Tag Archive for: cortisone

Why your Cortisone Injection Failed You

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Why your Cortisone Injection Failed You

When you have joint pain that won’t go away, especially after trying lots of physical therapy, your doctor might recommend you get a cortisone shot.

Cortisone shots are often prescribed for things like back pain, bursitis, bulging discs, cartilage tears, osteoarthritis, tendonitis, and many other conditions that are perceived to be inflammatory in nature. While every single one of these conditions can cause things to be inflamed, it doesn’t mean that inflammation is your underlying problem. If something else is causing any of these structures to get irritated and inflamed, then your cortisone injection won’t work. At the very best it will provide you temporary relief, but the problem will ultimately come back in about 6-12 months time.

Cortisone shots also come with many potential problems and side effects. So you really want to be sure that it’s necessary before you get one.

The list includes problems such as: cartilage damage, death of nearby bone, joint infection, nerve damage, temporary facial flushing, temporary flare of pain and inflammation in the joint, temporary increase in blood sugar, tendon weakening or rupture, thinning of nearby bone (osteoporosis), thinning of skin and soft tissue around the injection site, and whitening or lightening of the skin around the injection site. And none of these side effects account for human error with the procedure. If your doctor is “off” with his/her injection – you could end up with unnecessary tissue trauma and pain because your shot wasn’t injected correctly.

So when it comes to cortisone shots, you really want to make sure that 1) the root source of your problem is inflammation and 2) you actually need one.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the actual pain you are experiencing might be due to inflammation, the underlying cause leading to the inflammation could be something else entirely. Cortisone shots are used to address inflammation. But 80% of the time the musculoskeletal pain you’re experiencing is due to a mechanical or movement problem. So while the symptoms you’re experiencing could be due to inflammation, the root cause of your issue could be due to something else. In this case, the cortisone shot will not help – or worse – provide you with temporary relief that leads you to think it did.

Let me explain with a bit of scientific research.

Studies show that 70-80% of people over the age of 50 have a bulging disc on their MRI. 60% have a meniscus tear in their knee. These findings are considered normal as you age. The research also says that not all of these people experience pain. So you can have two people with the exact same MRI findings and one person will be perfectly fine while the other can barely walk. This is how we know that “the finding” (a bulging disc or meniscus tear for example) isn’t necessarily the problem.

The source of the problem is what is causing that bulge or tear to get annoyed.

About 80% of the time it’s going to be something like a faulty movement pattern or “mechanical issue,” such as poor mobility or stability, leading to some compensatory movement strategies in your body. When you don’t move well, structures like normally occurring disc bulges and meniscus tears can get irritated.

For example, let’s say you have a bulging disc in your back. If you sit for most of the day, travel a lot for work, or have a job that involves a lot of repetitive lifting, these types of activities are known to really aggravate a bulging disc. If all you do is inject cortisone to calm down the irritation, you won’t be fixing the real problem… which in this case is your daily movement habits. After about 6 months of returning to all these activities again, the pain WILL come back.

The good news is that there are ways to solve this type of problem (and others) naturally, and without a cortisone injection. But the important thing for you to realize here is that if you did get a cortisone shot recently and it appears to have “failed,” the last thing you want to do is get another one or resort to an even more invasive procedure. It’s possible you didn’t need it in the first place, so you want to make sure that is uncovered first.

So, if you’ve recently had a cortisone shot and it didn’t work, it could very well be that you never actually needed it… or that the wrong problem (inflammation) was being addressed instead of the underlying cause.

If you are considering something like a cortisone shot, it’s always a good idea to get a second opinion to make certain you really need it and that it’s the best course of action for your problem. And if you’ve already had one and it didn’t work, don’t worry, odds are good that there is still a solution out there for you… and it doesn’t have to involve more procedures.

It could be as simple as learning how to move better!

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you avoid quick fixes like cortisone shots and get long lasting results. 

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Is running bad for your knees?

Movement is medicine (when prescribed properly)

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I have a confession to make. A few months ago I hurt my own back.

Yes, you read that correctly, the back pain expert injured her own back! I preach this ALL the time to my clients, but one of the reasons I’m so passionate about helping people with back problems is because the treatment is not cookie-cutter. But once we find what works for you, physical therapy is so effective and rewarding.

In my case, I was able to use very specific movements to get rid of my back pain, and then start focusing on strengthening exercises to keep it gone. Don’t get me wrong, there were moments when I wanted to call my doctor and ask him for pain pills, and even the idea of an injection crossed my mind once or twice. But because I keep up with the research, I know that pills and injections really don’t work well for long-term results. Aside from the many potential complications and side effects, quick-fix treatments tend to mask your pain and keep you from doing the real work that is necessary to keep the problem from recurring in the future.

At CJPT & Pilates, long-term solutions are the only thing we are interested in. We believe that movement is medicine.

For all musculoskeletal injuries, including back pain, the research shows that movement and exercise really is the best course of treatment in about 80% of all cases. OK, I know what you’re thinking. If it were that easy, why can’t you just go to the gym, to yoga, or follow an exercise video at home to get rid of your own back or knee pain?

It’s because although movement IS medicine, it only works when prescribed for you properly.

Let me explain.

I’m working with a gentleman right now who’s had back pain for over a year. It started after a car accident. He’s tried regular physical therapy, chiropractic, steroid injections and radiofrequency ablation. None of it worked. He feels good when he exercises and moves around, but the pain always comes back.

When he came to see us, the really interesting thing I noticed about his back was when he put himself in certain positions, he would stand up and literally be crooked. His spine would shift to one side, and become very painful and stiff. In the PT-world we call this a lateral shift, and it’s a sign that indicates he likely has a bulging disc. The great thing about a bulging disc is that they tend to respond very well to corrective movements. Once we know what movement “fixes” you, we can prescribe it to you. This gentleman can now make himself straight and get rid of his back pain in under a minute. Of course the goal is to get him to the point where he no longer needs this corrective movement, but for now, it quite literally is his medicine.

I think the reason more people don’t use this approach is because it requires a little bit of work, and you don’t often see the results immediately. When you get an injection, or even take a pill, the pain is gone in a few hours and it will often stay gone for a period of time without you really needing to do much. With movement, you have to stick with it and do it correctly for it to work. And although you can get an immediate reduction in pain from the correctly prescribed movement, it takes several weeks for it to start to stick and produce long-term relief.

But here’s the best part about using movement as medicine — it’s natural, there are no harmful side-effects, and you can do it completely on your own.

If you’ve been suffering in pain for awhile and tired of using pills or quick fixes to manage your pain, sign up for a FREE Discovery Session with us to find out if movement can be your medicine instead! You can also check out our free back pain guide right here.

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Steroid injections may do more harm than good, research shows

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Have you been told you need to get a cortisone injection? Have you already tried them more than once? 

Research is now showing that cortisone injections may hurt more than help in the long run! 

The results of a recent study from Radiology has raised concerns in the medical community about potentially adverse effects on joints following corticosteroid injections. These injections are commonly used to treat arthritis, especially osteoarthritis of the hip and knee. The researchers in this study observed patients who had previously received steroid injections and found that some of the patients exhibited further joint damage on medical imaging tests. According to the original article, these patients presented with “accelerated OA [osteoarthritis] progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss.” 

The joint issues that can be triggered by cortisone injections don’t just show up right after the procedure — which makes it easy to see the steroid shot as a quick fix with no drawbacks.

And it’s true that there are usually no short-term side effects. However, when it comes to your joints, it’s all about the long game. And it’s worth noting that an analysis from the Cochrane Review in 2015 found that the benefits of steroid injections usually wear off after about six months…  meaning it’s a temporary “band-aid” solution to a bigger problem — a band-aid with the potential to result in permanent degradation of your joints!  

Arthritis is an issue we see all the time in our physical therapy practice, and that’s why patient and physician concerns with steroid injections are so relevant to us. Many of our clients have had injections suggested to them or have gone through with the procedure but not experienced any long-term healing. In many cases, this can be an overly simplified answer to the very complicated question of individual pain. Physical therapy, on the other hand, isn’t a one-size-fits-all solution. Our treatment model is entirely based around addressing the root cause of your pain instead of just providing temporary relief. Plus, we’re all about keeping your treatment non-invasive, movement-based, and entirely customized to YOU. 

If you’ve been told that you need a cortisone injection in your back, knee, or shoulder, think twice and get informed about other options!

If you’d like a NATURAL route to pain relief — and one that will make you more mobile and active at the same time — come talk with us! You can even schedule a FREE 30 minute Discovery Session with our Portsmouth, NH physical therapy specialists right now — no strings attached.