A major new article review recently published in The Lancet reveals what many in the natural health profession have suspected for a long time. The review examined the results of over 40 randomized trials and over 2500 patients with tendon injuries. The reviewers found that cortisone injections did in fact provide fast and significant pain relief compared with doing nothing or partaking in physical therapy. However, cortisone shots did not heal the structural damage underlying the pain. Instead, they actually hindered the structural healing.
When patients who received cortisone injections were re-examined at 6 and 12 months, the results were alarming. 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. The evidence for cortisone as a treatment for other aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting, the review found. But in terms of tennis elbow, the shots seemed to actually be counterproductive. In other words, in some way, the cortisone shots impede full recovery, and compared with those who do nothing but rest, those getting the shots are worse off. 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.
While at times its tempting to go for the quick fix, in this case it can actually result in a longer healing time. Conservative treatment should always be first (Chiropractic, Physical Therapy, Nutritional Supplements), when that fails, then its time to explore the more invasive options. Unfortunately, in reality it’s usually the other way around – we see patients who have tried everything – pain meds, cortisone shots, surgery- before visiting us as a “last resort”. Hopefully more studies like this will begin to change that.
