The short version: rest for the remainder of the day, avoid heat, skip strenuous activity and heavy lifting for about 48 hours, and do not treat a good first day as permission to undo the reason you needed the injection.
The detail matters, because two of the things people commonly do afterwards can either mask a genuine complication or bring the pain straight back.
What not to do in the first 24 hours
- Do not drive yourself home if you were given any sedation. Arrange a lift beforehand.
- Do not apply heat to the injection site. Heat increases local blood flow and swelling in tissue that has just been instrumented. Ice is the right choice.
- Do not soak — no bath, hot tub, pool or swimming while the puncture site is healing. A shower is fine.
- Do not lift, bend repeatedly, or exercise strenuously.
- Do not resume a blood thinner that was held for the procedure until you are told to. The timing follows published guidance and is not a judgement call.
- Do not treat sudden relief as a cure. Local anaesthetic given with the steroid can produce excellent relief for a few hours that then wears off. That is expected, not failure.
How long to rest
Rest the remainder of the day, then return gradually. Most people are back to routine activity within 24 to 48 hours.
Rest here means reduced load, not immobility. Gentle walking is beneficial and is not the sort of activity being restricted. Prolonged bed rest is unhelpful for back pain in general, and nothing about an injection changes that — the point of the procedure, as Dr. María Alejandra De La Peña frames it, is “improved lifestyle, improved functionality of the patient.” It exists to enable movement.
When you can exercise again
A reasonable progression, adjusted to what your clinician advises:
- Day of the injection — walking only, short distances.
- Days 1 to 2 — normal daily activity. No heavy lifting, no high-impact work.
- Days 3 to 7 — return to light exercise and resume physical therapy if it is part of your plan.
- After the first week — build back toward full activity as symptoms allow.
The one genuine trap is feeling well enough on day two to do something you have not done in months. The steroid has reduced inflammation; it has not repaired a disc or widened a narrowed canal.
When the steroid actually starts working
This is the part most worth understanding, because the pattern confuses people into thinking it has failed.
Hours 0 to 6. Often substantial relief, from the local anaesthetic rather than the steroid.
Day 1 to 3. The anaesthetic wears off and the pain frequently returns, sometimes worse than before. De La Peña describes this post-procedure pain as an expected event to be managed with reassurance, ice, NSAIDs or a muscle relaxant — not as a sign of a failed injection.
Day 3 to 14. The steroid takes effect. This is when genuine improvement appears.
Week 2 onward. The plateau, and the point at which the result should be assessed.
Judging an injection at 48 hours is judging it at its worst moment.
If you have diabetes
Epidural steroid raises blood glucose, and not briefly. De La Peña advises diabetic patients to check their levels for “usually the first three to five days” because of rebound hyperglycaemia, and where control is tight or insulin-dependent she involves the endocrinologist to adjust medication “just for that amount of time, until the peak of the steroid stabilises the glucose.”
Expect higher readings. Plan for them rather than being surprised.
Normal after-effects
All of the following are described by faculty as common and self-limiting: soreness at the injection site; a short-lived increase in the original pain; facial flushing; hiccups; a transient rise in blood pressure; difficulty sleeping for a night or two; and a mild rash where contrast was used, which is “quite common”.
Feeling faint during or shortly after the procedure is also common — De La Peña notes vasovagal syncope occurs “especially in strong young patients”, driven by anxiety rather than the medication, and is managed with lying flat, knees bent, and fluids.
What is not normal
Seek medical attention the same day for any of these:
- New or worsening weakness in a leg, or a foot that drags
- Loss of bladder or bowel control, or numbness in the saddle area
- Severe, escalating back pain unlike the pain you came in with
- Fever, chills, or a hot, spreading redness at the injection site
- A headache that is clearly worse sitting or standing and better lying flat
The first three raise the possibility of an epidural haematoma or abscess, both of which require urgent MRI. The last describes a post-dural-puncture headache — managed conservatively at first with hydration, NSAIDs and rest, and if it has not improved after two or three days, treated with an epidural blood patch, which usually resolves it within a day.
The follow-up conversation
Keep a simple record: what your pain was before, what it is at two weeks, and what you can now do that you could not. Faculty assess these injections on function, not only on a pain score.
Bring that to the review appointment. It is what determines whether the injection is repeated, the approach is changed, or the plan moves on.
Learn blocks with your hands, not from a page
Empire’s Pain Management Training (THE Pain Show) is accredited for 25.25 AMA PRA Category 1 Credits™, jointly provided by AKH, Inc, and Empire Medical Training. For narrower peripheral work, Joint, Extremity and Non-Spinal Injection Training carries 6.75 credits for the complete in-person hybrid program, and Advanced Musculoskeletal Ultrasound Guided Injections builds the guidance skills above.
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