Want Dr. Calendine’s articles to stand out in your Google and AI search results? Add him as a preferred source (one tap).
How painful is a knee steroid injection? After more than twenty years treating knee arthritis in Franklin and across Middle Tennessee, here is the honest answer I give patients every week: far less painful than most people fear. The dread in the waiting room is almost always worse than the needle itself.
I understand the worry. Nobody loves the idea of a needle going into a joint. So let me walk you through exactly what the shot feels like, second by second, and what you can do to make it easier.
How Painful Is a Knee Steroid Injection, Really?
Most patients feel a brief pinch when the needle passes through the skin, then a sensation of pressure inside the knee. That is it. In my experience, and in published reports, more than 95 percent of patients describe the discomfort as mild, and any sharp sensation typically lasts 3 to 5 seconds.
The knee is actually one of the more comfortable joints to inject. It is a large joint with a roomy capsule (the fluid-filled envelope that surrounds the joint), so the medication has space to spread. Small joints in the hand or foot tend to hurt more because the tissue is tight.
Here’s what I tell my patients: rate the fear before the shot and the shot itself afterward. Almost everyone tells me the injection was a 2 or 3 out of 10, and that they spent a week worrying over nothing.
What Does the Injection Feel Like, Step by Step?
Knowing the sequence takes away most of the anxiety. A cortisone shot (steroid and cortisone mean the same thing here) is a quick office procedure. No gown, no sedation, no recovery room.
Step 1: Cleaning and numbing the skin
First, I clean the skin with an antiseptic solution. Sterile technique matters because it keeps the risk of infection extremely low; published estimates put it at less than 1 in 4,000 injections. Many physicians, myself included, then use a cold numbing spray or a small amount of local anesthetic. The anesthetic can sting for a few seconds before the area goes numb.
Step 2: The needle: a pinch, then pressure
The steroid is usually mixed with a local anesthetic in the same syringe. You feel a quick pinch at the skin, then pressure as the medication enters the joint. Because the anesthetic starts working right away, many patients walk out of the office with less knee pain than they walked in with.
How long does a knee steroid injection take?
The injection itself takes seconds; the whole visit is usually done in minutes. If there is extra fluid in the knee, I may draw it off first through the same needle site (a step called aspiration). Removing that fluid relieves pressure and often improves comfort immediately.
Why Does the Knee Hurt More After Some Injections?
The most common reason is a steroid flare. Once the numbing medicine wears off, usually within a few hours, some patients notice the knee feels more sore, warm, or swollen than before the shot. A flare is a short-lived reaction to the injected material, not a sign that anything went wrong.
A flare typically settles within 24 to 48 hours. Ice, rest, and an over-the-counter anti-inflammatory (if your doctor allows it) are usually all it takes. Keep in mind the steroid itself is slower to act; full relief can take up to a week to arrive.
People with diabetes should also know that a cortisone shot can raise blood sugar for a few days. I ask my diabetic patients to check their levels a little more often that week.
How Can You Make a Knee Steroid Injection Hurt Less?
You have more control over comfort than you might think. These are the things that make the biggest difference in my Franklin clinic:
- Tell us you’re nervous. Needle anxiety is common and nothing to be embarrassed about. When I know, I can talk you through each step and use extra numbing.
- Relax the leg. A tense quadriceps muscle tightens the whole knee. Slow breathing and a relaxed thigh make the needle pass easier.
- Don’t watch. Look at the wall, not the syringe. It sounds simple; it works.
- Plan a lighter day. Take it easy for 24 to 48 hours afterward. Ice the knee as needed and skip hot tubs and strenuous exercise for two days.
If you take blood thinners, mention it before your visit. We sometimes adjust the plan to reduce bruising.
How Well Do Steroid Injections Work for Knee Arthritis?
This is the other half of the pain question: is the pinch worth it? For most patients with knee arthritis, yes. Roughly 80 to 90 percent get meaningful relief, and that relief often lasts three months or longer. Some patients get a shorter window; a few get much longer.
The safety record is reassuring, too. A randomized, placebo-controlled trial followed patients who received a steroid injection every three months for two years and found no damage to the joint structure compared with placebo. Even so, I limit injections to three or four per year in any one knee, which matches national guidance and protects the cartilage over the long run.
Injections are one tool in a larger toolbox. I usually pair them with additional nonsurgical joint pain treatments such as physical therapy, activity changes, and weight management, because the combination outperforms any single treatment. If you’re weighing this option, I’ve written a full guide to cortisone injections for hip and knee pain, including who they help and how long relief lasts.
When Should You Call the Doctor After a Knee Injection?
Call the office promptly if you notice severe or worsening pain after 48 hours, spreading redness, significant swelling, fever, or a knee that will not bend. These can be early signs of infection, and infection in a joint needs same-day attention. It is rare, but it is the one complication I never want a patient to sit on at home.
Mild soreness at the injection site, a small bruise, or temporary facial flushing are common and pass on their own.
When Is It Time to Look Beyond Injections?
A steroid shot calms inflammation; it does not rebuild cartilage. When patients from Franklin, Nashville, Brentwood, Columbia, and the surrounding Middle Tennessee communities need injections more and more often just to get through the day, that pattern tells me the arthritis is advancing.
That is the right time for an honest conversation about next steps, which may include partial knee replacement or total knee replacement. As a surgeon who performs more than 700 hip and knee replacements each year, I can tell you that patients who exhaust injections year after year often wish they had asked about surgery sooner.
If knee pain is steering your daily decisions, let’s talk about all of your options, injections included. You can schedule an appointment online or call the Bone and Joint Institute of Tennessee at (615) 791-2630. Our office is located at 3000 Edward Curd Lane, Franklin, TN 37067.
This article is for educational purposes only and does not replace professional medical advice. Every patient is different, and individual results vary. Always consult a qualified orthopaedic provider about your own symptoms, treatment options, and potential side effects.
References
- Raynauld JP, Buckland-Wright C, Ward R, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370-377. PMID 12571845.
- Foster ZJ, Voss TT, Hatch J, Frimodig A. Corticosteroid injections for common musculoskeletal conditions. Am Fam Physician. 2015;92(8):694-699.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Arthritis of the Knee. Accessed July 2026.
- Mayo Clinic. Cortisone shots. Updated March 2026.
- Cleveland Clinic. Cortisone Shots (Steroid Injections): Benefits and Side Effects. Reviewed February 2024.
