RaceGrader - Authentic Race Reviews - Swim, Bike, Run

The Debate Over Cortisone Shots

Posted by: on October, 23 2013

From Competitor.com and written by Kelly O’Mara

Doctors say yes, but it depends on the situation.

It used to be that cortisone shots, also known as corticosteroid injections, were considered a wonder cure. Doctors would prescribe them for virtually every injury and they were believed to relieve nearly all pain.

Not anymore.

“Cortisone shots are used less today than they were in the past,” said Dr. Andrew Nichols, director of the sports medicine fellowship at the University of Hawaii at Manoa.

Cortisone is simply an anti-inflammatory. “In that sense, it’s like Advil or Motrin,” said Dr. David Geier, an orthopedic surgeon and sports medicine specialist in South Carolina. Except cortisone shots are high-intensity anti-inflammatories injected directly into the problem area.

The shot is most commonly used to address arthritis, especially in the knees, because it relieves the inflammation caused by the disease and, in turn, much of the pain. There are also very few other remedies for arthritis. Cortisone shots have also been commonly used in tennis elbow and shoulder rotator issues. But for running injuries, both Nichols and Geier said they’re less advisable.

Most importantly, said Nichols, questions have been raised about the effectiveness of cortisone shots. Studies that followed patients who received shots and compared them to those who simply used rehab, rest and ice found very little difference between the two groups in the long-term.

“In the long-term, they don’t do better than the group with rest, etc.,” Nichols said.

RELATED: How To Get Rid Of IT Band Syndrome

There may be short-term relief of pain, but unless inflammation is the primary problem — for most running injuries, particularly use injuries, it’s not — then cortisone doesn’t solve the underlying issue. That means the pain likely could come back again.

Some studies have also found there to be an increased risk of tendon rupture and possible weakening of ligaments in the area of the shot. At least one study found that about 5 percent of patients who suffered from plantar fasciitis and received cortisone shots to address the injury later had plantar fascia ruptures related to the shots. However, because it’s hard to study tendon ruptures — you can’t force people to run until something tears — most of this information has come as a byproduct of studying the shots’ effectiveness. And, some of those studies have found no increased risk of rupture or weakening of ligaments, said Nichols, but he prefers not to take the risk.

It’s also not clearly understood why this might happen. “It does something to weaken the fibers,” Geier said.

Even if the cortisone shot does work and relieves the pain, this may not necessarily be a good thing. If you develop a running use injury, then the inflammation and pain is part of your body’s healing process. You need inflammation to spur a growth response and let your body heal itself.

“There’s concern about whether we’re doing our patients any favors by blocking inflammation,” Nichols.

Added Geier: “Any kind of injury that you need the body to heal, you probably shouldn’t use cortisone.”

The cortisone-induced lack of pain could also lead you to ignore warning signals from your body. All of those reasons are why Nichols said he simply doesn’t recommend cortisone shots for major, load-bearing tendons or ligaments. It’s also why he usually tries to prescribe a rehab- or physical therapy-focused treatment for sports injuries.

RELATED: The Pros Of Prolotherapy For Injured Runners

That’s not to say there aren’t instances where a cortisone shot makes sense for runners.

Nichols said he might recommend it for runners who have injuries of the bursa, fluid-like sacs between bones and tendons, or possibly for IT band syndrome. Geier said he shies away from it for tendon injuries, particularly large tendons like the Achilles, or for use injuries, but the shots can be useful when inflammation and irritation is causing other problems.

If you do receive a cortisone shot, you can expect the area to be swollen and uncomfortable for a few days. You can run on it, but “it’s not the worst idea in the world to cut down,” Geier said. That’s primarily because it takes two to three days to act as a pain reliever.

There can also be some side effects, said Nichols, such as a loss of skin pigmentation or skin dimpling. And, cortisone shots should be limited to three or four times a year because there is the potential for a long-term build-up of side effects, such as increases in blood pressure or bone damage, Nichols noted.

Still, both doctors said they do recommend cortisone shots in specific situations depending on the athlete.

“A lot of times it’s just a temporary solution,” Geier said.

That doesn’t mean the temporary solution isn’t a solution for some runners.