A cortisone injection is a common treatment for knee pain.

And I actually don’t recommend it all that often… but when I do recommend it it works great.

So why don’t I recommend cortisone injections all that often?

I don’t recommend a cortisone injection because they can cause more problems down the road and some doctors just do them like they’re passing out candy on Halloween.

When is cortisone helpful for knee pain?

Cortisone is very helpful for acute pain in the knee. This is for a brand new injury.

In a new injury the knee is likely swollen, warm, pink (or red) and painful. No matter what you do you can’t get comfortable. You can’t sit, you can’t lay… it feels like a gnawing pain. And the biggest key that I listen for is when my clients tell me that no matter what they do their knee hurts so much they can’t get sleep because they can’t get comfortable.

This is when I suggest a cortisone injection.

When pain interrupts your sleep… you’re too uncomfortable to get any sleep… that’s when I recommend a cortisone injection.

But Ali, I have pain when I walk… My doctor says an injection will help with that… should I get a cortisone injection?

I don’t recommend a cortisone injection if the only complaint is pain with an activity like walking, squatting, lunges, running etc.

And the reason for that is because it usually doesn’t work to get rid of the pain with the activity… or it doesn’t work well enough… or long enough.

If the pain is just during an activity there is usually something else that can be done. Like walking on a different surface (and strengthening)... modifying the squats, lunges (and strengthening), holding off on running (and strengthening)... if the pain is during an activity it usually has to do with localized inflammation that’s irritated from poor mechanics, too deep of a movement, bad form, incorrect footwear or doing the activity on the wrong surface.

If you think you need a cortisone injection to help your knee pain I invite you to think about the following:

Does my knee hurt only with certain movements? —> if the answer is yes, skip the injection.

Does my knee hurt only with certain activities (walking, certain exercises, running, etc)? —> if the answer is yes, skip the injection

Does my knee hurt so much I can’t find any comfortable position to sleep? —> if the answer is yes, consider getting an injection

There are many ways to get rid of pain and inflammation. Cortisone definitely is anti-inflammatory… but if the pain is caused by chronic inflammation, not acute inflammation, then cortisone doesn’t work well. Acute inflammation is a new injury or flare up. It can be from an accident, injury, surgery. Acute inflammation makes the knee red, hot, swollen and you can’t get comfortable in any position. If the pain comes and goes, you can find at least some way to be comfortable and get some sleep then I recommend skipping the cortisone and finding another way to get rid of the inflammation.