PT Myth Busters: Are Cortisone Shots Always a Good Option?
Updated: May 10, 2022
This week’s blog is about something that comes up often in the clinic, Cortisone shots. Weekly, we get asked “should I get a Cortisone shot?,” “are Cortisone shots dangerous?,” “Should I avoid cortisone shots?,” and a few other questions related to Cortisone shots. So, what is the truth about Cortisone injections?
First of all, what is a Cortisone shot exactly?
Cortisone is a synthetic version of cortisol, a steroid produced in our adrenal glands and released into the bloodstream in response to stress. Cortisone is anti-inflammatory and acts to suppress the immune system and reduce inflammation in irritated tissues. It will often be injected with Lidocaine, a local anesthetic that acts to numb areas and reduce pain.
Cortisone doesn’t actually heal the underlying problem triggering the inflammation, it just reduces the inflammation itself. Some patients feel pain relief immediately with a Cortisone shot, for others it takes weeks, and for some, they feel no different or sometimes even feel worse.
When are Cortisone shots potentially helpful?
Cortisone shots can be helpful in an isolated area of pain, such as a knee joint or shoulder joint, when you’re having a hard time getting that immediate pain relief otherwise. If you’ve already tried some PT and need that little extra something to get over the initial hurdle of pain and immobility, it may be helpful.
Cortisone shots can also act as a differential diagnosis tool. If an Orthopedist is unsure what joint is causing the pain, or if they can’t tell if the issue is an inflammatory issue vs. something else, they may use a Cortisone shot into one specific joint to see how the patient responds and get a better idea of what’s going on.
What are the potential dangers of Having One Cortisone shot?
According to Harvard Health/Harvard Medical School, injected cortisone, which is often combined with lidocaine, can clump into crystals and may worsen pain rather than relieve it. Small amounts of cortisone that have been injected into a joint can get into the bloodstream and rest of the body and have hormone-like effects that make diabetes harder to control. There’s also a small risk of a Cortisone injection actually causing joint infection.
What are the dangers of having repeated Cortisone Injections?
According to research summarized by the Mayo clinic, repeated and larger doses of Cortisone shots can have these side-effects:
Death of nearby bone
Temporary flare of pain and inflammation in the joint
Temporary increase in blood sugar levels
Tendon weakening or rupture
Thinning of nearby bone, potentially leading to localized osteoporosis
Thinning of skin and the soft tissue at the injection site
Whitening or lightening of the skin around the injection site
Given all this information, is a Cortisone shot right for me?
This will be a personal choice, given the information provided here and by your Orthopedic specialist. But this is what I tell my patients in the clinic: It is totally fine to get one or maybe two Cortisone shots into a single joint if it’s needed to get past the hump of moderate-severe, constant pain and immobility. It can be helpful in these cases to calm the area enough to allow the rehabilitation process to progress.
But I would personally avoid repeated Cortisone injections into a single joint, as it can break down the collagen in the joint, weaken your cartilage, bone, tendons, and other tissues, and actually lead to major joint damage over time. It’s important to keep in the back of your mind that many of the Orthopedic specialists recommending repeated Cortisone injections are also trained in Joint replacement surgery, so to them it’s no big deal if a joint does get to the point of total destruction, as in their mind, a feasible solution might be “well, we’ll just replace the joint when it gets to that point.” But, if you have another long-term outcome in mind that you’d prefer, you’d best steer clear of repeated Cortisone injections.
So, what are feasible alternatives to Cortisone Injections?
Physical Therapy https://www.thegrpt.com/services
Class IV laser therapy treatments https://www.thegrpt.com/services
Short-term course of oral NSAIDs
Anti-inflammatory diet (one simple version of this is to eliminate added sugar and dairy, and add lots of veggies to your diet)
Topical pain relievers such as Voltaren gel or Arnica cream
If you would like to discuss your case (and how to use Physical Therapy and/or Class IV Laser therapy as an alternative to Cortisone injections) with one of our Doctors of Physical Therapy by phone or in-person, you may sign up here https://www.thegrpt.com/events-and-offers
In good health,
Dr. Ashley Bertorelli, PT, DPT, Owner/Founder of The Green Room PT
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Clifton Park & Troy