In the 1940’s, American chemist Edward Calvin Kendall first identified the steroid cortisone, an anti-inflammatory drug. It soon became a popular means of treating patients with pain of chronic inflammatory conditions like bursitis, arthritis, tendinitis, carpal tunnel syndrome, and fasciitis. Many patients preferred cortisone treatment because it provided a rapid relief of pain and even today it remains a standard (and often requested) treatment.
A recently published article in The Lancet by Dr. Brooke Coombes, Dr. Leanne Bisset, and Dr. Bill Vicenzino, should intensify the doubts about cortisone’s effectiveness and value. The researchers ran approximately 50 trials, each enrolling thousands of patients with tennis elbow and achilles tendonitis. According to the article, the patients who received the cortisone treatment did get the expected rapid relief, when compared to the patients who did nothing or followed a physical therapy treatment plan.
However, the results were significantly different when the patients were re-examined 6 months later. Overall, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63% higher risk of relapse than those patients who did nothing. Dr. Bill Vicenzino, one of the authors of the article, said “There is a tendency …” among tendon injury sufferers “…for the majority (70-90 percent) of those following a wait-and-see policy to get better” after six months. But this is not the case for those getting cortisone shots, he wrote; they “… tend to lag behind significantly at those time frames.” In other words, the cortisone shot hampers full recovery and puts patients at a disadvantage. Patients that receive multiple cortisone shots have an even higher risk. “An average of four injections resulted in a 57 percent worse outcome when compared to one injection,” Dr. Vicenzino said.
So the question is: do cortisone shots still make sense as a treatment plan? Dr. Vicenzino says no. He believes that if the cause is not found and treated, the inflammation will return and the cycle of pain will continue. A cortisone injection may be effective as a quick fix, but it is not a permanent solution to the problem. And if it is used, he believes it should be used in conjunction with a physical therapy treatment plan. The American Academy of Family Physicians also supports this belief.
When a patient can get adequate pain relief they are able to move easier and exercises are less painful to perform. From a physical therapist’s perspective, we can better address the root causes of the problem (poor posture, limited joint mobility, weakness, etc…) rather than trying to just alleviate pain. To learn more about how we can help you at Reddy Care Physical & Occupational Therapy, call us at 516-829-0030.
Sources:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961308-6/fulltext
