A cortisone injection can reduce pain and inflammation for weeks or sometimes months, which can make it easier to exercise and rehab an injury. The downside is that it does not treat the cause of the problem, the relief is usually short-term, and for some conditions repeated injections can weaken tendons or cartilage.
The cortisone injection debate: pros and cons
Imagine you are two weeks out from the local triathlon and your shoulder has progressively worsened. You hear about the corticosteroid injection (or ‘cortisone shot’) and naturally you are drawn towards the promise of fast results. However, there is a saying ‘if it seems too good to be true, it probably is’. In many ways this applies when corticosteroid injections are used without a clear plan 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 guide 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 bodybuilders, 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
- Golfer’s elbow
- Bursitis of the hip, knee or shoulder
- Frozen shoulder
- Plantar fasciitis
- Carpal tunnel syndrome
- Herniated disc
- Rotator cuff injury
- Tendonitis
The pros and the cons
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 can work very well. However, many studies have drawn attention to the common side effects, and to poorer longer-term outcomes for some conditions.
A 2013 study of people with tennis elbow found that those who had a corticosteroid injection had less pain in the short term, but a lower rate of full recovery at 12 months and a higher rate of relapse. It is because of findings like these that many health professionals are concerned that reducing inflammation might mask a more serious injury. Studies have also shown that high doses of cortisone or repeated use can damage tissue, 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. They can help the pain settle, however, they do not address 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 happened in the first place because of weak scapular (shoulder blade) stabilisers or muscle imbalances. If you don’t treat the source of the injury, the pain is more likely to come back. 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 giving the cortisone injection’. Cortisone is most effective if it is delivered to the exact area of inflammation, and many injections are given under ultrasound guidance to help with accuracy. Some very experienced sports physicians may give certain injections without ultrasound. Cortisone given in the wrong area is unlikely to reduce your pain.
When might cortisone be appropriate?
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.
When deciding whether or not to have the injection, it is important to understand that cortisone is usually a short-term treatment and its effects often wear off. For many musculoskeletal problems, exercise-based treatment such as physiotherapy is a good place to start, either on its own or alongside an injection. Talk with your GP about the risks and benefits of each option for you and your condition. 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 focuses on long-term recovery, working out the drivers of your pain, to improve your function and movement for activities as simple as getting dressed, to competing in triathlons. If your shoulder is the problem, you can read more about shoulder pain.
