Cortisone shot or physical therapy: which is better?

What does a cortisone shot do, and what can it not do?

A cortisone shot delivers a corticosteroid, usually mixed with a local anesthetic, into or around a painful joint, bursa or tendon sheath. It reduces inflammation and pain, and the anesthetic can give relief within minutes, while the steroid effect typically builds over several days. It is a common and generally safe office procedure performed by a physician or other qualified clinician, not by a physical therapist.

What it cannot do is make a tendon stronger, restore lost range or change how you move. If the problem came from load outpacing capacity, such as a tendon that was asked to do too much, the cause is still there when the shot wears off. AAOS OrthoInfo notes there is no formal limit on injections, but providers often set a practical limit of three to four a year, and repeated shots carry risks to joint cartilage and nearby tendons.

What have trials comparing injections and therapy found?

Two well-known randomized trials point the same way. In 2020, Deyle and colleagues reported in the New England Journal of Medicine that people with knee osteoarthritis who received physical therapy had less pain and better function at one year than those given a steroid injection. In 2013, Coombes and colleagues found in JAMA that a single steroid injection for tennis elbow was linked to worse one-year outcomes and more recurrence than a placebo injection.

Neither trial means injections are never useful. They show that a shot alone is a short-term measure, and that active rehabilitation is what tends to change the longer-term picture. For rotator cuff problems, AAOS OrthoInfo reports that injections give pain relief for at least three months in about two-thirds of patients, which is exactly the window in which strengthening work can get done.

When does an injection make sense alongside rehab?

An injection makes most sense when pain is high enough to block the exercise that would solve the problem. Common examples are the painful early phase of frozen shoulder, an inflamed bursa that hurts at night, or an arthritic knee flare that stops someone walking. A calmer few weeks lets therapy make progress that pain would otherwise prevent.

If you have had a shot, use the window rather than treating it as the fix. It is tempting to go straight back to tennis, pickleball or a heavy yard project because the pain has vanished, but the tissue has not changed. Our page on physical therapy after a cortisone shot explains how to time it.

Hip bursitis is a good illustration. A shot can quiet the pain on the outside of the hip that makes lying on that side miserable, but the tendons of the buttock muscles that sit under the bursa often need weeks of progressive strengthening before the problem stays quiet. Without that work, many people find themselves back for another injection the following season.

What are the downsides of each option?

Each route has costs, and they are different kinds of cost. Injections are quick but carry medical risks, especially when repeated. Therapy carries little medical risk but asks for time, effort and several visits. Weighing them honestly is part of deciding.

Your physician can tell you how the injection risks apply to you, and a therapist can estimate how many visits a plan is likely to need. The cost and insurance page explains how therapy visits are priced and verified.

• Shot: temporary rise in blood sugar, which matters for people with diabetes.
• Shot: possible weakening of tendons and faster wear of joint cartilage with repeated injections; a short flare of pain and swelling at the site; rare infection.
• Shot: pain relief that may mask overload, so people return to full activity too soon.
• Therapy: slower relief, usually over weeks rather than days.
• Therapy: several visits plus home exercise, with copays or self-pay costs.
• Therapy: some soreness in the early sessions as the area is loaded again.

How do I choose between them with my doctor and therapist?

Decide based on how much pain is blocking function, what the problem is, and how many injections you have already had. If you can move and exercise, starting with therapy is a reasonable first step for most tendon and arthritis problems. If pain is severe, an injection followed promptly by therapy is a common combination.

Ask your physician what the injection is meant to achieve and what the plan is after it. Ask your therapist what they expect to change, and over what time frame. Ask both how you will know whether the choice is working, such as being able to sleep on the sore side, walk a set distance or lift a grandchild without pain. To start therapy without waiting for a physician visit, Indiana lets a physical therapist evaluate and treat for up to 42 days without a referral; the two-minute questionnaire gets you matched with a therapist in the network for knee pain, tennis elbow or other joint problems.