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/
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.)
