After an epidural steroid injection, the main priorities are resting for the first 24 hours, managing temporary soreness at the injection site, and knowing what’s normal versus what needs medical attention. Most people can go home within 30 minutes of the procedure, but the days that follow require a few specific precautions to get the best results from the injection.
The First 24 Hours
Plan to take it easy for the rest of the day. The first 24 hours should consist of relative rest so the medication can absorb properly and you can monitor for any reactions. That means no exercise, no heavy lifting, and ideally no strenuous activity around the house. Light walking is fine and can actually help prevent stiffness.
Whether you can drive yourself home depends on whether you received sedation. If the injection was done with only local numbing at the skin, most clinics will allow you to drive. If you were given any sedative to help you relax during the procedure, you’ll need someone to take you home. Ask your provider ahead of time so you can arrange a ride if needed.
You can shower the same day, but avoid baths, hot tubs, and pools for at least 24 to 48 hours. Submerging the injection site in water raises infection risk before the needle puncture has fully closed. A quick shower is a different story since the water runs off rather than pooling over the area.
Managing Soreness at the Injection Site
It’s common to feel sore or achy right where the needle went in. This is not the same as your original pain returning. Ice works well here: apply it for about 20 minutes at a time, then give it a break before reapplying. Avoid heat on the injection site for at least 72 hours, as heat can increase inflammation and swelling in the area. After those first three days, you can switch to heat if it feels better.
Some people also notice a temporary increase in their usual back or leg pain within the first day or two. This “steroid flare” happens because the medication hasn’t fully kicked in yet, while the injection itself caused some local irritation. It typically fades as the steroid begins working.
When Pain Relief Actually Starts
The local anesthetic mixed into the injection may give you a few hours of numbness or relief almost immediately, but this wears off quickly. The steroid itself takes longer. In a study tracking patients after their injections, about 73% reported significant relief by day one, while another 22% didn’t feel major improvement until around day four. A small number of patients took two to three weeks to notice a meaningful difference.
So if you don’t feel better right away, that doesn’t mean the injection failed. Give it at least two weeks before drawing conclusions. Your provider will likely schedule a follow-up to assess your response somewhere in that window.
Returning to Exercise and Normal Activity
After the first 24 to 48 hours of rest, you can begin gradually increasing your activity. Start with low-impact options like walking, stationary cycling, or gentle stretching. From there, progress based on how you feel. The goal is a gradual ramp-up rather than jumping straight back into intense workouts or heavy lifting.
There’s no universal timeline for returning to high-impact exercise or sports, because it depends on why you got the injection in the first place and how your body responds. Most people find they can resume their normal routine within a few days to a week, advancing as their pain allows. If you were getting the injection specifically to help with physical therapy, your therapist can guide the progression.
Side Effects That Are Normal
Steroids are systemic medications, meaning even though they’re injected into your spine, some of the drug enters your bloodstream and can cause effects throughout your body. A few common ones to expect:
- Facial flushing: A warm, red feeling in your face and chest that can last a day or two.
- Trouble sleeping: The steroid can act as a mild stimulant, making it harder to fall asleep for one or two nights.
- Increased appetite or mild mood changes: Some people feel jittery, anxious, or unusually energetic for a few days.
- Water retention: Mild swelling in your hands or feet that resolves within a few days.
These side effects are temporary and generally resolve on their own within a week.
Blood Sugar Spikes for People With Diabetes
If you have diabetes, this is one of the most important things to know. Epidural steroid injections cause a significant spike in blood glucose. In one study of 30 diabetic patients, blood sugar levels jumped by an average of 126 points after the injection. The increase was substantial regardless of how well controlled the patient’s diabetes was beforehand.
The good news is the spike is short-lived. Researchers found that blood sugar returned to baseline within about two days, with a half-life of roughly one day. Still, you should monitor your glucose more frequently in the 48 hours after the procedure and have a plan in place with your doctor for managing any highs. This is worth discussing before the injection, not after.
Red Flags That Need Emergency Attention
Serious complications from epidural steroid injections are rare, but they do happen. The FDA specifically warns patients to seek emergency care if they experience any of the following after the procedure:
- Vision changes or loss of vision
- Tingling in your arms or legs that wasn’t there before
- Sudden weakness or numbness in your face, arm, or leg on one or both sides
- Severe headache, especially one that worsens when you sit or stand up (this can signal a dural puncture, where the needle nicked the membrane surrounding your spinal fluid)
- Dizziness or seizures
- Fever with increasing pain at the injection site, which could indicate infection
These symptoms are uncommon, but they require immediate evaluation because early treatment makes a significant difference in outcomes.
How Many Injections You Can Get
Epidural steroid injections are not a one-time fix for most people. If the first injection provides partial relief, your provider may recommend a second or third injection spaced a few weeks apart to build on the effect. The general recommendation is no more than three to six injections per year, with at least three to six months between treatment series for chronic conditions.
The limit exists because repeated steroid exposure can weaken bone density, suppress your immune system, and affect your adrenal glands over time. If you’re not getting meaningful relief after two or three injections, your provider will likely recommend a different approach rather than continuing with more of the same.