The post rehab professional is often faced with managing the post rehab client after a cortisone injection. I just got back from teaching our first post rehab skills workshop. During one of the workshop breaks the participants asked when is it safe to begin exercise after cortisone injection. First, understand cortisone injections are an attempt to break the “pain/inflammatory” cycle associated with an injury. Once the pain cycle is broken, exercise is used to strengthen and stabilize the area. Wait at least 24 hours before beginning any exercise after cortisone injection. The injection itself may cause pain. If the client has pain beyond the 24 hour period, wait until the pain from the injection has completely subsided before beginning exercise. Contact the client’s physician or physical therapist before you begin exercise. Start with gentle exercise and a gradual increase in intensity based on the client’s tolerance. Gentle ROM and stretching exercise followed by light resistance activities for the first one or two sessions after the injection is my recommendation then you can gradually progress back to the levels the client was able to tolerate before the injection. Remember, the cortisone is used to break the pain cycle to allow strength and stability training. The cortisone may completely eliminate the client’s pain but the underlying pathology is still present. Progressive strength and stability training is a major factor in the resolution of the condition. If later during the course of the post rehab program the client’s symptoms re-appear, contact the client’s physician immediately for program guidelines or possible referral for further evaluation.