Cortisone Injections… Good or Bad?

Whether cortisone injections are good or bad depends on further clarification of the question.  Good or bad for what exactly?

Is it good for helping an injury heal?

What about pain relief?

For years I’ve had clients ask my opinion about them getting shots but I was never really certain about the facts.​ So I turned to the clinical researchers for some answers.

​Here’s what I found out:

More Facts Regarding Cortisone Injections:

There are zero long-term benefits for herniated discs BUT they don’t seem to make you any worse either.

Cortisone shots not only increase long-term re-injury rates for tendon injuries, but the more shots you get, the worse off you are.  Why?  Things like tennis elbow were once believed to be caused by inflammation – tendonitis – but are now known to actually be degeneration of the tendon – tendinopathy.  Cortisone degrades the tissue even further!

So What Should You Do?

Definitely see a physical therapist.  In every study I read, physical therapy groups had the best long-term outcomes.

Already saw a therapist but not happy with the results?  Ask around for recommendations and go see a different one.

Want to do something for your tennis elbow today?

Here’s my post showing you a tennis elbow treatment that has clinical research on its side.

 

 

References & Further Reading

Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Epicondylalgia

JAMA, February 6, 2013-Vol. 309, No. 5

Efficacy and Safety of Corticosteroid Injections and Other Injections for Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials

The Lancet, November 20, 2010-Vol. 376, Issue 9754

Epidural Corticosteroid Injections for Sciatica Due to Herniated Nucleus Pulposus

NEJM, June 5, 1997-Vol. 336: 1634-1640

Phys Ed: Do Cortisone Shots Actually Make Things Worse?

By Gretchen Reynolds, NYTIMES.COM

4 comments

  • Watched the video on PT vs cortisone. Was there a group that did cortisone shot and PT? If so. How did they fare at 1 yr?
    I am doing PT for l5 discogenic issue but still in pain and considering a shot. And yes I’m over 50 and active.

  • Sorry, there wasn’t a group the did both. My assumption is that the when the shot takes the pain away for a while, patients are less motivated to continue with PT. Plus, you are less aware of a movement that may be aggravating the injury.

  • Had cubital tunnel syndrome, forearm severe shooting pains, also numb, tingling outer fingers. Feel solution was time, shot, PT. Nerve damage takes a very long time to heal. First couple of years had a shot twice. Had lots of PT that was all therapist assisted with slow movements and massage that really did not resolve this. Had homework every day, too. PT followed the advice of the SOREHAND internet group that dealt with the soft tissue injuries. Third year things were toned down but still an issue. Had another shot on a flare up. This was followed in a few months by rotator cuff surgery for bone spurs cutting tissue. Had PT but in a month or so of mild ROM and mild stretching I developed frozen shoulder. Surgeon ordered aggressive PT. Total PT lasted about 4 or 5 months. At the end of that my entire body was “cured”. The aggressive PT worked through phases of ROM, stretch, strengthen up to machines for rowing and such, increasing resistance. The “aggressive” part was pushing my ROM into pain, but after each session I could freely move my arm a little bit more without pain. Heat before, ice after. I needed the therapist to push further than I alone could have done. I knew we were doing some breaking up of tissue. And I had homework 3 times a day every day. I was then about 55, female, computer worker. Today 10 years later I am fine. Actually I think the original cubital tunnel problem was caused by a blood clot in the slot I can feel in my elbow – there was a lump there for a long time. Doctors never remarked on that – if that was dissolved early on I might not have had the problem so strongly – and then that lump went away so I knew. I had been sitting a full weekend without leaving the house setting up a new computer, from dawn to bedtime. The numbness and tingling started Monday.

    Interesting, I am now dealing with frozen shoulder in the other side. The surgeon this time is not ordering aggressive PT, may be that this is not following surgery. The MRI proved thickening and edema. My problem is I can’t get my hand behind my head or behind my back, so I have good movement and strength otherwise. He gave a shot and said let it rest, his concern was about the inflammation, he did say he was concerned about PT with the small partial tear found (I am now 68). However, with so much on the internet and great PT videos, I am doing exercises. I am doing ROM now without weights. Lying on my back, in each direction, I move the arm back and forth up to discomfort, 30 times, gaining a little more movement. I repeat the ROM positions 5 times, 4 times a day. I am slowing gaining movement, ice afterwards, no added pain during day. I also joined a senior fitness class twice a week that gives an hour of ROM, stretching, and light strengthening with 2 lb. weights and then light bands (you can adjust as you need to). There are a few exercises I don’t do yet.

    Also, a note on carpal tunnel. 10 years ago I had some of that as well. What cured that was having a ruptured lower lumbar disc. The spine PT had me on the floor doing half sit-ups – pushing up my upper body leaving hips on floor to arch the back. The goal I believe was to keep the spine limber while it healed. In the beginning, every hour, 3 sets of 10 push-ups. In a month, the wrists were cured. In two months the therapist said symptom at that point looked like a spine nerve was glued in place, thus the pain still going down my leg, so 2 of them spent a lot of time twisting me into a pretzel, and that worked, the nerve broke free and the pain was gone, freedom !

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