Cortisone. We have all heard the name. Some of you probably know someone who has been treated with it – It may have been you. But what is cortisone and what does it actually do? Could cortisone actually make things worse? Let’s dive in and find out.
The emergence of cortisone started in the late 1940’s and it was immediately heralded as the safest and most reliable means to treat pain and inflammation. Cortisone shots very quickly became the standard for overuse injuries, like “Tennis Elbow,” Achilles “Tendonitis,” “Bicep Tendonitis” and “Plantar Fasciitis.” Cortisone remains the standard today.
Cortisone, closely related to cortisol and also produced naturally in the body by the adrenal glands in response to stress, acts to suppress the immune system resulting in reduction of inflammation, pain, and swelling at the site of injury. Cortisone is primarily used in the short term and typical results provide several weeks to months of relief. Sounds good, right?
Not so fast. A recently published review examined the results of several randomized trials, involving thousands of participants with overuse injuries. These studies did find that, in the short term, cortisone did work to relieve pain better when compared to doing nothing (no shock there) or physical therapy. But what the review also states is that when the same participants were reexamined 6 and 12 months later, not only did they have a LOWER rate of recovery than the other test group, they also had a significantly HIGHER chance of RELAPSE!
So why is this? Cortisone shots are used for the treatment of INFLAMMATION! Overuse injuries do not involve INFLAMMATION! More research is now showing overuse injuries (“Tennis Elbow,” “Golfer’s Elbow,” “Achilles Tendonitis,” “Plantar Fasciitis,” etc.) to be DEGENERATIVE! That means that the tendons of the involved structures actually begin to fray with overuse.
But why does cortisone work in the short term then? Cortisone has an undeniable effect on the nervous system. Cortisone increases the body’s pain threshold, increasing it in the short term. This is why you no longer have pain and can return to regular activity. But this is also why the pain returns after the cortisone wears off! Pain is a protective mechanism of the body. Pain is the body’s way of telling you to stop doing what you are doing. When pain is overridden, the degeneration of the overuse injuries continues to occur leaving you worse off than when you started.
So what should you do? With any degenerative injuries, the tendons and other soft tissues must be restored. The best way to do this is by getting a proper diagnosis! Far too often these injuries are misdiagnosed.
Once a proper diagnosis has been established, you can begin the right treatment for your problem. Most often this treatment includes, manual therapy and at-home exercises. Bracing and load management are possible options for those responding to care slower than usual. Cortisone injections should be the LAST place to start with treatment!
At Thrive Spine and Sport, we pick up where others have failed. If you have been debating on whether or not to get a cortisone injection, and you live in the Cedar Rapids or surrounding areas, I invite you to fill out the appointment request on this page or call our office today at 319-423-0925 and get to the bottom of your pain! If you have any questions, please feel free to reach out to Dr. Cody Scharf at firstname.lastname@example.org.
Thanks for reading!