Should I consider a knee injection for post-run pain in the absence of severe pain or significant functional impairment?

Knee Injections for Post-Run Pain Without Active Pain

Intra-articular corticosteroid injections are not recommended for knee pain that only occurs after running but is not actively present, as they are primarily indicated for flares of knee pain, especially when accompanied by effusion.1

Assessment of Post-Run Knee Pain

• Post-run knee pain without active symptoms suggests a need to address underlying biomechanical issues rather than pursuing injections as a first-line treatment 1
• Pain that only manifests after activity but resolves with rest indicates a functional issue that may respond better to exercise therapy and biomechanical correction 1
• Absence of severe pain or significant functional impairment makes injection therapy less appropriate as a treatment option 1

Evidence for Corticosteroid Injections

• Intra-articular corticosteroid injections are specifically indicated for:

  • Acute flares of knee pain 1
  • Pain accompanied by effusion (though some evidence suggests benefit even without effusion) 1
  • Short-term symptom relief when other treatments have failed 1

• Benefits of corticosteroid injections:

  • Provide short-lived pain relief (typically 1-4 weeks) 1
  • More effective than placebo for short-term pain relief (ES 1.27) 1
  • Can improve function temporarily 1

• Limitations of corticosteroid injections:

  • Effects are relatively short-lived 1
  • Potential long-term negative effects on bone health and joint structure with repeated injections 1
  • Should be avoided within 3 months of potential joint replacement surgery 1

Alternative Approaches for Post-Run Knee Pain

• Individualized knee-targeted exercise therapy should be the first-line treatment for post-run knee pain 1

  • Focus on quadriceps strengthening if there's good tolerance to loaded knee flexion
  • Greater focus on hip exercises if there's poor tolerance to loaded knee flexion

• Physical therapy has been shown to be more effective than glucocorticoid injections at 1 year for knee osteoarthritis:

  • Better WOMAC scores at 1 year (37.0±30.7 vs 55.8±53.8) 2
  • Improved functional outcomes compared to injections 2

• Biomechanical assessment and correction:

  • Evaluate running form and footwear 1
  • Consider prefabricated foot orthoses if indicated by treatment direction tests 1
  • Movement/running retraining may help address underlying causes 1

When to Consider Injections

• Consider injections only if:
  • Pain becomes persistent despite appropriate exercise therapy 1
  • Pain begins to occur during daily activities (not just post-run) 1
  • There is evidence of effusion or significant functional impairment 1
  • Other conservative treatments have failed 1

Conclusion

For knee pain that only occurs after running but is not actively present during daily activities, exercise therapy and biomechanical correction should be prioritized over intra-articular injections. Corticosteroid injections are more appropriate for acute flares with significant pain and/or effusion rather than for intermittent post-activity pain.