Cortisone Shots in Knee: Everything You Need to Know

If there ever were a magic bullet for recovering from an injury cortisone shots might be it.

Of course like all magic, it requires distraction from what’s truly occurring for it to work. In other words, you might feel like a million bucks, but you haven’t resolved the cause of the pain and that means it might very well return.

During my first visit with the Orthopedic surgeon he offered me a cortisone shot, while we waited things out with PT to see if surgery was really necessary.

I declined having heard various things about long term issues and knowing that overall I wasn’t in unbearable pain. Not like in 2007, when I cried in joy when the sports medicine doctor injected my IT Band.

Without my even knowing it, I’d made a great choice.

There’s a vast difference between injecting tendons and a cortisone knee injection…so here’s what we all need to know before thinking we’ve found the magic bullet. Cortisone injection side effects in the knee could be substantial.

Let’s get a better understanding of these injections and then I’ll answer some of your top questions from my discussions with multiple physicians and PT’s.

What are Cortisone Shots?

Cortisone shots, also known as intra-articular corticosteroid injections (CSI), are injections that can help relieve pain and inflammation in a specific area of the body. They’re usually injected into the joints, such as your knee, hip, shoulder, elbow, ankle, spine, or wrist.

The injections usually contain two different medications: a corticosteroid medication and a local anesthetic.

How Does a Cortisone Shot Help My Knee?

A cortisone injection reduces inflammation in a specific area for 6 weeks to 6 months.

The length of pain relief depends on the location and the type of injury. While it is not a pain reliever, that is generally the effect of of reducing inflammation.

Cortisone is naturally produced in the body by the adrenal gland and released when the body is under stress. While, a cortisone shot is synthetically produced to mimic what the body produces.

It is indeed a steroid, just not the kind that bulks you up in the gym.

Things to Consider Before Getting a Cortisone Shot

Before taking the injection, you need to understand the goal. It’s going to treat the inflammation, but it’s not going to resolve the underlying issue that created the pain.

You’ll have to be committed to a long-term solution. Doing physical therapy or other treatments for strengthening weak muscles or inflamed joints.

Simply put, cortisone shots are used to calm symptoms. They won’t resolve the underlying cause of the pain you’re experiencing.

There are several risks to getting cortisone injections. It’s important to consider them all for your particular case. We will dive in to them more in-depth later in this article.

Cortisone can make bone on bone injuries worse by thinning out the meniscus. These steroid injections are known to be toxic to cartilage, the connective tissue that keeps your bones from rubbing against one another. You never want repeated injections in to a joint.

While I had initially refused a shot, the Orthopedic recommended it as an option to see if reducing the inflammation would allow the knee to regain full mobility. Avoiding surgery sounded great to me, so I decided one shot was worth trying.

Repeated shots in to areas like the knee are what you’ll find I warn heavily against. The data is overwhelming about additional breakdown occurring from too many injections.

Should You Get a Cortisone Shot?

Let’s look at some of the most common injuries that might have you asking for some pain relief:

• A runner’s knee cortisone injection is generally not recommended. You need to resolve the weakness causing the issue.
• Cortisone shot for a torn meniscus can help with pain and swelling, but will not fix the tear. Some folks will try this as a first option before considering surgery (like myself).
• Steroid injections can be useful for running with arthritis. In this case, they inject in to muscle to get more of a full body response, rather than localized.

How Do I Get a Cortisone Shot?

Usually, a doctor does this right in the office, no need for a special setting.

Getting a cortisone shot is easy, understanding all that it entails is the part that’s most important. All the relevant information is included in this post so you can make a better, more informed decision.

While getting the shot, they may use an ultrasound machine to guide the specific location. But it seems most doctors have done it enough they just find the spot and quickly give you the shot.

Other times a type of X-ray known as fluoroscopy is used to watch the needle’s progress inside the body to place it in the right spot for the best results.

Regardless of how you’ll receive the shot, there is usually only minimal discomfort.

For some situations, such as a cortisone shot for plantar fasciitis, your doctor may perform a nerve block to make the process less painful and more comfortable.

How to Prepare for a Cortisone Shot

If you take any medications that are classified as blood thinners, you’ll need to stop taking them for several days before getting a cortisone injection. This is to reduce the risk of bleeding and bruising.

Blood thinners include common painkillers such as NSAIDs (Non-Steroidal Anti-Inflammatory Medications) like ibuprofen (Advil, Nuprin, Aspirin).

Make sure to speak to your doctor if you need to take any in the days before getting an injection as they can prescribe alternatives that will be better suited, such as acetaminophen (Tylenol).

Certain dietary supplements also have a blood-thinning effect, so inform your doctor of all medications and supplements you’re taking. You can also ask your doctor to guide you as to what you should avoid before getting the shot.

While taking your medical history, your doctor will also ask whether you’ve had a temperature of 100.4 F (38 C) or greater in the past two weeks.

What to Expect During and After a Cortisone Shot in the Knee

If you’ve decided to get a cortisone shot, here’s what you can expect during and after receiving it. I’ll share with you some of my experience and what I’ve heard from Orthopedic Dr’s.

What’s It Like to Get a Cortisone Shot?

Depending on the area you’re getting your cortisone shot in, you might be asked to change into a gown. You’ll then be positioned so that the needle can be inserted easily into the right spot by your doctor. It will not be performed by a nurse.

• The area around the injection site will be cleaned.
• Depending on where you’re getting the shot, as well as how tender the area feels, your doctor might also apply an topical anesthetic spray to numb the area where the needle will be inserted.
• Potentially an ultrasound machine will be used.
• You’ll receive the injection.
• That’s it, you’re on your way back out the door.

The process is relatively quick, and you should only experience slight discomfort.

Does a Cortisone Shot in the Knee Hurt?

No. At least I did not find it painful.

It’s like most general shots where there’s the prick of the needle and then the quick flush of something entering your body. The cortisone itself does not cause pain.

How Long Does It Take for a Cortisone Shot to Work?

The steroid will begin working and the anti-inflammatory effects should begin approximately 4 to 5 days after you receive the shot.

It’s generally recommended by doctors to keep a margin of about a week before an event (like a race) for the cortisone shot to start working. However, from personal experience and that of many runners you may very well notice it the next day.

What you should not let that pain relief lead you to do is race prematurely. As a running coach I have watched this play out too many times.

• Runner gets injection for a super painful issue
• Suddenly feels great
• Decided to run the race anyways
• Pulls out of the race
• Is now unable to run for months due to having made the injury far worse

Remember pain is how your body tells you that something is wrong.

Yes, I too have made this mistake!

What are the Immediate Effects of a Cortisone Shot?

Initial pain relief is from the anesthetic that is usually mixed into the steroid.

After it wears off in 8 to 14 hours pain may return.

This is a reminder that the steroid itself takes time to work. Don’t go out and immediately over do it.

Can I Walk After a Cortisone Injection to My Knee?

Yes. You should not have any issues walking in an out of your appointment.

Additionally, the reduction in pain means you should feel ok to move a little bit more than you have been, which could mean taking some easy walks.

Just ensure that you are doing a gradual ramp up from what you were doing. If you’ve been sitting all day, then don’t jump in with a daily 1 hour walk.

Should I Wear a Knee Brace After a Cortisone Injection?

If you have been wearing a knee brace for running or knee support for walking, then you may want to keep it for a bit. But the goal is to ween your body off of that support.

Continue wearing it for activity while you start doing more physical therapy and increasing your overall strength to help stabilize your knee. Then try taking it off for small amounts of movement and slowly work away from using it all the time.

This is all assuming your Dr believes you can work away from it!

How Long After a Cortisone Shot Can I Run?

The answer to this really changes based upon the injury and the athlete. What I have seen far too often is a runner gets the injection and immediately goes to run their race or big workout and ends up in more pain than when they started.

I say this also having done it myself! I’m a running coach who knows better, but you can really talk yourself in to believing things are fine.

Based on chatting with Orthopedic Drs, they say usually for a couple of weeks after the injection they just want to see you feeling good enough to do the rehab that’s going to help alleviate the cause of the issue. And to very slowly be reintroducing little bits of running after that.

If you’ve gotten to the point of needing an injection, you’ve likely been in pain awhile. So your body is going to need some time.

What To Do in the Days After Getting a Cortisone Injection?

Your doctor may ask you to protect the area where you were injected for a day or two, so as not to further exacerbate any pain. You may also be advised to ice the area; heat is not recommended.

Although uncommon, it’s good to keep an eye out for any signs of infection including redness, swelling, or an increase in pain in the area that lasts for more than 48 hours.

If you experience any such symptoms, contact your doctor immediately.

When the pain starts subsiding is when you should jump into the long-term treatment plan to reap the most benefits.

How Long Does Cortisone Injection Last?

Injections should last last 3 months or longer, but that’s looking at the short-term picture again.

The shot should be something we use to help us get over the initial hurdle of pain, so that we may continue physical therapy…not so we can be figuring out when to get the next shot.

It can absolutely last longer and hopefully you only need the one, if you can start in a on good treatment.

Why Didn’t the Cortisone Shot in My Knee Work?

As someone who fell in this category, I thought it might be useful for others!

If inflammation is not the underlying cause of the pain then the shot will initially feel good, but won’t really resolve things. For example, a bone on bone issue might feel better for just a bit, but it’s going to keep coming back. Or a cortisone injection in to the knee when the pain is actually from your IT Band won’t fix things either.

A Cortisone Injection is Part of a Larger Treatment Plan

Because of the immediately reduced pain thanks to the anesthetic, what most of us want to do is everything the injury has been stopping us from doing! Quickest way to make everything worse.

Instead, this is when you start resolving the underlying issue. Go to PT. Get a plan. Easing back into moving pain-free.

Many times, we have limited range of motion due to pain. The relief allows you to work on that to ensure you aren’t creating other muscle imbalances.

• Begin doing your physical therapy
• Use it to work on range of motion
• Ease back slowly over a period of weeks into activity
• Allow it to help combat inflammation
• Continue eating anti-inflammatory foods to help the process
• Focus on other natural ways to reduce pain and inflammation
• Start using more collagen to rebuild joint tissue for mobility

Post-Cortisone Shot Treatment Plan for Knee Pain

Depending on the cause of your knee pain, whether it be an injury or a condition such as arthritis, your doctor may recommend other treatments as well to address the joint pain.

Conditions such as tendon or ligament damage, obesity, or an autoimmune disorder can affect how your joint heals.

Therefore, it’s important to include treatments that are customized to address your knee pain.

Simple changes such as changing footwear, improving form and strength training can reduce the number of micro-traumas that a joint experiences daily. Such changes can improve a joint’s biomechanics and possibly even decrease or eliminate the need for cortisone shots in the future.

Without addressing the underlying cause of the knee pain, it will probably worsen over time. Always remember that a cortisone shot is just one step of a larger treatment plan and it’s important to take the time to rehabilitate yourself.

Potential Dangers of Cortisone Shots

So why don’t we use these all the time, if they’re so wonderful? Are cortisone injections bad for you?

“A lot of doctors use these injections in lieu of counseling patients that they may benefit from surgery,” (or alternative treatments) Dr. Bheeshma Ravi, an orthopedic surgeon.

If appropriately used, they are a fantastic anti-inflammatory. But they should be used to allow you to start doing physical therapy, not to immediately jump back to whatever may have caused the underlying issue.

Cortisone Flare

A period right after the shot where pain could be worse. This usually lasts for only 1-2 days and effects no more than 2% of people.

— I am now convinced this is what occurred for me during the half marathon DNF.

I had been running nearly pain free for months utilizing RockTape and yet in the day after that cortisone shot in knee I was nearly hobbled. The race course itself probably didn’t help, but the pain was worse than it had been since my injury started.

Degeneration Tendons and Cartilage

Most doctors limit injections to no more than 3 per year in a given site. This is due to potential weakening of tendons and softening of cartilage that was shown to occur in animal studies. Which obviously could create longer term issues.

In places like the heel where runners get it for plantar faciitis it can actually reduce fat, which means less padding to help that heel run happy.

In fact, Emily of Mile At a Time Running, sent me this example from her own life:

 I was 4 weeks out from a marathon, PF was bugging me enough I went to the dr and got a cortisone shot in my heel.

Took a week off of running, headed back out and the ligament completely ruptured! A little cortisone shot turned and injury that could have gone away with rest to a 10 month ordeal.

I also used one for my IT Band in 2007 when I was barely able to walk. It got me on the road to start recovery and after that I implemented all the tools outlined in the Ultimate IT Band solution to never need another!

Cortisone Injection Risks for Joints

A press release by the Radiological Society of North America, the publisher behind the medical journal Radiology, in 2019 mentioned several important risk factors to consider before getting cortisone shots in the knee or hip.

Researchers suggested that the injection entailed risks such as rapid progressive osteoarthritis. This can lead to joint collapse.

The same press release mentioned a recent study led by Dr. Ali Guermazi, M.D., Ph.D., professor of radiology and medicine at Boston University School of Medicine.

In the study, he uncovered that cortisone shots may be associated with complications that can potentially accelerate the destruction of the joint. It may even hasten the need for total hip and knee replacements.

“We’ve been telling patients that even if these injections don’t relieve your pain, they’re not going to hurt you,” Dr. Guermazi said. “But now we suspect that this is not necessarily the case.”

He further identified physicians do not commonly tell patients about the possibility of a joint collapse. Or of subchondral insufficiency fractures that may lead to earlier total hip or knee replacement.

Keeping in mind the current research we have from doctors such as Dr. Guermazi, I highly suggest doing further research before you make a decision to get cortisone shots in the knee.

Alternative Options to Cortisone Injections?

Knowing that there are downsides to surgery and cortisone isn’t a long term option, I had hoped PT would be enough.

But if it’s not, I’m starting to look at what else is out there, which lead me to a local doctor who does Prolotherapy.

Prolotherapy

This uses a dextrose (yup sugar) toxin injection compound to stimulate cartilage, ligaments and tendons to speed up the process of repair. According to advocates, it’s a much better long term option than cortisone shots.

• Stimulates the healing of the joint.
• Strengthens ligaments and tendons.
• Reduces pain from hypersensitive neurons.
• There is very little recovery time.
• Cost effective therapy (compared to surgery).

As always there’s a flip side.

There are not a ton of studies done yet on Prolotherapy. Some doctors are concerned that the stimulated regrowth is not of the same quality and could cause scar tissue or additional pain.

Unlike cortisone shots, prolotherapy itself can be painful due to the toxins used which result in swelling and aggravation of the area to induce the healing.

PRP: Platelet-Rich Plasma

This is currently not covered by insurance because it’s so new. There aren’t a ton of studies on it either.

For PRP, a small sample of your blood is placed in a centrifuge to separate the platelets from the other blood components. Then the concentrated PRP is injected at the site of pain.

Since platelets help to induce recovery, these injections are designed to increase that concentration for rapid healing.

Everyone has a different reaction to this. I can say that for me, it resulted in some serious pain and didn’t find it had any impact on my knee injury.

More on Knee Recovery:

• Kinesio Taping for a Meniscus Tear
• Best running shoes for knee pain
• Anti-inflammatory living for arthritis
• Physical Therapy for Runner’s Knee
• Physical Therapy for Meniscus Tear

There you have it my initial research on cortisone shots. I’ll update with my experience after a few more weeks, but I hope this helps you figure out what’s right! Just remember I’m not a doctor and I don’t play one on tv.

Have you ever tried a cortisone shot?

Are you open to alternative therapies?

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