Taking Another Shot At Cortisone For Treating Tennis Elbow

The Cortisone injection as a treatment for Tennis Elbow came under fire again this week by Gretchen Reynolds, of the New York Times, who takes another shot at the idea that Cortisone is a valid 'Quick Fix' for Tennis Elbow. (Is the short-term relief worth the long-term costs?)



In the article, For Tennis Elbow, No Such Thing as a Quick Fix Gretchen begins by affirming the continued popularity of the Cortisone shot as a Tennis Elbow treatment:

"Recent surveys in the United States and Britain show that injections of the steroid, which rapidly dulls pain and fights inflammation, are the preferred first line of treatment among many orthopedic specialists."

And then immediately raises the issue of the risks involved with these shots, referring to the:

"...growing evidence suggests that the injections, while effective in the short term, can frequently worsen the condition in the months that follow..."

She cites a study from Norway published in BioMed Central's Musculoskeletal Disorders Journal, which suggests that Cortisone injections, while effective in the short term for Tennis Elbow (in relieving pain) frequently worsen the condition in the months to come:

http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0582-6

This is not the first study showing positive short-term benefits to be followed by negative long-term outcomes. It has been preceded by many other studies and papers going back 20+ years, which suggest that Corticosteroid shots delay healing and weaken tendons.

In an Oct. 2010 New York Times Well Blog post, (for some reason not linked to in the more recent post) Phys Ed: Do Cortisone Shots Actually Make Things Worse?

Gretchen refers to one of those studies, featured in the Lancet:

Efficacy and safety of Corticosteroid Injections and other Injections for Management of Tendinopathy...

"Over all, 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 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach."

Another point the author makes consistently between these two articles (which I applaud!!) is that the overwhelming evidence shows that Tennis Elbow is a condition marked by degenerative changes and not inflammation, as is so often incorrectly, robotically parroted by medical websites, Doctors P.T.s and other sources and authorities.

"...numerous studies have shown, persuasively, that these overuse injuries do not involve inflammation." [2010 N.Y.T. article]

"Newer science, however, including biopsies of the sore tissues, shows little inflammation, except in the very early stages of the injury. Instead, it is thought to involve degeneration of the tissues..." [2016 N.Y.T. article]

I've been quoting these medical studies, papers and references since the early 2000s myself, trying to make Tennis Elbow and other Tendinopathy sufferers aware that the old "inflammatory model" was dead and gone, and that there is no healing value in "chasing" inflammation with pills, ice and, worst of all, Cortisone Shots.

Regardless of whether inflammation is there or not and whether these so-called treatments "treat" that inflammation effectively or not!

It doesn't matter. Inflammation is an aspect of the healing process, anyway!

It's an essential, "can't actually heal without it" necessity for which there is NO upside to treating, managing, reducing or otherwise suppressing - especially if one succeeds in completely eradicating it!

The sad thing is that Cortisone is so efficient at blocking and suppressing inflammation (and collagen synthesis, it seems) that it apparently leaves the damaged area at disadvantage - and in the case of multiple shots - possibly a state that is impossible to repair and recover from.

(But you may need to dig a little deeper into the medical studies and their terminology to really get that key knowledge.)

Here's my original article where I discuss that and reference some of those studies if you'd like to learn more:

https://tenniselbowclassroom.com/tennis-elbow-treatments/cortisone-shots-for-treating-tennis-elbow-pain-damaging-ineffective/

A Cortisone Shot for your Tennis Elbow? Desperate for relief? Think Twice! #TennisElbow https://t.co/PKU9dAYNXa

— Tennis Elbow Tutor (@TennisElbowTutr) July 20, 2016

Here's my Cortisone Shots podcast episode, above - And you'll find that podcast, as well as my Cortisone video along with the full post, here: (Click image below.)

The Tennis Elbow Test Your Doctor Probably Won't Give You

If this simple scan can tell how severe your Tennis Elbow injury is – Why won't your Doctor offer you one – And when should you ask for it?

Read the full post on The Sonogram as a Tennis Elbow Diagnostic Test here



If you think you have Tennis Elbow or have been diagnosed by your Doctor, how do you know how severe your injury really is?

Are there any tests that can tell you if the damage to your tendons is mild, moderate, severe – aside from an expensive, inconvenient MRI?

Yes, you may be able to fairly easily and inexpensively get a decently accurate picture of how bad your tendon injury actually is, right in a Doctor's office. (Certainly a lot cheaper and easier than an MRI, anyway!)

But first you need to know about it – You may have to ask for it – The truth is, you might even need to insist on it...

Read the full post on The Sonogram as a Tennis Elbow Diagnostic Test here

Tennis Elbow, Surgery And The Placebo Effect

Here's my new Storify story about a surgeon who claims to perform surgeries, including for Tennis Elbow, that may only work due to the placebo effect, and a surprising, recent medical study comparing actual Tennis Elbow surgery with a fake "placebo" procedure!

Autologous Blood And Platelet-Rich Plasma Injections: Are They Efficacious In Treating Tennis Elbow? [Video]

Is Platelet-Rich Plasma (PRP) truly a breakthrough in Tennis Elbow treatment?

In this “podcast video” Allen Willette from Tennis Elbow Classroom, discusses the upsides and downsides of PRP, (an injection procedure that uses your own blood)...

Including whether it's a safe and effective treatment for Tennis and Golfer's Elbow; whether it's worth the price – and the pain afterward (also sometimes during) – and whether there are any alternatives to achieve the same goals.

Here’s my full, detailed article on PRP and Tennis Elbow, (including the video)

Addressing the following questions in more detail than the video above, including links to news sources and medical study cites:

1. What is Platelet-Rich Plasma Therapy? – (See below, also)
2. What’s the difference between PRP and Autologous Blood Injection?
3. What’s the theory on how PRP and ABI work?
4. Is PRP an effective treatment for Lateral Epicondylitis?
5. What’s my opinion as a practitioner who specializes in treating Tennis and Golfer’s Elbow?

What is Platelet-Rich Plasma Therapy?

PRP (and its less-sophisticated relative, Autologous Blood Injection) are in-office “non-surgical” procedures that both begin by having a small amount of your blood drawn.

In the PRP procedure your blood is spun in a centrifuge to concentrate the platelets, by separating them from your red blood cells and your plasma, which is mostly water and Electrolytes.

Then your platelets (along with some of your plasma) is injected into the injured area that's not healing (usually a tendon or ligament.)

Platelets are the cells in your blood that are mostly responsible for blood clotting, and they also secrete growth factors (including human growth hormone) that are involved in tissue healing.

(The procedure with ABI is the same, except they skip the spinning and separating step, and simply inject you with the whole blood.)

“Compared to nearly ever other medical intervention or treatment for Tennis Elbow, (and other Tendinopathies) I would really like to be positive about this one. I can certainly say I like the theory on it!”

For a deeper look at PRP and ABI, including medical study cites, links to mainstream news articles and more, read my post here:

Full article on PRP and Tennis Elbow, (including video)

What's The Best Kind Of Brace For Tennis Elbow?

Here's my answer to this tricky question from Quora. (It really depends on what your goal is; playing tennis, pain relief or healing.)

Often the best brace for Tennis Elbow is none at all. Here's my full-length article on braces.

Read Allen Willette's answer to What is the best type of brace for tennis elbow (tendinitis in the elbow)? on Quora

Is The RICE Protocol The Right Approach To Treating Lateral Epicondylitis?

Here's my contrarian answer to this question on Quora - Why the answer is actually, "No!"

Read Allen Willette's answer to Is R.I.C.E. the right treatment approach to Tennis Elbow? on Quora

Platelet-Rich Plasma Injections: Are They Effective For Lateral Epicondylitis?

Is Platelet-Rich Plasma (PRP) Therapy a new Tennis Elbow breakthrough treatment? Or is it an expensive, unproven fad, driven by rock star-athlete publicity and questionable medical studies?

Tennis Elbow: A Common Golf Injury?

Medical studies, surveys and major golf-related websites all agree that not only do golfers suffer Tennis Elbow frequently, they actually get injured by it more often than Golfer's Elbow.

Why Isn't My Tennis Elbow Healing?

If you've been in pain a few months or longer without improvement you're probably wondering why your Tennis Elbow hasn't healed by now...

Chances are, you're finding out (to your great frustration!) that you can't just treat your symptoms with drugs, ice, and braces - rest it a while - and expect it to heal, like they tell you...

Smashing The Inflammation Myth Part Two - Evidence Tennis Elbow Is NOT An Inflammatory Injury

Is your Tennis Elbow "Inflamed?" - Probably not - Because that's a medical myth! Here's the proof it's NOT an inflammatory condition, and why the inflammation-fighting treatment approach is a dead end, and may do you more harm than good.

The Inflammation Fallacy - Why Your Tennis Elbow Is Probably Not Inflamed

Inflammation is the biggest fallacy and misconception of all time, when it comes to understanding and treating Tennis Elbow...

Do You Need A Tennis Elbow Brace? Will ANY Support Help Your Tendons Truly HEAL? (The Real Question)

A "Two-Minute Tennis Elbow Tutorial" video on the question of braces, bands, straps and supports for treating Tennis Elbow.

Is There An “Average” Tennis Elbow Recovery Time? - Weeks, Months, YEARS!?

A quick search of authoritative medical websites, like WebMD, reveals a wide range of time frames for healing Tennis Elbow - But no real, definitive answer.

Depending on who you ask, the injury takes from 1-3 months to 2 PLUS years to recover from, and might be a ‘self-limiting condition’ [My favorite.] Really?

Or see my blog post on Quora: Is there even such a thing as "a typical recovery time for Tennis Elbow?"

Tennis Elbow Treatment And The Inflammation Myth

Treatment for Tennis Elbow usually includes treating, reducing or "fighting" inflammation - but, in spite of all the medical websites and officials promoting this approach, it's a deeply flawed one.

In fact, you're about to learn why the inflammation-chasing treatment approach is so unfounded, unscientific and irrational it deserves to be labeled a myth - I call it The InflammaSCAM.

You may have only just discovered you have Elbow "Tendonitis," in which case this could help you avoid a huge mistake - Even more so if you've been suffering for months and find yourself wondering...

"Why does my Tennis Elbow keep flaring up again and again? - Why does it keep coming back no matter how much I treat it with ice, how many anti-inflammatories I gobble, or how much I try and rest it until the pain and inflammation go down?"

The answer may be, at least in part, that the inflammation-fighting treatment approach is not only failing to help your healing and recovery - It may be slowing your recovery down.

What Is Tennis Elbow?

A simple question that if you ask the average medical professional or query the typical medical website you get a fairly simply answer to. (Too simple, really.)

Tennis Elbow is a tendon injury to one or more of the group of tendons that connect the muscles of the outside of your forearm to a bony knob at the outside of your elbow.

It's also known as 'Elbow Tendonitis' or more technically as 'Lateral Epidondylitis'...

But these terms are outdated and even deceptive, because they emphasize and promote the idea that 'Chronic Inflammation' (chronic simple meaning long-term or persistent) is somehow the cause or the main concern.

Nope. Simply not true.

Of course, there is a lot more to the question of "What is Tennis Elbow" than we can cover here - but one thing is certain, it's NOT really about inflammation or inflamed tendons once we ask...

What Causes Tennis Elbow?

The official explanation gives token acknowledgement to there being some kind of Repetitive-Strain type injury to the tendons (which is true)...

But then it quickly skips over a lot of key facts and details, and implies that inflammation is somehow causing the problem.

Yes, inflammation (if present) may cause burning pain and irritation...

But here's the thing: Inflammation can't be the cause of your Tennis Elbow injury - because it's a symptom of the injury itself:

1. First comes an injury to the tendon [Cause]
2. Then comes inflammation - as a result of the injury [Symptom]
3. (And then comes the pain) [Another symptom]

So, the true root cause is the damage to your tendons, which is followed by inflammation, which in turn causes pain.

Inflammation: Friend - Not Foe?

The truth is inflammation is actually a part of your healing process!

And this is a basic, irrefutable fact of biology you can find in any medical textbook when it comes to the healing and repair of 'Soft Tissues' (Like tendons.)

It's not your enemy (in this case, anyway) it's your friend, because you can't have any healing in your tendons (or muscles or skin) without inflammation.

But, since inflammation causes pain, that makes it a big, easy target: Blame the inflammation!

And what about the often-repeated claim or implication that there's way too much inflammation going on when you have Tennis Elbow, and that you supposedly need to reduce it?

No. Still not true. (Unless there's significant swelling, which is very rare, in my experience.)

It's much more likely that there isn't enough inflammation happening in and around your tendon than too much.

What's that?... Not enough inflammation!?

Yes, tendons don't have much of a blood supply, which is critical to fast healing. And inflammation, which kicks off healing, is also supposed to bring more blood circulation to the damaged area to aid the healing process.

What too often happens when a tendon is damaged, however is:

• There's often not enough inflammation,
• So, there's often not enough repair and rebuilding,
• And the tendon often remains partially healed - Or not at all

You may FEEL a lot of burning pain and irritation that makes you suspect that:

"There must be a raging storm of inflammation going on here!"

But those "burning" pain symptoms are deceptive, because they often don't have anything to do with inflammation...

In other words, it's just how the tendon feels when it's injured - Inflamed or not.

Tendon Healing

Whether you have Tennis Elbow or some other kind of tendon injury / Tendonitis (Tendinopathy is the better, newer word) your challenge is to overcome the tendency tendons have of not healing properly.

I know it can be hard when it hurts, but I strongly encourage you to stop worrying about inflammation and thinking of it as something harmful - And to do what you can to encourage and speed up your own healing process.

You can't just wait and expect your tendons to heal fully by themselves.

And now that you understand that inflammation is a necessary part of your healing process, you have to make a choice about whether you want:

1. Relief in the short term (via drugs, ice and Cortisone shots)
2. Or repair and recovery in the long term (which eventually brings lasting relief)

Unfortunately, you can't hedge your bets by trying to do both - Because choosing to "fight" your inflammation to relieve pain in the short term is to fight against your own healing process.

It's been a long, long time since I had any tendon problems, but back whenever I felt the slightest "twinge" of warning pain in a tendon, I would put the heat to it under the hottest water I could stand in the shower every day and rub the area like crazy for a few minutes to bring the blood to the area, and it worked great.

Yes, it probably got more inflamed for a while from this - but that's the IDEA! - Always remember that this is a necessary step in the healing process.

So, forget the ice, forget the anti-inflammatory pills, forget the Cortisone shots, and consider putting the heat to it...

(Unless you just injured it within the last several days, in which case wait a few days, especially if there's significant swelling in the area you can clearly see. You don't want to put heat on an 'Acute Injury' Usually you ice it for up to 72 hours - And then switch to heat when it's past the 'Acute Stage.' Please look that up if it's not clear.)

Treat Your Tennis Elbow Yourself At Home

To learn more about how you can support your own healing process naturally, take a look at a Tennis Elbow treatment approach you can do on your own easily at home...

Tennis Elbow Classroom teaches you how to do your own therapy, stretches and exercises through a simple self-help video program.

All you need to do is follow the step-by-step video lessons to treat your own muscles and tendons, help speed your healing naturally, and break that vicious cycle of pain finally and forever.

No more inflammation-fighting pills, ice or shots! (And no miracle cures, gimmicks or affiliate offers, either.)

I'm a Neuromuscular Therapist who's been clinically treating Tennis Elbow with great success for over a decade - And I'm standing by, ready and able to be your virtual tutor at: Tennis Elbow Classroom

By: Allen Willette | Article Source