As massage therapists, we often see patients who have been struggling to find an answer for a particular pain problem. Some of these cases are acute (sudden onset) where others may be chronic (reoccurring over a long period of time). It is not uncommon to have a patient ask us if they think they should get a cortisone shot when a pain seems stubborn and just won’t go away. Sometimes, it comes from a recommendation made by their doctors, but most of the time, it is due to what they have heard or read about on-line.
The idea of cortisone seems like a forsaken means for treating pain problems by many holistic professionals, but as someone who will be the first to deter you from getting one at the first indication of pain, I have to say, they most definitely have their place in pain management.
The most common misconception about these injections is what they are actually doing. Most believe that they are a ‘pain reliever’. Indirectly, this is true. What they are actually doing is getting rid of the inflammation that is CAUSING pain. Sometimes the body (or brain) can get itself stuck in a perpetual loop of inflammation. This continuous inflammatory process can sometimes be slowed with NSAID’s (Non-steroidal Anti-inflammatory Drugs), but the brain, in all of its infinite wisdom, quickly restarts the process the moment stress is placed upon the injured area. Your brain will always follow the path of least resistance to solve its problems.
A cortisone injection will essentially create a stop-gap in the reoccurring inflammatory process and allow the tissues to begin to heal again properly IF/WHEN AN APPROPRIATE TREATMENT PLAN IS FOLLOWED. This is typically where the waters get murky.
Most who have the injection feel an immediate relief of the pain. This leads them to think that they are all better and can resume normal activity. Without appropriate advice from their doctor, it can lead to more problems. The pain may be gone (good for you), but the tissue is still weak and dysfunctional (bad for you). The appropriate rehabilitation plan MUST be followed to repair the damaged tissue(s), otherwise, they will continue to deteriorate and weaken. Within a few months, the cortisone injection ‘wears off’ and the pain, not surprisingly, returns. This is when many people opt for another injection. Hence, the bad rap on cortisone. Don’t blame the messenger.
There are many reasons to limit the amount of cortisone injections you receive both in a year and in a lifetime. They can have negative side effects too. The factors may be due to your age, the area/tissue being injected as well as other personal health risks. Always speak with your doctor about the side effects prior to any injections.
Cortisone injections, when used as a part of complete treatment strategy can be a god sent to those in pain….like me. I have been suffering for the past 15 years with intermittent elbow pain (putting that mildly). In recent months, due an increased load on my forearm from both work and softball, my pain became intolerable. I couldn’t brush my teeth, wash my hands or comb my hair without feeling like a knife was being jammed into my elbow. A recent MRI revealed partial tearing of some tendons. Surgery was perhaps an option, but cortisone was the recommended approach at this stage. (No one likes to go “under the knife”)
Having received the injection, my pain is 95% gone. However, the tendon tears are still 100% in existence. Before I can return to full activity, I must take the appropriate time to repair these tendons (4-6 weeks) and allow for them to properly strengthen. Failure to do this will likely result in continued tearing and eventually, even more pain over the next 6 months once the cortisone is out of my system. Those that skip this crucial step will typically find themselves back at the doctor asking for another injection. This is when you can run the risk of negative side effects from too much cortisone as well as tissues that are deteriorating even more.
There are certain conditions that cortisone is not recommended, such as in the Achilles tendonosis or Plantar Fasciitis. Cortisone can soften tendons, making the Achilles more susceptible to tearing due to the fact that it acts as a crucial spring system in our gait. Injecting the plantar surface of the foot has been shown to deteriorate the fat pad in the heel, causing further foot pain. This is why it is always a good idea to speak with your doctor and not your running friends, coworkers or Google when determining the future of your health.