Cortisone shots are a widely-used treatment that doctors commonly prescribe when confronted with fascia conditions like plantar fasciitis. But do they really work?
I'll address that question in a moment. But to start with, let's talk about what cortisone really is. Cortisone is a hormone that is produced by the adrenal gland. Specifically, it's a cortico-steroid (do not confuse this with the anabolic kind of steroid, which is what bodybuilders use to gain muscle), and naturally produced cortisone is absolutely vital if you want to maintain your body's proper function. Other than some unfortunate people who are stricken with Addison's Disease, cortisone is naturally produced by every human body, so there are no allergy issues to contend with.
If you receive a cortisone injection, the doctor generally will not give you the pure stuff, which has a short effective life and is not particularly potent. Instead, more commonly used alternatives are derivatives of actual cortisone that are longer-lasting and cause fewer side effects. Usually there is some sort of pain-relieving compound included in the injection as well.
In many cases cortisone works to suppress inflammation for limited periods of time, and of course this often provides a degree of pain relief. But it does not really help to deal with the root cause of the problem. The end result is that the discomfort will return once the effects of the injection have worn off. There is also a limit to the number of shots you can get within a particular time period. Research on animals has indicated that cortisone can actually weak tendons, fascia and cartilage in joints if it is over-prescribed and injected into local sites.
This potential (but frequent) adverse effect is more of a problem with younger people, because younger joints, tendons and fascia are still comparatively healthy. Patients in their mid-twenties or younger should definitely try other types of treatment before opting for cortisone injections. But with patients who are older, and who joints usually have already experienced some fairly significant damage, this is not as much of a concern. There are also certain tendons and fascia that have a high tendency to tear even if the injections themselves are given as carefully as possible.
The physiological process of infection is generally a useful reaction. But it can end up impeding the healing process when it is present to an excessive degree. A cortisone shot is supposed to suppress unnecessary inflammation, which will then help the body to heal itself. But recent medical studies are increasingly starting to show that long-term fascia conditions like plantar fasciitis are, despite the name, not actually the result of inflammation but of some different mechanism. (The most likely suspect is thought to be direct damage to the primary fascia tissue.) Of course, this means that the whole ratione for the shots is decidedly ifffy.
So why is it that patients often report a decrease in pain when they get a cortisone injection? Well, not all of them do – the injections are only effective about 50% of the time. But some people do experience some relief; for them, the most likely reason is that the analgesic that is put into the shots is temporarily masking the pain. And, of course, the possibility of a placebo effect should never be ignored.
Cortisone shots can be a good treatment option for certain conditions (for example, older patients with arthritis in their joints), but when it comes to conditions like fasciitis, fasciosis and so on there are some real questions about their effectiveness. Particularly in young people and plantar fasciitis sufferers, it appears that there really are more effective treatments … ones that have a higher ratio of cost to benefit and a much higher percentage of success. Naturally, there are some advantages to the shots as well:
1. Cortisone injections are fairly cheap
2. They're usually covered by insurance
3. They can be quickly and easily administered.
4. Doctors can monitor them very closely.
But for the patient there are also a lot of disadvantages. Some of these are:
1. Getting a needle inserted directly into damaged tissue (ouch!)
2. Potential side effects that can end up requiring surgery
3. The questionable way that it's supposedly to work
4. The practically random percentage of patients who even get short-term relief from pain.
Weighing up the evidence, it looks that the advantages are mostly economic, where the disadvantages are physical. It's an individual choice, of course, but if you're placing more priority on your health than your wallet, I think it's just common sense to want to give other treatment options a chance first.