It’s always important to understand what medications we are taking and the total effect they provide, both GOOD and BAD. When it comes to cortisone, in most people it does more BAD than good.
The GOOD (Mohamadi and colleague, 2017):
- Small short-term analgesic benefit for up to 2 months.
- Cortisone is a corticosteroid that actions as an anti-inflammatory. In The case of shoulders (and other tendon based injuries), It’s prescribed to reduce/address the ‘ITIS.’
What is the ITIS?
Maybe you are more familiar with terms such as bursITIS and tendinITIS. ‘ITIS’ refers to inflammation/swelling in a certain tissue of the body.
Ok, great! If I’ve got swelling, this stuff will be great – where do I sign?
Unfortunately, in reality, the inflammation phase of healing/injury is a very small window of a week to 2. Moreover, the majority of people with shoulder pain are progressing down a continuum of change that is taking place within the tendon. Without moving in tangents, this is a process where your tendons gradually degenerate due to age mainly and quicker due to excessive load and stress placed on the tendon/muscle complex. Causing your tendons to transform from a strong straight spaghetti structure to one with holes/tears.
Apart from its mild short-term benefit, unfortunately, cortisone acts to accelerate tendon degeneration by altering the matrix/spaghetti strings of the tendon (Coombes and colleagues, 2010).
Additionally, referring back to the study by Mohamadi and colleagues (2017), they shed light on something known as NNT. This stands for Numbers Needed to Treat, or how people do you need to treat to get a mild benefit of cortisone. In this case, it’s 5 or rather 1 in every 5 people will have a mild analgesic benefit.
To put this into perspective, that’s a 20% short-term benefit in exchange for long-term damage and the return of pain after 8 weeks.
The study also concluded:
- No added benefit with multiple injections
- Cortisone is not a Fix
- Possible placebo effect
When is the Trade-off worth it?
We recommend to commencing an active physiotherapy exercise program first. If your pain does not gradually improve (not pain-free) over the first 6 weeks with graduated exercises and education, then cortisone may be considered in conjunction with the exercise program.