Cortisone shots for sports injuries

Published in Medicinewise Living

Date published: About this date

Knowing the potential risks and benefits of corticosteroid injections will help you and your doctor decide if they are right for you. (Hues /

Whether it’s tennis elbow, a frozen shoulder or swollen knee, it’s no fun when injury and pain hamper your game.

Many conditions brought on by exercise and sports are notoriously painful and persistent, leading some people to opt for a corticosteroid injection (or ‘cortisone shot’) into the affected area.

While this medicine has been widely used to treat inflammatory pain since the 1950s, it is worthwhile remembering it is not a cure and may even be detrimental in some conditions.

Knowing the potential risks and benefits of corticosteroid injections will help you and your doctor decide if they are right for you.

What is a corticosteroid?

Corticosteroids (also known as ‘steroids’ or glucocorticoids) are medicines that mimic your body’s natural corticosteroid hormones (cortisone and hydrocortisone) produced by the adrenal glands above your kidneys.

They are not the same as anabolic steroids, which are sometimes misused by athletes and body builders, and they don’t increase your muscle strength.

Corticosteroids (such as betamethasone, hydrocortisone, methylprednisolone, prednisone, and triamcinolone) are mainly used to treat serious inflammation or to modify effects on the immune system. This can help a variety of conditions such as arthritis and common sports-related injuries, including:

  • tennis elbow (lateral epicondylitis)
  • golfer's elbow (medial epicondylitis)
  • bursitis of the shoulder, hip or knee
  • frozen shoulder
  • plantar fasciitis
  • carpal tunnel syndrome
  • herniated disc
  • rotator cuff injury
  • tendonitis.

Injecting corticosteroids into or around joints or soft tissue can reduce inflammation and pain in the affected area for up to several weeks or months.

Is it worth a shot?

A cortisone shot may seem like a fast-track solution to your injury, but it isn’t the ‘be all and end all’ of treatment.

Although corticosteroid injections can reduce inflammation and symptoms, they don’t cure the underlying condition, and you may still need other treatments, such as rest and rehabilitation.

What’s more, many health professionals and sportspeople have concerns that reducing inflammation might mask a serious injury.

In fact, corticosteroid injections in the long run may actually do nothing or even worsen some injuries, despite the positive short-term effects.

Studies have found that people who had corticosteroid injections for tennis elbow had significantly less pain in the short term than those who had no treatment. However, they had a much lower rate of full recovery six to 12 months down the track, and a significantly higher risk of relapse, after their corticosteroid injection.

Are cortisone shots safe?

Corticosteroid injections can be given safely to most people but as with any medicine side effects may occur, and some can be serious.

Side effects are mostly limited to the area near the injection, but some corticosteroid may get into your general system to cause problems.

Local reactions are common

Pain or swelling usually occurs for 24 to 48 hours after an injection, but generally disappears quickly. Some doctors give a local anaesthetic to reduce discomfort.

People will often notice a lightening of the skin around the injection site. This is not harmful and usually resolves. A loss or thinning of the skin or fatty tissue in the area of the injection can also occur.

Another local reaction is known as the ‘cortisone flare’. The injected corticosteroid can form crystals that irritate the soft tissues, including the lining of joints (synovial tissue), causing it to become inflamed. There is also a risk of infection at the injection site or in the joint.

Repeated use can be harmful

Corticosteroid injections can cause more severe side effects, especially if you have them regularly. Weakening or rupturing of tendons in the affected area has been reported, and repeated use may contribute to osteoporosis, osteonecrosis (death of bone) near the injection site, and eventual destruction of cartilage in joints.

Watch your blood glucose level

Many people experience a temporary rise in their blood glucose (sugar) levels for 24 to 48 hours. Let the doctor giving the corticosteroid injection know if you have diabetes as you may need to have your blood glucose checked after the injection, and your diabetes treatment adjusted.

Is a cortisone shot right for me?

Some people can’t have corticosteroid injections, or they may not be the right choice of treatment for your injury.

Clinical adviser at NPS MedicineWise, Dr Andrew Boyden, says it’s important to tell your doctor if you have had previous problems with corticosteroids, are already taking a corticosteroid in another form such as a tablet, or are taking any other medicines that could interact.

“If you’ve had an allergic reaction to a corticosteroid in the past or take an anti-clotting medicine like warfarin, it’s essential you let your doctor know before having an injection”, says Dr Boyden.

“Your doctor can help you weigh up the pros and cons of having a corticosteroid injection in your situation. They can also suggest other options that may be more suitable, such as physical therapy, simple pain relievers like paracetamol or ibuprofen, or resting the joint.”

People should not have a corticosteroid injection if there is an open wound or skin infection in the injury area, an infection in the joint, or a more generalised infection.

Find out more information about who can and can’t have a corticosteroid injection and possible interactions from your doctor or the consumer medicine information (CMI). You can download the CMI for your medicine from the NPS Medicine Finder or ask your pharmacist or doctor to print it out for you.

You can also call NPS Medicines Line on 1300 MEDICINE (1300 633 424) for more information about your prescription, over-the-counter and complementary medicines (including herbal, ‘natural’, vitamins and mineral supplements).

The bottom line: limit your shots

A cortisone shot may be the right choice to relieve the pain and inflammation of your injury. Even so, limit the number of injections you have to prevent any long-term complications, including joint damage.

“Generally, no more than four corticosteroid injections a year are advised for any single joint”, says Dr Boyden.

“Your doctor is likely to advise against any further injections in the joint if you haven’t gained any relief after two consecutive injections. It’s also important not to overuse the injured area after an injection to ensure you recover well.”

Calling the shots on medicines in sport

The use of corticosteroids is restricted or prohibited in competition sports. If taken orally, rectally, intravenously or intramuscularly, their use requires a Therapeutic Use Exemption approval. If inhaled (e.g. for asthma) or used in or around joints and soft tissue or into your spine (local corticosteroid injection) you need a declaration of use from your doctor.

Contact the Australian Sports Anti-Doping Authority (ASADA) Drugs in Sport Hotline on 1800 020 506 for more information.