January 26, 2023
Patients with knee, shoulder, hip or other pain/orthopedic conditions are often given recommendations of steroid or cortisone injections, sometimes even before consulting with a physical therapist. For someone in pain, a doctor’s recommendation of one or two joint injections for knee pain may seem like a great course of care. Injections are fast, readily available, and often involve little to no time off of work. So, it seems like this would be a great idea, right? Well, there is more to it than that.
Injections can give a dose of cortisone (a steroid used to treat inflammation) directly to an area that is inflamed and painful, however it does not actually treat the root cause of what is causing the pain and inflammation. It’s long-term effectiveness has been evaluated in several articles.
One of those was a Journal of American Medical Association article, where patients with knee pain were placed into two groups: those who received a series of standard steroid injections and those who received a series of saline (placebo) injections every 12 weeks for 2 years. An MRI of the knee was done at the beginning, at one year, and then at the end of the study. Pain levels were recorded throughout the study.
At the end of the two year study, it was concluded that the effects of the cortisone shots were equal to those of the saline shots for pain relief. No difference in pain, stiffness, or function between the groups. The concerning factor is that the patients who had received cortisone had thinning of their cartilage after the shot series when compared to those who had the saline injections. The arthritic process was actually sped up by the use of steroids.
This isn’t to say that injections are always bad and should never be used; but rather you should ask yourself not just if you are a good candidate but if and when. Consider seeking conservative options first before resulting to injections and other invasive options. Over the course of a physical therapy plan of care you will find out what the underlying cause of your pain and inflammation is and a path to help it. Now there are times that through this process, we run into road blocks and aren’t able to progress the way we would like to; be it from pain or motion restrictions, etc. That may be an instance when we would recommend you consider or discuss an injection to help the process move forward.
If you have only received an injection and not worked with your New Life Physical Therapist on the issue, you may be missing an important piece. You may also realize this if your injection helped for a little bit, but then pain has since returned. At this time, the damaging effects of frequent steroid injections is better understood, and many physicians will restrict the number they will give to you within a period of time.
Bottom line, injections can be helpful at times with the right person at the right time in their care, however ultimately it masks symptoms and does not get to the underlying cause of the problem. Don’t avoid and don’t alter your pain, but find the root cause and learn how you can handle the problem without medications, injections, or surgery.