You’ve had a steroid injection in your knee and expected the pain to improve. Perhaps it helped for a few days before the discomfort returned. Maybe several weeks have passed and you haven’t noticed much difference. Or your knee feels more painful now than it did before the procedure.
If this sounds familiar, you may be wondering whether the injection failed, whether something else is causing your pain or whether you need another treatment.
Knee pain can continue after a steroid injection for several reasons, including temporary post-injection inflammation, an underlying condition that has not fully responded to treatment or pain arising from structures that the injection cannot address.
Steroid injections are intended to reduce inflammation and relieve certain types of pain. They do not repair every form of joint damage, and their effects are often temporary.
Understanding how these injections work, what results are realistic and when further assessment is needed can help you make informed decisions about managing persistent knee pain.
How Do Steroid Injections Work for Knee Pain?
Steroid injections, also called corticosteroid injections or cortisone injections, contain medication designed to reduce inflammation.
When inflammation contributes to joint pain, reducing it may help ease discomfort, swelling and stiffness.
For some patients, this makes walking, climbing stairs and performing everyday activities more comfortable.
A corticosteroid injection may be considered for conditions such as knee osteoarthritis or certain inflammatory problems affecting the joint.
Depending on the diagnosis, medication may be injected into the knee joint itself or into a nearby structure.
The procedure may also involve a local anaesthetic to provide temporary pain relief.
This distinction matters because local anaesthetic and corticosteroid medication work differently.
A local anaesthetic may reduce discomfort relatively quickly but wears off after a short period. The steroid takes longer to produce its anti-inflammatory effect.
The NHS guidance on hydrocortisone injections explains how corticosteroid injections are used to treat painful joints and other inflammatory conditions.
For a broader explanation of these procedures, read our article Cortisone Injections for Joint Pain: What Patients Should Know.
How Long Does a Knee Steroid Injection Take to Work?
One common reason patients worry about persistent pain is that they expect the injection to work immediately.
However, the timing of pain relief varies.
Some people experience an initial improvement because a local anaesthetic was used during the procedure.
When the anaesthetic wears off, the original pain may return before the corticosteroid begins working.
The steroid itself may take several days to provide noticeable relief.
Some patients improve relatively quickly, while others notice little benefit.
If you received an injection recently, follow the aftercare advice provided by your treating clinician.
An NHS patient guide from the Royal National Orthopaedic Hospital explains that temporary worsening of symptoms may occur during the first 24 to 48 hours.
However, severe or increasing pain should not automatically be dismissed as a normal reaction, particularly if it is accompanied by swelling, redness, warmth or fever.
Why Does My Knee Still Hurt After a Steroid Injection?
Several explanations are possible.
The timing, location and nature of the pain can provide important clues.
1. You May Be Experiencing a Steroid Flare
Some patients experience a temporary increase in pain following a corticosteroid injection.
This is sometimes called a steroid flare.
The injected area may feel sore or uncomfortable during the first day or two after treatment.
The discomfort usually improves, but the severity and duration vary between patients.
A steroid flare is not the same as an infection.
If pain is severe, progressively worsening or associated with significant swelling, warmth, redness or feeling unwell, urgent medical assessment is needed.
It is particularly important not to assume that worsening pain is simply a steroid flare when the symptoms are unusual or more intense than expected.
2. The Injection Has Not Yet Taken Effect
Corticosteroid medication does not necessarily provide immediate relief.
If the procedure was performed recently, the medication may not yet have produced its full effect.
The timing depends partly on the preparation used and the condition being treated.
Your clinician should explain when improvement might reasonably be expected and when you should request a review.
If the expected period has passed and your pain remains unchanged, further assessment may be appropriate.
3. The Underlying Knee Condition May Still Be Present
Steroid injections mainly address inflammation.
They do not necessarily correct the structural changes or other problems responsible for ongoing pain.
For example, knee osteoarthritis involves changes within the joint that can affect cartilage, bone and surrounding tissues.
Reducing inflammation may help relieve symptoms, but the injection does not reverse osteoarthritis.
Similarly, if pain is associated with a meniscal injury, ligament problem or another mechanical condition, an anti-inflammatory injection may not address the main cause.
This is one reason why an injection can sometimes provide limited relief even when it has been administered correctly.
4. Your Pain May Not Be Caused Primarily by Inflammation
Not all knee pain is driven by inflammation.
Some patients experience pain associated with mechanical loading, soft tissue problems, nerve sensitivity or other conditions.
In these situations, reducing inflammation may not provide sufficient relief.
For example, a patient may experience pain when walking downstairs because of a problem affecting how the kneecap moves.
Another patient may have discomfort related to tendon loading or previous injury.
These conditions require different approaches.
A specialist assessment can help establish whether the original diagnosis still explains the symptoms.
5. The Injection Provided Temporary Relief
Some patients experience meaningful improvement after a steroid injection, only for the pain to return several weeks later.
This does not necessarily mean the procedure was performed incorrectly.
Steroid injections generally provide temporary symptom relief rather than a permanent solution.
For people with osteoarthritis, the NICE guideline on osteoarthritis management advises that intra-articular corticosteroid injections may be considered in appropriate circumstances, while explaining that relief is short-term, typically around two to ten weeks.
The duration and degree of benefit vary.
Some patients experience little improvement, while others find the temporary reduction in pain helps them participate more comfortably in rehabilitation.
If your pain returned after an initial improvement, a review can help determine whether the original condition remains the main problem or whether other factors need attention.
6. More Than One Structure May Be Contributing to Your Pain
The knee is a complex joint.
Pain may arise from the joint itself or from surrounding structures, including tendons, ligaments, bursae and muscles.
Sometimes more than one structure contributes to the symptoms.
For example, a person with osteoarthritis may also have muscle weakness or tendon-related pain.
An injection directed at one source of discomfort may not relieve pain arising elsewhere.
The pain may also be influenced by problems involving the hip or lower back.
This is why a comprehensive assessment considers more than the location where the patient feels pain.
7. The Original Diagnosis May Need Reviewing
When an injection provides no meaningful improvement, it may be necessary to reconsider the diagnosis.
This does not automatically mean the original assessment was incorrect.
Symptoms can evolve, and some conditions overlap.
For example, pain initially attributed to arthritis may also involve a meniscal problem, tendon disorder or another cause.
A clinician may review your medical history, examine the knee and consider whether further investigations are needed.
Our existing guide to Persistent Knee Pain: Causes, Assessment and Treatment Options explains the wider range of conditions that can contribute to ongoing knee pain.
Is It Normal for Knee Pain to Get Worse After a Steroid Injection?
A temporary increase in discomfort can occur after an injection.
However, there is an important difference between mild post-procedure soreness and symptoms suggesting a complication.
Mild discomfort around the injection site may settle within a couple of days.
In contrast, severe or worsening pain, especially with swelling, heat, redness or fever, needs urgent assessment.
Although infection following a joint injection is uncommon, it can be serious.
An infection inside a joint is known as septic arthritis.
This condition requires urgent medical treatment because it can damage the joint and make a person seriously unwell.
The NHS information on knee pain provides advice on symptoms that require urgent medical attention.
Warning Signs After a Knee Injection
Seek urgent medical advice if you experience:
- Severe or rapidly worsening knee pain.
- Significant swelling that continues to increase.
- Redness or unusual warmth around the joint.
- Fever, chills or feeling generally unwell.
- Increasing difficulty moving the knee.
- Inability to put weight on the affected leg.
- Pain that is much worse than expected after the procedure.
If you become seriously unwell or develop symptoms suggesting a medical emergency, attend A&E or call 999.
Do not delay an urgent assessment while waiting for a routine pain management appointment.
Can a Steroid Injection Make Arthritis Worse?
Steroid injections are sometimes used to manage symptoms associated with osteoarthritis.
They may reduce pain temporarily, but they do not cure the condition.
There are also concerns about the effects of repeated corticosteroid injections on joint tissues.
The potential risks and benefits depend on factors including the patient’s diagnosis, the medication used, the frequency of injections and previous treatment history.
Repeated injections should therefore not be regarded as automatically harmless.
They require individual consideration, especially where previous injections have provided little or no benefit.
For knee osteoarthritis, NICE recommends considering corticosteroid injections when other pharmacological treatments are ineffective or unsuitable, or when an injection could help someone participate in therapeutic exercise.
The guidance does not recommend using injections as a replacement for the core approaches to osteoarthritis management, such as appropriate exercise and weight management where relevant.
If your pain keeps returning, it may be more useful to review your overall treatment plan than to repeat an injection without reassessing the cause.
Why Did My Knee Injection Work for Only a Few Days?
Some patients notice an improvement immediately after the procedure, but the benefit disappears quickly.
One possible explanation is that a local anaesthetic was included in the injection.
Local anaesthetic can temporarily interrupt pain signals.
When its effects wear off, the original symptoms may return.
If the corticosteroid subsequently produces an anti-inflammatory effect, relief may develop again over the following days.
However, if the improvement lasts only a short time and does not return, the injection may have provided little sustained benefit.
This should be discussed with the treating clinician.
It may be useful to record when the pain improved, when it returned and which activities were affected.
These details can help during a follow-up assessment.
What If the Steroid Injection Did Not Help at All?
An injection that provides no noticeable benefit is an important part of your treatment history.
However, it does not prove that the knee pain is untreatable.
It may indicate that the condition has not responded to corticosteroid treatment, that inflammation is not the main cause of the symptoms or that another problem is contributing.
Further assessment may involve:
- Reviewing the original diagnosis.
- Examining the location and pattern of pain.
- Assessing knee movement and stability.
- Considering muscle strength and walking patterns.
- Reviewing previous imaging and investigations.
- Checking whether pain could originate from the hip or spine.
- Discussing other appropriate treatment options.
The next step should be guided by the clinical findings rather than automatically repeating the same treatment.
Should I Have Another Steroid Injection?
Whether another steroid injection is appropriate depends on several factors.
A clinician may consider how much relief the previous injection provided, how long the benefit lasted and whether any adverse effects occurred.
The diagnosis and wider treatment plan are also important.
If the first injection provided meaningful temporary relief, repeating treatment may sometimes be considered.
However, there is no guarantee that another injection will produce the same result.
If the previous injection offered little benefit, it may be more appropriate to investigate other options.
Repeated corticosteroid injections also carry potential risks, including infection, changes in blood glucose and possible effects on joint or surrounding tissues.
For people with diabetes, steroid injections can temporarily increase blood glucose levels.
The NHS advice on hydrocortisone injections explains that the number and timing of injections depend on the treatment area, medication and clinical circumstances.
There is no universal injection schedule suitable for everyone.
What Treatments Can Help When a Knee Steroid Injection Has Failed?
Persistent knee pain does not necessarily mean that surgery is the next step.
Several approaches may be considered depending on the underlying condition, previous treatments and the impact on daily activities.
Physiotherapy and Strengthening Exercises
For many people with knee osteoarthritis, therapeutic exercise is an important part of treatment.
Appropriate exercises can help improve muscle strength, movement and confidence using the affected knee.
Strengthening the muscles around the knee may help support the joint during walking, climbing stairs and other activities.
An exercise programme should be tailored to the person’s symptoms and physical ability.
For some people, pain relief may be needed to make rehabilitation more manageable.
The NHS guide to osteoarthritis treatment explains the role of exercise, weight management where appropriate and other non-surgical treatments.
Medication Review
If knee pain continues despite an injection, your clinician may review whether existing medication is effective and appropriate.
For knee osteoarthritis, NICE recommends offering a topical non-steroidal anti-inflammatory drug (NSAID) when medication is required.
Oral NSAIDs may be considered in certain circumstances, but they carry risks and are not appropriate for everyone.
Factors such as kidney problems, cardiovascular conditions, stomach ulcers and interactions with other medicines must be considered.
Medication decisions should be made with an appropriate healthcare professional.
Weight Management Where Appropriate
For patients with knee osteoarthritis who are overweight or living with obesity, weight management may help reduce symptoms and improve function.
However, this is only one component of treatment and should not be presented as the explanation for every patient’s knee pain.
The most suitable approach depends on the person’s health, abilities and circumstances.
Rehabilitation and Pain Management
Some patients develop persistent pain that affects movement, confidence and everyday activities.
A rehabilitation programme may help improve physical function and support a gradual return to normal activities.
Management may also involve education about pain, activity pacing and strategies for dealing with persistent symptoms.
You can learn more about our Rehabilitation and Pain Management Programme.
Genicular Nerve Block and Radiofrequency Ablation
For selected patients with persistent knee pain, particularly pain associated with osteoarthritis or certain postoperative conditions, procedures targeting the genicular nerves may be considered.
The genicular nerves carry sensory information from areas around the knee.
A diagnostic genicular nerve block involves injecting local anaesthetic near selected nerves.
In suitable patients, radiofrequency treatment may then be considered to reduce pain signals.
These treatments do not repair damaged cartilage or correct mechanical instability.
They are also not appropriate for every patient, and the evidence, expected benefits and potential risks should be discussed individually.
Our Genicular Nerve Block and Ablation page explains how these procedures are assessed and performed.
Further Joint Treatment
Some patients may benefit from further joint-specific treatment following a clinical review.
However, the choice of treatment should reflect the diagnosis and available evidence.
For example, NICE advises against offering intra-articular hyaluronan injections for osteoarthritis.
Other injection-based approaches have different evidence bases, indications and regulatory considerations.
Patients should discuss the expected benefits, uncertainties and risks before proceeding with any treatment.
Pain Consultants provides information about its Joint Injection service, including assessment and treatment planning.
Orthopaedic Assessment
Some knee conditions require assessment by an orthopaedic specialist.
For example, patients with significant mechanical problems or advanced osteoarthritis may need advice about surgical treatment.
Knee replacement may be considered when osteoarthritis symptoms substantially affect quality of life and non-surgical treatment has been ineffective or unsuitable.
A pain management consultation does not replace orthopaedic assessment when surgery or a structural knee problem requires consideration.
Do I Need an MRI If My Knee Still Hurts?
Not everyone with persistent knee pain needs an MRI scan.
The most appropriate investigation depends on the suspected condition and the findings from a medical examination.
For example, knee osteoarthritis can often be diagnosed clinically, particularly in adults over 45 with activity-related joint pain and no significant morning stiffness.
NICE advises against routinely using imaging to diagnose osteoarthritis unless there are atypical features suggesting another diagnosis.
However, imaging may be appropriate in certain situations.
An MRI might be considered when symptoms suggest a specific soft tissue injury or another problem that could change treatment decisions.
An X-ray may be useful when structural joint changes need assessment.
A clinician may also decide that further imaging is unnecessary if the diagnosis is sufficiently clear and the result would not alter management.
The purpose of imaging is to answer a relevant clinical question, rather than simply to obtain another scan because pain persists.
What Does the Location of Knee Pain Tell You?
The location of pain can help guide an assessment, although it cannot establish the diagnosis on its own.
| Location of pain | Possible considerations |
|---|---|
| Front of the knee | Patellofemoral pain, tendon problems or arthritis |
| Inner side of the knee | Medial joint problems, meniscal conditions or ligament-related pain |
| Outer side of the knee | Lateral joint or soft tissue problems |
| Behind the knee | Posterior joint problems, including a possible Baker’s cyst |
| Widespread knee pain | Osteoarthritis, inflammation or several contributing factors |
| Knee pain with hip or back symptoms | Referred pain or another contributing condition |
These examples are not exhaustive.
Pain location must be considered alongside symptoms, examination findings and relevant medical history.
For instance, pain behind the knee accompanied by significant calf swelling may require urgent assessment for a possible blood clot rather than routine pain management.
How Long Should I Wait Before Seeking Further Advice?
The appropriate timing depends on the severity and progression of symptoms.
If you have mild discomfort immediately after an injection, follow your clinician’s aftercare instructions.
However, if the pain is severe, continues to worsen or is accompanied by concerning symptoms, seek medical advice promptly.
If you have not experienced meaningful improvement after the expected period discussed by your clinician, a follow-up appointment may be appropriate.
There is no benefit in waiting indefinitely when persistent pain is significantly affecting mobility, sleep or daily activities.
A review can help determine whether the original treatment should be reconsidered or whether further investigations are necessary.
Can Knee Pain Return Even After a Successful Injection?
Yes.
A steroid injection may successfully reduce inflammation and relieve pain temporarily without removing the underlying cause.
This can happen in conditions such as osteoarthritis.
A patient may feel more comfortable for several weeks before the original symptoms gradually return.
This does not necessarily mean the injection was inappropriate.
In some cases, temporary pain relief allows patients to participate more effectively in strengthening exercises or rehabilitation.
However, if symptoms repeatedly return, longer-term management should be considered.
The goal is not simply to repeat temporary treatments, but to develop a plan that addresses pain, movement and quality of life.
When Should You See a Pain Management Specialist?
A pain management specialist may be helpful when knee pain persists despite appropriate initial treatment.
This may include situations where:
- A steroid injection has provided little or no relief.
- Pain returns repeatedly after temporary improvement.
- Knee pain affects walking or climbing stairs.
- Symptoms interfere with sleep.
- Previous investigations have not fully explained the pain.
- Multiple treatments have been tried without sufficient improvement.
- Surgery is not currently suitable or other options need consideration.
- Ongoing pain is affecting work, mobility or quality of life.
A specialist consultation should begin with an assessment rather than an assumption that another injection is necessary.
The clinician may review the diagnosis, consider whether the pain has more than one source and discuss appropriate treatment options.
You can read our guide to What Happens During Your First Pain Management Consultation? to understand what an appointment may involve.
How Pain Consultants Can Help
Pain Consultants provides consultant-led assessment and management for people experiencing persistent pain.
For patients whose knee pain has continued after a steroid injection, a consultation may involve reviewing the original diagnosis, the previous procedure and how symptoms responded.
The assessment may consider:
- The location and severity of knee pain.
- How long symptoms have been present.
- Whether pain improved after the injection.
- Previous injuries or operations.
- Existing joint conditions.
- Mobility and daily function.
- Previous scans and investigation results.
- Current medication and earlier treatments.
- Whether additional investigations or referrals are needed.
Depending on the findings, management may involve rehabilitation, medication review, further joint treatment or consideration of other specialist procedures.
Not every patient will benefit from another injection.
The aim is to identify the most appropriate options for the individual rather than repeat a treatment that has already provided insufficient relief.
For more information, visit our Comprehensive Diagnosis service.
The clinic’s medical leadership includes Dr Magdy Aglan, Medical Director.
Frequently Asked Questions
Why is my knee still painful a week after a steroid injection?
Steroid injections may take several days to work, and some patients experience temporary discomfort after the procedure. If the pain remains unchanged, the injection may not have provided sufficient benefit. Severe or worsening symptoms require medical assessment.
Is it normal for knee pain to get worse after a cortisone injection?
A temporary steroid flare can cause increased discomfort during the first 24 to 48 hours. However, severe or progressively worsening pain, particularly with redness, warmth, swelling or fever, needs urgent assessment.
How long should a steroid injection last in the knee?
The duration varies. For osteoarthritis, NICE advises that corticosteroid injections typically provide short-term relief of around two to ten weeks. Some patients experience less benefit, while others may notice improvement for longer.
Why did my knee injection only work for a few days?
Temporary relief may be related to local anaesthetic used during the procedure, or the steroid may have provided only limited benefit. A review can help determine the likely explanation.
Can a steroid injection fail completely?
Yes. Some patients experience no meaningful improvement. This may occur because the underlying condition does not respond sufficiently to corticosteroids or because another source of pain is present.
Should I get another injection if the first one did not work?
Not automatically. The decision depends on the diagnosis, previous response, expected benefits and potential risks. Reassessment may be more useful when the first injection provided little relief.
Can a steroid injection damage the knee?
Corticosteroid injections have potential risks, particularly when repeated. Your clinician should consider the possible effects on joint tissues, infection risk and other adverse effects before recommending further injections.
Can I walk after a knee steroid injection?
Many patients can walk after the procedure, but clinicians often recommend limiting strenuous activity for a short period. Follow the specific aftercare instructions provided by the treating team.
Should I have an MRI after an unsuccessful knee injection?
Not necessarily. Whether imaging is useful depends on symptoms, examination findings and whether the results would influence treatment decisions.
Can knee arthritis be treated without steroid injections?
Yes. Depending on the diagnosis and severity, management may include therapeutic exercise, weight management where appropriate, medication and other treatments. Surgery may be considered when symptoms remain severe despite suitable non-surgical care.
What if my knee pain returns after two months?
Pain may return when the temporary anti-inflammatory effect wears off. A clinician can review whether further treatment, rehabilitation or another approach is appropriate.
Are genicular nerve blocks an alternative to steroid injections?
For some patients with persistent knee pain, genicular nerve procedures may be considered following specialist assessment. They are not suitable for everyone and do not treat every underlying cause of knee pain.
When should I see a knee pain specialist?
Consider specialist assessment when pain persists despite initial treatment, repeatedly returns, limits mobility or significantly affects your quality of life.
Book a Pain Management Consultation in Lancashire
Persistent knee pain can make everyday activities difficult, particularly when you have already undergone treatment without achieving the improvement you hoped for.
If a steroid injection has not provided sufficient relief, the next step is not necessarily another injection.
Understanding why the pain continues is essential to selecting appropriate treatment.
Pain Consultants provides consultant-led pain management assessments for patients experiencing persistent knee pain and other chronic pain conditions.
During a consultation, the clinical team can review your symptoms, previous investigations and treatment history before discussing the available options.
Book a Pain Management Consultation to enquire about an appointment.
Medical disclaimer: This article is intended for general educational purposes and does not replace personalised medical advice, diagnosis or treatment. If you experience severe or worsening knee pain after an injection, particularly with swelling, redness, warmth, fever or inability to bear weight, seek urgent medical assessment.