If you are suffering extreme fatigue after a cortisone injection you aren’t alone.
Cortisone shots can make you tired.
When you scheduled your cortisone shot, you were probably looking for relief from a chronic injury. But I bet you didn’t consider that you might suffer fatigue after your cortisone injection.
You see, cortisone has a dark side. For all the pain-relieving benefits cortisone has, there’s a long list of potential side effects, including fatigue.
Before you book your next cortisone injection, read this post and educate yourself on the potential risks. Make an educated and informed decision. Because there are risks to cortisone injections.
Cortisol vs Cortisone
You’re probably more familiar with cortisol. Cortisone and cortisol are closely related. (1)
Cortisol is anti-inflammatory. Your body releases it in response to allergies or other inflammatory conditions.
Cortisone is a stronger anti-inflammatory due to the way it binds to receptor sites. This is incredibly helpful when dealing with an injury that never seems to heal.
But cortisone does more than act as an anti-inflammatory. Cortisone is a glucocorticoid, which is a steroid hormone. And that means it influences much more than inflammation.
The dark side of cortisone
Your blood sugar and cortisol are closely connected. So connected in fact that if your blood sugar isn’t balanced you may develop adrenal fatigue.
The same relationship exists between cortisone and your blood sugar. When you receive a cortisone shot your blood sugar is going to increase – sometimes dramatically. For most people this is temporary. However, if you’re like most people in North America you may already be dealing with a blood sugar issue (find out if you are) – you just might not know it yet!
If you’re already struggling to regulate your blood sugar it’s very likely that you will experience fatigue after your cortisone injection.
How does blood sugar affect fatigue?
Regulating the quantity of sugar in your blood is extremely important. If you have too much sugar in your blood your tissues start to die. If you don’t have enough sugar in your blood you may end up in a coma close to death. To be healthy you need to control your blood sugar.
For most of you, your body runs on sugar (glucose), much like your car runs on gas. Without gas, your car won’t run. And without sugar, your body can’t create energy and you’ll feel fatigued.
Fatigue is your body protecting itself. By making you tired, your body conserves what little energy it has. Fatigue prevents you from doing activities that require energy output – which may be as simple as getting out of bed.
If your blood sugar is too high, too low, or fluctuating dramatically between highs and lows, you’ll also experience swings in your energy levels. When you are experiencing fatigue I can guarantee you have a blood sugar imbalance. I can show you how to achieve and maintain the perfect blood sugar.
A cortisone shot’s effect on blood sugar
A cortisone shot pulls sugar out of your cells and dumps it into your blood. As a result, your blood sugar levels go up. (2) In most people, this usually doesn’t last very long. But for some people, a cortisone shot could be enough to give you high blood sugar (hyperglycemia). And should this happen, it’s likely that you’ll experience fatigue.
If you don’t have diabetes, monitor your blood sugar levels before and after a cortisone injection.
You need to ensure your blood sugars return to normal within two weeks following the injection. They should. But that’s not a guarantee. If your sugars do not return to normal, you’re on the fast track towards fatigue.
To get them back on track you’ll need to alter your diet and lifestyle.
More ways cortisone shots make you tired
Your body uses something called the HPA axis to best handle the stresses of life. It is what controls the fight or flight and rest or digest responses.
Adrenal fatigue is a condition that occurs when your HPA axis is no longer resilient. Instead of adapting to a stressful event, your body crumbles. Adrenal fatigue often develops due to:
- Sleep disturbances
- Hidden sources of inflammation
- Blood sugar irregularities
And blood sugar irregularities can occur after a cortisone injection.
A cortisone shot floods your body with the hormone – and the larger the dose, the larger the response. This triggers a phenomenon known as feedback inhibition. The high levels of cortisone from the injection tell your body that there’s plenty of this hormone. Therefore, no need to make any more. When this occurs, your body slows its production of cortisol.
One cortisone injection dramatically lowers circulating levels of cortisol in the body. (3)
In a study conducted on 10 athletes given a cortisone shot (4), after two weeks three of the participants were suffering from adrenal fatigue. This was tied directly to the cortisone shot.
If a cortisone injection causes adrenal fatigue in healthy, fit athletes, what do you think it will do to you?
How to avoid fatigue after a cortisone injection
There are some things you can do to avoid extreme fatigue after a cortisone injection:
Balance your blood sugar. You can do this all on your own with some simple dietary changes. A keto diet will have your blood sugar balanced in no time. If that seems too radical for you, check out my eCourse, Stop Feeding Fatigue. I’ll show you how to identify exactly which foods are wreaking havoc on your blood sugar so you can avoid them.
Determine if your cortisol levels following the injection are high or low. Laboratory testing is your best option here. If lab testing is not an option, skip to the bottom of this section to learn what to do.
If you have high cortisol levels you need to lower them. You can do this with herbs like magnolia, cowhage, and eleuthero. GABA and phosphatidylserine can also help lower cortisol levels. I’ve also written a blog taking a deep dive into the best supplements for adrenal fatigue.
If you have low cortisol levels you need to increase them. I recommend using adrenal glandulars combined with licorice root. Other herbs/supplements that can help increase cortisol include ginseng and cordyceps.
Do not take supplements if you don’t know whether your cortisol is high or low. They are only to be used when you actually know your cortisol levels. If lab testing is not an option, you’re going to want to use adaptogenic herbs. These herbs have a balancing effect on your cortisol; raising it when it’s low and lowering it when it’s high.
My recommendations for adaptogenic herbs include Rhodiola, Schisandra, and Ashwagandha. Opt for a combination of these three and you won’t make your fatigue worse.
Take the supplements until your fatigue improves. Just remember that you’re going to have to ensure your blood sugar remains balanced! Otherwise, none of these supplements are going to work.
Cortisone injections – more risks than feeling tired
Fatigue is not the only adverse effect of cortisone shots. You can also experience:
- Pain and swelling
- Skin discoloration
- Fat atrophy
- Tendon injuries
- Cartilage loss
- Allergic reaction
- Irregular menstruation
Pain and swelling
After an injection, cortisone can crystalize inside your body. This will intensify your pain signals – big time. Fortunately, this will typically last just a few days. Should it happen to you, grab an ice pack and sit on the couch!
Months after your cortisone injection, you may notice that the skin surrounding the injection site is a different shade than your surrounding skin. This is called hypopigmentation and can occur after cortisone injections. (5)
While not harmful or painful, the condition can be permanent. The darker your skin tone the more likely hypopigmentation is to occur. Rough estimates suggest this to occur in 1-4% of patients. (6)
If you noticed depression or divot surrounding the injection site, that’s due to fat cell atrophy. If the fat cells underneath your skin disappear, the skin and tissue will appear to fall in on themselves. The cells will regenerate but it can take upwards of 2-3 years. (7)
Be absolutely certain your physician is not injecting cortisone into your tendons. Cortisone weakens tendons making them more prone to tearing. (8) Ideally, cortisone should not be injected anywhere near tendons.
Should your injection need to take place in close proximity to a tendon, ensure you rest the affected joint for a few days following the procedure. No heavy lifting or exercise are recommended.
Cortisone is a catabolic hormone which means it breaks down tissues. This includes cartilage. One study found that cortisone injections in the knee caused more than 0.1cm of cartilage loss (that’s a lot!). (9)
FYI, cartilage loss is what occurs in osteoarthritis. Meaning continued cortisone injections into joint spaces will cause long-term, irreversible, degenerative changes. No bueno.
You won’t have an allergic reaction to cortisone itself. But allergic reactions can occur in response to the local analgesic used before a cortisone injection. If you’ve reacted to anesthetics before, make sure your doctor knows about it!
To be clear, sex-related side effects are rare and tend to only occur in women. Sex-related side effects include irregular menstruation, disturbances in lactation, and excess hair growth. (10)
Can cortisone injections make you tired? – final thoughts
Cortisone shots can be a ridiculously fast and effective means to relieve chronic pain. I’m not at all against the use of cortisone. But I take a strong stand against the uninformed use of cortisone – and any hormone.
Cortisone injections can have adverse side effects:
- Extreme fatigue
- Imbalanced blood sugar
- Tissue atrophy at the injection site
While these effects may be relatively rare, heed the following:
Check your cortisol levels before scheduling your injection
- I recommend a cortisol test that involves testing at four different times throughout the day.
- At the very least, opt for an AM cortisol reading with your family doc.
- If your levels are either low or high, postpone that injection!
Monitor your blood sugar
- High blood sugar and low blood sugar readings are both indicative that your body is struggling to balance its sugars.
- If your blood sugars are irregular, avoid getting a cortisone shot until they’re properly balanced. I can show you how to balance your blood sugars.
If the cortisone injection didn’t work the first or second time, don’t keep scheduling appointments.
- Cortisone breaks your tissue down. You don’t want this to happen.
- The more injections you get, the higher your risk for cartilage loss and tendon injuries.
- Cortisone shots should not be a regular occurrence.
Ask your family members about adverse reactions.
- If your mom, dad, brother, or sister had an allergic reaction to cortisone, you’re more likely to experience a similar reaction.
- Talk to your doctor about alternatives to cortisone
- There’s plenty of injectable therapies that won’t trigger fatigue yet still offer pain relief.
- Protein-rich plasma (PRP), hyaluronic acid, and prolotherapy are three alternatives to help improve your joint pain while not affecting your hormones.
Ok, now you know all the risks associated with a cortisone injection. If you experienced extreme fatigue after a cortisone injection, be sure to check your cortisol levels! You’re likely dealing with adrenal fatigue.
It’s time for me to hear from you!
How did cortisone affect your energy?
What steps did you take to improve your energy after the injection?
Leave your answers in the comments section below!
Jan Cloward says
I had a cortisone shot in my hand for trigger figureabout 11am. I was ok until about 3pm when I was overwhelmed with tiredness. I never take naps during the day so I I think there’s a connection.
Mark Volmer says
Right you are, Jan!
Check your blood sugar to make sure you’re now back in normal ranges.
Krislyn K Lowry says
I had radiation to my head and neck so my pituitary sends no message to my adrinal gland so I take cortisol and get injections for pain. Wow I need advice. I have fatigue, but then I am disabled.
Mark Volmer says
Check out my blog on blood sugar and adrenal fatigue. I think it will have some helpful info.
I had a cortisone shot in my knee and around a half hour to an hour I got extremely tired and woozy I wasn’t thinking straight I had to go to bed
I’ve had the shots before but not in my knee the other places were my wrist and my shoulders
And now I’m fighting a splitting migraine
I had a shot thee weeks ago for my right hip. No issues. Just had a shot for my left. Extremely tried and didn’t help much on my hip.
I had a steroid injection 2 wks ago and always feel like I’m always sleepy
I had a cortisone injection into my shoulder at 6pm and while the pain seems to have subsided I am extremely tired and shaky. I was awake by 2:30 am (not normal for me) I wish I read your posts before having the injection and I would have prepared some keto meals.
Thanks for the advice. A 10 hour work day ahead of me.
Linda Six says
I had a prednisone injection two days ago and still very fatigued from it. Kind of bedridden from it. How long will this last? The pain from the hip bursitis is better but I’m not.
I had a steroid injection in my knee 2 weeks ago. a first for me. Within an hour my knee was great. I could go up and down stairs without a problem, the swelling in the Bakers cyst was down by about half.. I was wired and couldn’t sleep for the first week. No I am so tired I just lay around the house all day. So I a looking for alternatives to the shots. Suspect I am dealing with inflammation secondary to arthritis rather than a bone on bone arthritis problem. I had x rays before the shot and it showed arthritis. lol
I had a cortisone injection into my left shoulder yesterday for an excruciatingly painful frozen shoulder that l have had for many weeks.
I felt okay until this afternoon when l suddenly felt unbelievably exhausted with a bad headache. I was so tired l felt l would stop breathing, I’m still a bit groggy four hours later.
Michele townsend says
I have stayed awake since my steroid jab which was 6 days ago
Will it last?
Mark Volmer says
It shouldn’t last. Give it another couple weeks 🙂
I had a steroid shot in both hips , I fell asleep when I got home and my husband said he has an extremely hard time waking me up. Thoughts?
Suzanne Penninger says
Had an injection at L4 and L5 3 days ago. No energy, lower back pain. I’ve had shots before and never felt this bad. The plus side is the pain in my leg is almost nonexistent.
Denise Burns says
I had extreme fatigue for 2 days after a cortisone shot
I had a caudal injection a week ago. This was my second time. First time went great. Not so much this time. I’m extremely sore at injection site and tired. I’ve been in bed for almost a week only doing what is necessary. How long will the fatigue last. I don’t deal with blood sugar issues.
Jacki knight says
I had a steroid injection in my right shoulder 4 weeks ago now I have extreme fatigue , not me at all
I have chronic piriformis syndrome and have had a few trigger point injections for it in the past 9 months.
This last injection left me so fatigued the following day I’m actually writing this from my bed in the afternoon!
I’m hoping to feel more like myself again soon. I noticed the older I get (I am 55) the less able I am to tolerate these steroid injections. I feel fatigued AND anxious- what a combo!
I had two cortisone shots in my knees one day apart. Two days later I had terrible gas and terrible pressure in my chest I thought I was having a heart attack. I had pain under my breast going to my back. I am extremely tired. I feel this is related to the shots. How long do you think the tiredness will last. The gas seems to be letting up with mylanta. What do you think. I called where I get the shots and they never heard of this. I also feel very depressed and anxious. Please answer me if possible. Thank you. Also a little nauseous and lost about five pounds in a matter of days.
Evelyn Bechtel says
I’ve been getting numerous injections in my neck , spine L4 through S1 and tailbone, I’m exhausted, I didn’t get much relief for the chronic pain I’m in, so I decided not to go back to the pain management doctor. It’s been 4 months I’m in serious spine, neck and sciatic pain., I’m also exhausted, I had a kidney removed due to a 3.6 by 3.9 kidney stone.. I have headache’s and chronic diarrhea for 4 months.. I feel like I’m slowly dying ..is there any help or hope for me? Im 70
Christine Carretta says
I got A Steroid shot in my spine three days ago and i feel like my blood has been drained out of me. I have had these shots before and felt tired after them but nothing like this. I am having trouble breathing and tempted to go to the hospital. I feel listless. I even thought i had the covid but didnt have any other symptoms. This is very scary. Hope it goes away soon.
Jane Coe says
I had a epidural shot two weeks ago , I feel dizzy and extremely fatigued, and just not well !
I hope this clears soon I’m 64 and working .
Tanya Morton says
Seems to be a connection as I too had cortisone 3 weeks in a row for L4 L5 and can hardly get out of bed or stay awake all day