A cortisone shot (corticosteroid injection) is a localized treatment designed to reduce swelling and pain in a specific area, such as a joint, tendon, or bursa. The injection typically contains a corticosteroid, a potent anti-inflammatory medication, often mixed with a local anesthetic for immediate pain relief. Proper care following the procedure is important for maximizing the steroid’s anti-inflammatory effect and minimizing discomfort.
Managing Immediate Discomfort
Initial relief is primarily due to the local anesthetic mixed with the corticosteroid. This numbing agent is short-lived, usually wearing off within a few hours. Once the anesthetic fades, a patient may experience a return of pain, which can sometimes be more intense than the original discomfort.
This temporary increase in pain and inflammation is a common side effect known as a “cortisone flare” or “steroid flare.” The flare is attributed to the body’s reaction to the injected steroid crystals, a phenomenon called crystallization synovitis. These microcrystals can cause irritation in the joint lining or surrounding tissues, triggering a localized inflammatory response.
A cortisone flare typically begins between 6 and 48 hours after the injection. This reaction is a recognized, temporary response and does not mean the treatment has failed. The pain usually peaks within the first 24 hours and subsides on its own, generally resolving within one to three days. The main anti-inflammatory effect of the corticosteroid begins to take effect after this initial period, often within two to five days post-injection.
Protocols for Using Cold Therapy
Cold therapy after a cortisone injection is generally recommended to manage injection site soreness and discomfort from a potential cortisone flare. Applying ice helps to constrict blood vessels, which reduces localized swelling and provides effective pain relief. This manages the immediate post-injection pain while the steroid begins its work.
Cold therapy should be applied for a maximum of 10 to 20 minutes per session. This duration is long enough to numb the area and reduce inflammation without risking damage to the skin or underlying tissues. The application can be repeated every two to four hours as needed for discomfort, particularly during the first 24 to 48 hours.
Always place a thin towel or cloth barrier between the ice pack and the skin to prevent frostbite or irritation. Heat should be avoided for at least the first 48 hours post-injection. Applying heat can increase blood flow to the area, which may increase swelling and inflammation, working against the desired effects of the corticosteroid.
Post-Injection Activity and Monitoring
Resting the treated area is important to help the medication work effectively. Patients should limit activity and avoid strenuous exercise, heavy lifting, or high-impact movements for at least 24 to 48 hours after the injection. This rest period allows the corticosteroid to remain localized in the targeted area, preventing it from being prematurely absorbed or displaced from the joint.
Gentle, low-impact movements, such as walking, are often permissible, but any activity that causes increased pain should be stopped immediately. For managing pain during the initial 48 hours, over-the-counter pain relievers like acetaminophen can be used. Patients should discuss the use of nonsteroidal anti-inflammatory drugs (NSAIDs) with their physician, as some advise against them immediately following a steroid injection.
While a cortisone flare is common, certain signs may indicate a serious complication, requiring immediate contact with a healthcare provider. These warning signs include severe pain that progressively worsens beyond the initial 48 hours, fever, or spreading redness, warmth, or drainage at the injection site. Monitoring for these symptoms is important to rule out a rare but serious complication like infection.