Cortisone Injections: Magic Pain Juice or Simply Silencing Your Body’s Alarm System
Updated: Jan 17, 2021
No...not those kind of steroids.
Cortisone is a synthetic (man-made) version of a hormone commonly found in the body: Cortisol. Cortisone mimics the effects of cortisol in your body but tends to create a much stronger response in regards to reducing inflammation in and around tissue. Not to be confused with Ibuprofen, Tylenol, Aleve (Naproxen/Naproxen Sodium), etc. which are all Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Steroidal vs. Non-Steroidal
Corticosteroids can be taken orally, given via IV or injected directly into a joint.
Cortisone is typically prescribed to treat:
Bursitis Osteoarthritis (OA)
Plantar Fasciitis Rotator Cuff Problems
Carpal Tunnel Tendonitis/Tendinosis
Tennis Elbow Golfer’s Elbow
While the generally accepted word on the street is that cortisone is a wonder drug; a magical pain eliminating juice…and sometimes it is. But sometimes it’s not.
The purpose of the injection can vary from doctor to doctor. Sometimes the injection helps the doctor in ruling in or rule out a specific condition, it can sometimes provide immediate pain relief or it can allow for other, more conservative treatments to become more effective.
Results vary from patient to patient. Some patients see complete resolution of symptoms whereas others notice no changes in symptoms. Sometimes the dampening of symptoms lasts only 2 weeks while in other cases it can last upwards of 1 year.
Unfortunately, the purpose of the injection is not explained in a clear way or not explained at all to the patient, it’s simply sold as “this should help with the pain and inflammation.”
The issue with injections as a means of treating a problem area is that the source behind the symptoms is rarely ever addressed. If the injection is effective the symptoms are calmed down or even eliminated outright.
Inflammation and angry tissue do NOT randomly appear. Inflammation tends to occur when muscles, ligaments, tendons, cartilage and/or bony surfaces are chronically overused, overloaded and abused.
When these tissues become chronically irritated they become inflamed which causes pain.
Pain is your body's security system. It is how your brain communicates to you that something is wrong and you need to change your behavior.
Specifically, with musculoskeletal issues, it is your brain's way of telling you that you're overloading tissue and causing harm.
Shy of a major trauma, the pain/inflammation is a direct result of faulty mechanics. These faulty mechanics may be the result limited range of motion, poor strength, poor muscular endurance or some combination of these three.
When you receive an injection, it wipes out the inflammation which effectively silences the alarm system meaning the inflammation and pain are gone/reduced BUT the faulty mechanics remain.
The injection will not make you stronger or restore missing range of motion.
Read that one more time.
The injection will not make you stronger OR restore missing range of motion.
Your body will continue to hunt for ways to work around the deficits which will lead to more tissue irritation/overload. Meanwhile the security system is still going off but you just can’t feel it anymore.
Loads of research has been done on the efficacy of cortisone injections with unsurprising results.
In one study, a group of patients received an injection and were told to rest for a period of time. Most of the participants saw improvements in overall pain with symptoms subsiding and upon return to activity/exercise their symptoms almost immediately returned.
The second group received the injection but attended regular PT visits. The resulting effect?
Symptoms calmed down with the injection + PT approach.
And when these patients returned to activity/exercise?
Symptoms did not return
So what does this tell us?
Using an injection to calm symptoms down allows PT to be more effective at addressing long standing mechanical deficiencies!
Don't just get an injection and continue to abuse tissue because the likelihood of failure with this method is much higher. Tendons rupture, cartilage wears out, etc.
If you use the injection to feel better while fixing the mechanical issues the likelihood of tissue failure all but fails off.
So if you're having pain and considering an injection or have already received one and you're not participating in Physical Therapy, let us know. We'd love to help you out in returning to doing what you love.
Give us a call or text us directly (HERE).