Cortisone - What, Why & When

Inflammation plays a huge part in the body’s regulation of homeostasis, the ability to maintain a regular and stable environment. We require inflammation to live and to continue to be healthy however there are times when inflammation can become a hindrance to our recovery or progress.

Cortisone injections are a common tool used to manage higher levels of inflammation in more localised areas such as bursitis, tendinopathies or joints that have pain. There is a really fine line as to when Cortisone should enter the treatment process and for many injuries the evidence out there would suggest it isn’t beneficial to inject.

A typical story would be a person gets a sore shoulder so present to their GP (side note: GP’s aren’t trained to properly assess detailed movements and injuries of the body so going to them as a first port of call wouldn’t be recommended). The GP sees that they are in pain so they send them off for a scan which reveals something like ‘bursitis, tendinopathy of the rotator cuff with some degenerative arthropathy of the articular joint surface.’

Now, a good GP or medical professional will reassure the patient that these symptoms are very much common occurrences and can be managed, improved and solved given appropriate rest, exercise prescription and ongoing advice. On the other hand, there are a lot of health professionals who would suggest a Cortisone injection into the joint to reduce the inflammation. Now is this a good or a bad idea? The symptoms are causing inflammation so getting rid of that would be a good thing right? Wrong! Let me explain further…

Cortisone is a corticosteroid medication which has a powerful anti-inflammatory effect. They are not technically a pain killer, however because inflammation can cause pain, they will reduce symptoms and assist in this manner. So for some short term relief of symptoms this injection can assist, but the mechanism of injury which caused the damage to the tissue will not be changed. Therefore, it is rare that a single shot of cortisone to a surfer’s shoulder for example will permanently fix their complaint - it will merely give them a small window of time where they may experience less pain.

There is a lot of evidence to suggest that Cortisone can actually be detrimental to soft tissue such as ligaments and tendons so we need to be cautious in our approach to using it as part of treatment. If a person is getting multiple steroid injections it can create ligament laxity, tendon weakness or even bone atrophy which will only cause more harm than good.

So when is Cortisone useful Simon? Good question!

The first step is getting a thorough assessment of the way that a joint moves, whether there are any deficiencies in strength, control, etc, and understanding what movements are causing that person problems. If there are obvious areas to work on but some good range of motion and minimal limitation then most experienced, good, therapists will suggest that conservative management with no injection is the way to proceed. If the patient is very limited in their range of motion and are not able to work or keep their activity level up then it would be recommended then to use a Cortisone injection to settle down something like a bursa or tendon. The key in this example though is that the injection is just opening up a window of opportunity for the patient to work on their weaknesses with less or no pain.

Overall Cortisone is definitely not the answer but it is a helpful tool that we can use in the rehab process. My advice however is that you should first try to approach a medical professional who will assess your movement patterns and figure out the cause of the inflammation in the first place. Then together work on building strength, mobility and resilience of the joints and muscles!

The body is a weird and wonderful thing, but most of all it requires a bit of love so treat it with respect and put some time and work into it!

Do you have any aches or pains that you want to get checked out? Book in online here to see one of our Physio's today, or call us (08) 9448 2994.

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