A cortisone injection can seem like a quick fix when pain is holding you back, but it is not always the right choice, and it is rarely the whole answer. Knowing when a corticosteroid injection genuinely helps, and when options like dry needling or PRP injections might suit you better, makes for a smarter decision.
Cortisone injections are given by a doctor, not a physiotherapist, so this is a decision to make with your medical team. This guide explains how it works, its benefits and risks, the main alternatives, and how physiotherapy fits in, so you can weigh it up with confidence.
What Is a Cortisone Injection?
A cortisone injection, also called a corticosteroid injection, delivers a steroid medication into an area of inflammation such as a tendon, bursa or joint. Corticosteroids are hormone-like substances, similar to those your adrenal glands produce naturally, that calm the immune system to reduce inflammation and pain. The injection is often guided by ultrasound to target the right spot, and it tends to work more quickly than many other options for settling inflammation.
How Does a Cortisone Injection Work?
It works by dampening the local inflammatory response, which can ease pain and swelling in the treated area. Most injections also include a local anaesthetic, which is why many people feel noticeably better for the first day or two. The steroid itself then acts over the following days. It is worth understanding that it targets symptoms rather than the underlying cause, which is why what you do afterwards matters so much.
Do They Always Work?
No. Despite their benefits, cortisone injections do not work for everyone. Because an anaesthetic is included, some people feel better for a couple of days and then find their pain returns, sometimes to the same level or worse, once it wears off. This is one reason cortisone is best used alongside physiotherapy rather than instead of it. Where conservative treatment alone has not been enough, it can create a window of reduced pain that lets you get more out of your rehabilitation.
Risks and Side Effects of a Cortisone Injection
Because corticosteroids are powerful, doctors limit how many injections you can have, as repeated use carries risks. Possible adverse effects include damage to nearby cartilage, thinning or death of nearby bone, joint infection, nerve damage, a temporary rise in blood sugar, and weakening or, rarely, rupture of a tendon. These risks are part of why it is considered carefully rather than offered routinely, and why your doctor will weigh it against other options.
Alternatives to a Cortisone Injection
Cortisone is not the only option, and for tendon problems in particular the evidence is evolving. Some research suggests cortisone can be counterproductive for certain tendinopathies, which has increased interest in alternatives. The most established non-surgical option remains progressive loading and rehabilitation with a physiotherapist. Two injectable alternatives are also sometimes considered.
Dry Needling
Dry needling involves inserting a fine needle into the affected tissue to create a small, controlled stimulus that may encourage the body’s natural healing response. Some research reports that dry needling reduces pain in a large proportion of tendinopathy cases, though results vary and dry needling is usually one part of a broader plan rather than a standalone cure. A physiotherapist can advise whether dry needling is appropriate for you.
PRP Injections
PRP injections, or platelet-rich plasma, involve taking a small sample of your blood, spinning it to concentrate the platelets, and injecting that back into the injured tendon. The idea is that the growth factors in the platelets support healing. The evidence for PRP injections is mixed and still developing, and PRP injections are not right for everyone, so they are a discussion to have with a specialist alongside your physiotherapy.
What to Do After a Corticosteroid Injection
If you do go ahead with a corticosteroid injection, aftercare matters. Rest for at least 24 hours and avoid strenuous activity, such as heavy lifting, for around two weeks, as loading the area too soon can stir up inflammation. Keep an eye on your symptoms and seek medical advice promptly if pain, numbness or other symptoms worsen, as this can occasionally signal a complication such as infection. It also helps to apply ice rather than heat to the site after a corticosteroid injection, since heat increases blood flow and inflammation. Always follow the specific advice your treating doctor gives you.
Common Questions About Cortisone Injections
How long does cortisone relief last?
It varies. Some people get several weeks or months of relief from a cortisone injection, while others find the benefit is short-lived once the anaesthetic wears off. Using the pain-free window to progress your physiotherapy tends to give the most lasting result.
How many injections can I have?
There is no single rule, but doctors deliberately limit the number of injections into one area because of the risks of repeated use. Your doctor will advise what is safe in your case, which is another reason injections are best combined with a longer-term rehab plan.
Is dry needling better than cortisone?
Neither is simply better; they do different jobs. A cortisone injection can rapidly calm inflammation, while dry needling aims to stimulate healing and is often used within physiotherapy. The right choice depends on your diagnosis, and a physiotherapist or doctor can help you decide.
How BeFit Can Help
At BeFit Training Physiotherapy, we help you get to the bottom of your pain and build a plan that addresses its cause, not just its symptoms. Whether or not an injection is on the table, our sports physiotherapy team can assess the problem, and evidence-based strength and conditioning is often the most reliable way to rehabilitate a stubborn tendon. If an injection is being considered, we work alongside your doctor so the pain-free window is put to good use. Initial consultations run for 45 minutes, one-on-one, so there is time to understand your history and your goals.
Our team at Edgecliff and Coogee would be glad to help you make a confident, informed decision. No referral is required, and HICAPS is available on-site for immediate health fund claiming.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805 | befittrainingphysio.com/book-now
Related Services at BeFit
Learn more about how our team can help:
Sports Physiotherapy
Strength & Conditioning
References
Coombes BK, et al. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review and meta-analysis. Lancet. 2010.
Dean BJF, et al. The risks and benefits of glucocorticoid treatment for tendinopathy. Semin Arthritis Rheum. 2014.
Krey D, et al. Tendon needling for treatment of tendinopathy: a systematic review. Phys Sportsmed. 2015.
Fitzpatrick J, et al. The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis. Am J Sports Med. 2017.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
