Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Are Cortisone Shots the Best Option for Chronic Shoulder Pain?

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Nagging shoulder pain can be extremely annoying.

But when it starts to interfere with things you love to do – you can’t help but wonder – is it time to get a cortisone shot? 

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast. Just because cortisone shots for shoulders are routine, popular, and often effective at getting rid of pain – it doesn’t mean they are the best or right thing to do.

What is a cortisone shot and how does it work?

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action. But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom? This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – you put yourself at risk for irreversible damage to your joints and tendons if you keep getting cortisone shots when you don’t actually need them. 

So how do you know if a cortisone shot is best for your shoulder pain?

Step one is making sure you’ve correctly identified the root source of your shoulder pain. Is it a chemical source – where the inflammatory process to heal something injured within your shoulder has gone haywire? Or is it a mechanical source – meaning the source of your pain is due to poor movement habits and imbalances in your body.  The difference matters – and will determine whether or not a cortisone shot is, indeed, the best option for your chronic shoulder pain.  Let’s look at the differences between the two sources of pain to help you figure out when a cortisone shot is best for your shoulder pain – versus when you should hold off.

“Chemical pain”

Chemical pain is normal (until it isn’t) – and it’s the result of your body’s natural inflammatory response to injury. When your body is trying to heal from an acute injury or tissue damage, a complex chemical reaction occurs between your blood and other cells that involves the releasing of chemicals to “flush out” the injured area and start the healing process. A good example of this is when you fall and sprain something. The sprain causes tissue damage – so your body creates inflammation to heal it. Normally this process has a start and an end. As your pain subsides, so does this chemical process called inflammation. But sometimes this inflammatory process can get out of control for various reasons. And the accumulation of toxic chemicals sticks around (they don’t ever flush out or go away). The result is constant irritation to your nerve endings and surrounding tissues. You’ll experience constant, dull pain (even at rest) that will appear extremely sensitive to any and all movements. There will be no reliability as to what makes your shoulder feel better – or worse. As you’ll read below – the presentation of shoulder pain due to an underlying chemical cause behaves quite differently from shoulder pain due to a mechanical cause. When it’s chemical – a cortisone shot is often necessary – and the best option for your shoulder pain 

“Mechanical pain”

Mechanical pain is responsible for 80% of all shoulder pain. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. You’ll find, for example, that your shoulder pain eases with exercise, movement, and certain positions – while other times it seems to have a mind of its own and will hurt constantly. But typically, you’ll have some sense about things you can do to ease and/or aggravate your shoulder pain. And this is what makes mechanical pain so confusing  – because when you’ve aggravated it – your shoulder will feel inflamed. But the presentation is different from that I’ve just described above, namely, your pain comes and goes. This type of inflammation is a symptom – and not the root cause of your shoulder pain. A cortisone shot may work temporarily to abolish this type of shoulder pain, but it’s going to keep coming back until you address the root mechanical reason that is causing the shoulder inflammation. What you risk here is getting repeated cortisone shots in your shoulder because you think they are working – when they are only serving as bandaids. 

The verdict?

For chemical pain, a cortisone shot is likely the best option for getting rid of your shoulder pain. But for mechanical pain – it’s not. For shoulder pain that is mechanical, you fix it naturally, with specialized and corrective movement strategies. The tricky part here is distinguishing between primary inflammation that’s gone haywire versus secondary inflammation that is responding to activities, overdoing it, or simply the way you move. Don’t try to figure it out yourself – let a mechanical pain expert do that for you.

Are you local to Portsmouth, NH?

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Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or reserve a seat in her upcoming free Masterclass for headaches, neck & shoulder pain – email [email protected] or call 603-380-7902

Man getting knee pain treatment

Four Surprising Contributors to Lingering Knee Pain

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Approximately 25% of adults suffer from lingering, chronic knee pain without any clear reason why.  For some, aging and arthritis is to blame, and it’s something to just “live” with. For others, they’re told it’s due to “wear and tear”. Yet despite one or more surgeries to “clean out the knee” – the pain lingers and persists. 

So why then, do some folks age, get arthritis, and put tons of wear and tear on their knees without any issue – where others suffer from chronic knee pain? The answers may surprise you. 

Let’s look at four lesser-known (and often overlooked) contributors that cause knee pain to linger and not go away.

1. “Hyper” mobility is lacking

I remember early on in my career (22 years ago) when “hyper” mobility was considered a bad thing. But since then, both research and experience have proven me wrong. If you’ve followed me for a while – then you know one of my favorite sayings is “mobility before stability”. That’s because a joint that moves fully and freely feels and functions better – and allows the muscles around that joint to work at their best. Too often, people mistakenly look at muscular strength first as the solution to solving pain, when they should be looking a bit deeper.  Regarding knees, you need a bit of what we call “hyper-extension”. But most practitioners tend to focus only on how well a knee is bending. For knees – just getting to straight isn’t good enough. You need a certain amount of “more than straight” – otherwise known as hyperextension. I see this problem most in knees that have had surgery.  If their full knee extension (hyperextension) wasn’t restored properly during rehab, or perhaps they didn’t have any rehab at all (common practice now after most arthroscopic knee surgeries), knee pain will persist. And it won’t go away no matter how much you try and strengthen it. Moral of this story – make sure you have full knee extension – which includes a bit of hyperextension – and that it matches your other knee. This could be a reason your knee pain isn’t going away.

2. It’s really a back problem

Did you know that 40% of the time, an extremity problem (aka: knee, shoulder, etc) comes from the spine – even when you don’t have any neck or back pain? It’s more common than you think for knee pain to be caused from your lower back, and when this gets missed, it’s a huge reason for lingering knee pain that never seems to get resolved. With a true knee problem, your symptoms tend to be pretty specific and localized to just your knee joint. But if your pain tends to move around your knee, or travels up and down your leg, there’s a good chance your knee pain is coming from your back. If you’ve been treating your knee for months (or years) – and it’s not going away –  consider that your knee problem is actually a back problem. This could be especially true if you’ve had cortisone injections and/or various procedures done to your knee with little or no effect.

3. Poor core strength

When it comes to core strength, most people associate it with something that’s important for resolving and preventing back pain. But good core strength is vital to good knee health as well. Your abdominals, low back muscles, hips, and glutes all make up what we call your “powerhouse” – otherwise known as your core. Your powerhouse – specifically your hips and glutes – have a huge influence on how well your lower extremities function. If your core is weak, your legs will need to work harder and eventually overcompensate. And knee joints often take the brunt of all this. The truth is, although your knees require a certain amount of stability to function well – they aren’t designed to be a stabilizing joint. That’s what your hips and ankles are for. If your core is weak (particularly hips and glutes), and your knees start trying to help out as an extra stabilizer, this could be the reason why they keep hurting. If you haven’t yet gotten your core strength properly assessed – do it – this could be the culprit.

4. Weak ankles

As I alluded to above – if your ankles aren’t strong enough to stabilize your foot and lower leg, your knees will kick in to help. If this pattern is allowed to continue – your knees will start to hurt – and will keep hurting until the pattern is discovered and fixed. Another interesting phenomenon that can occur in any joint (not just your ankles) is that when a joint lacks strength or stability – it will stiffen up to compensate. So in terms of your ankles – if they lack range of motion on top of being weak – your knees will really pay the price. This is particularly evident during activities such as running, hiking, pickleball, or tennis. You need really good mobility and stability of your ankles for these activities – or your knees will suffer in response. If you’ve got lingering knee pain and haven’t yet taken a look at your ankles – I recommend doing so – they could be the overlooked issue. 

Knee pain can be tricky to figure out – especially if it’s chronic. The key to successfully getting rid of knee pain starts with correctly identifying the cause. And from my experience – arthritis, age, and wear and tear serve as “excuses” when a practitioner doesn’t know where to look. If you’re suffering from chronic knee pain and haven’t yet explored any of the four lesser-known contributors I mentioned in this article – talk to a specialist who knows how to look at the big picture instead of just your knee – because the true cause could be elsewhere.

Are you local to Portsmouth, NH?

CLICK HERE to speak with one of my specialists for free.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her Knee Pain Free Report CLICK HERE  or to get in touch, email her at [email protected].