A Lumbar Epidural Steroid Injection (LESI) is a common, minimally invasive procedure used to treat lower back and leg pain, often called sciatica. This pain usually results from inflammation irritating a spinal nerve root, often due to a herniated disc or spinal stenosis. The injection delivers an anti-inflammatory corticosteroid into the epidural space, which surrounds the spinal nerves, to reduce swelling and pressure. Following post-procedure instructions is essential for safety and maximizing the injection’s effectiveness.
Immediate Care and Activity Restrictions
The first 12 to 48 hours following a LESI require specific limitations to allow the medication to settle and the injection site to heal. You must not drive for the remainder of the procedure day. The local anesthetic can cause temporary numbness or heaviness in the legs, which impairs your ability to operate a vehicle safely. Arrange for a responsible adult to drive you home and plan to rest in a reclined position for the first 24 hours.
Physical activity must be restricted during this initial period to prevent undue stress on the treated area. Avoid strenuous exercise, excessive bending, or twisting motions of the back. Limit heavy lifting to no more than five to ten pounds for at least the first week following the procedure.
Proper care of the injection site helps prevent infection and manages local discomfort. Keep the small dressing or bandage clean and dry, and typically remove it the following day. For 48 hours, avoid submerging the injection site, meaning no baths, hot tubs, or swimming.
You can apply an ice pack to the injection site for 10 to 20 minutes at a time to soothe localized soreness or tenderness. Avoid applying heat, such as a heating pad or hot compress, for at least three days post-injection. Ice helps reduce surface inflammation, while heat may increase blood flow and potentially dissipate the steroid medication too quickly.
Managing Expected Post-Injection Symptoms
It is normal to experience a temporary return or increase in your original pain once the local anesthetic wears off a few hours after the procedure. This reaction, often called a “pain flare,” is an expected part of recovery. The flare occurs because the injected fluid temporarily increases pressure within the epidural space, slightly irritating the sensitive spinal nerves.
This temporary discomfort should subside within 24 to 48 hours as your body adjusts and the corticosteroid begins its anti-inflammatory action. Another element is that other common, transient side effects include facial flushing or a feeling of warmth, sometimes called a “steroid flush.” The corticosteroid can also temporarily cause difficulty sleeping or mild anxiety, which typically resolves within one to three days.
Patients with diabetes must closely monitor their blood sugar levels, as the steroid medication can cause a temporary elevation. Discuss any necessary medication adjustments with your prescribing physician ahead of the procedure. To manage the post-injection pain flare, over-the-counter pain relievers like acetaminophen are acceptable.
Confirm with your provider whether you can use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, as these are sometimes restricted immediately following the procedure. If you were prescribed a specific pain medication, take it as directed to manage the discomfort. The goal is to keep the pain manageable while the steroid begins to work, not to eliminate it completely.
Monitoring Recovery and Recognizing Warning Signs
The therapeutic effect of the corticosteroid is not immediate, so it is important to have realistic expectations regarding the timeline for pain relief. This delay is known as the “steroid lag.” It typically takes three to seven days for the medication to fully begin reducing nerve inflammation. Maximum relief is often not felt until approximately two weeks post-injection, though some patients may feel improvement sooner.
After the initial 48-hour rest period, you can gradually return to light activities such as walking. Low-impact exercises like swimming, cycling, or using an elliptical machine are safe to resume after three to five days. Avoid high-impact activities like running or contact sports for at least two weeks. Slowly increasing your activity level while monitoring your body’s response helps prevent re-injury and promotes the long-term effectiveness of the injection.
While a LESI is a safe procedure, recognize rare but serious symptoms that require immediate medical attention. A persistent, severe headache that worsens significantly when you sit or stand upright may signal a dural puncture. This occurs when spinal fluid leaks out of the protective covering around the spinal cord. Report this symptom to your doctor right away.
Signs of a possible infection, though uncommon, include:
- A fever of 100.5° F or higher.
- Chills.
- Significant warmth, swelling, or drainage at the injection site.
New or worsening neurological symptoms are urgent warning signs and should prompt an immediate trip to the emergency room. These include sudden, severe weakness, new numbness in your legs or arms, or loss of bowel or bladder control, which could indicate a serious nerve compression issue.