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  • Brendan McGovern

Cortisone Injections - Should I Get One?




When it comes to pain, it can be a terrible experience, one that may make you want to do anything to make it stop!



What do you do?


  • Rest?

  • Physio? Osteo? Chiro? Massage?

  • Painkillers and/or anti-inflammatories?

  • Advice from your doctor?

  • See a surgeon?

  • Exercise?




All of the above can be helpful ways to alleviate pain by modulating pain receptors in the body and improving movement strategies to offload any tissues or structures contributing to your pain.


As a Physiotherapist, common persistent conditions we see include:


  • Neck pain.

  • Headaches and migraines.

  • Frozen shoulder.

  • Shoulder pain - bursitis, tendinitis

  • Referred pain from your neck into your arm, or your back into your leg.

  • Back pain.

  • Hip pain.

  • Tendinopathy.

  • Bursitis.




These are conditions that your doctor may recommend you have a cortisone injection for and surprisingly (give all the research) sometimes before other interventions such as physiotherapy or exercise.


What is a cortisone injection?


Cortisone is an anti-inflammatory agent and cortisone injections are used to relieve pain and inflammation in a specific area of the body, mostly commonly injected into joints - the spine, hip, shoulder, elbow, knee. They are sometimes referred to as steroid injections.




They offer temporary relief and are best used in conjunction with physiotherapy.


The effects of an injection can be immediate, however this is often due to the local freezing agent applied and sometimes may take up to 2-3 weeks before any impact is felt.


Injections repeated over time often become less effective with the period of pain relief becoming shorter.


Considerations for repeat injections, particularly those over a short period of time can result in damage to the soft tissues (tendons, ligaments, and articular cartilage).


For this reason injections should be spaced at least 4-6 weeks apart, with no more than 4 injections to one site per year. Cortisone should not be injected directly into tendons for this will weaken the tendon, increasing risk of tear or rupture. The research has shown this specifically with Achilles and Patellar tendons, even when injected near the tendon.


Are cortisone injections effective?


Often many people report their first injection to be helpful, easing their painful symptoms.




If the pain returns and they have a second injection it is often not as effective.


The main thing to consider when determining if an injection is going to be effective for pain relief: what is the underlying cause for the pain you're experiencing?


If it is purely inflammatory, an injection may help.


However, I would not recommend an injection for an acute injury, as the inflammatory process is necessary for soft tissue healing and an injection may impede this process.


Injections should be considered more for those suffering from more persistent pain, lasting greater than 3-6 months.


And if your pain is more mechanical in nature and driven by how you are moving, it may only take the edge off, as the underlying mechanisms have not been addressed. Again, this is why injections should always be used in conjunction with physiotherapy.


How long will the positive effects of a cortisone injection last?


Relief of pain and inflammation from an injection can be anywhere from 6 weeks to 6 months. Sometimes they offer no relief. There is often an initial increase in pain for the first 48 hours following an injection.


Are there any negative side effects of getting a cortisone injection?


Potential side effects include:


  • Increased pain and swelling

  • Skin discoloration around injection site

  • Elevated blood sugar

  • Infection

  • Allergic reaction


Do I need to rest after having an injection?


It is recommended to avoid strenuous activity, such as exercise or lifting for 10 days after an injection. This may vary depending on the site of injection. You should not have any physio or massage right after an injection. When can you? This will vary, but physio should wait at least 7-10 days and massage around the area 2 or more weeks.




Are cortisone injections covered by Medicare?


Depending on where you get your injection, the site of injection and whether it is guided by ultrasound or CT scan the procedure may be bulk billed, you may have to pay an out of pocket expense with or without a rebate.


Coming back to the title of this blog, should you get a cortisone injection?


My main recommendation would be to first see a Physiotherapist who can assess the underlying mechanism of your pain - whether it be radiating pain from your neck or back, shoulder bursitis or a gluteal tendinopathy, before rushing off to get an injection. Having an injection may give you relief for a few weeks or many months, but it will not address the underlying issue of why your pain started!



References:


Cardone, D. A., Tallia, A. F. Joint and soft tissue injection. American Family Physician (2002). Jul 12; 66 (2): 283-289.


Kompel, A. J., Roemer, F. W., Murakami, A. M., Diaz, L. E., Crema, M. D., Guermazi, A. Intra-articular corticosteroid injections in the hip and knee: Perhaps not as safe as we thought? Radiology (2019).

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