top of page

Cortisone Injections: Pros & Cons

Updated: Jun 17

Cortisone Injection

A common question I receive from patients is whether they should consider cortisone injections. While these injections fall outside my scope of practice, my stance on their use depends on the individual case and the available research. I encourage patients to review the peer-reviewed research and discuss the Pros and Cons with their physician to make an informed decision.

In this article, I will present some of the key findings from research to help you draw your own conclusions or at least spark some interest in learning more about the benefits and risks of cortisone injections that you can discuss with your physician.

Article Index:


Thumbs Up Image

Pros of Cortisone

Cortisone injections, or corticosteroid injections, are a mainstay in the management of musculoskeletal (MSK) conditions due to their potent anti-inflammatory and immunosuppressive properties. These injections are particularly effective in treating conditions such as osteoarthritis, rheumatoid arthritis, tendinitis, and bursitis, where inflammation plays a pivotal role in the pathophysiology. The primary mechanism of action involves the suppression of inflammatory cytokines and inhibition of the phospholipase A2 enzyme, leading to a reduction in the production of pro-inflammatory mediators like prostaglandins and leukotrienes.

This biochemical process can rapidly alleviate pain and swelling, significantly enhancing joint function and patient mobility. The decrease in pain not only improves daily activities but also leads to better sleep quality, as discomfort often disrupts rest. Furthermore, with reduced inflammation and pain, patients can more comfortably engage in physical exercise and tolerate manual therapy, critical components of a comprehensive rehabilitation program.

Enhanced mobility and reduced pain also allow patients to participate more effectively in physical therapy, which is essential for long-term recovery and maintenance of joint health. This holistic improvement in function and comfort underscores the value of cortisone injections in the therapeutic arsenal for MSK conditions.


Image of Arthritic Knee Joint

Cons of Cortisone

Now that we have covered the benefits of cortisone injections, it’s essential to consider some of the potential negative factors. Despite their anti-inflammatory advantages, cortisone injections carry significant risks, especially with repeated use. Peer-reviewed studies highlight that frequent corticosteroid injections can lead to the thinning and weakening of ligaments, tendons, and cartilage. This is primarily due to the catabolic effects of corticosteroids on collagen, a crucial structural protein in connective tissues, which inhibit collagen synthesis and promote its degradation, thereby undermining tissue integrity and tensile strength.

Cortisone-induced tendinopathy is a notable adverse effect, resulting from corticosteroids directly impairing tendon fibroblast function. This leads to weakened tendons and an increased risk of tendon rupture, particularly in high-stress, weight-bearing joints like the Achilles tendon and the rotator cuff. Additionally, corticosteroids disrupt the balance between matrix metalloproteinases (MMPs) and their inhibitors, further compromising tendon structure.

Furthermore, corticosteroids adversely affect cartilage by inhibiting chondrocyte proliferation and reducing proteoglycan synthesis, compromising cartilage integrity and function as a shock absorber in joints. This accelerates degenerative changes seen in osteoarthritis. Long-term use of corticosteroids is also associated with osteonecrosis. Osteonecrosis is the death of bone tissue due to a lack of blood supply. Particularly at the femoral head, caused by disrupted blood supply due to fat embolism, intravascular coagulation, and increased intraosseous pressure. Subchondral bone atrophy can also occur, leading to structural failure and joint surface collapse.

Systemic side effects include elevated blood glucose levels, posing risks for diabetic patients, alterations in adrenal function leading to adrenal suppression, hypertension, increased susceptibility to infections due to immunosuppression, and potential exacerbation of peptic ulcer disease. Cortisone injections can interact with medications like anticoagulants, increasing bleeding risks, and with certain vaccines, reducing efficacy.


Too Much of a Good Thing

Patient Getting an Injection

Cortisone injections can effectively manage inflammation and pain in musculoskeletal conditions, but their frequency should be carefully considered. General guidelines suggest limiting injections to three or four times a year in a single joint to minimize tissue damage and systemic side effects. For some patients without pre-existing conditions such as diabetes, osteoporosis, or a history of tendon injuries, this frequency may effectively manage symptoms without significant adverse effects. These individuals benefit from reduced inflammation, pain relief, and improved joint function.

However, for others, even three or four injections a year may be excessive. Patients with diabetes risk elevated blood glucose levels, while those with osteoporosis may experience accelerated bone density loss. Individuals with prior tendon or ligament injuries are more susceptible to cortisone-induced tendinopathy or tendon rupture. The impact of repeated injections also varies based on the joint treated, with weight-bearing joints like knees and hips potentially being more vulnerable. Healthcare providers must tailor the treatment plan to each patient's health status and response, considering alternative therapies to reduce corticosteroid dependence.


Grandparents Out With Their Grandchildren


In conclusion, cortisone injections play a role in managing musculoskeletal conditions by providing rapid relief from pain and inflammation, enhancing joint function, and improving patient mobility. These benefits can lead to better sleep quality and enable patients to participate more actively in physical therapy and rehabilitation programs, which are crucial for long-term recovery. However, it is essential to weigh these benefits against the potential risks, especially with repeated use. The adverse effects, including the thinning and weakening of ligaments, tendons, and cartilage, highlight the need for careful consideration of the frequency and necessity of cortisone injections.

For some patients, receiving cortisone injections three or four times a year may effectively manage symptoms without significant adverse effects. However, others, particularly those with conditions like diabetes or osteoporosis, or a history of tendon injuries, may face increased risks even at this frequency. The decision to use cortisone injections should be made on a case-by-case basis, with healthcare providers tailoring treatment plans to each patient's specific health status and monitoring their response closely. By thoroughly reviewing the peer-reviewed research and discussing with their physicians, patients can make informed decisions about the use of cortisone injections in their treatment plans.

Don't Forget the Rehab & Exercise

A key point is that these injections do not replace manual rehabilitation or a functional exercise program. Still, they may allow a patient to receive treatment or do their exercises with painful conditions they would not be able to otherwise. Cortisone injections should be considered part of a comprehensive treatment plan that includes manual rehabilitation and functional exercises, as these elements are vital for achieving long-term health and preventing future injuries.

I come from a multidisciplinary collaborative perspective where we all work as a team to achieve the best results for our patients. This team approach ensures that every aspect of a patient's condition is addressed, promoting optimal recovery and long-term well-being.



  1. Assouline-Dayan, Y., Chang, C., Greenspan, A., Shoenfeld, Y., & Gershwin, M. E. (2002). Pathogenesis and natural history of osteonecrosis. Seminars in Arthritis and Rheumatism, 32(2), 94-124.

  2. Bhattacharjee, A., Bhattacharya, R., & Mallick, P. (2016). Intra-articular corticosteroids: Effects on articular and extra-articular pathology. Journal of Orthopaedic Surgery and Research, 11, 39.

  3. Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. Lancet, 376(9754), 1751-1767.

  4. Dean, B. J., Getgood, A., Al-Mansoori, A., & Carr, A. J. (2003). The risks and benefits of corticosteroid injection for rotator cuff tendinopathy: A critical review. Clinical Journal of Sport Medicine, 13(1), 18-23.

  5. James, R., Kesturu, G., Balian, G., & Chhabra, A. B. (2008). Tendon: Biology, biomechanics, repair, growth factors, and evolving treatment options. Journal of Hand Surgery, 33(1), 102-112.

  6. Nishii, T., Sugano, N., Miki, H., Takao, M., Yoshikawa, H., & Ochi, T. (2001). Does the extent of osteonecrosis affect the outcome of conservative treatment? Clinical Orthopaedics and Related Research, 386, 176-185.


The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.

This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.

By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies in this website.



Photo of Dr. Brian Abelson

Dr. Abelson is dedicated to using evidence-based practices to improve musculoskeletal health. At Kinetic Health in Calgary, Alberta, he combines the latest research with a compassionate, patient-focused approach. As the creator of the Motion Specific Release (MSR) Treatment Systems, he aims to educate and share techniques to benefit the broader healthcare community. His work continually emphasizes patient-centred care and advancing treatment methods.


MSR Instructor Mike Burton Smiling

Join Us at Motion Specific Release

Enroll in our courses to master innovative soft-tissue and osseous techniques that seamlessly fit into your current clinical practice, providing your patients with substantial relief from pain and a renewed sense of functionality. Our curriculum masterfully integrates rigorous medical science with creative therapeutic paradigms, comprehensively understanding musculoskeletal diagnosis and treatment protocols.

Join MSR Pro and start tapping into the power of Motion Specific Release. Have access to:

  • Protocols: Over 250 clinical procedures with detailed video productions.

  • Examination Procedures: Over 70 orthopedic and neurological assessment videos and downloadable PDF examination forms for use in your clinical practice are coming soon.

  • Exercises: You can prescribe hundreds of Functional Exercises Videos to your patients through our downloadable prescription pads.

  • Article Library: Our Article Index Library with over 45+ of the most common MSK conditions we all see in clinical practice. This is a great opportunity to educate your patients on our processes. Each article covers basic condition information, diagnostic procedures, treatment methodologies, timelines, and exercise recommendations. All of this is in an easy-to-prescribe PDF format you can directly send to your patients.

  • Discounts: MSR Pro yearly memberships entitle you to a significant discount on our online and live courses.

Integrating MSR into your practice can significantly enhance your clinical practice. The benefits we mentioned are only a few reasons for joining our MSR team.


bottom of page