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Steroid injection (cortisone shot) – what you should know

The steroid injection is a popular therapeutic method that can help relieve pain and inflammation in a specific area of the body. It is most often used to treat joint or periarticular complaints — for example ankle, elbow, hip, knee, shoulder, spine or wrist.
In our country people usually say “steroid injection”, while Anglo-Saxon doctors often use the term “cortisone shot” (cortisone injection). The injectable solution typically contains a drug from the corticosteroid group and a local anesthetic.
In this guide you can learn everything about steroid injections: when they may be useful, what risks they carry, and what you should do before and after administration.

If you are interested in steroids more broadly — from oral forms to systemic effects — read our pillar page Steroid-containing medication – friend or foe?.

What are steroid injections used for?

Local steroid injections are used to treat many musculoskeletal problems:

Joint inflammations (arthritis, rheumatoid arthritis)
Bursitis (bursa inflammation)
Tendonitis and tenosynovitis
Osteoarthritis-related joint pain
Gout attacks
Heel spur pain
Spine-originating pain (epidural injection)

Steroid injections are primarily symptomatic treatment – they can rapidly reduce pain and inflammation, but it is important to know they do not cure the underlying disease.

How does it work?

Corticosteroids suppress the body’s inflammatory response and the excessive activity of the immune system. When injected directly into the inflamed area, the active ingredient goes straight to the target site – it does not have to pass through the digestive system where it would be broken down.

The local anesthetic, which is often part of the injection, can provide immediate pain relief. The steroid effect usually begins within 24–72 hours and can last from weeks to months.

Who is it recommended for, and who should avoid it?

When can it be particularly useful?

A steroid injection may be effective if:

You are in an acute inflammatory phase (e.g. a gout attack)
The problem is localized to one or two joints
Pain limits rehabilitation or physiotherapy
Other treatments (medication, physiotherapy) alone are not sufficient
You need time while the effects of rehabilitation take place

When NOT to get a steroid injection?

Steroid injection is contraindicated in the following cases:

Active infection at the injection site or in the body
Joint prosthesis – it is forbidden to inject into an artificial joint
Fracture at the treated area
Taking blood thinners or anticoagulants – increased bleeding risk (inform your doctor first)
Allergy to the corticosteroid or the local anesthetic
Poorly controlled diabetes – steroids can temporarily raise blood sugar

If you had a fever, a cold, or have taken antibiotics in the past two weeks, be sure to inform your doctor before treatment.

Before you receive a steroid injection

For a safe treatment, tell your doctor if you:

Take blood thinners or anticoagulants
Have diabetes
Have osteoporosis
Have high blood pressure
Previously had an allergic reaction after an injection
Have had a fever or infectious illness in recent weeks
Are pregnant or breastfeeding

Possible risks of steroid injections

After a single, occasional injection, side effects are rare. The risk increases if you receive injections frequently and repeatedly to the same area.¹

Local side effects

Transient increase in pain (steroid flare): May occur in the 24–48 hours after injection and usually resolves on its own
Skin discoloration: The skin at the injection site may become lighter
Thinning of the skin and soft tissues: Can occur after repeated injections
Infection: Rare but serious complication (reported at a rate of about 1:10,000–50,000)²

Joint-related risks

Recent research has highlighted that repeated intra-articular steroid injections may not always have favorable long-term effects:

Accelerated cartilage loss: Some studies suggest steroid injections can speed up joint cartilage degradation³
Changes in bone structure: Rarely, subchondral insufficiency fracture or osteonecrosis may occur⁴
Tendon weakening: Repeated injections near a tendon may increase the risk of tendon rupture

Systemic effects

Although a local injection has fewer systemic side effects than oral steroids, some effects may still occur:

Transient facial flushing and sensation of warmth
Increase in blood glucose (important to monitor in people with diabetes)
Transient adrenal suppression after larger doses

Red flags – when to contact your doctor immediately?

After the injection, watch for the following warning signs. If you experience any of them, contact your doctor without delay:

Worsening pain beyond 48 hours – it does not improve but worsens
Increasing swelling and redness at the injection site
Fever (over 38°C) after the injection
Chills
The joint feels hot and tense
Pus or discharge from the puncture site

These symptoms may indicate an infection, which requires urgent medical attention.

What to do after the injection?

In the first 24–48 hours:

Protect the treated area: Avoid strenuous activity
If shoulder: Do not lift heavy objects
If knee: Avoid prolonged standing, running, or jumping
For pain: Apply ice to the area, but DO NOT use a heat pack
Only shower: Do not soak in a bathtub, go to a spa, or enter a swimming pool
Monitor symptoms: If it is still painful, swollen, or red after 48 hours, inform your doctor

How often can steroid injections be repeated?

Repeated steroid injections can damage joint cartilage and bone structure.³ For this reason, the number of treatments should be limited:

There should usually be at least 6–12 weeks between two injections
No more than 3–4 injections per year into the same joint
The exact frequency depends on the preparation used and the individual situation

If you need frequent injections, this may indicate that alternative treatment strategies should be considered.

Steroid injection or physiotherapy?

Several studies have compared the effectiveness of steroid injections and physiotherapy. The results are informative:

A 2020 randomized trial in patients with knee osteoarthritis found that although both treatments improved the condition, after 1 year the physiotherapy group showed better results in pain and function than those who received steroid injections.⁵

For tennis elbow, one study showed: steroid injection produced faster improvement up to 6 weeks, but at 1 year the recurrence rate was higher (54% vs. 12%) than the placebo group.⁶

These findings suggest that steroid injections can be useful for short-term symptom relief, but physiotherapy plays an important role for better long-term outcomes.

Home physiotherapy alternatives

You can supplement your treatment with modern home therapeutic devices and reduce the need for steroids:

TENS pain relief: Electrical nerve stimulation can help alleviate pain
Soft laser therapy: Research indicates it may beneficially influence inflammation and tissue regeneration
Magnetic therapy (PEMF): May support the healing processes
Microcurrent therapy (MCR): May aid tissue regeneration

Summary – Quick overview

What is this article? A detailed guide to local steroid (corticosteroid) injections: when they can be used, what risks they carry, and what to do before and after treatment.

Who is it for? For anyone who has received or is considering a steroid injection, or who suffers from joint, tendon or bursa inflammation.

Main message: Steroid injections can be an effective tool for short-term reduction of pain and inflammation, but they do not cure the underlying disease. Repeated injections carry risks, so limitation and physiotherapeutic supplementation are important.

Aspect	Steroid injection	Physiotherapy
Effect onset	Rapid (24–72 hours)	Gradual (weeks)
Short-term pain relief	Effective	More moderate
Long-term outcomes	Variable, relapses more common	More stable
Repeatability	Limited (up to 3–4× per year)	Continuous application possible
Joint risk	Repeated administration may be damaging	No damaging effect

Frequently asked questions

How long does the effect of a steroid injection last?
The effect varies between individuals. Generally it can last from a few weeks to a few months. This depends on the treated area, the preparation used and the severity of the underlying condition.

How long does the effect of a Diprophos injection last?
Diprophos (betamethasone) contains two components: a fast-release form (sodium phosphate) which acts within hours, and a slow-release form (dipropionate) which provides longer-lasting effect. Most of the drug leaves the body within 2–3 weeks, but the symptom-relieving effect can persist longer.

Is the injection painful?
The needle prick can be uncomfortable, but the local anesthetic typically reduces the pain. Many people feel only mild pressure or a sharp sting.

Can I drive home after the injection?
Generally yes, unless your doctor advises otherwise. If the limb is temporarily numb from the anesthetic, wait until normal sensation returns before driving.

Sources

Kompella P, Grogan R. (2023). Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications. AJR Am J Roentgenol. PubMed: 38117096
ASRA et al. (2025). Use and safety of corticosteroid injections in joints and musculoskeletal soft tissue. Reg Anesth Pain Med. PubMed: 40015722
Zeng C, et al. (2020). Intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty. Bone Joint J. PubMed: 32349592
Kompel AJ, et al. (2019). Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. PubMed: 31617798
Deyle GD, et al. (2020). Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. PubMed: 32268027
Coombes BK, et al. (2013). Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia. JAMA. PubMed: 23385272

The information in this article is for guidance only. A steroid injection is a medical procedure that should be performed by a healthcare professional. Home physiotherapy devices are intended to complement medical treatment, not replace it. If you have complaints, consult your treating physician.