Many people get cortisone injections to help with knee pain, hip pain, or pain in another joint. If it helps with pain, then it must be right for you. But is cortisone really good for you? Not really. Sure, cortisone may help to alleviate pain temporarily. But what is the trade-off?
If the goal is to weaken your ligament-bone junction eventually, then cortisone just may do that. And of course, that is not what anyone wants. But studies “suggest that negative structural outcomes including accelerated osteoarthritis progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received intra-articular corticosteroid injections.”1 Cortisone and other steroid injections, unfortunately, have detrimental effects on articular cartilage. And eventually, the result is a weakened joint and the development of a degenerated joint.
Cortisone injections inhibit the synthesis of proteins, collagen, and proteoglycans in articular cartilage, by inhibiting chondrocyte production, the cells that comprise and produce the articular cartilage. The net catabolic (breakdown) effect of steroids is inhibition of fibroblast production of collagen, ground substance, and new blood vessel formation. The result is weakened synovial joints, supporting structures, articular cartilage, ligaments, and tendons. This weakness increases the pain…and the increased pain leads to more steroid injections.
Steroids also limit calcium absorption by the gastrointestinal tract, inactivate vitamin D and increase the urinary excretion of calcium. Bone also shows a decrease in calcium uptake with cortisone use, ultimately leading to weakness at the fibro-osseous junction. Corticosteroids also inhibit the release of growth hormone, which further decreases soft tissue and bone repair. Ultimately, corticosteroids lead to a decrease in bone, ligament, and tendon strength.
Although anti-inflammatory medications and steroid injections reduce pain, they do so at the cost of destroying tissue. In one study, some joints were injected only one time. Even after one steroid injection, cartilage remained biochemically and metabolically impaired. Other studies have confirmed similar harmful effects of steroids on joint and cartilage tissue. A cortisone shot can permanently damage joints.
Cortisone does degenerate joints. But these injections are not your only option. Fortunately, there are other injections that are regenerative in nature. Regenerative Orthopedic options, like Stem Cell Therapy, PRP, and Prolotherapy, actually encourage repair and regeneration of the joint. Regenerative injection alternative, like Prolotherapy, have the opposite effect of cortisone. They actually strengthen the joints, ligaments, and tendons.
Some professional athletes and weekend warriors want quick relief. But the problem with choosing cortisone for quick relief, is that even though the athlete may get pain relief at the moment, it may be at the expense of a permanent inability to participate in athletics. Athletes often receive cortisone shots in order to play. They return to the playing field with an injury after getting a steroid injection to relieve the pain. Unfortunately, they cannot feel the pain anymore…so they play as if there was no injury. We know (see above) that the injury could not possibly be healed because of the tremendous anti-healing properties of cortisone. Thus, the athlete can further injure the joint while playing on an injury, plus can add to the problem by weakening the joint from the cortisone itself. The result of this choice is worsening of the already bad injury.
Bottom line- get a “quick fix” with steroid injections and set yourself up for further damage. Or fix your problem for good with Prolotherapy. The choice is yours.
Have questions? Give us a call. We’d be happy to talk about your options.
1Guermazi, Ali, et al. “Intra-articular corticosteroid injections for the treatment of hip and knee osteoarthritis-related pain: considerations and controversies with a focus on imaging—Radiology Scientific Expert Panel.” Radiology 297.3 (2020): 503-512.
2Jurgensmeier, Kevin, et al. “Intra-articular Injections of the Hip and Knee With Triamcinolone vs Ketorolac: A Randomized Controlled Trial.” The Journal of Arthroplasty (2020).