Cortisone shots are one of the most common treatments that doctors prescribe for tendonitis conditions like tennis elbow and RSIs such as carpal tunnel syndrome. But do they really work?
I’ll address that question below, but to begin with, what is cortisone anyway? Cortisone is a hormone produced by the adrenal gland. It is technically a cortico-steroid (not to be confused with the anabolic steroids that bodybuilders often use), and it is essential to maintain proper function of your body. Aside from certain people who suffer from Addison’s Disease, it is naturally produced by every human being, so no one is allergic to it.
If you get a cortisone shot, you probably won’t be injected with the pure stuff. Instead, cortisone derivatives such as Kenalog or Celastone, which last longer and produce fewer side effects, are more commonly used. Also, there is usually a pain reliever included in the shot. People who suffer allergic reactions to the shots are generally allergic to the pain reliever rather than the cortisone derivative itself.
Cortisone can be effective in suppressing inflammation for short periods of time. This will provide some pain relief, but without addressing the underlying cause of the condition, the pain will return after the effects of the shot have worn off. Also, there is a limit to the number of shots that can be performed within a given time period, since animal studies have shown that cortisone can weaken tendons and cartilage in joints when over-administered via local injections. (This is not a problem with oral cortisone doses, which are absorbed by the body gradually over a period of time.) This possible adverse effect is more worrisome in younger people, as their joints and tendons are still healthy, so patients below the age of 25 especially are encouraged to exhaust all other forms of treatment before getting cortisone injections. With older patients, whose joints generally have already experienced significant damage, it is not as much of a concern. Also, certain tendons – the Achilles tendon in particular – are prone to rupture even when the injections are performed with the utmost care.
Inflammation, while often a useful physiological reaction, can actually hinder healing when it is present in excess. The idea behind a cortisone shot is that by helping to suppress unnecessary inflammation, it will thereby aid in healing. However, the most recent medical studies are increasingly showing that tendonitis, RSIs (tennis elbow and runner’s knee; carpal tunnel syndrome and related conditions suffered by data entry professionals) and the like are not actually caused by inflammation, but by some other mechanism — the most likely culprit being direct damage to, and/or fraying of, the tendon. This, of course, calls into question the entire rationale for the shots in the first place.
So why do patients report a decrease in pain? For starters, not all do – cortisone shots are reported as being effective in only about 50% of the people who receive them. For those that do experience relief, the most likely explanation is that the analgesic included in the shots has a temporary deadening effect on the pain. Also, placebo effects are powerful and can never be discounted.
While cortisone shots are a very effective treatment for certain conditions such as arthritis in older patients, there are serious questions as to their effectiveness when it comes to conditions like RSIs, tendonitis, tendonosis and the like. In younger patients and runners suffering from Achilles tendonitis in particular, it seems that there are more effective tendonitis treatments available, with a better cost/benefit ratio and far better success rates. Admittedly, cortisone shots are relatively inexpensive, easy to administer, and don’t take a lot of time. Further, they fit very well into the usual medical paradigm of addressing a condition rather than the cause of the condition. And, of course, doctors can monitor their use. But when you consider the discomfort of receiving an injection directly into damaged tissue, the questionable mechanism by which it is supposed to work, the coin-toss percentage of patients who report even temporary pain relief, and the possibility of potentially severe side effects, it makes sense to try other treatments first.
Article by Alex Nordach. If you’re looking for a tendonitis treatment that will address the underlying cause of your condition, doesn’t require a physician’s supervision, is extremely safe and that you can control in your own home, simply click on the link.