Cortisone Injections: When They Help and When to Avoid Them
Should I Get a Cortisone Injection? Here Is What the Evidence Says
Your GP has mentioned a cortisone injection. The idea of quick pain relief is tempting when you have been sore for weeks. But cortisone is not the universal fix it is often marketed as. For some conditions it works brilliantly, for others it barely helps, and for a few it can actually make things worse. Here is what our physio team at PHYZFIT Bexley North and Marrickville want you to know before you say yes.
Short Answer
Cortisone injections provide meaningful short term pain relief (6 to 12 weeks) for many musculoskeletal conditions, but long term outcomes at 6 to 12 months are often no better than physiotherapy alone, and in some conditions (particularly tendinopathy) cortisone can produce worse long term outcomes. Best evidence is for frozen shoulder, subacromial bursitis and severe knee osteoarthritis flares. Avoid or use with caution for Achilles tendinopathy, plantar fascia, and repeat injections in the same area. In every case, cortisone works best paired with rehab, not as a standalone.
Below we walk you through what cortisone actually is, the honest evidence by condition, when it makes sense, when to avoid, and how our physio team at PHYZFIT works alongside injection based treatment.
What is a cortisone injection?
A cortisone injection is a shot of corticosteroid (a potent anti inflammatory medication) mixed with a local anaesthetic, delivered directly into a joint, bursa, tendon sheath or soft tissue. It is not the same as an anabolic steroid used for muscle building.
Corticosteroids work by suppressing the local inflammatory response. That reduces pain and swelling, often within days, and the effect typically lasts 6 to 12 weeks (sometimes longer, sometimes shorter). The pain relief window can be used to progress rehab that was not possible while pain was severe.
Injections are best performed under ultrasound guidance to ensure the medication lands in the exact target tissue. Landmark guided injections (no imaging) are less accurate.
The evidence by condition — what actually works?
Here is the honest evidence based summary of when cortisone helps, when it barely helps, and when it can make things worse.
Frozen shoulder (freezing phase)
Intra articular cortisone plus hydrodilatation shortens the pain and stiffness timeline significantly. One of the strongest indications.
Subacromial bursitis
Meaningful short term pain relief when severe pain is limiting sleep and rehab. Best combined with progressive rotator cuff loading.
Trochanteric bursitis / gluteal tendinopathy flare
Short term relief when night pain and lying on the side is severe. Long term outcomes match rehab.
Knee osteoarthritis
Short term pain relief for severe flares but repeated injections may accelerate cartilage loss. Not a long term strategy.
Carpal tunnel syndrome
Useful short term relief and can delay surgery. Long term outcomes similar to conservative care.
Lumbar radicular pain (sciatica)
Epidural steroid injections can help severe leg pain that is not settling. Not first line treatment.
Tennis elbow (lateral epicondylalgia)
Short term relief but worse outcomes at 6 to 12 months compared to physio alone. Not recommended as first line.
Achilles tendinopathy
Generally avoided due to risk of tendon rupture. Not a first line treatment.
Plantar fasciitis (acute high pain phase)
Multiple randomised trials show meaningful short term pain relief at 4 to 12 weeks when acute plantar fascia pain is severe. Best under ultrasound guidance. Risks (fat pad atrophy, rare fascia rupture) apply mostly with repeat injections. One injection paired with proper loading rehab is a reasonable option for severe acute cases.
Rotator cuff tendinopathy (repeated injections)
Repeated cortisone into the rotator cuff area can accelerate tendon degeneration and increase tear risk. One shot in the bursa is different to repeated tendon injections.
Not sure if cortisone is right for your injury?
A physio assessment gives you an honest read before you commit.
How does cortisone actually work?
Cortisone works through several mechanisms:
- Reduces local inflammation by suppressing inflammatory cytokines and immune cell activity
- Decreases capillary permeability so less swelling accumulates
- Blunts pain signalling from local nerve endings
- Local anaesthetic in the mixture gives immediate pain relief for 4 to 24 hours
- Steroid effect kicks in over 2 to 7 days and lasts 6 to 12 weeks typically
Notice what is missing from that list. Cortisone does not repair damaged tissue, regrow a torn tendon, restore joint cartilage, or strengthen a muscle. It settles inflammation and reduces pain. The underlying condition still needs rehab to actually get better.
What are the risks of cortisone injections?
- Post injection flare: 5 to 20 percent of patients get a temporary flare of pain in the first 24 to 48 hours as the crystal suspension causes local irritation. Settles with ice and paracetamol
- Skin depigmentation and fat pad atrophy: local tissue changes at the injection site, more common with superficial injections
- Temporary blood sugar rise in diabetics for 3 to 7 days
- Facial flushing for 24 to 48 hours in some patients
- Infection: very rare when performed under sterile conditions with imaging guidance (roughly 1 in 15,000 to 50,000)
- Tendon rupture: particularly Achilles, patella tendon and rotator cuff with repeated injections
- Accelerated cartilage loss in weight bearing joints with repeated injections
- Temporary menstrual cycle changes in some women
- Sleep disturbance for 24 to 72 hours
Generally cortisone is considered safe for a single, well targeted, ultrasound guided injection in an appropriate condition. Repeat injections at the same site are where most of the risks compound. Most guidelines recommend no more than 3 injections at the same site per year, at least 3 months apart.
When does a cortisone injection actually make sense?
Reasonable scenarios include:
- Severe unrelenting pain significantly disrupting sleep, work or daily function
- Rehab progress is completely stalled because pain is preventing you from doing the exercises
- A short pain relief window is needed for a specific event (upcoming holiday, wedding, milestone game)
- Frozen shoulder in the freezing phase where the pain is severe
- Severe subacromial bursitis or trochanteric bursitis
- Severe osteoarthritis flare where surgery is being considered
- You have tried and progressed with quality rehab and pain is still limiting function after 6 to 12 weeks
⚠ Cortisone is generally not appropriate if
- You have not tried a proper rehab program yet
- You are considering the injection as a standalone fix without rehab afterwards
- You have Achilles tendinopathy (rupture risk site)
- You have already had a plantar fascia injection recently (repeat injections at the same site raise fat pad atrophy and fascia rupture risk)
- You have already had 3 or more injections at the same site in the past year
- There is active infection anywhere in the body
- You are on strong blood thinners without medical clearance
- You have poorly controlled diabetes
What if I have already had a cortisone injection?
Great — the pain relief window is exactly when rehab progresses fastest. Our physio team (Julian De Rosa, Ari Moushis and Sam Nunan) will:
- Wait 24 to 48 hours after the injection before starting hands on treatment to let the flare settle
- Use the pain relief window to progress range of motion, strength and functional loading that was not possible while pain was severe
- Build a structured rehab plan aimed at fixing the underlying cause so you do not need another injection in 3 months
- Educate you on activity modification, sleep setup and workload management
- Communicate back with your GP or sports medicine doctor
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from Bexley North, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from Marrickville.
What are the alternatives to cortisone?
- Progressive rehabilitation (physio): the first line for almost every musculoskeletal condition. Fixes the cause, not just the symptom
- Load management and activity modification: reducing aggravating activity while continuing safe movement
- Shockwave therapy: particularly effective for chronic tendinopathy (plantar fasciitis, tennis elbow, gluteal tendinopathy, Achilles)
- Dry needling and hands on release for muscle related pain contributors
- Non steroidal anti inflammatories (NSAIDs) under GP guidance for short term inflammation control
- Hydrodilatation for frozen shoulder (saline volume distension of the joint capsule, usually with cortisone added)
- Platelet Rich Plasma (PRP) injections for some tendinopathies (mixed evidence)
- Referral for a surgical opinion when conservative care has failed and structural changes are the primary problem
Frequently asked questions about cortisone injections
Typically 6 to 12 weeks of pain relief. Some patients get longer, some shorter. The effect is not permanent and does not repair the underlying tissue.
Physio first for most conditions. Cortisone is best reserved for cases where pain is so severe that rehab cannot progress, or where the evidence specifically supports it (frozen shoulder, subacromial bursitis, severe joint arthritis flares).
Yes. Most guidelines cap at 3 injections per site per year, at least 3 months apart. Repeat injections can accelerate cartilage loss in joints and weaken tendons.
No. Cortisone reduces inflammation and pain. It does not repair tissue, regrow tendons or restore joint cartilage. That is why rehab remains essential.
Yes, generally. Ultrasound guided injections ensure the medication lands in the target tissue. Landmark guided (no imaging) injections are less accurate and can miss the target.
Yes. Medicare covers 5 physio sessions per year under a Chronic Disease Management plan. Private health Extras rebates through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If you are weighing up a cortisone injection or you have already had one and need proper rehab to make the most of the pain relief window, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. Same day appointments are usually available.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.