Myths around Corticosteroid Injections

Corticosteroid injections have long been used within the worker’s compensation system to reduce inflammation and pain in a joint. I have found in particularly over the last six months with my own patient load that there have been a few incorrect statements and advice given along with an injection, that I will clear up in today’s blog.

 

If my pain doesn’t decrease straight away, the injection didn’t work.

MYTH.

Short-acting steroid injections can give relief within hours and the benefit should last for at least a week. Longer-acting steroid injections can take up to 1-4 weeks to become effective.

 

You need to rest the joint for a few days following an injection.

MYTH.

This is a controversial one and there is conflicting evidence surrounding the optimal rest period following injection. The advice I have heard regarding rest varies between 48 hours up to five days. Two studies I came across compared groups that had 48 hours rest and groups that had no rest following an injection. The study found no difference between the groups regarding pain, tenderness, swelling, and range of movement.  Another study found that 24 hours of rest following injection was adequate and resulted in better outcomes than no rest, however, no studies supported a rest period beyond 48 hours.

If I have a cortisone injection, I do not need other forms of therapy.

MYTH.

All studies I came across found that combining a cortisone shot with exercise therapy provides better long-term relief over an injection by itself. The reasons being that exercise therapy strengthens joint tissues and addresses the underlying issue and condition, as well as encouraging lifestyle modifications such as weight loss which can also reduce joint stress and improve joint biomechanics.

 

I can have an unlimited number of corticosteroids injected into my painful area.

MYTH.

Only one to four injections into a joint is recommended over a year period.

 

Remember, the main purpose of the steroid injection is to decrease pain and increase movement and use of the affected area. If you are considering cortisone injections, it’s important to remember that the relief they provide is temporary. When injections are repeated, the period of pain relief can become shorter and shorter over time. Frequently, this is not a result of increased tolerance, rather pain becomes harder to control because the underlying condition causes the joint to degrade further. Introducing a structured exercise regime can maximise the benefits of an injection and treat the underlying problem. If you would like further guidance around exercise therapy for joint conditions or pain, contact Absolute Balance to have a chat with our team of accredited exercise physiologists.

Tayla O’Halloran (Bsc. Exercise Physiology)

Workers Compensation Specialist – Exercise Rehabilitation Team Leader (AEP) (ESSAM)

 

 

Resources:

  1. Barr, S., Cerisola, F., & Blanchard, V. (2009). Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review. Physiotherapy95(4), 251-265. doi: 10.1016/j.physio.2009.05.002
  2. CHAKRAVARTY, K., PHAROAH, P., & SCOTT, D. (1994). A RANDOMIZED CONTROLLED STUDY OF POST-INJECTION REST FOLLOWING INTRA-ARTICULAR STEROID THERAPY FOR KNEE SYNOVITIS. Rheumatology33(5), 464-468. doi: 10.1093/rheumatology/33.5.464
  3. Chatham, W., Williams, G., Moreland, L., Parker, J., Ross, C., Alarcon, S., & Alarcon, G. (1989). Intraarticular corticosteroid injections: Should we rest the joints?. Arthritis Care & Research2(2), 70-74. doi: 10.1002/anr.1790020209