Why you should seek physiotherapy before getting a cortisone shot

Why you should seek physiotherapy before getting a cortisone shot

When you are suffering from a painful injury it’s natural to want to do anything possible to get rid of the pain NOW. But what if a quick pain relieving option isn’t always the most effective long-term treatment?

Although there are benefits to many different treatments, there are also side effects that must be considered and a view to looking at long term recovery when deciding which steps to take.

Should I get a cortisone shot?

Corticosteroid injections, AKA Cortisone shots are anti-inflammatory steroid based medicines used to treat a range of conditions including tendinopathies, bursitis, arthritis and plantar fasciitis. Cortisone shots in NSW can only administered by healthcare professionals and the corticosteroid family also includes triamcinolone and methylprednisolone.

The perceived pain relief from these shots can be immediate, with many patients hailing them as a miracle cure for their ailment. But are they really? Both physiotherapy and cortisone shots are used to treat an injury, however, particularly in conditions that are chronic, it’s likely you won’t feel any better beyond the very short term, plus a number of well known risks that cortisone injections carry too.

How do steroid injections work?

Many people believe that a cortisone shot is a pain reliever, it is not. It is usually administered with a local anaesthetic; it’s a large gauge needle about to be inserted, it’s not the most pleasant feeling.

Corticosteroids are medicines that mimic your body’s natural corticosteroid hormones produced by your adrenal glands; two small glands found above the kidneys. Cortisone injections are used to decrease the inflammation from an injury which may lead to decreased pain in the short term.

What are the side effects of a cortisone shot?

Possible side effects of steroid injections depend on where the injection is given. They can include:

• Flare-Up: 10% of people who get a cortisone shot experience sharp pains which sometimes resolve after three to five days.
• Joint infection/Joint damage
• Nerve damage
• Thinning of the bones (Osteoporosis)
• Tendon rupture
• Skin lightening around area of injection

Is physiotherapy a better choice?

Physiotherapy is usually highly recommend as a non-surgical, science based and natural treatment to help fix the cause of your injury and improve your overall function.

Importantly, in studies comparing physiotherapy to cortisone injections in knee osteoarthritis researchers found –

“Significantly less pain and disability in the group who underwent physiotherapy compared to injection”[1]

Dry needling is at also least as effective as a cortisone shot for the treatment of a number of injuries and afflictions. For example, Greater trochanteric pain syndrome (GTPS), previously known as trochanteric bursitis is a common orthopaedic problem affecting the hips.

“Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN (dry needling). Our data suggest that DN is a non-inferior treatment alternative to cortisone injections in this patient population”.[2]

Studies have also shown that high concentrations of cortisone or repetitive use can lead to tissue damage, which can lead to softening of cartilage in joints and/or weakening of tendons.

In addition, cortisone shots do not treat the root of the injury or pain. It can cause the pain to settle in the short term, however, it will not fix what caused you to be injured to begin with.

For example, your sore and inflamed back might feel great immediately after an injection, however if it was being exacerbated by referred pain and muscle imbalances from your hip and thigh, you’ll be back at square one in no time. If you don’t treat the source of injury, the pain will no doubt come back to haunt you eventually.

If you are suffering from a painful injury and would like to see an expert, we are seeing patients in the clinic as normal and offering extra services for any “at risk” patients via home-visits or tele-health online physio.

All Physiotherapy, Hydrotherapy and Exercise Physiology appointments will still be available in the clinic, at home and online via tele-health. Please call us on 9428 5772 to organise a time or email us at info@lanecovephysio.com.au

[1] Deyle GD, Allen CS, Allison SC, et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. 2020;382(15):1420-1429. doi:10.1056/NEJMoa1905877

[2] Brennan KL, Allen BC, Maldonado YM. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports Phys Ther. 2017;47(4):232-239. doi:10.2519/jospt.2017.6994