If there ever were a magic bullet for recovering from an injury cortisone shots might be it.
Of course like all magic, it requires distraction from what’s truly occurring for it to work. In other words, you might feel like a million bucks, but you haven’t resolved the cause of the pain and that means it might very well return.
During my first visit with the Orthopedic surgeon he offered me a cortisone shot, while we waited things out with PT to see if surgery was really necessary. I declined having heard various things about long term issues and knowing that overall I wasn’t in unbearable pain. Not like in 2007, when I cried in joy when the sports medicine doctor injected my IT Band.
Without my even knowing it, I’d made a great choice.
There’s a vast difference between injecting tendons and a cortisone joint injection…so here’s what we all need to know before thinking we’ve found the magic bullet. Cortisone injection side effects in the knee could be substantial.
How a Cortisone Shot Works?
A cortisone injection is designed to reduce inflammation in a specific area for 6 weeks to 6 months. The length of pain relief appears to depend on the location and the type of injury. While it is not a pain reliever, that is generally the effect of of reducing inflammation.
Cortisone is naturally produced in the body by the adrenal gland and released when the body is under stress. A cortisone shot is synthetically produced, but similar to the body’s own production.
How to get one?
Usually a doctor can do this right in the office, no need for additional appointments. They may have an ultrasound machine to guide the specific location, but it seems most doctors have done it enough they just find the spot and quickly give you the shot. There is a little discomfort with the shot, but it’s minimal.
Initial pain relief is from the anesthetic that is usually mixed in to the steroid. After it wears off in 8-14 hours pain may return, which I hope makes it clear that cortisone shots are steroids, just not the kind that make you hulk up in the gym.
3-4 Days after shot?
The steroid will begin working and the anti-inflammtory effects should begin.
Long term goals?
Before taking the injection, you need to understand the goal. It’s going to treat the inflammation, but it’s not going to resolve the underlying issue that created the pain. You’ll have to be committed to a long term solution, meaning physical therapy or other treatments for strengthening weak muscles or inflamed joints.
While I had initially refused a shot, the Orthopedic recommended it as an option to see if reducing the inflammation would allow the knee to regain full mobility. Avoiding surgery sounded great to me, so I decided one shot was worth trying.How long should a cortisone shot last?
Most people would say they last 3 months or longer, but that’s looking at the short term picture again. The shot should be something we use to help us get over the initial hurdle of pain, so that we may continue physical therapy…not so we can be figuring out when to get a next shot.
What should you do after a cortisone shot?
Because of the immediate reduced pain thanks to the anesthetic, what most of us want to do is everything the injury has been stopping us from doing!! Quickest way to make everything worse.
Instead, as noted above this is when you start in on resolving the underlying issue. Get going with PT, easing back in to moving pain free. Many times, we’ve limited our range of motion due to the pain. This allows you to begin working on that again to ensure you aren’t creating other issues.
- Begin doing your physical therapy
- Use it to work on range of motion
- Ease back slowly over a period of weeks in to activity
- Allow it to help combat inflammation
- Continue eating anti-inflammatory foods to help the process
- Focus on other natural ways to reduce pain and inflammation
- Start using more collagen to rebuild joint tissue for mobility
Does a cortisone shot in the knee hurt?
No. At least I did not find it painful, it’s like most general shots where there’s the prick of the needle and then the quick flush of something entering your body.
Potential Dangers of Cortisone Shots?
So why don’t we use these all the time, if they’re so wonderful? Are cortisone injections bad for you?
“A lot of doctors use these injections in lieu of counseling patients that they may benefit from surgery,” (or alternative treatments) Dr. Bheeshma Ravi, an orthopedic surgeon.
If appropriately used, they are a fantastic anti-inflammatory, but that should be used to allow you to start doing physical therapy, not to immediately jump back to whatever may have caused the underlying issue.
A period right after the shot where pain could be worse. This usually lasts for only 1-2 days and effects no more than 2% of people.
— I am now convinced this is what occurred for me during the half marathon DNF. I had been running nearly pain free for months utilizing RockTape and yet in the day after that cortisone shot in knee I was nearly hobbled. The race course itself probably didn’t help, but the pain was worse than it had been since my injury started.
Degeneration Tendons and Cartilage
Most doctors limit injections to no more than 3 per year in a given site, due to potential weakening of tendons and softening of cartilage that was shown to occur in animal studies. Which obviously could create longer term issues.
In places like the heel where runners get it for plantar faciitis it can actually reduce fat, which means less padding to help that heel run happy.
In fact, Emily of Mile At a Time Running, sent me this example from her own life:
I was 4 weeks out from a marathon, PF was bugging me enough I went to the dr and got a cortisone shot in my heel. Took a week off of running, headed back out and the ligament completely ruptured! A little cortisone shot turned and injury that could have gone away with rest to a 10 month ordeal.
I also used one for my IT Band in 2007 when I was barely able to walk. It got me on the road to start recovery and after that I implemented all the tools outlined in the Ultimate IT Band solution to never need another!
Alternative Options to Cortisone Injections?
Knowing that there are downsides to surgery and cortisone isn’t a long term option, I had hoped PT would be enough. But if it’s not, I’m starting to look at what else is out there, which lead me to a local doctor who does Prolotherapy.
This uses a dextrose (yup sugar) toxin injection compound to stimulate cartilage, ligaments and tendons to speed up the process of repair. According to advocates, it’s a much better long term option than cortisone shots.
- It stimulates the healing of the joint.
- It strengthens ligaments and tendons.
- It reduces pain from hypersensitive neurons.
- There is very little recovery time.
- It is a cost effective therapy.
As always there’s a flip side. There are not a ton of studies done yet on Prolotherapy and some doctors are concerned that the stimulated regrowth is not of the same quality, could cause scar tissue and for many results in additional pain. Unlike cortisone shots, prolotherapy itself can be painful due to the toxins used which result in swelling and aggravation of the area to induce the healing.
PRP: Platelet-Rich Plasma
This is currently not covered by insurance because it’s so new, which means there aren’t a ton of studies on it either. Since platelets help to induce recovery, these injections are designed to increase that concentration for rapid healing. A small sample of the your blood is placed in a centrifuge to separate the platelets from the other blood components, then the concentrated PRP is injected.
More on Knee Recovery:
- Kinesio Taping for a Meniscus Tear
- Anti-inflammatory living for arthritis
- Physical Therapy for Runner’s Knee
- Physical Therapy for Meniscus Tear
There you have it my initial research on cortisone shots. I’ll update with my experience after a few more weeks, but I hope this helps you figure out what’s right! Just remember I’m not a doctor and I don’t play one on tv.
Have you ever tried a cortisone shot?
Are you open to alternative therapies?
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