Local cortisone injections are commonly used for the treatment of many orthopaedic conditions such as arthritis, tendonopathies and bursitis to name a few. The cortisone injection is composed of a synthetically derived substance that mimics cortisone, a hormone that is naturally produced in the body when it is under stress. Cortisone acts to reduce inflammation around the injured tissues. The injection can provide immediate relief of symptoms as the inflammation resolves. Studies have shown that cortisone injections can have a significant benefit in the short term. Unfortunately, for most conditions, the long-term benefit of cortisone is far from outstanding.
What is Inflammation? When should It be controlled?
Inflammation is an essential part of the body’s response to heal itself when there is an injury. By limiting this reaction, the healing process might remain incomplete. There are some cases where it might be reasonable to limit or reduce the inflammation our body produces however in most cases, it seems reasonable that allowing the natural inflammatory reaction to occur will stimulate healthy healing. You may want to reduce the inflammation in cases where the inflammatory response is persistent or chronic in nature. In the example of a soft tissue injury, inflammation can become chronic when the underlying mechanical dysfunction is not resolved and the injured tissue is repeatedly stressed over and over again. Another situation where you might want to address the inflammation is when the body is having an autoimmune response. This means that the body is reacting unnecessarily and the inflammatory response that takes place may be damaging healthy tissues such as in the case of frozen shoulders.
Cortisone + Physical Therapy = Better Outcomes
It is very important to remember that cortisone just targets the inflammation. It will not change the underlying or root problem that is causing injury to the bodily tissues in the first place. For instance, if your tight calves and stiff ankle joint are contributing to your plantar fasciitis, then cortisone will alleviate your symptoms in the short term but your symptoms will reappear once the effects of the cortisone fade. As such, if you decide that cortisone is a good option for you, then it is important to combine the cortisone injection with a solid physical therapy treatment plan that will help to correct the root cause of your injury and prevent it from returning.
There are high quality studies with respect to Tennis Elbow, which demonstrate that individuals who received only cortisone injections did really well in the short term but in the long term there were very high recurrence rates. Individuals that only received physiotherapy treatment had better long-term outcomes and very low recurrence rates. It is important to recognize that it took much longer to see the results to appear for individuals who only received physical therapy but these individuals had the best results compared to any other intervention in the long term. Individuals who received cortisone injections combined with physical therapy had better results then cortisone alone but the results were not superior to the group that received physiotherapy only. This finding correlates with the theory that cortisone may degrade the quality of the tissue and weaken the collagen fibers that make up the soft tissues.
Ultimately the choice is yours and will depend on many different individual factors. Speak to all of your health care providers and ensure you understand all the treatment options that are available to you so that you can make the best decision.