Epidural steroid injections for hip pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

To better explain an epidural steroid injection (ESI), it is helpful to understand the anatomy. There is a membrane called the dura covering the nerve roots in the spine. Around the dura is a sleeve-like space called the epidural space. Before nerves can travel from the spine into the legs, they travel through the epidural space, and exit through small nerve holes.

An epidural steroid injection delivers steroids into the epidural space around spinal nerve roots to relieve pain - back pain, hip pain, leg pain, or other pain—caused by irritated spinal nerves. Hip and leg pain are common symptoms when a patient has a “pinched nerve” in the lumbar area.

The steroid used in the epidural steroid injection reduces the inflammation of those nerves, which is often the source of the pain. The inflammation is felt to be due to presence of substance P and other cytokines. It is important to note that an epidural steroid injection should not be considered a cure for back pain or leg pain. The goal is to help patients get enough pain relief in order to be able to progress with their rehabilitation program.

An epidural steroid injection significantly reduces pain for approximately 50% of patients. It works by delivering steroids directly to the painful area to help decrease the inflammation that may be causing the pain. It is felt, perhaps, that there is also a flushing effect from the injection that helps remove the inflammatory proteins from around the structures that may cause pain. In addition to relieving pain, the process of natural healing can occur more quickly once the inflammation is reduced.

Spinal nerves can become inflamed due to irritation from a damaged disc or from contact with a bone spur. Depending on which part of the lumbar spine the inflamed nerves are located in, pain and/or other symptoms (such as numbness, tingling) may be experienced in the low back, hip, buttock, or leg.

The injection procedure for an epidural includes the following steps:

• The patient lies face down or sits up on the examination table and the skin is well cleaned with an antiseptic.
• The area where the epidural needle will be inserted is numbed with a local anesthetic.
• A combination of numbing medicine (an anesthetic) and time released anti-inflammatory medicine (a steroid) is injected.


The procedure usually takes approximately 30 minutes, followed by about 45 minutes of recovery time at the clinic. On the day of the epidural steroid injection the patient should not drive. Rest is needed and strenuous activities must be avoided on the day of the epidural steroid injection.

Following the epidural injection, some partial numbness from the anesthetic may occur in the patient’s legs. Any partial numbness usually subsides after a few hours.

Epidural injections should be administered using either ultrasound or fluoroscopy for needle guidance.

There may be an increase in the patient’s pain that may last for up to several days. This may occur after the numbing medicine wears off but before the steroid has had a chance to work. Ice packs may help reduce the inflammation. Improvements in pain will generally occur within 10 days after the epidural injection, and may be noticed as soon as one to five days after the injection.

On the day following the procedure, the patient may return to his or her regular activities. When the pain has improved, regular exercise may be resumed in moderation. Activities should be increased slowly over one to two weeks to avoid recurrence of pain.

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