The cortisone injection debate: Pros and Cons
Imagine you are two weeks out from the local triathlon festival and your shoulder has progressively worsened. You hear of a ‘miracle treatment’ called the corticosteroid injection (or ‘cortisone shot’) and naturally you are drawn towards the proclaimed fast and effective results. However, there is a saying ‘if it seems too good to be true, it probably is’. This saying can in many ways apply to the uneducated and inappropriate administration of the corticosteroid injection for many musculoskeletal conditions. While this medicine has been widely used to treat inflammatory pain since the 1950s, it is worthwhile being familiar with the pros and cons of corticosteroid injections to help dictate your decision.
What is a corticosteroid/cortisone injection?
Corticosteroids are medicines that mimic your body’s natural corticosteroid hormones (cortisone and hydrocortisone) produced by the adrenal glands above your kidneys. They are not the same as anabolic steroids sometimes misused by athletes and body builders, and they don’t increase your muscle strength.
Corticosteroids that are used appropriately can help a variety of conditions such as arthritis and common sports-related injuries, including:
- Tennis elbow
- Golfers elbow
- Bursitis of the hip, knee or shoulder
- Frozen shoulder
- Plantar fasciitis
- Carpal tunnel syndrome
- Herniated disc
- Rotator cuff injury
In some cases, they can reduce inflammation, relieve pain, and improve function for up to several weeks or even months. When cortisone injections work, they work really well. Still sounds like a miracle right? However, many studies have drawn attention to the common side effects, and the detrimental and failed outcomes that can result from cortisone shots.
Studies have found that people who had corticosteroid injections for tennis elbow had significantly less pain in the short term than those who had no treatment. However, they had much lower rate of full recovery six to 12 months down the track and a significantly higher rate of relapse. It is because of these statistics that many health professionals are concerned that reducing inflammation might mask serious injury. Studies have shown that high concentrations of cortisone or repetitive use can lead to tissue damage, which can lead to softening of cartilage in joints and/or weakening of tendons.
In addition to this, cortisone shots do not treat the cause of the problem. It can make the pain settle, however, it will not fix what caused you to be injured to begin with. For example, that sore shoulder of yours may feel ‘as good as gold’ after an injection allowing you to compete. However, that shoulder injury may have occurred to begin with due to poor scapular (shoulder blade) stabilisers or muscle imbalances. If you don’t treat the source of injury, the pain will no doubt come back to haunt you. It is somewhat like a payday loan, it may help you get by right now, but you can’t live on them.
The other important thing to consider is ‘who is administering the cortisone injection’. Cortisone is most effective if it is delivered to the exact area of inflammation. Cortisone delivered under ultrasound guidance is the most effective and safe mode of delivery. Some sports physicians who are very experienced may be able to deliver the cortisone without the guidance of an ultrasound machine in specific circumstances. Cortisone administered in the wrong area will be ineffective in decreasing your pain.
Cortisone is often appropriate in cases where you have trialled conservative management and the inflammation is not settling after a 6-12 week period. Sometimes pain can be a barrier to your progress and cortisone can be used to settle down symptoms and allow you to progress your strengthening program with your physiotherapist.
It is therefore very important when debating whether or not to receive the injection to understand that cortisone is only a short-term treatment and it will most likely wear off and bring you back to square one. Your first step should always be physiotherapy. You should consult your GP and discuss physiotherapy as an option for you and your condition, and weigh up the risks and benefits. The physiotherapists at Physionorth will look at the way you are moving, and assess your body as a whole to help you move and feel your best. Our team supports long-term healing, establishing the driver (or cause) of your pain, to improve your function and movement for activities as simple as getting dressed, to competing in triathlons.
In my opinion, when it comes to cortisone injections it is important to be informed and know your options. For more information consult your healthcare provider or call us on 4724 0768 to book an appointment to discuss your options with one of our experienced physiotherapists.
Brianna O’Toole Physiotherapist – Physionorth