Cortisone Shot vs. Physical Therapy: Which Is Right for You?

Invasiveness. A cortisone shot (corticosteroid injection) breaks the skin: a provider inserts a needle into the treated area and injects the steroid, sometimes using ultrasound to guide it (Cleveland Clinic, undated). Physical therapy (PT) is non-invasive — nothing enters the body; it is exercise, manual therapy, education, and a home programme (MD Bone & Joint, undated).

Anesthesia type. The injection uses local anesthetic only — a numbing medicine such as lidocaine (Xylocaine) or bupivacaine (Marcaine) mixed with the steroid for faster relief, since the steroid itself takes a few days to start working (AAOS/OrthoInfo, 2024-07). Some teams also spray a skin-numbing medicine at the site (Mayo Clinic, undated). No moderate (conscious) sedation and no general anesthesia are used for a standard joint injection. Physical therapy uses no anesthesia at all — not local, not sedation, not general.

Typical duration. The whole injection process is quick, and the overall clinic visit is brief, including the history and medication review beforehand (Mountain Spine Orthopedics, undated; Knee Pain Centers of America, undated). Physical therapy is the opposite shape: a longer first visit for an in-depth evaluation of health, mobility, strength, and lifestyle (PTSMC, undated), then repeat appointments over weeks.

Typical recovery length. After an injection, most clinicians advise relative rest and avoiding strenuous activity on the joint, after which normal activity is generally permitted (Gale, undated); pain may briefly worsen for 1 to 2 days first (AAOS/OrthoInfo, 2024-07). Physical therapy has no recovery period in the procedural sense — there is nothing to heal from — but soreness after sessions is common and progress is measured in weeks of the plan built at your evaluation.

Candidacy. Shots are limited: providers often set a practical yearly cap (AAOS/OrthoInfo, 2024-07; Cleveland Clinic, undated), they are generally avoided for tendinitis because of rupture risk in the biceps, patellar, or Achilles tendons (AAOS/OrthoInfo, 2024-07), and a shot into a joint means replacement surgery in that joint should be delayed to lower infection risk (AAOS/OrthoInfo, 2024-07). Ask your surgeon before accepting an injection if a joint replacement is on your horizon. Do not ask us to price either option — confirm cost and coverage with your provider's billing office and your insurer.

Cortisone shot (corticosteroid injection)

• Your provider reviews your medical history and medications and may ask you to stop certain blood thinners; raise this at least 7 days before the appointment so your prescriber has time to name an exact stop date (Knee Pain Centers of America, undated).
• The skin is cleaned with antiseptic (Knee Pain Centers of America, undated).
• Numbing: a local anesthetic such as lidocaine or bupivacaine is used, often mixed with the steroid (AAOS/OrthoInfo, 2024-07); the team may also spray a numbing medicine on the skin (Mayo Clinic, undated). Steroid choice, dose, and timing are physician-directed.
• The needle goes into the treated area and the steroid is injected. Ultrasound or fluoroscopy (a type of X-ray) may be used to watch the needle's progress (Cleveland Clinic, undated; Mayo Clinic, undated). You will feel pressure and brief stinging, as described in the consent discussion.
• Afterward, most people walk immediately and drive themselves home (Mountain Spine Orthopedics, undated). If you have diabetes, check your blood sugar more often starting the day of the injection, because of a temporary rise (Cleveland Clinic, undated); ask exactly how many days to keep checking.

Physical therapy (supervised exercise and manual treatment)

• Numbing: none. No local anesthetic, no moderate (conscious) sedation, no general anesthesia at any point.
• First visit: an in-depth evaluation of your health, mobility, strength, and lifestyle, used to build a personalised plan (PTSMC, undated), including range of motion, strength, flexibility, and balance testing (MD Bone & Joint, undated).
• Following visits combine exercises, manual (hands-on) therapy, education about the condition, and home care between appointments (MD Bone & Joint, undated).
• Arrive 15 minutes before your first appointment to finish intake paperwork, and bring a list of your current medications.
• Your therapist reassesses and adjusts the plan as you go. Ask at visit one how many weeks the plan is written for.

Routine and expected after a cortisone shot: a flare of worse pain or swelling for 1 to 2 days before the steroid takes effect (AAOS/OrthoInfo, 2024-07; Mountain Spine Orthopedics, undated); a numb area that wears off; a short-lived blood sugar rise if you have diabetes (Cleveland Clinic, undated).

Routine and expected after physical therapy: muscle soreness after new exercises; fatigue; a temporary increase in stiffness that eases.

Call your care team (not routine): pain and inflammation that are still there after the number of days your provider named following the shot (Cleveland Clinic, undated); pain that worsens session after session in therapy; any new weakness.

Go to the ER or call 911: a hot, red, swollen joint with fever and chills, or spreading redness at the injection site — possible joint infection; a sudden pop with inability to bear weight or move the limb — possible tendon rupture; sudden chest pain, trouble breathing, or facial swelling and hives after the injection. These are different from the expected 1-to-2-day flare.

Take these to the appointment and ask them aloud. Confirm the answers with your own care team, since protocols differ by facility and physician.

• "Is my problem inside the joint, or is it tendinitis? If it's tendinitis, does the tendon rupture risk rule out a cortisone shot for me?"
• "Am I likely to need joint replacement in this joint, and how long would a shot delay that surgery?"
• "Will you use ultrasound or fluoroscopy to guide the needle, and does that change the chance the injection misses the joint space?"
• "What local anesthetic will you mix with the steroid, and how long will the numbness last?"
• "How many of these shots can I have in a year, and how long must I wait between rounds?"
• "Exactly how many days after the shot should I call if the pain hasn't improved?"
• "Which of my blood thinners do I stop, and on which date?"
• "I have diabetes — how many days should I check my blood sugar more often afterward?"
• "How many days of relative rest before I lift, run, or go back to my usual job tasks?"
• "If we start physical therapy instead, how many weeks is the plan, and how will we know it's working?"
• "Can I do both — and if so, which comes first, and how long after the shot does therapy start?"
• "Who do I call after hours, and which symptoms mean the ER instead of a phone call?"
• "Who do I speak to at your office about cost and coverage for each option?"