companion guide on exactly how to use that window — what to do in the first days after an injection, when to start exercising, and how to progress.
Myths about cortisone injections
- "It fixes the problem." It reduces pain and inflammation; it does not rebuild tissue strength.
- "The pain is gone, so I can go straight back to everything." The tissue has not changed; overloading it often brings the pain back.
- "More injections are better." Repeated injections can harm tendons and cartilage.
- "Cortisone is the same as bodybuilding steroids." They are different medicines with different effects.
- "If an injection didn't work, nothing will." Exercise-based treatment often helps when injections have not.
When to see a physio
- Before deciding on an injection, to understand your diagnosis and options
- After an injection, to make the relief count with a progressive programme
- When pain has returned after one or more injections
How UpPlus Physiotherapy helps
- A thorough assessment to identify whether the problem is a tendon, joint, nerve or something else
- Honest advice on where an injection fits, and liaison with your GP or sports doctor
- A structured rehab programme to build strength and capacity, with or without an injection
- Other options such as shockwave therapy for persistent tendon pain
Finding a physio near me for joint and tendon pain
When searching for the best physio for tendon or joint pain, look for someone who explains your diagnosis clearly, gives you the evidence for each option — including injections — and builds a strengthening plan that lasts beyond any short-term relief.
Our clinic is at 177 Trimmer Parade, Seaton, a short drive from Woodville, Findon, West Lakes, Grange and Henley Beach. No referral is needed, and you can claim on the spot with private health cover.
Physio take-home message
- Cortisone injections can ease pain quickly, but relief is often temporary.
- For tendon pain, injections can lead to worse long-term results than exercise or waiting.
- For knee arthritis, repeated injections are linked with more cartilage loss; exercise works better long-term.
- Use an injection as a window to start strengthening, not as the whole plan.
- Seek urgent help for redness, heat, fever or severe pain after an injection.
If you are weighing up an injection, or want to make one count, our physiotherapists can help you decide and plan. Book online or call 0403 907 587.
This article is general information, not medical advice about any particular medicine or procedure. Talk to your doctor about whether a cortisone injection is right for you.
