Do Orthopedic Injections for Back Pain Really Work?

Back pain is one of the most common reasons Canadians consult a healthcare professional and miss work. Most episodes improve with time, movement and physiotherapy, but some persist for months. In these cases, targeted injections can reduce pain enough to allow patients to resume activity and rehabilitation. This article explains how they work, what results to expect and when they are recommended.

Understanding Orthopedic Injections for Back Pain

Back pain injections place medication, usually a corticosteroid and/or a local anaesthetic, close to the structure causing the pain: a nerve root, a facet joint, the sacroiliac joint or a tense muscle. They are generally performed under imaging guidance, such as fluoroscopy or ultrasound, to ensure accuracy. Unlike knee viscosupplementation, their main role is to calm inflammation and interrupt the pain signal.

How Back Pain Injections Work

Corticosteroids reduce inflammation around irritated nerves or joints, while local anaesthetics provide immediate, temporary relief. By reducing pain, injections break the cycle of pain, muscle tension and inactivity, which makes physiotherapy and exercise possible. Some injections also have a diagnostic role: if the pain disappears after an anaesthetic is injected into a specific structure, that structure is likely the source.

The Four Main Types of Back Pain Injections

Epidural Steroid Injections

The medication is injected into the epidural space around the spinal nerves. These injections are mainly used for radiating pain in the leg (sciatica) caused by a herniated disc or spinal stenosis.

Facet Joint Injections and Medial Branch Blocks

Facet joints connect the vertebrae and can become painful with osteoarthritis. An injection into the joint, or a block of the small nerves supplying it, can relieve pain and help confirm the diagnosis before other treatments such as radiofrequency ablation.

Sacroiliac Joint Injections

The sacroiliac joint connects the spine to the pelvis. When it is the source of pain in the lower back or buttock, an image-guided injection can reduce inflammation and clarify the diagnosis.

Trigger Point Injections

These injections target tight, painful knots in the back muscles. They can quickly relieve muscle pain and make stretching and strengthening exercises easier.

How Effective Are Back Pain Injections?

Results vary depending on the cause of the pain. Epidural injections can provide meaningful short- to medium-term relief of sciatica in many patients, although the effect often diminishes over a few weeks to a few months. Facet and sacroiliac injections are useful both for relief and for diagnosis. Injections are most effective when combined with an active rehabilitation program; on their own, they rarely solve the underlying problem.

What to Expect During the Procedure

The patient lies on the stomach or side. The skin is disinfected, a local anaesthetic is applied, and the needle is guided by fluoroscopy or ultrasound. The procedure usually lasts 15 to 30 minutes, followed by a short observation period. A ride home is recommended. See our guide to preparing for an orthopedic injection.

Recovery and Aftercare Tips

Rest for the rest of the day, then resume gentle movement. Temporary soreness at the injection site is common. Relief from the anaesthetic may fade after a few hours before the corticosteroid starts to work, usually within a few days. Physiotherapy should resume as soon as pain allows. Our post-injection care guide describes warning signs to watch for.

When to Consider Back Pain Injections

• Pain persists after several weeks of physiotherapy, exercise and medication.
• Radiating leg pain limits walking, sleep or work.
• Pain prevents participation in rehabilitation.
• The clinician needs to confirm the source of pain before planning other treatments.

Urgent symptoms, such as loss of bladder or bowel control, numbness in the groin area or progressive leg weakness, require immediate medical attention, not an injection.

Benefits of Back Pain Injections

• Targeted relief with a lower dose than oral medication.
• Faster return to physiotherapy and daily activities.
• A diagnostic role that guides further treatment.
• A minimally invasive option that may help some patients avoid or delay surgery.

For joint pain in the knee, hip or shoulder, other options such as viscosupplements may be considered; see our overview of orthopedic injection types and our orthopedic injections category.

References

• Chou, R., Hashimoto, R., Friedly, J., Casiano, V. E., Brodt, E. D., Fu, R., Selph, S., & McDonagh, M. (2022). Epidural corticosteroid injections for radiculopathy and spinal stenosis: A systematic review and meta-analysis. Annals of Internal Medicine, 176(7), 957–972. https://www.aafp.org/pubs/afp/issues/2022/0700/fpin-hda-epidural-steroid-injections-low-back-pain.html​
• Zhang, J., Zhang, Y., Li, J., & Wang, X. (2024). Efficacy of epidural steroid injection in the treatment of sciatica: A systematic review and meta-analysis. Frontiers in Neurology. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1406504/full​
• Lee, J. W., Myung, J. S., Park, K. W., Lee, S. J., & Kim, J. H. (2012). Transforaminal epidural steroid injection in lumbar radiculopathy: A systematic review and meta-analysis. European Spine Journal, 21(2), 440–448. https://pmc.ncbi.nlm.nih.gov/articles/PMC3265602/​
• Narayanaswami, P., Dhall, R., & Qureshi, A. (2025). Efficacy of epidural steroid injections for chronic back pain: A systematic review. Neurology. https://practicalneurology.com/news/a-new-systematic-review-summarizes-the-efficacy-of-epidural-spinal-injections-for-chronic-ba​
• Liu, K., Wang, H., & Xiao, J. (2024). Epidural steroid injection for the treatment of sciatica caused by disc herniation: A meta-analysis. Pain Physician, 27(4), E321–E332. https://pmc.ncbi.nlm.nih.gov/articles/PMC11150834/​