Why Cortisone Works for Joint Pain (and Why It Doesn’t Fix the Problem)
Before my time with Crossover Symmetry, I visited a doctor for a bout of shoulder pain that flared up due to swimming.
I primarily wanted reassurance that it wasn't bad, but deep down, I was hoping for some kind of shot in the arm to get me back to full capacity quickly.
In the world of pain management, particularly for those dealing with persistent joint or soft tissue pain, the magic sauce is referred to generally as steroids, but more specifically called corticosteroids or cortisone.
It can be remarkably helpful for many conditions, but there are risks and considerations, and it's certainly not a free pass for fixing the problem.
Corticosteroids are a class of medications that mimic the anti-inflammatory effects of hormones naturally produced by your adrenal glands. When inflammation becomes chronic or severe, these injections are administered directly to the site of pain to reduce inflammation and, consequently, alleviate pain.
They specifically work on a class of messengers called the COX pathway.
Think of the COX pathway as a messaging service that gets activated when there's damage or stress in your body.
The COX enzymes (COX-1 and COX-2) tell your body to increase inflammation and send more blood to the area and drive other parts of the healing process.
- COX-1: This is like the "housekeeping" enzyme. It works all the time to keep your body running smoothly. For example, it helps protect the lining of your stomach and keeps your blood flowing properly.
- COX-2: This enzyme is more like the "emergency response" team. It kicks into high gear when you have an injury or infection by producing chemicals that drive inflammation (and pain) to help your body deal with the problem.
Inflammation, while part of the body's natural healing process, can become problematic when it persists, leading to ongoing pain and dysfunction.
Inhibiting the COX pathway can reduce swelling and pain, providing relief lasting for weeks or even months.
(Ibuprofen is one of the most widely used pain medications that works via blocking the COX pathway).
The primary benefit of corticosteroid injections is their ability to provide rapid pain relief, often allowing individuals to return to their normal activities more quickly. Research has shown that corticosteroid injections can be particularly helpful in the short term, making them a valuable tool for managing acute flare-ups of chronic conditions.
Although, despite being highly effective, they have risks.
Overuse of corticosteroids can weaken tendons, cartilage, and bones, potentially resulting in tendon rupture or joint damage. Additionally, repeated injections may diminish the tissue's ability to heal naturally, potentially leading to longer-term complications.
For this reason, the frequency one can use a steroid injection is limited, and it should be reserved for only when necessary for the condition. There is a special concern for administering steroid injections into commonly ruptured tendons like the Achillies and rotator cuff.
They are particularly effective for treating:
- Arthritis: Particularly in the knee, hip, or shoulder joints, where inflammation is a primary driver of pain.
- Tendinitis: Inflammation of tendons, such as in tennis elbow.
- Bursitis: Inflammation of the bursae, the fluid-filled sacs that cushion joints.
- Frozen Shoulder: Thickening and tightening of the shoulder capsule that causes pain and restricted movement.
- Other Soft Tissue Injuries: Such as plantar fasciitis.
Most importantly, a steroid injection is not a cure (it doesn’t generate any structural change) but rather a means to manage symptoms while the body undergoes healing.
It decreases pain temporarily, which opens a window to do some exercise, which is ultimately needed to overcome the problem.
One PT I work with explained the effect of steroids as breaking the "pain memory," which is part of the struggle when dealing with chronic conditions.
By allowing your brain to “forget” about the pain it’s become used to, it allows for doing the work to drive strength and mobility changes needed for lasting improvements.
In summary, injections can be a huge win in getting over the hump when dealing with an injury. Still, they should be used judiciously and as part of a broader strategy for rehabbing an injury.
And steroid injections aren't the only option for needle infused therapies. We'll cover more of them in future newsletters.
Originally published as Movement #232
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