Do Cortisone Shots Make Things Worse?

In the late 1940s, the steroid cortisone, an anti-inflammatory drug, was first synthesized and hailed as a landmark. It soon became a safe, reliable means to treat the pain and inflammation associated with sports injuries (and other conditions). Cortisone shots became one of the preferred treatments for overuse injuries of tendons, like tennis elbow, which had been notoriously resistant to treatment.

Then came the earliest clinical trials, including one, published in 1954, that raised doubts about cortisone’s powers. In that early experiment, more than half the patients who received a cortisone shot for tennis elbow or other tendon pain suffered a relapse of the injury within six months. But that cautionary experiment and others did little to slow the accelerated use of cortisone or the widespread enthusiasm for the seemingly magical, immediate effect against pain. Today cortisone shots remain a standard, frequently requested treatment for tennis elbow and other tendon problems.
However, recent research is once again raising doubts about the efficacy of cortisone. In a major new review article published in The Lancet (October 2010), the results of nearly four dozen randomized trials, which enrolled thousands of people with tendon injuries (primarily tennis elbow), were examined. While most of those suffering from tennis elbow did initially receive fast and significant pain relief from the cortisone injections as promised, the results were substantially different when the patients were re-examined at 6 and 12 months.
Overall, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. In fact, the shots seemed to actually be counterproductive. Additionally, those people receiving multiple injections may be at particularly high risk for continuing damage. In one study that the researchers reviewed, “an average of four injections resulted in a 57 percent worse outcome when compared to one injection.”
On the other end of the spectrum, patients who treat their injuries at Airrosti are pain-free in an average of three visits. After a thorough consultation, Airrosti Certified Recovery Specialists use a manual therapy technique to improve soft tissue and joint mobility. Depending on the injury, they may also prescribe at-home care routines. Based on patient reports, 89.5 percent of Airrosti’s patients reported injury resolution, and 92 percent of patients reported that Airrosti’s treatment prevented further medical services.

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