Is physiotherapy recommended immediately after a corticosteroid (corticosteroid) injection for conditions like osteoarthritis, tendinitis, or bursitis?

Physiotherapy Timing After Corticosteroid Injection

You should avoid overusing the injected joint for 24 hours after corticosteroid injection, but physiotherapy should not be delayed and immobilization is actively discouraged. 1

Immediate Post-Injection Period (0-24 Hours)

• Restrict overuse of the injected joint for the first 24 hours following injection 1
• Do not immobilize the joint - studies demonstrate that 24-48 hour post-injection immobilization (bed rest, splinting, or bandages) provides no benefit compared to normal activity 1
• Light activity and gentle movement are permitted and encouraged during this initial period 1

Physiotherapy Initiation

• Physiotherapy can begin immediately after the 24-hour restriction period - there is no evidence supporting delayed initiation 1
• For chronic subacromial bursitis specifically, combining corticosteroid injection with an 8-week physiotherapy program emphasizing therapeutic exercise produces superior outcomes compared to injection alone, with lower recurrence rates (17.1% combined vs 36.1% injection alone) 2
• The American College of Rheumatology recommends physical therapy as a strongly recommended treatment that should be integrated into the overall management plan 1

Evidence-Based Rationale

• The 24-hour activity restriction is based on Level 1B evidence showing no additional benefit from prolonged immobilization 1
• Multiple studies confirm that normal activity after 24 hours does not compromise injection efficacy 1
• Active physical therapy interventions (supervised exercise) are conditionally recommended over passive modalities (massage, ultrasound, heat) when physiotherapy is initiated 1

Critical Timing Considerations

• Corticosteroid anti-inflammatory effects typically begin within 2-7 days after injection, not immediately 3
• Patients may experience a post-injection flare during the first 24-48 hours before improvement occurs 3
• The initial anesthetic component provides immediate pain relief (minutes to hours), but therapeutic benefits develop over days 3

Common Pitfalls to Avoid

• Do not prescribe prolonged immobilization or splinting - this provides no benefit and contradicts current evidence 1
• Do not delay physiotherapy beyond the initial 24-hour period - early mobilization and exercise are beneficial 1, 2
• For conditions like insertional Achilles tendinitis, avoid corticosteroid injections entirely due to tendon weakening risk 3
• Avoid peri-tendon injections of Achilles, patellar, and quadriceps tendons due to rupture risk 1

Condition-Specific Guidance

• For knee osteoarthritis: Intra-articular corticosteroids provide short-term pain relief (1-2 weeks), and physiotherapy should complement this treatment 1
• For rotator cuff problems: Evidence for combining injection with exercise is inconclusive, but exercise programs show no adverse effects and may provide benefit 1
• For temporomandibular joint disorders: Physiotherapy and jaw exercises are recommended alongside injections for symptomatic dysfunction 1

Optimal Treatment Algorithm

1. Day 0 (injection day): Perform injection with proper aseptic technique 1
2. Hours 0-24: Advise patient to avoid overuse but maintain light activity 1
3. Day 1 onward: Initiate physiotherapy program emphasizing active therapeutic exercise 1, 2
4. Days 2-7: Monitor for corticosteroid anti-inflammatory effects to develop 3
5. Weeks 2-12: Continue physiotherapy to maximize functional outcomes and reduce recurrence 2