Cortisone Injections | are they a miracle cure?
Cortisone injections were introduced to medical practice in the 1950’s and revolutionised the way inflammatory disorders like arthritis were being treated. They have been widely used for conditions like Frozen shoulder and knee arthritis as well as systemic diseases such as Rheumatoid arthritis but are they a miracle cure?
What is cortisone?
Cortisone, which is sometimes referred to as Hydrocortisone, comes from a group of drugs called Corticosteroids which have strong anti-inflammatory properties as well as being involved in the metabolism of sugars and proteins in the body. Cortisone is modelled on the body’s natural steroid, Cortisol but as the biochemistry has developed the corticosteroids used now in practice are more potent and last longer. And that can have an incredible impact on the pain and disability associated with many musculoskeletal conditions such as shoulder, elbow and hip bursitis, frozen shoulder, tenosynovitis and trigger finger. Chronic or severe pain that may have existed for many months that has not responded to other treatments can disappear within a few days and that response is why many people feel like it is a miracle cure! Physiotherapists use cortisone injections to dramatically reduce inflammation and pain so that the important work of restoring movement and normal function can continue. There are many patients who would describe it as a miracle cure but there are one or two things we should be aware of before we think about having one ourselves.
Sounds great – sign me up…
Over the last decade or so, research looking at the longer term effects of cortisone has shown that overly frequent exposure to injected corticosteroids could have deleterious effects on the joint. There have been stories in the media about ex-footballers who had excessive injections during their playing career who now have longer term problems and this does raise concerns. The maximum recommended frequency of joint injections is 3 per year and there is no evidence that shows this is harmful. That said, if any treatment is only providing less than 4 months of relief, it may well be time to look for a more effective solution and in this case surgery is likely to be the answer. In practice, we find that a carefully executed exercise programme combined with manual therapy and occasional joint injections (of either cortisone or hyaluronic acid) negates the need for repeated injections. That, combined with other treatment options like Hyaluronic Acid injections and physiotherapy has enabled clinicians with other effective modalities of managing these painful conditions.
Cortisone is also criticised for only providing short-term relief. This is true – cortisone generally provides the greatest benefit in the first 3 months or so. That is not to say that is always the case and many people derive benefit for many months (and even years!). The key is not to see the injection as the whole treatment. We find that the injection will provide a lovely window of pain relief for the patient which then enables them to engage with the important business of improving movement and strength so that the knee can withstand the demands of day to day life. A few months of pain relief is often enough to bring improvement and longer-term recovery.
I would like to consider a cortisone injection
Cortisone (corticosteroid) injections do have a very important part to play if used as part of an overall strategy to reduce pain of course, but also help to restore the best possible function by working on mobility and strength. The beauty now is that we have other options to offer our patients too should cortisone not be the best option.