Should I have a steroid injection for an injury? Things to consider

This article explains why a steroid injection for an injury should only be used in very specific circumstances. It also discusses the steroid injection side effects, such as the risk of rupturing your tendon, you should consider when deciding whether to have one. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

In this article:

1. How does a steroid injection work?

2. Sometimes used with local anaesthetic

3. Short-term vs. long-term use

4. Risk of tendon rupture

5. Other negative steroid injection side effects

6. A steroid injection is not a magic fix

7. How we can help

We’ve also made a video about this:

How does a steroid injection work?

A steroid injection consists of corticosteroid, which contains cortisone, which is a synthetically produced substance that mimics the effect of the cortisol that our bodies produce naturally in response to stress. It dampens down our immune response as well as our bodies’ inflammatory reaction to injuries.

So, the cortisone is usually injected when an injury has resulted in inflammation that causes pain and maybe also some other issues.

However, many musculoskeletal injuries are not very inflammatory, so the positive effects of cortisone on these conditions won’t be significant.

Sometimes used with local anaesthetic

Some steroid injections contain a local anaesthetic, which obviously also provides pain relief, but much quicker than the cortisone.

So, if you get almost immediate pain relief after such an injection, it is a good indication that the injection was done in the right spot – where your pain is actually coming from.

For example, if you get a steroid injection containing a local anaesthetic in the knee joint and the pain goes away almost instantly, then it is the joint that is causing your issue and not any of the structures around it.

Short-term vs. long-term use

For most injuries to heal, you need an inflammatory response; it’s part of your body’s process of getting rid of damaged or dead cells and replacing them with new ones. So, you don't want to dampen your inflammatory response if you can help it.

However, sometimes the inflammation from an injury causes a patient so much pain that they can’t do their rehab exercises. This is where the sensible use of a steroid injection would provide them with sufficient short-term pain relief to get going with their exercises; and it’s those exercises that will get their injury better in the long run.

The least sensible way to use steroid injections is to try and manage an injury in the long term.

It will become clear from the side effects discussed below why long-term use is a no-no, and also why you should think twice about even its short-term use in certain instances.

Risk of tendon rupture

Most tendinopathies do not have a lot of inflammation, so for this reason alone a steroid injection won’t be of much use.

But also, one of the side effects of cortisone is a risk of tendon rupture. It is a small risk, and it doesn’t affect everyone, but it’s there. So, it’s better to address things like the loads that the injured tendon is being subjected to and getting it stronger through exercise than to inject it with something that could potentially cause it to rupture.

Steroid injections are not that good for tendons

Other negative steroid injection side effects

Corticosteroids are immunosuppressive, so you would not want to have it before you’re having a vaccine, for example, or when you are ill or have some sort of infection.

You might not want to have the cortisone injection done if you’re on other medication that it's likely to interact with. For example, if you’re taking diabetic medicines, cortisone will cause your blood sugar levels to fluctuate for a while after.

An injection obviously breaks the skin, so there's a small risk of infection. It's common to have a bit of redness and soreness after the injection, but if there’s a worsening redness and/or worsening pain after 24 hours, then obviously that is a sign that there's an infection that needs immediate medical treatment.

Another possible side effect is fat atrophy. The skin has a layer of fat just beneath it, and sometimes a steroid injection can cause some of that fat to disappear, which will leave you with a little bit of a dent in the skin.

It can also cause skin depigmentation, leaving you with a spot that is lighter than the rest of your skin.

A steroid injection is not a magic fix

I hope it is clear from the above that it’s not just a case of turning up at your GP and going, “Hey, I’ll have myself a steroid injection! Happy days!”

You do need to think about why you would want to have the steroid injection. Is it to provide you short-term pain relief in order to do your rehab exercises, or are you expecting some miracle cure?

Like I said, it can be really helpful for short-term pain relief to get you going with your rehab. And what you need to do then, is to get the right rehab plan so that you can benefit fully from the effects of the injection, using the injection as an adjunct to help you get better and not as a magic fix.

If you've got, for example, a tendon issue, then you need to address the loading, the exercises, the strength of the tendon, and the activities that you're doing; you need to address all those things whether you have a steroid injection or not.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can read more about her here, and she's also on LinkedIn.

References:

1. Coombes, B. K., et al. (2010). "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376(9754): 1751-1767.

2. Del Valle Soto, M., et al. (2016). "Consensus on the use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine."

3. Orchard, J. W. (2020). "Corticosteroid injections: glass half-full, half-empty or full then empty?" British Journal of Sports Medicine 54: 564-565.