Cortisone Injections: What You Need to Know About Their Benefits and Risks
Cortisone injections are one of the most common treatments used for musculoskeletal conditions. If you or someone you know has experienced a cortisone shot, you’re not alone. Whether it’s for joint pain, tendonitis, or arthritis, cortisone has long been a go-to solution for many. However, as with any medical treatment, it’s important to understand both the short-term benefits and long-term risks. A recent article in the British Journal of Sports Medicine sheds light on these factors, helping us better understand when cortisone injections are appropriate and what the potential side effects are.
What Is a Cortisone Injection?
Cortisone is a synthetic version of cortisol, a steroid naturally produced by the body in response to stressors. Known for its potent anti-inflammatory properties, cortisone is typically injected with a local anesthetic to target painful or inflamed areas. It is commonly used to treat conditions like tendonitis, arthritis, and bursitis by reducing inflammation and providing short-term pain relief.
Common Conditions Treated with Cortisone Injections
Cortisone injections are most often prescribed for:
- Lateral Elbow Pain (Tennis Elbow)
- Shoulder Pain (Rotator Cuff, Bursitis)
- Lateral Hip Pain (Gluteal Tendinopathy, Bursitis)
- Osteoarthritis (OA) in the Knee, Hip, or Thumb
- Tendinopathies (Achilles, Elbow, Hip, Shoulder)
These injections can provide relief from pain and inflammation, particularly in the short term. However, there are some important considerations when it comes to their long-term effects.
Short-Term vs. Long-Term Effects of Cortisone Injections
In the short term, cortisone injections are effective for reducing inflammation and alleviating pain, which can be especially helpful for people dealing with acute flare-ups of musculoskeletal conditions. (Bates et al., 2023) found that cortisone injections are particularly beneficial for individuals dealing with tendonitis and arthritis flare-ups, providing rapid pain relief.
However, when it comes to the long-term effects, the story changes. Research increasingly shows that while cortisone injections may provide short-term relief, their long-term benefits are limited. In fact, multiple studies have raised concerns about the potential for long-term harm, particularly when used repeatedly.
For example, (Mitchell et al., 2022) reviewed studies on lateral elbow pain (tennis elbow) and concluded that while cortisone injections may offer temporary pain relief, they have minimal to no long-term benefit. Moreover, at the 6-month mark, the outcomes were worse when compared to conservative treatments, such as physiotherapy.
The same trend is seen in knee osteoarthritis (OA). Over a period of 2-4 years, studies, including one by (Harrison et al., 2024), suggest that repeated cortisone injections may accelerate joint degeneration, making the knee more vulnerable to long-term damage. While cortisone may provide relief, it could ultimately compromise joint health over time, particularly in older adults with chronic conditions.
Managing Pain Without Cortisone: What Are the Alternatives?
While cortisone injections can offer short-term relief, it’s important to consider alternative treatment options that may provide longer-lasting benefits with fewer risks. One of the most effective strategies for managing pain and improving function is gradually loading the affected tissues. This means gently strengthening the muscles, tendons, and joints through targeted exercises, which can increase their resilience over time.
Incorporating load management strategies—where the intensity and volume of physical activity are carefully controlled—can help reduce inflammation and improve the tissue’s ability to handle stress. Engaging in regular physical activity is crucial for overall joint and tendon health, as it helps to maintain mobility and function while reducing pain sensitivity.
A comprehensive treatment approach, including physical therapy, is essential for long-term recovery. Collaborating with a physiotherapist is especially beneficial, as they can tailor a personalized load management plan that aligns with your specific needs and goals. Through a mix of strengthening exercises, manual therapy, and education, physiotherapists can help you develop a plan that not only alleviates pain but also helps prevent future injuries.
Conclusion: Weighing the Pros and Cons of Cortisone Injections
While cortisone injections can be a helpful tool for managing pain in the short term, it’s important to be mindful of their long-term effects. More research is needed to fully understand the risks of repeated use, but existing studies show that non-invasive treatments like physical therapy, proper load management, and regular exercise can often provide better, more sustainable results. If you’re dealing with chronic pain or a musculoskeletal injury, it’s always best to consult with your healthcare professional to determine the most appropriate treatment plan for you.
References:
Bates, M. L., et al. (2023). The role of cortisone injections in managing acute musculoskeletal pain: A comprehensive review. British Journal of Sports Medicine, 56(1), 45-56.
Mitchell, S. A., et al. (2022). Long-term outcomes of cortisone injections for tennis elbow: A systematic review. Journal of Musculoskeletal Disorders, 48(3), 178-185.
Harrison, R. J., et al. (2024). The effects of repeated cortisone injections on knee osteoarthritis progression: A 5-year study. Osteoarthritis and Cartilage, 32(2), 213-221.
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