Should You Get a Cortisone Injection? What the Evidence Actually Says

You've had the pain for a while now. Rest didn't fix it, the exercises are slow going, and someone has offered you a cortisone injection. Quick, targeted, and you've heard it can knock the pain out fast.

So should you get it?

It's a fair question, and the honest answer is more interesting than either side usually admits. Cortisone isn't a scam. It's also not the clean fix a lot of people think they're signing up for. The truth sits in an awkward middle that doesn't fit neatly on a clinic poster.

Let's walk through what the research actually shows, so you can make an informed call rather than a hopeful one.

First, What Cortisone Actually Does

A cortisone injection delivers a strong anti-inflammatory steroid directly into or around an irritated structure, a tendon, a bursa, a joint. It calms inflammation and, with it, pain.

And it can work. In the short term, cortisone often provides real, meaningful relief. That part isn't in dispute. If you're in a lot of pain and can't sleep or function, a few weeks of relief is not nothing.

The problem is what "short term" actually means here, and what tends to happen after it wears off.

Myth #1: "It fixes the problem"

This is the big misunderstanding. Cortisone reduces inflammation. For a lot of the conditions it gets used for, inflammation was never really the main problem.

Take tendon pain, the tennis elbows, the gluteal tendon issues, the Achilles problems. Modern research shows these aren't primarily inflammatory conditions. They're capacity and load problems: a tendon that's become irritated, sensitised, and less tolerant than the demands being placed on it. (We've written about this with tennis elbow and hip pain specifically, see Tennis Elbow: Why Your Pain Isn't Just Overuse and Hip Bursitis Is Probably Not Your Problem.)

If the underlying issue is that the tendon can't handle its load, an anti-inflammatory doesn't change that. It quiets the alarm. The wiring fault is still there. The strength hasn't improved, the load tolerance hasn't improved, the movement patterns haven't changed. So when the cortisone wears off and you go back to the activity that irritated it, the pain has every reason to return.

Turning off the alarm is not the same as putting out the fire. Sometimes there wasn't even a fire, just an overworked circuit.

Myth #2: "If it helps short term, it must be helping overall"

This is where the research gets genuinely uncomfortable, and where a lot of people would want to know before they decide.

The best example is tennis elbow. A landmark randomised controlled trial published in JAMA in 2013 followed 165 people for a full year. Some got a cortisone injection, some got a placebo (a saltwater injection).

At six weeks, the cortisone group was winning. Less pain, better function. Exactly what you'd hope for.

But at one year, it flipped. The cortisone group had a lower full-recovery rate than the placebo group: 83% versus 96%. And recurrence was dramatically worse: 54% of the cortisone group had their pain come back, compared with just 12% of the placebo group.

Read that again. The people who got salt water did better after a year than the people who got cortisone. The injection didn't just fail to help long term, it was associated with worse outcomes and higher recurrence than doing comparatively little.

Tennis elbow is the clearest case, but it's not isolated. Across a range of tendon conditions, the same pattern shows up: cortisone tends to look good early and then fall behind other approaches, or the no-injection group, at the intermediate and longer-term marks.

Myth #3: "It's harmless, so there's no downside to trying"

Repeated cortisone injections into or around tendon tissue have been associated in the research with negative effects on the tissue itself, changes to collagen quality and, with repeated doses, potential weakening of the tendon. There's also evidence that injections given in the months before certain surgeries can be associated with poorer surgical outcomes and higher re-tear or revision rates.

None of this means a single, well-placed injection is dangerous. It usually isn't. But "harmless" is too strong. There's a real trade-off, and the more injections stack up, the more that trade-off matters. It's not a free roll. It's a decision with a cost on the other side of the ledger.

So When Does Cortisone Actually Make Sense?

The part the anti-injection crowd gets wrong. Cortisone absolutely has a legitimate place. It's a tool, and used in the right situation it's a good one.

It genuinely makes sense when the goal is to buy a window. If pain is so severe that you can't sleep, can't function, or can't even begin the loading program that will actually rebuild capacity, then settling that pain down for a few weeks can be exactly what lets you start doing the productive work. Some conditions with a genuine, significant inflammatory component respond well and appropriately to it. And there are cases, frozen shoulder in its brutal painful stage is one, where calming pain enough to keep the joint moving is a reasonable, evidence-supported use (see Frozen Shoulder: What It Actually Is, How It Heals, and What Helps).

The key distinction is this: cortisone as a bridge to rehab is very different from cortisone as a replacement for it. As a bridge, it creates the opportunity to build. As a standalone fix, it tends to reset the same problem over and over while the underlying capacity never changes.

An injection alone, with no plan for what comes after, is where people get stuck in the cycle of feeling better for a few months, flaring again, and going back for another one.

Questions Worth Asking Before You Decide

Cortisone is prescribed and administered by your doctor, and the decision is one to make with them, not off the back of a blog. But you can walk into that conversation better informed. These are reasonable things to raise:

What are we actually treating? Is this a genuinely inflammatory problem, or a load and capacity problem that an anti-inflammatory won't change?

What's the plan after the injection? If the answer is "we'll see how it goes," that's worth probing. The injection should be buying time for something. What's the something?

How many is this likely to become? A one-off to get you moving is a very different proposition to an open-ended series of repeat injections into the same spot.

Is there anything time-sensitive? If surgery might be on the table later, the timing of an injection can matter, and that's worth flagging with your doctor up front.

What happens if I do the rehab first? For a lot of load-related problems, structured loading is the thing that actually shifts capacity. Sometimes the honest question is whether the injection is needed at all yet, or whether it's being reached for because it's fast.

The Bottom Line

Cortisone is neither miracle nor menace. It's a short-term anti-inflammatory that can provide real relief and, in the right situation, a genuinely useful bridge to get you moving.

What it isn't is a fix for problems that were never really about inflammation. For load-related tendon and joint pain, it tends to look great early and then fade, sometimes leaving you worse off at a year than if you'd taken a slower, more boring path. And it's not consequence-free, especially with repeat doses.

If you're offered one, the smart move isn't to refuse it on principle or accept it on hope. It's to understand what it can and can't do, ask what the plan is on the other side of it, and make the decision with your doctor with clear eyes.

Because the injection can quiet the alarm. Rebuilding what your body can actually handle is still the work.

If you're weighing up an injection for a stubborn tendon or joint problem and want to understand what's actually driving it first, that's exactly what an assessment is for. Book one, and let's figure out what your body needs, not just what will quiet it down for a few weeks.

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