Cortico-steroid injections is a highly debated topic amongst medical professions.

What is Cortisone?

Cortisone is a powerful anti-inflammatory that is given in the form of an injection to help relieve pain and inflammation. Cortisone is a hormone that we produce naturally from our adrenal glands. Cortisone is released in response to stress to prepare the body for fight or flight mode. Cortisone supresses the immune system, reducing inflammation and pain.

Cortisone has many uses, however in this BLOG, we will be focusing on corticosteroid injections used for musculoskeletal conditions.

What are Cortisone injections used for?

Cortisone injections are commonly used to help with short term relief of many painful musculoskeletal conditions by reducing inflammation. Some common conditions include:

• Bursitis (trochanteric/hip, ischial (hamstring), retro-achilles)
• Tendonitis (however recent studies have recently shown that little to no inflammatory changes occur in tendons, therefore cortisone is not regularly injected into tendons, unless inflammation is present and conservative management has failed)
• Carpal tunnel
• Chronic plantar fasciitis
• Tennis elbow
• Sciatica
• Arthritic joints
• Adhesive capsulitis
• Adhesive capsulitis
• Neuromas
• Trigger finger

Cortisone takes roughly 2-4 weeks (or sometimes even longer) to have a pain-relieving effect. And even then, these benefits are often only reported in the short term, having no long term benefits following corticosteroid injection (ref, ref).

However, everyone responds very differently to cortisone injections. Those who report only short-term relief are usually those who have been experiencing this pain for a long time and haven’t quite figured out how their pain developed in the first place. In order to get long term relief, it is important to understand the underlying cause of the condition. This may be due to:

• Altered or poor movement patterns
• Weakness
• Stiffness
• Increased load and stress
• Positioning? (e.g – ergonomic set up)

If the underlying cause of the condition is not treated, then unfortunately once the cortisone wears off, the pain may return.

Are Physiotherapists against cortisone injections?

As mentioned above, there is not much evidence for cortisone injections used ALONE and there is also no long-term benefits of corticosteroid injection– however, when used in COMBINATION with physiotherapy, it can prove positive outcomes in the short and long term.

Some people really struggle to exercise because they are so limited by their pain. We believe there is a time and place for cortisone injections and initially receiving an injection can help to break the pain cycle and allow a lot of people to participate in Physiotherapy with little to no pain. A Physiotherapist will get to the bottom of WHY you are in pain and HOW to manage and treat your condition.

It is recommended that a cortisone injection is only given greater than six weeks apart and usually no more than three or four times a year.

Negative effects of cortisone injections

• May weaken tendons
• May make tendons vulnerable to rupture
• May delay healing process
• Softens cartilage (amongst people who receive several cortisone injections). Something to think about if you are considering getting a cortisone injection to help with your arthritis.
• Local soreness from injection
• Potential infection

Conclusion

Considering there is no long-term benefits of using corticosteroid injection as a single treatment as well as the many detrimental effects of cortisone injection use, we highly recommend being reviewed or talking to your Physiotherapist prior to receiving an injection.