Cortisone Injections - They're Common, But Are They Effective?

Cortisone shots are one of the most common treatments that doctors prescribe for tendon and fascia conditions like tennis elbow and plantar fasciitis. But are they genuinely effective?

I'll deal with that question in a moment, but first let's talk about cortisone itself. 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 for maintaining proper function of your body. Aside from certain people who suffer from Addison's Disease, it is naturally produced by every human being, so nobody is allergic to it.

Generally speaking, modern cortisone shots don't actually contain much pure cortisone. Derivative compounds, like Kenalog and Celastone, are more widely used because they have advantages like longer potency and fewer side-effect complications. Also, there is ordinarily a pain reliever included in the shot. So if you're one of those people who has an allergic response to the injection, it's probably due to the pain reliever, not the cortisone derivative.

In the short term, it's true that cortisone is often effective in decreasing the level of inflammation you're experiencing. This might make you feel better for a little while, but when the effect of the shot wears off (and it will, all too soon), the pain will come back with a vengeance if you haven't taken care of the underlying tendon problem as well. One other issue is that you can't keep getting the shots forever. Animal studies have shown that cortisone injections can actually weaken tendons and joint cartilage if too many are given in the same area. (This problem doesn't happen with orally administered cortisone, which is slowly taken in by the body and dispersed over a larger amount of tissue.) Especially in younger patients, this potential side-effect is cause for worry; if you're under twenty-five years old it is highly recommended that you investigate other types of treatment before resorting to cortisone shots. With older patients, whose joints usually have already experienced significant damage, it is not as much of a concern. Another concern is that some tendons (the Achilles comes to mind) are prone to rupture even when the shots are carefully administered by competent medical personnel.

There's no question that inflammation can be a useful physiological reaction. But when there is too much of it, it can hinder or even prevent recovery. 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, runner's knee, carpal tunnel syndrome and related conditions suffered by data entry professionals), fasciitis 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 fascia or tendon. Given such data (and more is being added very quickly), you really have to ask yourself why a cortisone shot is necessary in the first place.

So how is it that patients report lessened pain through such shots? To begin with, it's not true that everyone does. Around 50% of the people who get cortisone injections never report any alleviation of pain. For those that do report relief, the most likely explanation is that the analgesic included in the shots has a temporary deadening effect on the pain. Of course, the placebo effect is always present as well.

Cortisone has been proven to be effective for some types of ailments (arthritis in older patients is one example). But real questions exist about its application to tendon and fascia pain conditions such as tendonitis, fasciitis, tendonosis, fasciosis and so on. (Arthritis affects joints, which are made of cartilage, while tendons and fascia are composed of collagen.) In younger patients and runners suffering from Achilles tendonitis in particular, it seems that there are more efficacious tendon pain treatments available, with a better cost/benefit ratio and far better success rates. The shots do have some points to recommend them, of course. They're fast, easily administered, and fairly economical. Further, they fit very well into the usual medical paradigm of treating a problem rather than the cause of the problem. Finally, many doctors prefer them due to the ease of monitoring their use. But think about the discomfort of receiving an injection directly into damaged tissue... the unproven mechanism by which it is supposed to work... the coin-toss percentage of receiving even temporary pain relief... and the possibility of what could be severe side effects. It just makes sense to try other treatments first.