In my experience, when something seems too good to be true, that’s usually the case, especially when it comes to the medical field. I’m sure many of you have tried a new treatment or medicine that is assured to help you with your pain or injury, with the added promise of little to no side effects. I wish it could be that simple, but unfortunately, there tends to be a catch. For this blog, I’m going to explain why (to a degree) cortisone injections are no different.
Over the past 70 years, cortisone injections have become more and more common to heal injuries, especially when used to treat issues in orthopedics. This potent anti-inflammatory shot, which is basically a man-made steroid that mimics the effect of cortisol, can help to reduce the inflammatory response of many painful conditions.
Think about the relief you get when taking an oral anti-inflammatory medication, such as Advil. When a medicine is taken orally, this distributes the medication in very small doses throughout the entire body. A cortisone injection, on the other hand, places a large, potent dose directly at the location of inflammation. Therefore, the medication acts very powerfully against the problem.
When people suffering from pain feel that level of relief, it’s no wonder they wish to rely on this simple quick fix. But keep in mind….because of its potential side effects, the number of cortisone shots you can get in a year generally is limited (usual practice is not to give someone more than three cortisone shots per year in the same part of the body). So think about it – if doctors are limiting how much they can administer to one patient, maybe it isn’t the safest remedy to rely on.
Let’s read on a bit more to really understand the positives (yes, there are a few) and negative effects that come with cortisone injections.
THE LURE OF CORTISONE INJECTIONS
It’s not hard to see why so many people, whether they are professional athletes or active adults, turn to cortisone injections right away when dealing with pain.
As I mentioned before, cortisone shots can help relieve pain and inflammation in a specific area of your body. They're most commonly injected into joints — such as your ankle, elbow, hip, knee, shoulder, spine or wrist. Even the small joints in your hands or feet might benefit from cortisone shots. The fact that you can place the cortisone specially in the exact area of pain is very attractive.
How long a cortisone shot lasts depends on the amount that a doctor injects, as well as whether the cortisone interacts with other medications. But typically, the effects of cortisone shots can last for more than a month with some lasting as long as several months.
ALLEVIATES PAIN ALMOST ANYWHERE IN THE BODY
Corticosteroids, as they're also called, can be extremely helpful in alleviating pain for patients suffering from a range of conditions, including knee and hip arthritis, rheumatoid arthritis, back pain, bursitis or tendinitis.
Now, I’m not saying that I’m completely against the use of injections; there are times in a person’s life when the pain is so intolerable that their use is warranted. For example, I agree with its use when there are significant levels of inflammation that are preventing participation in natural healing modalities with something like Physical Therapy or when someone with rheumatoid arthritis is going through a significant flare up and their usual remedies and treatments are not working as they usually do or should.
ALL THAT GLITTER IS NOT GOLD….THE NEGATIVE ASPECTS TO CORTISONE INJECTIONS
Now, you might be asking yourself, “So Dr. Rob, how bad can cortisone injections’ side effects actually be?” I’m sad to say, but there are many ranging from mild to severe, that I would like to share below. Cortisone injections are known to have a negative impact on:
CARTILAGE AND TENDONS
Cortisone injections administer a high concentration of a substance that is normally only found in small concentrations in your body. Studies have shown that high concentrations of cortisone or repetitive use of the medication can lead to damage of the tissues in the body. This may lead to a softening of the cartilage in joints or weakening of tendons.
The primary concern that patients should be wary of is the use of cortisone in young healthy joints and tendons. In older patients with more well-used joints or damaged tendons, the concern is less significant, because the age and stress-related changes are already done. The use of cortisone in young healthy joints, however, should be done with caution. Therefore, younger athletes are often advised to exhaust all treatment options (specifically physical therapy) before considering a cortisone injection and then limit the number of injections given. Also, when I say young, I am not just talking about those in their teens, 20’s and 30’s…I am talking about those in your 40’s, 50’s and potentially your 60’s as well if you consider yourself a young active 60.
There are also certain tendons that are especially prone to rupture when treated with a cortisone injection. The most frequently encountered example is the use of cortisone around the Achilles tendon and plantar fascia. Even when performed carefully, injections of cortisone around the Achilles can lead to traumatic rupture of the tendon.
Cortisone, as mentioned, belongs to a broad class of medications known as corticosteroids. Evidence exists that shows these medications and other steroids can cause a variety of mood changes in some individuals. While these mood changes are usually minor, sometimes they can be quite serious. Usual mood-related side effects of cortisone injections include irritability, anxiety, memory loss, and difficulty concentrating. In rare cases, however, more serious effects have been reported. They include patients experiencing paranoia, delusions, or depression.
Some studies have reported insomnia as a side effect in up to 50% of patients who received cortisone injections. This makes insomnia one of the most common side effects linked to such injections. Why does this happen? Well, cortisone, and similar steroids, have strong effects on the adrenal glands. These glands are responsible for regulating adrenaline levels in the body. Too much adrenaline running through the body causes restlessness and difficulty sleeping. Individuals feel like they must keep moving. As cortisone injections can cause an increase in adrenaline, many patients experience insomnia after them.
One of the most serious risks associated with getting cortisone injections is the possibility of nerve damage. A small percentage of individuals who receive cortisone injections develop numbness, pain, or even partial paralysis. As the joints contain so many nerves, injecting anything into them carries at least some risk of causing nerve injury. This includes cortisone injections. Even though these cases are rare, they should not be taken lightly. Individuals considering cortisone injections should talk to their doctors and ask questions similar to this topic before receiving injections.
BODY’S ABILITY TO FIGHT INFECTION
It's important to remember that cortisone injections alter your immunity function, lowering the inflammatory response that your body mounts to fight injury and infection. This will reduce pain and swelling, but it can leave you open to infections and other issues.
BLOOD SUGAR LEVELS
Also, keep in mind that cortisone raises blood sugar levels in people, so much so that doctors monitor blood sugar levels to make sure they are stable before delivering a cortisone injection. This means that cortisone injections for those with diabetes are incredibly risky.
SO IF NOT CORTISONE INJECTIONS, THEN WHAT?
Now I know I may seem biased here, but I, AND many in the medical field, believe that physical therapy should be given a shot before relying on other more invasive alternatives like cortisone injections.
Physical therapists will perform a thorough evaluation to identify the possible cause(s)of pain and prescribe a comprehensive treatment approach to correct dysfunctions contributing to their patients’ symptoms. Patients receiving physical therapy not only receive treatments to relieve pain and inflammation during their appointments, but they also receive prescribed exercises to do at home and education to make sure that this issue never comes back.
This extension of the therapists’ care allows the patient to preempt a problem before it starts. With steroid injections, the patient often must go back to their provider when the injection wears off. The goals of physical therapy are to support long term relief of pain and to reduce the future recurrence of injuries.
If you are debating about whether to have a cortisone injection or physical therapy, why not try physical therapy first? In the state of New York, you are able to see a physical therapist first prior to even seeing another doctor or specialist for 10 visits or 30 days, whichever comes first. If you are reading this and are from another state, please ask your trusted local physical therapist.
As of writing of this blog, there are only about 1 or 2 states that do not have some variety of direct access care. While there are definite risks and side effects associated with steroid injections, there are none associated with early implementation of physical therapy. If physical therapy is unsuccessful initially (especially when receiving a good round of it…not sure what that means? Ask us!), then injections can still be considered in the future if you are a candidate. If you are interested more in how physical therapy itself can help you, please click the link HERE to check out our blog piece on that.
I hope this post was helpful to you and gave some insight the dangers of cortisone injections. If you have any questions, please reach out by calling 516-387-0053 or visit www.ascentptny.com. We are always here to help you. You can also fill out a patient inquiry form HERE to help get you set up with a Doctor of Physical Therapy.