Before You Get a Cortisone Injection: What You Should Know

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? Lets 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,” 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!  Overuse injuries (“Tennis Elbow,” “Golfer’s Elbow,” “Achilles Tendonitis,” “Plantar Fasciitis,” etc.) are DEGENERATIVE!  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.