Why Cortisone Injections are Making Your Shoulder Pain Worse

Why Cortisone Injections are Making Your Shoulder Pain Worse 

Shoulder impingement syndrome remains one of the most common musculoskeletal complaints seen in primary care and orthopedic practice. Subacromial corticosteroid injections have long been used to reduce pain and inflammation, often providing rapid short-term symptom relief. However, a growing body of research suggests that while corticosteroid therapy may reduce pain temporarily, it does little to address the underlying mechanical causes of shoulder impingement—and may introduce avoidable risks. And corticosteroids may be making your pain worse.

In contrast, physical therapy grounded in Applied Functional Science offers a safer, longer-lasting solution by correcting the movement dysfunctions that drive impingement in the first place.

The Risks of Corticosteroid Therapy

Corticosteroid injections can be effective in dampening inflammatory pain, but multiple studies have demonstrated important limitations and risks:

• Short-term benefit, poor long-term outcomes
  Research consistently shows that pain relief from corticosteroid injections is often transient, with outcomes at 6–12 months no better—and sometimes worse—than exercise-based interventions.

• Tendon degeneration and structural compromise
  Repeated corticosteroid exposure has been linked to collagen breakdown, reduced tendon tensile strength, and delayed tissue healing. In the shoulder, this raises concerns for rotator cuff degeneration and increased risk of partial or full-thickness tears.

• Masking of biomechanical dysfunction
  By suppressing pain without correcting faulty movement patterns, injections may allow patients to continue loading dysfunctional mechanics, accelerating joint and tendon stress.

• Systemic and local adverse effects
  While generally considered safe, corticosteroids carry risks including transient hyperglycemia, infection, skin atrophy, and post-injection flare—particularly concerning in older adults and patients with metabolic disease.

For these reasons, many clinical guidelines now recommend corticosteroid injections only after conservative care has failed—or not at all as a first-line treatment.

Shoulder Impingement Is a Movement Problem

Modern research increasingly supports the concept that shoulder impingement is rarely an isolated shoulder issue. Instead, it reflects poor force transfer and coordination across the entire kinetic chain.

Common contributors include:

• Limited thoracic spine extension or rotation

• Scapular dyskinesis and poor neuromuscular control

• Deficits in hip or trunk stability affecting upper-extremity loading

• Inability to decelerate, rotate, or load the shoulder in multiple planes

Treating inflammation alone does not correct these factors.

Why Applied Functional Science Physical Therapy Works

Applied Functional Science physical therapy evaluates and treats shoulder impingement through the lens of real-world, three-dimensional movement. Rather than isolating the shoulder, AFS assesses how the entire body contributes to shoulder loading during reaching, lifting, rotation, and overhead activity.

Key advantages supported by research include:

• Superior long-term outcomes
  Exercise-based physical therapy consistently matches or outperforms corticosteroid injections at 6 and 12 months for pain reduction and functional improvement.

• Restoration of movement efficiency
  AFS targets scapular control, thoracic mobility, trunk rotation, and lower-extremity contribution—reducing mechanical stress at the shoulder.

• Tissue-protective loading
  Progressive, multi-plane loading stimulates tendon adaptation and resilience rather than degeneration.

• Reduced recurrence and dependency
  By addressing root causes, patients are less likely to experience symptom recurrence or require repeated interventions.

• Safe for aging populations
  AFS therapy supports strength, coordination, and adaptability without exposing patients to pharmacologic risks.

A Safer First-Line Strategy

For patients seeking lasting outcomes, Applied Functional Science physical therapy represents a problem-repair solution rather than a symptom-suppression strategy. It aligns with current research emphasizing active care, movement variability, and kinetic chain integration.

While corticosteroid injections may still have a limited role in select cases, evidence increasingly supports early referral to functional physical therapy as the safer and more effective approach for shoulder impingement—particularly for patients who wish to remain active long-term.

Shoulder impingement is not simply an inflammatory condition—it is a failure-of-movement problem. Treating it successfully requires restoring how the body loads, rotates, and transfers force in three dimensions. Applied Functional Science physical therapy does exactly that, offering patients relief that lasts and movement that protects.

Check to see when our next Shoulder Pain Relief Workshop is scheduled: Free Shoulder Pain Workshop

Or watch our Self-help Videos for Shoulder Pain Relief here: https://youtu.be/f158ui1VAJo?si=9ozp-M_Ygkb6q5rp