More than 500,000 cortisone injections are given each year for musculoskeletal conditions such as arthritis and tendonitis. Cortisone reduces inflammation effectively, yet it’s often stigmatised. So are cortisone injections bad for you — and when are they genuinely worth having?
What is cortisone?
Cortisone is a potent anti-inflammatory drug, used to reduce inflammation in musculoskeletal and immune conditions such as rheumatoid arthritis. It’s a synthetic version of the corticosteroid your adrenal glands make naturally — and it’s a drug to be respected, with effects beyond inflammation, including on blood pressure and blood sugar. Importantly, cortisone is not the same as anabolic steroids, which build muscle but don’t reduce inflammation.
The case for cortisone (the pros)
Tendonitis and arthritis involve inflammation. You can reduce inflammation with tablets (cortisone or ibuprofen), but they distribute a small amount throughout the whole body, increasing the risk of side effects. A cortisone injection delivers the drug straight to the inflamed site, with far less reaching the rest of the body.
Cortisone works best for genuinely inflammatory problems such as trigger finger and De Quervain’s tenosynovitis. It’s less effective where degeneration dominates — tennis elbow, Achilles tendonitis, and patellar tendinopathy — and in tennis elbow, it may even worsen pain at three months. For knee osteoarthritis, cortisone gives only mild, short-lived relief (about three months), and there’s concern that repeated injections may accelerate the arthritis. So we use cortisone more selectively than we used to.
The real risks (the cons)
A cortisone injection delivers a high local concentration, which carries genuine risks:
- Cartilage damage. Repeated joint injections can worsen cartilage loss — one study found roughly twice the cartilage damage versus other drugs. This matters more in younger patients, whose cartilage is still worth protecting.
- Tendon weakening. Cortisone reduces the mechanical strength of a diseased tendon, mainly in the first few weeks, which is why we advise resting an injected tendon (for example, from running) for 10–14 days afterwards.
- Skin and fat changes. Cortisone near the skin can cause thinning, fat loss, and reduced pigmentation — so we’re cautious about injecting superficially and use ultrasound to place it accurately.
- Other effects: a temporary rise in blood sugar, a cortisone flare for a few days, a small risk of infection, and facial flushing.
Cortisone myths, debunked
“You can only have three cortisone injections in a lifetime.”
Not true. We do limit injections to about 2–3 per area over 3–6 months, and if the first doesn’t help, more in that spot usually won’t either. But there’s no lifetime limit across the whole body — different areas can be injected.
“Cortisone will weaken my bones and make me fat.”
The amount reaching the rest of your body after a local injection is minimal, and it clears within 1–2 weeks. Weak bones and weight gain are concerns with high-dose, long-term cortisone tablets, not one or two injections.
“It’s just a painkiller, so why bother?”
Cortisone does relieve pain, but it also reduces the inflammation driving the problem — the key is using it for the right conditions.
“Does cortisone weaken the immune system?”
It does suppress immunity, but studies suggest it lasts only a few weeks, with no evidence that one or two injections have long-term effects.
What are the alternatives to cortisone?
Because of these concerns, we increasingly use alternatives for certain conditions — hyaluronic acid (such as Durolane), PRP, combined PRP and hyaluronic acid, and Arthrosamid for knee arthritis. We compare the two main options head-to-head on our cortisone vs hyaluronic acid page.
Frequently asked questions about whether cortisone is bad for you
Are too many cortisone shots bad for you?
Yes — that’s the real concern. Repeated injections into one joint or tendon can damage cartilage or weaken a tendon. One or two well-placed injections for the right condition are generally safe; the problem is frequent injections into the same spot.
Is cortisone bad for you if you only have one injection?
Generally no. A single, well-targeted injection for an appropriate condition is low-risk, and the cortisone clears within 1–2 weeks. The risks rise with repetition and with the injection of the wrong conditions.
Why do some people say cortisone shots are bad for you?
The stigma comes partly from overuse — cortisone given too often, or for degenerative problems it doesn’t help — and from confusion with anabolic steroids. Used selectively, accurately, and for the right conditions, cortisone remains a useful and safe treatment.
When should cortisone be avoided?
When the problem is degenerative rather than inflammatory (where it helps little), when an area has already had 2–3 injections, in a replaced joint (infection risk), and with caution in unstable diabetes.
Are cortisone injections safer under ultrasound?
Yes — ultrasound improves accuracy and reduces side effects such as skin changes. See a doctor experienced in ultrasound-guided injections.
Final word from Sport Doctor London: Are cortisone injections bad for you?
Cortisone injections can still be used safely and effectively — for the right conditions, accurately placed, and not too often. We now use cortisone more selectively and substitute alternatives such as hyaluronic acid and PRP where they are better suited. Ask your doctor which option fits your problem, and choose a physician experienced in ultrasound-guided injections.
Dr Masci is an expert in ultrasound-guided injections, including cortisone, hyaluronic acid, PRP, and Arthrosamid. Contact the team here or call +44 (0) 203 488 0350.
Related topics:
- Cortisone vs hyaluronic acid
- Do cortisone shots cause weight gain?
- Cortisone injection and diabetes
- Do you need to rest after a cortisone injection?
- How long does it take for a cortisone shot to work?
- PRP for arthritis and tendonitis
I have RA and for 2 years now living with extreme headaches, neck pain , tingling in the tongue, painful teeth, throbbing mouth, extreme pain in my cheeks and they go red and puffy . I’ve had several injections of cortisone in the base the head /neck , the first injections worked and now they’re not nearly as effective , I’ve had 6-8 injections . I’m lost I can’t stand the pain anymore. Would a natural healing dr have effect ?
I’d avoid more cortisone injections. Botox is an option if you’re headaches are tension-related. Speak to your doctor.
Hi two years ago I was given Ciprofloxacin and it caused dry painful knees (MRI showed degenerative meniscus ) in addition to Achilles tendinosis which healed and tennis elbows which are still healing. My physiatrist wants to give me cortisone shots for the degenerative meniscus but I am very afraid tat it will weaken surrounding tendons and cartilage further
I’ve been managing with natural anti inflammatory supplements avoiding both NSAIDS & cortisone shots and doing mild physical therapy until a rent FLARE of inflammation and pain
I am average weight non smoker and no alcoholic beverages
My physiatrist said some people can get a bad reaction to HA injections – should I continue to avoid cortisone shots and NSAIDS after taking Ciprofloxacin 2 years ago which harmed my tendons and cartilage and prob bones. At the time of the Cipro injury I was given steroids IV at the same time which made matters worse for me
Thank you !! I believe PRP is not covered by insurance in the states and doctor said there’s a risk I can get a bad reaction to HA injections
Thank you 🙏
Generally, I recommend avoiding repeated cortisone injections for joints and tendons. NSAIDs are fine if you don’t use them continuously and you don’t have major issues with your heart or kidneys.
Hyaluronic acid injections are a reasonable option for arthritis. Yes, reactions can occur but are not common, especially with imaging such as ultrasound. Please see my blog on Durolane. LM
I’d reach for all natural 100 % tumiric cucumrin & essential oils !!!!!!!!!!! no more shots …………….