Should I have a steroid injection for an injury? Things to consider
Updated: Sep 23
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 help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
Weโve 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 bodiesโ 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 wonโt 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 โ 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; itโs part of your bodyโs 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 canโt 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 itโs 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 wonโt 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 doesnโt affect everyone, but itโs there. So, itโs 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.
Other negative steroid injection side effects
Corticosteroids are immunosuppressive, so you would not want to have it before youโre 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 youโre on other medication that it's likely to interact with. For example, if youโre 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 thereโs 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 itโs not just a case of turning up at your GP and going, โHey, Iโll have myself a steroid injection! Happy days!โ
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 help with an injury? Youโre 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 Masterโs 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 Masterโs Degree in Sports and Exercise Medicine. You can read more about her here, and she's also on LinkedIn.
