Cortisone shots are often used to treat pain and inflammation in joints like the hip. While these injections can provide relief, there are some activities and precautions to follow after receiving a cortisone shot in the hip.
Cortisone shots contain a steroid medication and a local anesthetic. The steroid helps reduce inflammation that may be causing pain, while the anesthetic provides temporary numbness.[1] When injected into the hip joint, cortisone can help treat conditions like osteoarthritis, rheumatoid arthritis, and bursitis.
However, cortisone is not a cure and offers temporary relief that may last from a few weeks to several months.[2] The duration of relief depends on the severity of inflammation and the underlying condition. Furthermore, there are some restrictions following a cortisone injection to avoid complications.
Limitations on Physical Activity
After a cortisone shot, strenuous activities should be avoided to allow the medication to work effectively and prevent further injury.[3] Running, jumping, heavy lifting, and impact exercises can put too much stress on the joint and hip muscles that are trying to heal.
Therefore, for at least the first 1-2 days, rest is recommended with only minimal physical activity. After that, light exercise like walking, swimming or stationary cycling can be gradually introduced as tolerated.[4] Any activity that causes pain should be avoided. It may take 2 weeks before more intense exercise can be resumed. Contact sports or heavy labor should be avoided for at least 4-6 weeks.
Recommended Activities
- Walking
- Swimming
- Water aerobics
- Stationary biking
- Light yoga or stretching
Avoid These Activities
- Running
- Jumping
- Weight lifting
- Aerobics classes
- Tennis
- Golf
- Contact sports
Restrictions on Standing and Walking
While light walking is generally fine, standing or walking for prolonged periods should be avoided after a hip cortisone injection. Too much time upright can put pressure on the joint and irritate the inflamed area that is trying to heal.
For the first 48 hours, it is advisable to rest as much as possible and limit standing or walking to short intervals of about 10 minutes or less. After that, increase upright activity gradually while taking frequent breaks to sit or recline.[5] Avoid being on your feet for longer than 30 minutes at a time for at least the first week.
Tips to Reduce Standing and Walking
- Use crutches or a cane to take pressure off the hip when standing or walking
- Take regular sitting breaks every 10-15 minutes
- Limit grocery shopping and running errands
- Ask for help with cooking, cleaning, and other chores
- Arrange your home and work area to reduce need to walk or stand
Avoiding Heat Treatments
Heat should not be applied to the hip that received a cortisone injection in the days immediately afterwards. Heat causes increased blood flow which can wash out the cortisone before it has time to work.[6] The goal is to keep blood flow low initially to concentrate the medication’s effects.
Avoid using hot packs, heated blankets, taking hot baths, or submerging in hot tubs for at least the first 48 hours. It is safer to use an ice pack on the injection site to reduce swelling instead of heat.[7] After a few days, warm (not hot) compresses can be used judiciously for short periods if needed for comfort.
Heat Sources to Avoid
- Heating pads
- Hot packs
- Heated blankets
- Hot tubs
- Saunas
- Hot baths
Modifying Sleeping Positions
Sleeping on the side with the hip injection should be avoided for the first 1-2 nights. Lying directly on the affected hip can increase pain and inflammation and prevent the cortisone from settling into the joint.[8]
The best initial sleeping position is on your back with a pillow under the knees to take pressure off the hip joints. If you must sleep on your side, keep a pillow between your knees and lie on your unaffected hip.
An orthopedic hip wedge pillow can also make side sleeping more comfortable. After a few nights, you can resume your normal sleeping position as long as it does not cause an increase in hip pain.
Recommended Sleeping Positions
- On back with pillow under knees
- On side with pillow between knees
- Reclined in lounge chair or recliner
Avoid Sleeping On
- Affected hip
- Stomach
Limiting Weight-Bearing
Activities that put weight or pressure on the treated hip should be minimized, especially in the first few days after the injection. At a minimum, use crutches or a cane for standing and walking to reduce the weight placed through the hip joint.
Avoid lifting heavy objects or carrying loads for at least the first week. Movement and exercises will be restricted at first but can be advanced gradually. Listen to your body and avoid weight-bearing activities that cause increased hip pain.
Precautions to Avoid Weight-Bearing
- Use crutches or a cane
- Avoid lifting objects over 5-10 pounds
- Don’t carry bags or loads on affected side
- Sit down to get dressed, bathe, etc.
- Ask for help with tasks requiring lifting or carrying
Restricting Hip Flexion
Bending at the hip joint more than 90 degrees, known as hip flexion, can also put more stress on the joint and surrounding muscles. Avoid movements requiring deep hip flexion such as squatting, kneeling, or leaning forward for the first several days.[9]
Sitting in low chairs or on low toilets that cause excessive bending can aggravate the hip as well. Use of raised toilet seats, chair raisers, and other adaptive devices can help take pressure off hip flexion until you recover.
Activities Requiring Hip Flexion to Avoid
- Squatting
- Kneeling
- Bending over or leaning forward at waist
- Sitting in low chairs or low toilets
- Getting in and out of low vehicles
- Putting on shoes and socks while seated
Avoiding Side-Lying Leg Lifts
Leg lifts to the side, known as abduction exercises, can place harmful leverage on the hip joint after a cortisone injection. Avoid lifting the leg on the treated side out to the side while lying down for 2-3 weeks until the cortisone has a chance to work.[10]
You can perform gentle range of motion exercises while reclining, but do not attempt to lift the injected leg up off the bed or couch. After a few weeks, gradually resume normal hip abduction and leg lift exercises as tolerated without pain.
Precautions for Side-Lying Leg Lifts
- Do not lift injected leg out to side
- Avoid abduction exercises while reclining
- Can do gentle range of motion without lifting leg
- Resume normal abduction after 2-3 weeks
Delaying Manipulation of the Hip Joint
Twisting, extending, and gross manipulation of the hip joint should also be avoided in the early period after a cortisone injection. This includes actions like forcefully rotating the hip outward or pulling the leg to extend the hip joint.
Aggressive stretching, massage, adjustment, or mobilization techniques could displace the cortisone before it has time to work. Gentle range of motion exercises can be done, but rough manipulation of the joint may need to be avoided for up to 2 weeks.[11]
Precautions for Hip Joint Manipulation
- Do not forcefully rotate hip outward
- Avoid pulling leg to extend hip joint
- No aggressive stretching of hip muscles
- Delay massage and adjustments to hip
- Perform gentle range of motion only
Elevating the Leg
Keeping the injected leg elevated above heart level as much as possible for the first 1-3 days can help minimize swelling and maximize results from the cortisone shot.[12] While resting, place 2-3 pillows under the ankle to keep the hip raised.
Try to avoid letting the leg hang down such as when sitting in a chair. Take breaks to elevate the leg above the heart. Keeping it raised helps drainage and reduces fluid buildup in the joint.
Tips for Leg Elevation
- Prop leg up on 2-3 pillows when reclining
- Avoid dangling leg off chairs or beds
- Take breaks to elevate leg when sitting
- Lie down and raise leg periodically
- Elevate at least 30 minutes 4-5x per day
Warning Signs to Watch For
In some cases, complications can occur after a cortisone injection. Contact your doctor if you experience any of the following warning signs:[13]
- Increased pain and swelling in the hip
- Joint redness, bleeding or bruising
- Signs of infection like fever, chills
- Difficulty walking or bearing weight on leg
- Skin rash, hives, itching
- Dizziness, headache, nausea
- Blurred vision or visual changes
While cortisone shots are generally safe when given by an experienced provider, potential side effects need to be monitored after receiving one.
Conclusion
Cortisone injections can provide important pain relief for hip arthritis and bursitis. However, some restrictions apply for a period of time afterwards. It is important to avoid strenuous activity, heat, weight-bearing, and manipulation of the joint.
With an appropriate period of rest, limited activity, and gradually increased movement, cortisone has time to decrease inflammation so normal activities can be resumed. Work closely with your health provider to safely integrate this treatment into your recovery plan.