Marathons are gruelling events. Often, for many contestants, the hard work of training starts early. The goal is to develop fitness slowly and gradually without getting injured. However, some runners experience injuries just as they ramp up their training weeks to months before the big event. In some cases, steroid injections can help runners continue with training. But is running after cortisone injections safe? When should you have a cortisone shot during exercise, and what should you do after a cortisone shot in the knee? We list the answers to these common questions below:
What injuries are responsive to a cortisone shot?
Generally, common marathon injuries that respond to cortisone include joint swelling and tendon-related pain from overload. Common conditions that work well with a cortisone shot are patellofemoral pain (or runner’s knee), IT band syndrome, knee arthritis, and greater trochanteric pain syndrome (or hip bursitis). However, due to potential risks and side effects, a steroid injection is not recommended for some injuries. These conditions include any large weight-bearing tendon, such as the Achilles or patellar tendon.
A cortisone shot should only be a small part of the overall management of injuries, which also includes physiotherapy, medication, and training modification.
Running after cortisone injection: Is it safe?
Generally, we choose carefully those conditions that are safe to inject. For example, while ramping up your training, we would not recommend injecting large weight-bearing tendons such as the Achilles or patellar tendon due to the potential risk of tendon damage or rupture. However, some common injuries in marathon runners, such as hip bursitis and ITB friction syndrome, are safe to inject. However, we advise rest from running for at least a week after the injection. So, the timing of the injection is essential.
How long before a marathon should I have a cortisone shot?
Generally, a steroid injection can take up to a week to work and sometimes a little longer. In addition, we advise taking up to a week of rest following a cortisone shot. So timing is everything regarding a cortisone shot.
Generally, we recommend an injection just before the final phase of your intense training (4-6 weeks before a marathon). Alternatively, you could consider an injection at the start of tapering (1-2 weeks before a marathon).
How long after a cortisone injection can I exercise?
Usually, we suggest a complete rest of the injected joint or tendon for at least three days. Then, you can resume non-impact activities such as swimming or cycling. It would be best if you waited until after a week before you resume impact activity such as running.
How long does a cortisone shot last?
In general, a cortisone shot lasts for about 2-3 months. However, in some cases, the injection may last longer or shorter. So, we would advise against a cortisone shot more than two months before a marathon.
What are the potential side effects of a cortisone injection?
Overall, most runners tolerate a cortisone injection if used safely and carefully. However, you need to be aware of the more common side effects that may affect your training:
- A typical cortisone flare can last 3-5 days.
- Skin changes such as fat atrophy and skin depigmentation
- Weakening of tendons structure. There is some evidence from animal studies that cortisone injection can temporarily weaken the tendon structure. Therefore, we advise against injecting large weight-bearing tendons. However, if you have an injection, you must rest from running for at least a week.
- infection risk – estimated at 1:10000
Please take a look at this blog for more information about the potential side effects of cortisone injections.
Are there injection options other than a cortisone shot?
Hyaluronic acid is a naturally occurring substance in tendons, ligaments, and bones. Injecting hyaluronic acid into joints improves pain and function associated with arthritis. Often, these injections take 2-4 weeks to start working and are suitable for mild discomfort associated with arthritis. In addition, unlike cortisone, which requires at least a week of rest from running, hyaluronic acid needs minimal rest.
Platelet-rich plasma, or PRP, is produced by spinning whole blood in a centrifuge. To reduce pain, we inject PRP into joints and tendons.
Overall, hyaluronic acid and PRP are less valuable just before a marathon.
What about a local anaesthetic on the day of the marathon?
A long-acting local anaesthetic could be injected on the morning of the marathon. This injection will start working in 30 minutes and last about 12 hours. Some conditions that respond to a local anaesthetic include IT band syndrome. Patellar tendonitis, Achilles tendonitis, greater trochanteric syndrome, or foot tendonitis. This local anaesthetic injection must be done with ultrasound to improve the accuracy and reduce the risk of leakage to other structures, such as nerves or blood vessels.
Final word from Sportsdoctorlondon on running after cortisone injections
Cortisone injections only play a small role in managing most MSK injuries. Generally, we combine injections with therapy and rehab to achieve the best outcomes. Running after cortisone injections is safe if you take a common sense and cautious approach. Timing is everything in marathon running: Speak to an expert in Sports Medicine to decide if your injury will improve with an injection and when you should inject.
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