They Seem Harmless--But Here's What Steroid Shots Do to Your Joints
Last week, a client was considering whether she wanted to get a steroid shot in her knee before her upcoming ski trip.
The subject of steroid shots comes up frequently because they're one of the most commonly offered treatments for a host of joint issues, particularly knee osteoarthritis.
They’re often framed as a way to “buy time” or get through a demanding event.
It gets my attention because my mom relied on them when her knee pain flared or when she had something big coming up, like moving to Birmingham. At first, they seemed to help. Then… they didn’t.
That’s why a large new study on steroid injections for knee OA caught my eye.
Steroid injections are one of the most common treatments offered for knee osteoarthritis (OA).
A large study of U.S. veterans tested their effectiveness and found....
Steroid injections didn’t help any more than lidocaine (a numbing agent)… and neither worked well.
The Study
Researchers followed221 veterans with knee OA who received 2 injections, one steroid shot (40 mg methylprednisone) and one lidocaine shot, in random order. After each injection, symptoms were tracked for 12 weeks.
No one knew which shot was which, not the patients, clinicians, or evaluators.
They used two gold-standard knee pain scales, KOOS and PROMIS, and defined a “meaningful improvement” as at least 10 points on the KOOS.
What happened?
Pretty much… nothing.
Both groups saw tiny improvements, just 3–4 points with steroids and 1 point with lidocaine.
By 12 weeks, scores were back to baseline.
Neither treatment reached the level doctors consider meaningful.
The results weren't statistically significant.
👉 22–24 people would need steroid shots for ONE person to feel meaningful relief.
As the lead researcher put it, there was “no evidence that corticosteroids are effective in this real-world population.”
Even if we could identify patients more likely to see improvement from this treatment, "the benefits are still likely to be small."
This isn’t the first study to question steroid injections. A few found mild short-term help, but:
Benefits rarely last beyond a few months
Several studies suggest steroid shots may accelerate joint damage
Carefully controlled trials often don’t translate to “real-world” OA patients with OA and their everyday activity.
This new study is important because it looked like real life: the people who typically show up in orthopedic clinics asking for relief.
Even in this group, steroids didn't do much.
There were interesting patterns
Researchers noticed:
Men responded slightly better to steroids
Women responded slightly better to lidocaine
People with more severe OA saw slightly more relief with steroids
None of these differences was large enough to matter in real life
The results might look different with:
A higher steroid dose
A population limited to moderate–severe OA
A more balanced mix of men and women (this was a VA study; 84% were men)
The results align with a growing body of evidence: steroid injections aren't the game-changer many people think they are.
I’ve seen this firsthand. My mom got them for knee and shoulder pain. They helped a bit at first, then stopped making any difference.
Ultimately, all four of those joints needed to be replaced. Coincidentally, we learned.......
These shots may contribute to joint disintegration.
What Does Help?
Long-term improvement in osteoarthritis comes from:
Strength training
Weight management, if needed
Improving joint mechanics
Consistent, progressive movement
Addressing inflammation through lifestyle, not injections
Steroid shots may help a few people for a short time. But for most, they’re closer to placebo--and not a very effective one.
