What is the Deal with Cortisone Injections?
By: Kelsie Mazur, DPT
Picture this: you wake up only to notice your knee pain from several years ago, has flared up. You manage to get through the day and work through the pain for the next few weeks, but the pain is interfering with your workouts, the ability to climb stairs and you haven’t made it to pickleball in weeks! You make an appointment with an orthopedic doctor and they give you 4 options: surgery, physical therapy, medication, or injection. This week's blog is all about the last option, Cortisone injections. I’ll explain what they are, how they may or may not benefit you, and when the most appropriate time to use them is… let’s get into it!
When it comes to injections, cortisone is definitely the most used type of steroid for musculoskeletal aches and pains. But what is cortisone anyway? Cortisone (a corticosteroid) injections are a type of medication that helps reduce inflammation and pain. They work by mimicking a hormone called cortisol, which our body naturally produces to help control inflammation. When you get a cortisone injection, it helps calm down swelling and irritation by reducing the chemicals that cause inflammation and by limiting the activity of certain immune cells that can contribute to your brain perceiving/feeling pain and swelling. This can provide relief and help you feel better, faster in joints like the knee, shoulder, and hip.
An important theme to remember while reading the blog is this: Cortisone decreases inflammation & provides short-term pain relief. It does not help heal any tissues, in fact it may decrease the likelihood of allowing tissues to get stronger.
Cortisone injections can offer temporary pain relief, giving you a chance to tackle issues that are too painful to address here and now. For example, we would tackle your knee pain (mentioned above) by strengthening the muscles around your knee, but if we find that you simply cannot (and all other measures to reduce pain have been exhausted) because of the discomfort, then cortisone MAY help reduce that pain. This temporary relief makes it easier for you to work on building strength and improving function, leading to more lasting improvements.
The most important thing is the simple fact that while cortisone is a great invention modern medicine graced us with, the inflammatory process your immune system and body go through after and during an injury is both natural and essential for healing and making our bodies resilient. In other words, toughen up and ride out the pain while working with your physical therapist and you will start to feel better!! I guess a more professional way to put it is: Cortisone is not a first line defense for injuries to a joint like meniscal tears, hip pain, osteoarthritis, shoulder impingement. Hopefully, a good physical therapist probably explained this to you in the past.
So, what are the downsides of cortisone injections?
As a physical therapist, I rarely recommend cortisone injections and truly love to educate my patients on the negative aspects of cortisone injections. Multiple studies, including the one linked here clearly state that the long-term effects of cortisone include the breakdown of really strong joint tissues, wearing away these structures over time. That’s why most MD’s will not inject the same joint twice in a year. I am sure yourself or someone you know has received a cortisone injection in the past, and you’ve most definitely experienced or heard them say that the cortisone wore off and the pain is back. That’s right folks, cortisone is only temporary and the result is different in every single person. While some will feel relief for 3-6 months, others might feel their pain after 2 weeks. Furthermore, err on the side of caution when a doctor recommends a cortisone injection for tendinopathies like golfer’s elbow, tennis elbow, hip labral injuries, and any type of “impingement,” as the efficacy of corticosteroids is minimal and low for reducing pain. But movement based physical therapy is actually proven to improve function.
To wrap this up, inflammation is normal, natural and okay to experience. Especially if you’re experiencing symptoms from arthritis, a new injury, or a chronic injury that you never sought out physical therapy for. Cortisone injections have a very specific time and place for specific orthopedic injuries such as frozen shoulder. The decision to receive a cortisone injection should not be taken lightly. You should seek out advice from a movement specialist like a doctor of physical therapy before receiving an injection. In closing, cortisone injections are not a cure-all, but can be a helpful tool in the tool-kit if deemed necessary to assist with pain relief.
If you or someone you know is thinking about getting a cortisone injection, chances are physical therapy can help as a first line of defense and potentially deter you/them from an unnecessary doctor’s visit, foreign steroid in the body, and a hefty bill in the mail months later! Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.