Should I get a cortisone injection for my pain?

Questions regarding cortisone are very common within our practice, as often patients have already been advised to get an injection by a radiologist or doctor when they have had an injury investigated prior to attending Physiotherapy for management.

Having ongoing pain can be debilitating and it is only natural to want to reduce the pain as quickly as possible. Therefore it is no wonder that when a patient has been told that an injection will relieve their symptoms, that they are keen to participate with the treatment recommendation! Understanding what corticosteroid injections actually are, and the effect on the body, is important in minimising risk and wasting time and money on treatment that may not be appropriate for your particular issue.

So what is cortisone?

Cortisone is a powerful anti-inflammatory medication that reduces the inflammatory response of an injury. The medication works by decreasing inflammation. Anti-inflammatory medications can be taken orally, but this distributes the medication in very small doses throughout the entire body. A cortisone injection, on the other hand, places a large, powerful dose directly at the location of the inflammation. 

Cortisone injections can be an excellent treatment in many conditions that cause inflammation but they aren't without potential problems. Sometimes even one small dose of cortisone can effectively eliminate the inflammation at the site of the problem and alleviate the pain.

 Because cortisone injections administer a high concentration of a substance that is normally only found in small concentrations in your body, there are some risks associated with repetitive use.  Laboratory studies have shown that high concentrations of cortisone or repetitive use of the medication can lead to damage of the tissues in the body. This may lead to softening of the cartilage in joints or weakening of the tendons.

In older patients with worn out joints or damaged tendons, the concern is less significant, because the damage is already done. Use of cortisone in young healthy joints, however, should be done with caution. 

There are also certain tendons that are especially prone to rupture when treated with a cortisone injection. The most frequently encountered example is the use of cortisone around the Achilles tendon. Even when performed carefully, injections of cortisone around the Achilles can lead to traumatic rupture of the tendon.

Will it help me?

What is important to remember is that cortisone will only be effective in reducing pain if the source of the pain is from inflammation in the first place. This is NOT always the case in painful injuries or episodes. Some injuries, such as chronic pain or tendinopathy pain involve minimal inflammation, and so a cortisone has no effect on reducing pain, and can be a waste of time.

An injury that involves inflammation will show signs of heat, redness, throbbing pain or constant pain that is worse at night. Scans done of the area will show fluid. A thickened bursa or tendon on a scan is NOT an indication of inflammation.

Finally, if a cortisone injection is indicated in your instance, please remember that having this form of treatment is only a temporary measure to reduce symptoms. It can effectively reduce inflammation and pain, but if you do not address the cause of that injury in the meantime, symptoms may return. For long term improvements, you need to address the movement, activity and strength deficits that may have led to the injury in the first place. A cortisone injection can be effective in giving a patient a break from symptoms to allow them to tolerate exercises in order for them to improve in the long run.

For more information, or for a thorough assessment by one of our experienced Physiotherapists, make a booking today.