Cortisone shots offer people immediate pain relief for joint and tendon pathology. How we manage patients after a cortisone shot varies depending on various factors, such as the pathology injected and the activity levels of the patient pre-injection. How long do you have to rest after a cortisone injection, and when can you return to weight training and running?
What are the possible side effects of a cortisone injection?
Generally, cortisone shots are very safe if used for the right reasons.
However, like any medical treatment, there are always side effects. These potential side effects include:
- Allergic reaction (rare)
- Infection (1/100000)
- Skin thinning and discoloration. We can reduce these side effects by using cortisone, which has less damaging skin effects. Also, using ultrasound to perform the injeciton reduces skin side effects.
- Bleeding into joints.
- Temporary increase in blood sugar in people with diabetes. This increase lasts for two weeks.
- Cortisone flare, which causes pain for 3-5 days (see below).
- Some worry about long-term side effects such as weakening tendon strength or further joint damage. For example, recent studies suggest that repeated cortisone injections can damage cartilage. Moreover, a cortisone injection can weaken tendon strength for a few weeks. But we can reduce these concerns by using cortisone shots sparingly and for the right reasons. Also, using ultrasound to direct the injection into the right spot reduces the chances of a poorer result.
What happens after a cortisone injection?
Once you receive a cortisone shot, you should offload the affected area for the rest of the day. So, a knee or foot injection means you must reduce your step count, whereas a shoulder injection means you should minimise lifting or picking up objects with your affected shoulder and arm.
Other essential aftercare instructions include:
- Ensuring the injected area is kept clean. You should keep the bandage in place until the end of the day and wash the area to keep bacteria away from the injected area.
- Avoid submerging the injected area. You can shower the affected area, but avoid hot tubs or swimming pools for 24 hours.
- Treat with anti-inflammatory measures to reduce or mitigate a cortisone flare. We suggest applying ice for 10-15 minutes to the injected area every 2-3 hours and starting oral ibuprofen 400mg thrice daily. Continue anti-inflammatory measures until the acute flare settles.
- For injections into the hip, knee or foot, you should avoid excessive activity such as walking, running or cycling immediately after the injection.
What should you do for a cortisone flare?
Generally, pain after cortisone injection is due to a cortisone flare. Usually, a cortisone flare starts after 6 hours and lasts up to 5 days. One study suggested a cortisone flare can last up to 4 days.
We think a cortisone flare occurs because cortisone forms crystals in the body. These crystals can irritate soft tissue and cause inflammation.
If you develop a cortisone flare, we recommend rest from activities, including gym and running, until the pain settles. In addition, try regular ice packs for 10 minutes every 3-4 hours and regular ibuprofen 400mg thrice a day.
How long do you need to rest after a cortisone injection?
Generally, we suggest you rest the injected area for two days. After two days, you can gradually increase your activity levels. However, if you still have a cortisone flare after two days, you should rest until the flare settles.
Return to activity is dependent on the structure injected. For example, injections for tendonitis need a more extended period varying from one to two weeks, with extended periods required for weight-bearing tendons such as Achilles, patellar, gluteus medius and peroneal tendons.
How long do you need to rest from weight training after a cortisone injection?
Returning to the gym depends on various factors, including the structure injected and the exercises you want to perform. Generally, we suggest you return to the gym 3-4 days after a cortisone injection. Initially, you should exercise body parts at a distance from the injected area. After seven days, you can gradually load the injected structure, being protective of the structure for ten days.
An example of a modified gym program after a shoulder tendon injection:
- Rest shoulder for two days. Treat flare with regular ice packs every 4 hours and ibuprofen until flare settles.
- Day 3: return to the gym and perform lower-body exercises and lower-leg aerobic activity
- Day 7: Reintroduce lighter back and pulling exercises, but avoid pushing exercises such as shoulder and chest exercises.
- Day 10: Reintroduce lighter shoulder and chest exercises at 50% of your previous lift and re-engage with physiotherapy.
- Gradually increase weight and intensity of pushing exercises supervised by a physiotherapist.
How long do you need to rest from running after a cortisone injection?
For upper limb injections, you can return to running after two days or when the cortisone flare settles.
We suggest you rest from running for seven days for lower limb injections, although the rest duration depends on the structure injected. Generally, you can return to running after seven days for joint injections, whereas we suggest after ten days for tendon injections.
An example of a modified running program after a cortisone injection to the hip joint for hip arthritis:
- Rest hip for two days. Treat flare with regular ice packs every 4 hours and ibuprofen until flare settles. Reduce step count by 50%.
- Day 3: return to upper body weights at the gym and swimming without kicking.
- Day 7: Return to cross-training, including cycling and lower body weights.
- Day 10: Re-engage with physiotherapy.
- Day 14-21: Return to graded running supervised by a physiotherapist.
Other frequently asked questions after a cortisone injection?
Can I walk after a cortisone injection in my knee?
For lower limb injections, we recommend you avoid walking immediately after the injeciton. Moreover, you should reduce your step count for a few days after the injeciton, especially if you experience a cortisone flare. We suggest you use public transport, private cars or taxis for 3-4 days following a cortisone injection into the knee joint.
Can I drive home after a cortisone injeciton?
In general, we suggest you avoid driving immediately post-injection. Many insurance policies have strict rules on driving after a medical procedure. They require you to be able to apply an emergency brake when driving. Also, cortisone is a powerful drug that can make you feel dizzy and faint and affect your vision, which may affect your ability to drive home.
So, as a general rule, we advise against driving after a cortisone injection. We suggest a friend or family member drive you home, or you take the tube or Taxi.
You can resume driving the day after a cortisone injection if the cortisone flare is not severe.
How long after a cortisone shot can I drink alcohol?
Alcohol can increase blood flow and bleeding. Generally, we suggest you avoid heavy drinking for 24 hours after a cortisone injection.
Can I take painkillers after a cortisone injection?
Yes. If you suffer from pain post-injection, you can take paracetamol and ibuprofen.
Why not use heat after a cortisone injection?
Heat increases blood flow to the injected structure. Greater blood flow will increase swelling, leading to increased pain. We suggest you treat pain and swelling post-injection with regular ice packs 10-15 minutes every 3-4 hours rather than hot packs.
Final word from Sportdoctorlondon about the need for rest after a cortisone injection
Generally, we suggest you rest the injected structure for at least two days. Returning to the gym or running will vary from 7 to 14 days, depending on the structure injected and the pathology.
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