If you’ve dealt with stubborn knee, hip, shoulder, or thumb pain, someone has probably suggested a “cortisone shot.” These injections—more precisely, intra-articular corticosteroids—can quiet inflammation and sometimes offer welcome short-term relief. But what do they do for joint health long term, and where do they fit alongside exercise therapy and other conservative options like shockwave?
Below is a clear, research-driven guide to help you decide (with your clinician) if a steroid injection makes sense right now—and what else you can do to protect your joints for the long haul.
The short version
- Benefit window: Most people feel pain relief for a few weeks after a steroid injection. The effect typically fades by 4–6 weeks, with little evidence of durable benefit beyond a few months.
- Risks to weigh: Repeated or frequent injections can carry joint and systemic risks, including cartilage loss in the knee with repeated triamcinolone, blood-sugar spikes (especially if you have diabetes), temporary adrenal (HPA) suppression, and rare infection.
- Use wisely: Best framed as a short-term tool to unlock activity—not a disease-modifying solution.
- Often better for the long term: A structured exercise therapy program (strength, mobility, and load-management) consistently improves pain and function and outperforms “injection-only” approaches over time.
- Timing before surgery: Avoid injections into a joint scheduled for replacement soon; infection risk appears higher if an injection is done within the prior 3 months.
What the current research shows (in plain English)
1) Pain relief is real—but usually short-lived
Randomized trials and systematic reviews agree: steroid injections can reduce osteoarthritis (OA) pain for several weeks, particularly in the knee and hip. For many, the effect wanes by 1–3 months. That’s why expert guidelines position injections as short-term relief rather than a cure or joint-building treatment.
2) Cartilage health matters
A high-quality two-year trial in knee OA (repeated triamcinolone vs saline) found greater cartilage volume loss and no pain advantage in the steroid group. Not every steroid, dose, or joint behaves the same, but this is one reason many clinicians limit frequency and emphasize alternatives that build tissue capacity (strength, movement quality, weight management).
3) Systemic effects are real—especially for diabetes
Even though the medicine is injected locally, some is absorbed. Common systemic effects include transient blood-sugar elevations for 1–3 days (sometimes longer) and temporary HPA-axis suppression, especially with higher doses or multiple joints injected. If you have diabetes or a major illness/surgery coming up, plan monitoring with your physician.
4) Around joint replacement surgery
Meta-analyses suggest higher periprosthetic joint infection rates when knee replacement follows a steroid injection given within the preceding 3 months. Many surgeons ask patients to wait at least 3 months between a shot and arthroplasty.
5) Local side effects (uncommon but important)
These include post-injection flare, skin depigmentation or fat atrophy, and septic arthritis (rare but serious). Tendon rupture is a known risk when injections are placed into or around tendons; strictly intra-articular injections carry far lower tendon risk when performed correctly.
How often is “safe”?
There isn’t a universal cap, but a pragmatic rule used by many systems is spacing injections by ≥3 months, with no more than ~3 per year in the same joint. Your personal plan should account for comorbidities (e.g., diabetes), your activity goals, and what you’re doing between shots to build capacity.
Where steroid injections can fit
- Short, focused reset when pain is blocking participation in exercise therapy.
- Hip OA when image-guided injection helps manage a flare while you ramp up a strengthening and gait-training plan.
- Inflammatory flares (e.g., gout in a single joint) where a local shot may be safer than high-dose systemic steroids—always as part of a broader plan.
Key idea: If you choose an injection, use it to unlock exercise, not replace it.
Strong alternatives that protect joint health
1) Exercise therapy (first-line, high-value)
A well-designed program improves pain, function, and confidence—often more durably than injections alone. Core elements:
- Strength training: progressive loading of the muscles that control the joint (e.g., quadriceps, hip abductors, calves for knee OA; rotator cuff and scapular muscles for shoulder).
- Movement quality & mobility: restore range where it’s limited; improve gait mechanics and balance.
- Load management: scale volume and intensity to avoid boom-and-bust flares.
- Home program: short, consistent sessions (8–15 minutes) most days beat heroic, infrequent workouts.
2) Weight management & cardio
For hip and knee OA, even 5–10% weight loss reduces pain and improves function. Low-impact cardio (walking with interval pacing, cycling, rowing, elliptical) improves joint nutrition, mood, and capacity without high joint stress.
3) Medications with favorable risk–benefit
- Topical NSAIDs (knee/hand OA) as a safer first try; consider oral NSAIDs when appropriate at the lowest effective dose and shortest duration.
- Duloxetine can help when pain processing/central sensitization is part of the picture.
- Acetaminophen has modest effect but can be used strategically for short windows.
4) Bracing, canes, and taping
For tibiofemoral knee OA, offloading braces and canes can reduce pain during walking. Patellofemoral taping or bracing can help select patients. These are bridges that make exercise possible.
5) Shockwave therapy (ESWT)—where it may help
Focused shockwave delivers acoustic pulses to tissues that are painful or degenerative. The strongest evidence supports tendinopathies (plantar fasciitis, patellar tendon, lateral epicondylitis, Achilles, calcific rotator cuff), where ESWT can reduce pain and improve function—often without needles or medications. For knee OA, early studies suggest ESWT may improve pain and function when paired with exercise, but research is still evolving; we treat it as an adjunct, not a replacement for strengthening and habit change.
Why people like it
- Non-invasive, quick (10–15 minutes), and typically a series of 3–6 sessions.
- Lets many patients stay active while they build capacity with exercise therapy.
- Pairs well with load-progression and mobility work.
What to expect
- A brief evaluation to localize the painful tissue(s), then application of shockwave at a dose tailored to your tolerance. Mild soreness after sessions is common and generally short-lived.
(Curious about mechanisms and evidence summaries? See the Arthritis Foundation’s OA guideline for context on non-drug interventions and the growing literature on ESWT for tendons.)
External resource: American College of Rheumatology/Arthritis Foundation guideline on osteoarthritis management (hand, hip, knee): https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf
A practical decision framework
- Clarify your primary goal.
Are you seeking a short pain reset so you can move, or are you after durable change for sport/work/life? Injections can help the former; exercise therapy (with or without shockwave) builds the latter. - Inventory your risks.
Diabetes? Plan for glucose monitoring after an injection. Surgery planned? Avoid injections within 3 months before joint replacement. Infection risk? Prior adverse reactions? - Build the plan around movement.
If you do get an injection, start or resume exercise therapy the same week—and let the shot’s relief help you earn capacity. Use shockwave as a needle-free adjunct for tendon-driven pain generators when appropriate. - Limit frequency & reassess.
Space injections by ≥3 months, keep to the fewest necessary, and reassess after each dose. If you keep needing shots to function, it’s a sign to upgrade the plan (stronger exercise progression, weight management, footwear/bracing, or a surgical consult if red flags are present).
FAQ
Do steroid shots “wear out” the joint?
A well-designed knee OA trial linked repeated triamcinolone injections to greater cartilage loss over 2 years without better pain control. That doesn’t mean every steroid harms every joint, but it’s a caution—especially if injections are frequent or if you rely on them instead of building capacity.
I’m diabetic—can I get an injection?
Possibly, with a plan: expect blood-sugar spikes for 1–3 days. Check more often, adjust as advised, and coordinate with your PCP or endocrinologist.
Are injections safe right before joint replacement?
Best to avoid within 3 months of surgery due to higher infection risk. Discuss timing with your surgeon.
How many injections can I have?
Personalized, but many clinicians suggest no more than ~3 per year per joint with ≥3 months between doses. If you need more than that, it’s time to rethink the strategy.
Where does shockwave fit with arthritis?
For classic OA pain, shockwave is adjunctive at best; it shines most for tendon-related problems that commonly coexist with OA (e.g., gluteal or patellar tendinopathy). We often combine ESWT with a targeted strength plan to address both pain and capacity.
Bottom line
Steroid injections can be a helpful short-term tool—especially to break a painful flare that’s blocking progress—but they don’t rebuild joints and may carry meaningful risks if repeated frequently. The most durable protection for joint health still comes from exercise therapy (progressive strength, mobility, and load management), supported by smart medication use, weight management, and—when indicated—shockwave for tendon-driven pain.
If you’re considering a shot, use it as a bridge to movement, not a substitute for it.
Ready for a plan that prioritizes strength, movement, and measurable progress—with shockwave available when it helps? Book your consult now to map the fastest, safest route back to the activities you love.
Recent Comments