Epidural steroid injections (ESIs) are a common treatment for back and neck pain from inflamed spinal nerves. These injections deliver anti-inflammatory medication, typically corticosteroids, directly into the epidural space. While ESIs can offer significant pain relief and improve function, patient safety depends heavily on adhering to specific post-procedure instructions. Understanding what actions to avoid after an ESI ensures proper healing and maximizing therapeutic benefits.
Immediate Post-Procedure Precautions
Immediately following an epidural steroid injection, precautions are necessary for the first 12 to 24 hours to prevent complications and support recovery. Driving is not advisable immediately after the procedure due to the potential for lingering effects of sedation or temporary numbness in the legs or arms. Have someone drive you home and refrain from operating a vehicle for at least 12 to 24 hours.
Activities involving immersion in water (baths, hot tubs, swimming) should be avoided for at least 24 hours to minimize infection risk at the injection site. Showering is usually permissible after a few hours, but avoid scrubbing the injection area. Alcohol consumption is also discouraged for at least 12 to 24 hours, as it can impair judgment and balance, increasing the risk of falls.
Patients should also avoid strenuous activities like heavy lifting, bending, twisting, or vigorous exercise during this initial period. These movements can strain the injection site and potentially exacerbate pain or lead to complications. Making important decisions or signing legal documents should be postponed for at least 12 to 24 hours, especially if sedation was administered, as judgment and cognitive function may be temporarily affected.
Activity and Lifestyle Limitations
Beyond the immediate post-procedure period, activity and lifestyle limitations remain important for several days to weeks to allow the steroid to take full effect and facilitate healing. Heavy lifting and high-impact activities should continue to be avoided for a specified period, often limiting lifting to no more than 5-10 pounds for the first week. This precaution helps prevent increased pressure on the spine and allows the corticosteroid to reduce inflammation effectively.
Specific movements that place excessive strain on the spine, such as deep squats, certain yoga poses, or repetitive bending and twisting, should be avoided until a healthcare provider clears them. While rest is important, instead, a gradual return to normal routines is encouraged. Light activities like short walks can improve circulation and prevent stiffness, but listen to your body and avoid pushing through pain.
Applying heat directly to the injection site should be avoided for at least 3 days. Heat can increase inflammation, counteracting the anti-inflammatory effects of the steroid. Instead, apply ice or cold packs to the injection site for 10-20 minute intervals to reduce any soreness or discomfort.
Recognizing and Responding to Concerns
While epidural steroid injections are generally safe, it is crucial to be aware of certain signs and symptoms that warrant immediate medical attention. Ignoring these concerns could lead to serious complications.
Signs of infection at the injection site include increased redness, swelling, warmth, tenderness, pus-like discharge, or a fever (100.5°F or higher). Although rare, infections can develop deeper in the spine.
Neurological symptoms are also a concern. These can include new or worsening numbness, tingling, weakness in the arms or legs, vision changes, severe headache (especially one that worsens when sitting or standing), or new loss of bowel or bladder control. These symptoms could indicate nerve damage, a spinal fluid leak, or other serious issues.
A temporary increase in pain or soreness at the injection site is common for a few days. However, report significant or worsening pain not relieved by typical methods. Allergic reactions can occur, presenting as a rash, itching, swelling, or difficulty breathing. Contact your doctor or seek emergency medical care immediately if any concerning or unexpected symptoms arise after an epidural steroid injection.