Tag Archive for: mechanical pain

tendinitis and tendinosis

Why Cortisone Shots Often Fail in the Knee

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When you’ve got nagging, persistent knee pain, it’s common for doctors to recommend a cortisone shot in the knee.

A cortisone shot in the knee, also known as corticosteroid injections, or “steroid shots”, works by reducing inflammation in your knee joint in an effort to alleviate pain. Sounds pretty straightforward, right?  Well… not so fast.

Assuming your knee pain is truly due to inflammation, then yes, a cortisone shot can be a successful treatment option. For example, it’s often used as a pain management strategy when you’re awaiting a major joint replacement surgery.

Advanced osteoarthritis is a common cause of knee inflammation.  The only real “cure” for this is joint replacement. Periodic cortisone shots may help give you the pain relief you need to pass the time until surgery. But this is a very specific and not common circumstance.

What we see more often than not is cortisone shots either working temporarily, or not working at all in your knee joint.

Patients are often told they need up to three cortisone shots to see results. There’s a problem with this approach. Every time you get a cortisone shot, you risk damaging the cartilage and tissue in your knee joint. This not only leads to irreversible joint damage, but more persistent pain in your joint that gets harder and harder to fix.

So when it comes to whether or not you should get a cortisone shot in your knee – you really want to make sure that the root source of your problem is inflammation.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the knee pain you are experiencing might be due to inflammation, the underlying cause leading to that inflammation could be something else entirely. Eight percent of the time the knee pain you’re experiencing is due to a mechanical or movement problem.

So while the symptoms you’re experiencing could be inflammatory in nature, the root cause of your issue is not. A cortisone shot is not going to help your knee in this case. Or worse, you’ll get temporary relief that fools you into thinking it worked. This only delays treatment that will give you the long-lasting relief you’re looking for.

So how do you know if you have a true inflammatory problem in your knee?

Let me explain.

Let’s say you have some arthritis and general wear and tear in your knee joint. You have good days and bad days. The pain comes and goes. Certain movements and exercises make your knee feel better while others seem to really aggravate it.

This is a pretty classic presentation of a mechanical knee problem. The mechanical issue (aka movement problem) in your knee can irritate certain structures within your knee joint (like a meniscus or ligament) and cause it to be inflamed.

If you go ahead and just inject cortisone into this knee, it might relieve the inflammation for a short time. It won’t help the underlying movement problem. It’s only a matter of time before the cortisone wears off and the structures in your knee feel irritated again. Not only have you masked the problem, but now you risk creating actual damage to those structures from the cortisone. Studies have shown that repeatedly injecting cortisone into your knee (or any joint) can advance the formation of osteoarthritis.

Another interesting statistic is that 41% of knee pain has been shown to be coming from your spine – even when there is no back pain present.

In this case, your knee could really hurt and appear to be inflamed. If a doctor can’t find any real explanation for this from an X-ray or an MRI (because the real problem is coming from your spine), he or she may assume it’s just inflammation from wear and tear and suggest a cortisone shot. This is not going to help your knee. Once again you risk causing real damage to an otherwise healthy knee joint.

These are just a few examples of where cortisone shots are unnecessary and can go wrong when incorrectly prescribed.

Have you recently had a cortisone shot in your knee and it didn’t work? It could  be that you never actually needed it. Or that the symptoms (inflammation) was being addressed instead of the underlying cause.

If you are considering a cortisone shot in your knee, it’s always a good idea to get a second opinion to make certain you really need it. A mechanical pain expert can tell you whether or not your knee pain is truly due to inflammation. If your knee pain is due to a movement problem (80% of time it is) then a proper movement prescription is your answer.

Are you local to Portsmouth, NH and looking for help with your knee pain NOW?

Consider speaking to one of my specialists.

Tell them about your knee pain and they’ll see if we would be a good fit to help you!

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].

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How MRI’s Lead Back Pain Sufferers to Unnecessary Procedures

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Have you ever had back pain and wondered…Do I need an MRI to figure it out? One popular questions I get from clients is if they need an MRI when experiencing back pain or sciatica. It’s pretty standard protocol when you go see a doctor – but is it necessary?

In most cases… NO.

About 70-80% of back problems, even sciatica, are considered mechanical in nature and quite normal. That means there isn’t anything “serious” causing your pain.

Serious causes of back pain include things like a tumor, infection, fracture, or severely compromised nerve. Your symptoms will be pretty specific and obvious to a back pain specialist – and will typically require advanced medical intervention. An MRI can be useful in these cases to get more clarity before medical intervention begins. But when your back pain is mechanical in nature, an MRI is more often than not misleading – and may lead to unnecessary procedures or surgery.

If you’ve had back pain for years, it comes and goes, or you’ve had relief in the past from things like physical therapy or chiropractic treatment…

You most likely have mechanical back pain.

The root cause of mechanical back pain can NOT be diagnosed by an MRI. If your back pain falls into the mechanical category, and you get an MRI anyway, you can end up with treatments you don’t need. Over the years, I’ve seen SO many people with mechanical back pain get major medical procedures that were irreversible and made them worse.

Here’s the problem….

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. Everything from bulging discs, arthritis, stenosis, and degenerative discs, which are all considered normal as we age, but are usually NOT the root cause of your back pain.

What typically happens is the MRI finds them, and your back pain gets blamed on them.

But what we know from research is that all those common MRI findings I just mentioned rarely correlate with what’s actually causing your back pain. Research has shown consistently that you can have two people with identical MRI’s showing something like bulging discs and arthritis, but only one of them will be suffering in pain.

That’s how we know the root cause of your back pain is coming from something else!

One notable study was the Lancet series. Three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian. In fact, he says: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Do you notice that certain positions or movements relieve your back pain? Or you feel better after walking and exercise? Your back pain is likely mechanical in nature. You don’t need an MRI to diagnose you.

Mechanical back pain responds to specialized movement therapy and a selectively progressed exercise protocol. Mechanical back pain does NOT respond well in the long run to injections, procedures, or surgery, which is what you can end up with if you get an MRI and don’t really need one.

I can’t tell you how many people I’ve seen over the years get surgery for a bulging or herniated disc. Only to find that it didn’t help their problem. Or it came back again with a vengeance. After all, once you have surgery mechanical back pain can actually become more difficult to fix. Your tissues and ligaments are now compromised from surgical scarring. No matter how minimally invasive they say your surgery will be.

If you’re confused, I don’t blame you.

CLICK HERE to speak with one of my specialists for free. They will figure out the right treatment plan for you. And at the very least give you some helpful tips moving forward.

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 guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

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Nagging pain in your shoulder can be extremely annoying. But when it starts to interfere with things you love to do – you can’t help but wonder – Will a Cortisone Shot Help Your Nagging Shoulder Pain?

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 are extremely routine and popular – it doesn’t mean they are the best or right thing to do.

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?) – it’s a problem if you keep getting cortisone shots when you don’t actually need them.

Why?

Well overuse of cortisone shots can cause degeneration of your tendons and joint structures. So you only want to get one when you know: 1) it’s going to help and 2) if it’s necessary.

But how do you know? The key is in understanding the source of your pain. With chemical sources of pain, the source is inflammation and a cortisone shot is a good idea. But when it comes to mechanical pain, inflammation may exist but it’s not the source of your shoulder problem. In these cases, cortisone is either not helpful – or worse – it “works” but then masks your problem, sometimes for years.  

Let’s talk about the two sources of Shoulder pain to help you understand.

 

“Chemical Pain”

Chemical pain is the result of your body’s natural inflammatory response to injury. It’s a complex chemical reaction that occurs after tissue damage that involves the releasing of chemicals from your blood and other cells to “flush out” the area and start the healing process.

A good example of this is when you fall and sprain something. The sprain causes temporary tissue damage so your body creates inflammation to heal it. Normally this process only lasts a few days, your pain subsides, and you’re back to normal in no time. But sometimes this inflammatory process lingers longer than it should.

For various reasons the accumulation of toxic chemicals sticks around and the result is constant irritation to the nerves and surrounding tissues. Constant, dull pain, even at rest, that tends to be very sensitive to any and all movement is often a tell-tale sign that you’re dealing with pain that is chemical in nature. In this case, a cortisone injection could be a good course of action for you.

“Mechanical Pain”

Mechanical pain does not need a cortisone shot and it won’t respond well to it. 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. Eighty percent of all musculoskeletal problems – including shoulder pain – are mechanical in nature.

Now, the real problem is that whether or not your pain is mechanical, a cortisone shot often does take away your pain. Not only is this confusing – but many people question why they should even be concerned about this. Well – when the pain and inflammation you’re experiencing is secondary – which is often the case with mechanical pain.

 You never actually treat the true source of your shoulder pain when you “cover it up” with a cortisone shot.

For example, you might have an irritated rotator cuff tendon or arthritis that is exacerbated because of poor posture or immobility in your shoulder joint. If you inject cortisone into your tendon or joint, the pain will likely be relieved. But this will only be temporary. It’s only a matter of time before your poor posture and movement habits cause irritation and pain again. This is the vicious cycle I see a lot of folks get themselves into. You risk never fixing the real problem. And irreversible damage to your tendon that might eventually need to be fixed surgically. 

Moral of this story… don’t rush to get a cortisone shot just because you’ve been told you have inflammation.

You must figure out the source of your inflammation first. Cortisone shots are not necessary if your pain is mechanical in nature. And it might actually prolong your problem. If your pain comes and goes, or you have good days and bad days, this is a classic sign that your pain is likely coming from a mechanical source.

Your best course of action is to work with someone who understands and specializes in this. I’ve seen many cases where getting a cortisone shot provides a false sense of hope, and as a consequence, delays quality treatment that you should be getting instead. 

Are you local to Portsmouth, NH?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

If you can’t wait for the call  – get our free guide to neck and shoulder pain now. 

This totally free guide – written by leading back pain specialist, physical therapist, and movement expert, Dr. Carrie Jose – reveals seven easy ways (plus a bonus section!) that are PROVEN to help you ease neck and shoulder pain quickly – without pain medication, procedures, or surgery.

Click here to download the guide!

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 email her at [email protected] or call 603-605-0402