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So… you’ve gone to the doctor and they said you need to get a Cortisone shot! (Oh no!)
You might be thinking:
“… What exactly is it? …What do I do? …Will it hurt?”
This blog post will cover… absolutely everything you will ever need to know when considering getting the Cortisone shot. (in respect to injuries)
What this post will cover: [Click to jump to the answer]
- What is a Cortisone Shot?
- How does it work?
- What is the procedure?
- Where is it used?
- Does it hurt?
- How effective is it?
- How many do I need?
- What are the side effects?
- How long does it last for?
- Do NOT do this!
- Do you really need to get the Cortisone shot? (my personal opinion)
What is a Cortisone Shot?
It is an injection that is administered to help reduce pain in a certain area.
How does it work?
The Cortisone shot consists of 2 components:
This is a corticosteroid medication which has a role in the reduction of the inflammation around an area.
Since areas of increased inflammation are generally painful, by decreasing inflammation, you also decrease pain.
(… and in case you are wondering… they are not like the ones bodybuilders use at the gym)
This is a chemical (usually lidocaine, bupivacaine or marcaine) which is used to provide numbness to the area over a short period of time.
It’s like this:
You know when you go to the dentist and they inject your gum to make it all numb? Well – this is exactly what it is.
What is the procedure?
- Depending on the painful area, you will be placed in a position that will allow for the easy insertion of the cortisone shot.
- The injection site is then cleaned with disinfectant.
- Imaging guidance (usually Ultrasound or CT guided) may be used to accurately administer the injection. The doctor will be able to see where to inject using a display screen.
- The doctor will then insert the needle into the target area.
Does it hurt?
(Well – I personally think getting any needle would hurt!)
Many patients describe the feeling as a pinching or burning sensation.
Where is it used?
I will answer this question with another question.
“Where does it hurt?”
Wherever it hurts, is usually where the cortisone is injected.
Common areas where people get the injection:
- Lower back:
- (Disc bulges, nerve issues)
- (Inflamed tendons, bursitis)
- (Inflamed tendons, bursitis)
- (Tennis/Golfers elbow)
How effective is it?
From what I have seen in the clinic:
The first injection is generally successful if the onset of pain is relatively quite recent (within 4-6 weeks).
However – there are debates whether that the pain would have subsided naturally over time anyway.
Following injections tend to be less effective.
How many can I get?
There is no set maximum number.
However – It is recommended that you do not receive more than 4 cortisone shots per year. (… and at least 6 weeks in between them).
This is to reduce the chances of side effects.
What are the potential side effects?
a) Weakening of the tendon
This can result in an increase risk of a tear occurring in tendons/muscles. Sounds counter-productive, doesn’t it?
b) Fat Atrophy
This basically means that there is thinning of fat around the injection area. The issue with this that there is decreased padding around the area.
c) Nerve damage
If the injection is incorrectly administered, it may touch and damage a nerve.
Any penetration of the skin (especially into deep structures like the joint) increases the risk of infection.
e) Other potential side effects
- Thinning of bone (Osteoporosis)
- Lightening of the skin (Hypo-pigmentation)
- Temporary increase in blood sugar
- Hot flushes
How long does it take for a cortisone shot to take effect?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours to days.
The actual cortisone starts working in about 3 to 5 days.
How long does it last for?
(Sorry – I wish I could give you a definite number)
But more often than not – I would say it’s effect can last from a few days to a few months.
What should you do after a cortisone shot?
Rest for 24-48 hours as the injection site may still be tender.
You may apply an ice pack to the area to help with this pain.
After the 48 hour rest period:
This is what I refer to as “your window of opportunity”.
It’s time to commence the appropriate exercises to get the area strong enough before the cortisone wears off.
Do NOT do this:
After the injection – DO NOT keep doing the same aggravating activity that has caused the inflammation in the first place.
Read that last sentence again.
The injection is not there to just block the pain so that you can keep aggravating it.
Do you really need to get the Cortisone shot?
(Before you read: This is my OPINION. It is based on what I have personally seen with my patients over several years.)
To put it simply:
I do not agree on how hastily the cortisone shot is prescribed to patients.
Unfortunately – many doctors are convinced that this injection is the answer to all painful injuries without even giving proper consideration to conservative management (… like exercises!) to naturally reduce pain.
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It is commonly used as band-aid solution with no direct attention to the CAUSE of your pain.
It is a NOT a magical fix.
More often than not, we are able to completely resolve an injury without having to inject chemicals into your body.
There are times when there is simply too much inflammation in the area and the injection is absolutely necessary. In these cases, the cortisone shot proves to be quite effective when used in conjunction with exercises.
The cortisone shot is merely one component of the whole treatment plan in addressing your pain. It is NOT designed to be the ONLY treatment.
“But Mark! What is YOUR recommendation? Should I get it?”
No, no and NO! …
Well, to be more precise, I would say NOT YET.
My advice: (In a nut shell)
– Try exercises first!
– Get on some simple anti-inflammatory medication for the first 2 weeks or so.
– Make sure you take adequate rest from whatever activity that is causing your pain in the first place.
– Persist with the right exercises. Perform at the appropriate intensity. Give it at least 4-6 weeks.
– If nil improvement at all, then maybe consider getting it.
What exercises should I do?
Still unsure whether you should get the Cortisone shot or not?
Don’t you worry. That’s completely normal.
Shoot me a question down in the comments section below and I’ll help you out!