Tag Archive for: cortisone injections

herniated disc

Herniated Discs and Cortisone Shots – What Most People Get Wrong

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Herniated Discs and Cortisone Shots: What Most People Get Wrong About Back Pain Treatment in Portsmouth, NH

If you’ve been told you have a herniated disc and that your next step might be a cortisone shot, you’re not alone. This is one of the most common treatment paths recommended for people dealing with back pain after an MRI reveals a disc bulge or herniation.

Many people assume that if their MRI shows a herniated disc and they’re experiencing pain, the logical next step is a cortisone injection. But that assumption often sends people down a path of procedures that don’t actually address the root cause of their back pain.

At our Portsmouth, NH physical therapy clinic, we frequently see patients who were advised to get injections before anyone fully explained why their pain was happening in the first place.

The truth is that cortisone shots—most commonly delivered in the spine as an epidural steroid injection (ESI)—can help in certain situations. The problem is that they are often recommended without first understanding the type of back pain someone is experiencing. When that happens, people may undergo injections that do little to solve the real problem.

Understanding when injections help begins with recognizing that not all back pain behaves the same way.

Not All Herniated Disc Pain Is the Same

When people hear the words “herniated disc,” they often imagine a serious structural injury that needs to be treated with medication or a procedure.

But the presence of a herniated disc on an MRI does not automatically mean injections are necessary. In fact, research has shown that many people have herniated discs on imaging and experience no symptoms at all.

What matters far more is how the body is responding to the disc and the type of pain it creates.

Broadly speaking, most back pain falls into two categories:

  • Inflammatory pain
  • Mechanical back pain

Both can occur with a herniated disc, but they behave very differently and respond to different treatments. Unfortunately, this distinction is rarely explained to patients, which is one reason cortisone injections are often misunderstood and overused.

When Cortisone Shots Can Help

While cortisone injections are rarely my first recommendation, they can be helpful when pain is primarily driven by inflammation.

Inflammation is a normal part of the body’s healing process. When tissue becomes irritated or injured, the body releases chemicals that increase blood flow and begin repair.

Occasionally, however, this inflammatory response doesn’t shut off properly. When those inflammatory chemicals linger longer than necessary, they can irritate nearby tissues and create persistent “chemical” pain.

This type of pain tends to:

  • Feel constant
  • Change very little with movement or posture
  • Be described as hot, inflamed, or deeply irritated

When inflammation behaves this way, cortisone injections can help by suppressing those inflammatory chemicals and calming irritated tissue. Once inflammation settles, movement and exercise can become effective again.

However, this type of inflammatory pain is not the most common cause of back pain.

Most Herniated Disc Pain Is Mechanical

Most back pain—even when a herniated disc is involved—is mechanical in nature.

Mechanical back pain is related to how the joints, muscles, and spine move together. It often develops when certain areas of the body become stiff while others compensate, creating inefficient movement patterns and excess stress on the spine.

Many people with herniated discs notice patterns like:

  • Pain worsening when sitting too long
  • Relief when standing or walking
  • Improvement with stretching or changing positions

These patterns are important clues.

When back pain improves with movement, the most effective treatment is usually restoring proper movement patternsthrough physical therapy.

This includes:

  • Identifying mobility restrictions
  • Correcting faulty movement habits
  • Strengthening the muscles that support the spine

Herniated discs can sometimes become irritated by everyday activities like lifting awkwardly, twisting suddenly, or even coughing or sneezing. When this happens, nearby muscles and nerves may become temporarily inflamed, making the pain feel intense and alarming.

But in many cases, this irritation is temporary and part of the body’s normal response—not something that requires injections or surgery.

The bigger issue is often the mechanical stress that caused the disc irritation in the first place.

Unless that underlying problem is addressed, the disc may continue to flare up repeatedly. Once movement patterns improve and mobility restrictions are corrected, the disc bulge or herniation often becomes far less significant.

The Problem With Treating Symptoms Instead of Causes

One of the biggest limitations of cortisone injections is that they treat symptoms rather than causes.

By reducing inflammation, the injection may temporarily decrease pain. But it does not correct the movement problems or mechanical stress that contributed to the disc irritation.

In some cases, this temporary relief can even backfire. When pain is masked, people may return to activities that continue irritating the spine without realizing it.

Over time, this can reinforce the same patterns that caused the injury and increase the likelihood of repeated back pain flare-ups.

New Non-Invasive Treatment Options for Back Pain

Fortunately, newer regenerative therapies are offering alternatives to cortisone injections for calming inflammation and promoting healing.

One example is Extracorporeal Magnetotransduction Therapy (EMTT). This technology uses high-frequency magnetic energy that penetrates deep into tissue and stimulates healing at the cellular level.

It is often combined with shockwave therapy, which helps stimulate circulation and tissue repair in irritated areas.

These therapies are non-invasive treatments for back pain that work with the body’s natural healing systems rather than suppressing them.

How to Tell What Type of Back Pain You Have

If you are considering a cortisone shot or epidural steroid injection for a herniated disc, the most important step is understanding how your pain behaves.

The way your symptoms respond to movement can provide valuable clues.

If your symptoms:

Improve when you walk, stretch, or change positions
Your pain is likely mechanical in nature. In these cases, treatment focused on restoring proper movement—often through physical therapy—can be the most effective solution.

Feel constant, inflamed, and largely unaffected by movement
Inflammation may be playing a larger role, and treatments designed to calm inflammation could potentially help.

Either way, cortisone injections do not fix structural disc problems or movement dysfunction. They simply reduce inflammation.

Long-term recovery from back pain almost always requires addressing how the body moves. When those underlying issues are corrected, many people find their back pain improves without ever needing injections.

Dr. Carrie Jose, Physical Therapy Specialist and Mechanical Back Pain Expert in Portsmouth, NH, writes for Seacoast Media Group.

To learn more about natural treatment options for back pain in Portsmouth, NH, or to request a free copy of her guide to relieving back pain naturally, visit www.cjphysicaltherapy.com or call 603-380-7902.

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Cortisone Shots for Knee Pain? Why You Should Think Twice.

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Knee pain can be incredibly disruptive – turning simple, everyday activities like walking, climbing stairs, or even standing up from a chair into painful challenges. In search of quick relief, many people turn to cortisone shots. By targeting inflammation in the knee joint, cortisone injections can temporarily ease pain and swelling, making them an appealing option when you’re hurting.

But cortisone shots are just that – a temporary fix. And they come with significant risks and downsides that are often overlooked. Let’s take a closer look at why relying on cortisone injections may not be the best long-term solution for your knee pain – and what you can do instead to find natural, healthier, and lasting relief.

The Problems with Cortisone Shots:

1. Temporary Relief Without Addressing the Root Cause

Cortisone injections can offer pain relief that lasts for weeks or even months – but they don’t address the underlying issue of your knee pain. Instead, they mask your symptoms, allowing conditions like osteoarthritis, tendonitis, or mechanical imbalances to quietly worsen over time. By simply numbing your knee pain, cortisone shots act as a band-aid – covering up the real problem while harmful movement patterns and joint stress continue unchecked. This can eventually lead to more serious, long-term damage without you even realizing it.

2. Risk of Joint Damage

Since cortisone injections only offer short-term relief, many people end up getting them repeatedly. But over time, frequent cortisone shots can actually do more harm than good – leading to cartilage breakdown and weakening the tendons and ligaments around your knee. Research shows that repeated cortisone injections can accelerate joint deterioration, increasing your risk of needing knee replacement surgery down the line. This is especially concerning for active individuals who want to stay mobile, avoid major surgery, and protect their joint health for the long run. Many people aren’t aware of this – so it’s important to know the risks.

3. Disrupts Natural Healing

Inflammation, while painful and uncomfortable, is a vital part of your body’s natural healing process. It increases blood flow, delivers nutrients, and recruits immune cells to repair damaged tissue. Cortisone injections suppress this natural inflammatory response – easing pain and swelling temporarily, but at a cost. By interfering with inflammation, cortisone limits the delivery of key nutrients and healing cells needed to repair cartilage, tendons, or ligaments. Over time, this leaves your knee joint and surrounding tissues weakened, making full recovery harder to achieve. When knee inflammation does get out of control, it’s far better to choose natural healing accelerants that support your body’s repair process – rather than disrupt it.

4. Potential Side Effects and Complications

As with any injection or invasive procedure, cortisone shots come with potential risks, including infection. Other side effects can include increased blood sugar levels, skin thinning, and changes in pigmentation around the injection site. While these risks may seem minor, they deserve serious consideration – especially when the relief they offer is only temporary. Over time, repeated cortisone use increases the likelihood of experiencing these complications. It’s important to ask yourself if short-term relief is worth the growing list of potential long-term consequences.

What to Try Instead of Cortisone Injections:

When it comes to knee pain, I always advocate for natural and effective alternatives that not only alleviate discomfort but also promote true healing. Here are three proven methods that address the root cause of knee pain rather than just suppressing symptoms:

1. Regenerative Shockwave Therapy

Shockwave therapy is a non-invasive treatment that uses acoustic sound waves to stimulate the body’s natural healing processes. By creating micro-traumas in the affected tissues, shockwave therapy boosts blood flow and encourages tissue regeneration. This treatment has been shown to improve mobility, reduce pain, and help with conditions like calcific tendonitis and osteoarthritis. Unlike cortisone injections, which only mask symptoms and can contribute to tissue breakdown, shockwave therapy actively supports healing and long-term relief. When combined with EMTT (Electromagnetic Transduction Therapy), the effectiveness of shockwave therapy is further enhanced – EMTT penetrates deeper into tissues, increases cellular activity, and accelerates the healing process, giving you even faster and more lasting results.

2. Dry Needling for Muscle Imbalances

Dry needling is a highly effective technique for targeting muscle tightness and trigger points around your knee joint. By inserting thin needles into specific areas, this therapy helps release muscle tension, improve circulation, and restore proper function. Dry needling is particularly beneficial for individuals suffering from tendonitis, chronic stiffness, or muscular imbalances that contribute to knee pain. It encourages natural healing by allowing muscles to function more efficiently, reducing strain on your knee joint.

3. Working with a Mechanical Knee Pain Specialist

A mechanical knee pain specialist is trained to analyze movement patterns and pinpoint the underlying causes of your knee discomfort. Unlike general healthcare providers who may prescribe pain medications or generic exercises, these specialists take a customized approach – identifying joint misalignments, muscle imbalances, and faulty movement patterns to develop a personalized rehabilitation plan. They assess how the entire body contributes to knee mechanics, ensuring all contributing factors are addressed. This comprehensive, root-cause approach not only restores knee function and prevents future pain but also leads to more effective, lasting results compared to the temporary relief offered by cortisone shots.

A Smarter Path to Knee Pain Relief:

While cortisone shots may seem like a convenient and quick option, they do little to promote true healing of your knee pain and can actually cause long-term harm. Natural treatments – such as regenerative shockwave therapy, dry needling, and working with a mechanical knee pain specialist – offer a more effective and safer path to knee pain relief. Instead of masking pain, these alternative treatments address the root cause, restore function, and help prevent future injury – giving you real, lasting relief.

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.