Cortisone Cons
Thinking of getting cortisone shots? Know your options and the risks!
Cortisone shots numb the pain, and for some people they work very well. However, they may cause degeneration and breakdown of the cartilage and collagen fibres in joints, tendons, and ligaments, causing increased pain after the shot wears off because there is further injury and instability in that area. This is why use of cortisone shots in one person are limited per area and per year. For the people for whom cortisone doesn’t work, common reactions are: no pain relief at all, and some pain relief but then worse pain when it wears off.
Cortisone is a very powerful anti-inflammatory, so it makes sense to use it if inflammation were the root cause of pain. However inflammation is usually the side effect of other processes, and it’s one of the ways the body indicates to the immune system where healing needs to occur. So by suppressing this inflammatory response, you also suppress the healing response. This is why it works for some people but not for everyone, it’s not actually getting at the root cause of the pain.
A shot alone is never enough
Injuries from sports and overuse are only not only due to weakened tissues like ligaments and tendons, but also involve an improper alignment or musculoskeletal balance around that area. So ignoring rehabilitation of that joint’s tissues and use of that joint is to just set yourself up for the same injury again in the future. I feel very strongly that no matter what pain relieving shot is being used, that exercise and mobility are being utilized to change how those tissues move and function so that the pain is less likely to come back in the future.
In conditions like arthritis, where long term inflammation is associated with joint tissue damage, cortisone is still only temporarily helpful, and becomes less effective at pain relief the more injections you get. In comparison, prolotherapy is associated with an increase in hyaline cartilage within an arthritic joint as well as long term pain relief. Hyaline cartilage is the protective cartilage layer that lines the bones within a joint. It is also called “articular cartilage”. Arthritis is a degenerative condition of this hyaline cartilage and eventually the bone underneath it. Building up this tissue helps reverse some of the damage from this condition, and addresses the root cause for the pain. So prolotherapy stimulates tissue regeneration and restarting the healing response, rather than squashing it.
Even in conditions like bursitis, an inflammation of joint tissue, cortisone is being used increasingly less because treatments like dry needling that have far less side effects are just as effective as cortisone shots at reducing pain and increasing functional use of that joint.
But for those for whom damage is very bad, or they have failed to respond to other treatments, cortisone can be an amazing option!
The Coles notes
Cortisone treats symptoms, but prolotherapy and other RIT along with proper strengthening physiotherapy treat the root cause and strengthen that area which reduces pain and repairs the injury. Cortisone is great to have as a last resort if it is needed, but should be utilized as a last resort, rather than one of the first.
“If pain and signs of inflammation are persistent, repeated efforts to turn off the body’s alarm is not a substitute for finding the cause of the fire. Indeed, to remove the ‘fire alarm’ of pain from the onset of an injury can clearly place the athlete in great jeopardy with respect to tissue overload and failure.” (Leadbetter, 1995)
Interested in learning more? Dr. Shannon offers prolotherapy and ozone treatments here at the clinic! Book a free 15 minute meet and greet to see if you might benefit from these therapies and ask any further questions you might have!
References
Brennan KL, Allen BC, Maldonado YM. Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: A non inferiority randomized clinical trial. J Ortho Sports Phys Ther. 2017. 47(4): 232-239.
Leadbetter WB. Anti-inflammatory therapy in sports injury. The role of nonsteroidal drugs and corticosteroid injection. Clin Sports Med. 1995. 14(2): 353-410.
Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014. 35(4): 313-8.
Topol GA et al. Chondrogenic effect of intra-articular hypertonic-dextrose (prolotherapy) in severe knee osteoarthritis. Physical Medicine and Rehabilitation. 2016. 8(11): 1072-1082.
