While getting shoulder rehab...cortisone shot in elbow????

[McEnborg]

I have had struggles with tennis elbow for quite a while.

Right now, I'm getting physical rehab for my shoulder. The PT feels I should lay the rackets down for about a month. He thinks my rotator cuff weakness and some other issues in the shoulder area will respond well to rehab/therapy.

Since I won't be playing tennis for 4 weeks, I was thinking I could get a cortisone shot in my elbow and allow that the 3 weeks or so to do its healing while not playing tennis. The PT said one cortisone shot is not harmful at all-I've never had one.

Any thoughts on this logic?? Thanks.

 

[mikeler]

Do PT on your elbow too. Save the cortisone for more severe injuries.

 

[Posture Guy]

Definitely do PT on the entire arm, not just the rotator cuff.

re a cortisone shot, there are a couple issues with them, one of which isn't really an issue in your situation.

First, cortisone DOES act as a potent anti-inflammatory, but it also weakens connective tissue by disrupting the cross-linking of collagen fibers. That's not good. The risk of significant connective tissue damage from one injection is low, but the chemical DOES have this impact on connective tissue (like tendons, for example). This is a concern in your case.

Second, understand that pain is not the problem. Rather, pain is a message ABOUT a problem. It's the red warning light on your dashboard coming on to tell you something needs attention. The standard medical approach is to simply shut up the warning signal because they think the pain itself is the problem. So if engaging in certain motions generates pain, from my perspective the proper response is to either change the position and/or function of the painful body part, or stop engaging in the movement. What often happens when people get a cortisone injection is that the pain goes away so they resume normal activities that would otherwise generate the pain. Well why did the pain go away? Because you chemically suppress the body's ability to inflame. The inflammation is NOT the problem, it's the body protecting the affected structure from excessive friction so that it does not incur structural damage. So now you've left the joint defenseless, unable to inflame to protect itself, and you've disabled the warning light on the dashboard. You go back and do things that would normally cause pain and inflammation but the body CAN'T send those signals because you've turned them off chemically. So guess what is happening? You're grinding your body down. When the chemical suppression wears off, you're going to have a problem. I see it all the time in our clinic.

This isn't as much an issue for you if you're concurrently taking an extended time off to allow the body to heal and rehab. My concern here, though, is that during the rehab process if the therapist asks your body to do something that the elbow cannot do properly, you'll no longer get the same pain signal you would've otherwise gotten that tells you your body is not yet able to perform that movement safely and functionally.

If it were me, I'd go after the inflammation in more natural methods. Ice, topical ointments like arnica gel/cream, cold laser therapy (which I'm not convinced is helpful but I'm seeing some reports that it might speed inflammation reduction), things like that.

trust your instincts, and follow them. That's my core advice.

 

[ollinger]

As tennis elbow is a tendinosis and not a tendinitis, i.e. almost no inflammatory cells, the value of cortisone is obscure. And the medical literature is full of negative studies of cold laser (which is described above, perhaps for the first time, as a "natural method." If you can find intense beams of collimated light in nature, let me know.)

 

[Posture Guy]

ollinger.....my bad, sloppy wording. I intended to communicate the use of methods not involving chemical suppression of inflammatory responses. I completely agree that cold laser therapy is not 'natural' in the sense that it is found freely occurring in nature.

More on its efficacy or lack thereof in a moment.

re tendinosis vs tendinitis, that's a solid point but in the studies I've read, most cases of tendinosis will not find inflammatory cells in the tendon itself but will find inflammatory cells in the areas surrounding the tendon. There is some speculation that there is an inflammatory process at work disrupting normal collagen repair/synthesis. That said, given that tendonisis is fundamentally a collagen ordering/repair issue and cortisone can disrupt collagen's structure, it would seem like a curious choice for the treatment of such an issue.

re cold laser's effectiveness, yes, there are a lot of studies showing it does nothing. There are also some showing it has some benefit. I have clients who have had both experiences. (note: I do not administer cold laser therapy nor do I actively recommend it to clients, these are folks who just did it on their own).

here's a study referenced by Aetna insurance about the use of cold laser therapy in the treatment of tennis elbow, showed it may have some benefit in conjunction with a specific exercise protocol. Again, I'm not arguing for its efficacy, just another thing someone can try, and with which SOME studies and some people have reported positive results.

http://www.aetna.com/cpb/medical/data/300_399/0363.html

Stergioulas (2007) compared the effectiveness of a protocol of combination of laser with plyometric exercises and a http://tt.tennis-warehouse.com/images/editor/italic.gifprotocol of placebo laser with the same program, in the treatment of tennis elbow. A total of 50 patients were randomized into two groups: (i) group A (n = 25) was treated with a 904 nm Ga-As laser, frequency 50 Hz, intensity 40 mW and energy density 2.4 J/cm(2), plus plyometric exercises, and (ii) group B (n = 25) that received placebo laser plus the same plyometric exercises. During 8 weeks of therapy, patients of the two groups received 12 sessions of laser or placebo, 2 sessions per week (weeks 1 to 4) and 1 session per week (weeks 5 to 8). Pain at rest, at palpation on the lateral epicondyle, during resisted wrist extension, middle finger test, and strength testing was evaluated using visual analog scale. Also, the grip strength, the range of motion and weight test were evaluated. Parameters were determined before treatment, at the end of the 8th week course of treatment (week 8), and 8th (week 8) after the end of treatment. Relative to group B, group A had (i) a significant decrease of pain at rest at the end of 8 weeks of the treatment (p < 0.005) and at the end of following up period (p < 0.05), (ii) a significant decrease in pain at palpation and pain on isometric testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (iii) a significant decrease in pain during middle finger test at the end of 8 weeks of treatment (p < 0.01), and at the end of the follow-up period (p < 0.05), (iv) a significant decrease of pain during grip strength testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (v) a significant increase in the wrist range of motion at 8 weeks follow-up (p < 0.01), (vi) an increase in grip strength at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.01), and (vii) a significant increase in weight-test at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.005). The authors concluded that these findings suggested that the combination of laser with plyometric exercises was more effective treatment than placebo laser with the same plyometric exercises at the end of the treatment as well as at the follow-up. Moreover, they stated that future studies are needed to establish the relative and absolute effectiveness of the above protocol.

 

[larry10s]

i very well respected physical therapist once told me
he never saw someone with elbow issues that didnt have underlying shoulder issues
so rehabing your shoulder will help your elbow
if you have pain in your elbow if your ortho sees no reason not to then get a shot and rehab the elbow while you rehab the shoulder

 

[GuyClinch]

Personally not convinced cortisone shots are ever worth it.. Even for athletes that are rushed back on the field - it causes long term damage IMHO. For regular joes - hell no..

 

[achokshi99]

I would disagree. Celebrex for example is useless for me so when I've had issues in the past I needed 10 days of 600mg (min level of prescription strength ibuprofen) 3x a day. My stomach can handle it but other people can't. And if the inflammation is in an area where due to just normal activity, you can't immobilize it or reduce the activity enough where the swelling declines, a cortisone shot can help.

For me I had bicep tendonitis in both shoulders at different times mainly from working out. The high dose ibuprofen helped after 10 days of no activity but it was marginal so my ortho decided a cortisone shot would be better than continuing. I had both shots at different periods in 2009 and since then do a lot of rotator cuff work at home. I think if the pain/problem is severe enough, take the cortisone and then be smart about avoiding inflammation in that area.

For example, now I don't start chest workouts with flat bench w/a bar. I start w/incline with DBs. That along with RC work at home has helped.

Personally not convinced cortisone shots are ever worth it.. Even for athletes that are rushed back on the field - it causes long term damage IMHO. For regular joes - hell no..

 

[Torres]

Cortisone = bad

http://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/

 

[Torres]

The PT said one cortisone shot is not harmful at all

You need to find a new PT, very, very quickly, because your one is clueless.

 

[achokshi99]

Not really. The Lancet article NYT cited stated:

Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy.

--------

The issue I have w/the article is that we have no insight into how the behaviors differed from the group that got the cortisone shot vs those that did not.

The biggest risk for people who get a cortisone shot is that they abuse what it does and do not alter anything in their future workouts or exercises that caused the problems to begin with. In my previous post in this thread I cited I used the cortisone but then altered my workout and incorporate to this day rotator cuff exercises and as a result have had no problems whatsoever. If I took the cortisone shot and did no RC work and continued to bench heavy on flat barbell, I have no doubt that I'd have had major issues with my shoulder.

What this means is that I would suspect, if we could get into the details of the lancet study, is that the TE sufferers that received a cortisone shot probably were awestruck by how awesome it works (w/my shoulders it was like having new shoulders within 10 min of the shot) and thought, hey this is great, let me go out and use that luxilon big banger on my Roddick PDGT and play tennis like I used to and thus within 6 months were in even worse shape.

In contrast, those that take long lay offs (~6 months of avoiding the activity causing the TE) and do the PT and other other mechanical adjustments will in fact do better than the group I described above because they gave themselves real time to heal and then modified things to eitehr strengthen problem areas that led to the tendinopathy.

Cortisone can be of benefit but you need to incorporate PT and modify the problems that put you in pain in the first place so you won't need a future cortisone shot or surgery. I am on the fence on TE being tendonitis v tendonosis but for my bicep tendons in my shoulder (RC), it was clearly inflammation based on an examination by my ortho and cortisone got the inflammation down immediately vs a long, unnecessary lay off.

Ideally, if we knew that the people getting cortisone then did the exact same regimen (theraband flex bar, whatever PT) as those that took the lay off and PT and then still had worse outcomes 6+ months later, then I'd be willing to say cortisone is "bad". But we don't know that info. If those that received the cortisone felt so great after that they actually increased the amount of TE inducing activities and did no PT vs the other group, then obviously they would be in worse pain down the road.

Cortisone = bad

http://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/

 

[GuyClinch]

^^It fights the pain but doesn't address the actual cause of the injury at all. How anyone could think this is good - is beyond me.

If you shoulder hurts from playing tennis - you should STOP playing tennis and do physical therapy/stretching etc before resuming your tennis. Same with elbow etc etc.

To say oh its not bad if you remember to change your habits - well that's not good enough. The pain is your body telling you to change your habits. We should listen to that pain not try to cover it up.

It's the same with ibubrofen/celebrex. Treat the underlying condition - don't mask it with a shot that will just cover it up.
That's why I said its dubious for pro athletes (who might feel they NEED to play and can't take time off) its ridiculous for average joes who CAN make the necessary adjustments to solve the problem nearly all the time..

 

[Arthuro]

I have had orthopedic issues since I was a kid and recently had a full recovery (complete healing) of a partial rotator cuff (40%) tear from an accident.

My advice is stay away from cortisone, there are peer-reviewed studies and great comparative studies that show more than 1 shot does effect soft tissues and can kill cartilage cells. If you are in Texas, I would suggest you look into Prolotherapy (proliferation therapy) and PRP (platelet rich plasma). This uses your own cells to heal your body--by activating the healing response in your body. These are two great and relatively inexpensive,(200-400) for Prolo and about 1000.00 for PRP, treatments that actually heal your tendinitis, tears, and injuries.

 

[drak]

do a google search on "PRP therapy tennis elbow", it's a shot but only using your own blood after it's spun in a centrifuge the best result they have had with this are for tennis elbow. PRO ay my club had it doen and it worked where nothing else did for two years

I just had my second PRP achilles injection last week and I'll let you know how it turns out

Drak

 

[mikeler]

do a google search on "PRP therapy tennis elbow", it's a shot but only using your own blood after it's spun in a centrifuge the best result they have had with this are for tennis elbow. PRO ay my club had it doen and it worked where nothing else did for two years

I just had my second PRP achilles injection last week and I'll let you know how it turns out

Drak

How well did the first one work? Or is this supposed to be a multiple injection therapy?

 

[drak]

How well did the first one work? Or is this supposed to be a multiple injection therapy?

I was feeling good but I was only doing cardio bike work and stretches/strengthening work, I won't know on the Achilles for many weeks and especially until I start playing tennis.

I will say the results for PRP elbow treatment have been very, very good. There is mo sure thing but the percentage good results for the elbow ate pretty darn high, while for the ASchilles are much more of a hit and miss thing - I took my shot.

Its about $300-400 for a doctor visit and one shot in my area, which is often enough for the elbow. Insurance usually does not cover this.

Drak