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Cortisone Ineffective for Long-Term Healing

The anti-inflammatory steroid drug provided rapid relief from pain, especially the kind that resulted from overuse of tendons, such as tennis elbow and injured Achilles tendons, which had been difficult to treat effectively. Cortisone shots are routinely used today for treatment of various sports injuries. However, their long-term effectiveness has been cast into doubt by a recent review of studies.

A recent article published in The Lancet that evaluated the results of 41 randomised controlled trials that involved 2,671 participants with tendon injuries found that treatment with cortisone shots helped in the short term, but actually made things worse in the long term than if nothing at all were done to treat the injury.

Most of those who had been treated with cortisone injections for tennis elbow experienced significant and fast relief from pain, sometimes for weeks, when compared with following a course of physical therapy or even simply doing nothing. But when the same patients were re-evaluated after 6 or 12 months, the results were quite the opposite.
Those who had received the cortisone shots showed as substantially lower rate of full recovery from their injuries when compared with those who had done nothing or undergone physical therapy.

The inefficacy of cortisone for long-term healing was suspected as early as 1954, when the results of a clinical trial showed that over half the patients who had received cortisone injections for tendon pain experienced a relapse of the problem within six months. And in the specific treatment of tennis elbow, the injections were actually found to be a detriment to healing.

According to Professor Bill Vicenzino, the chairman of sports physiotherapy at Australia's University of Queensland, that among those suffering from tennis elbow, "There is a tendency for the majority (70-90 percent) of those following a wait-and-see policy to get better" within six months to a year. However, those getting cortisone shots "tend to lag behind significantly at those time frames."

So those who receive the shots are actually worse-off in the long run than those who did nothing. In fact, those who received multiple injections showed evidence of being at much greater risk of lasting damage. According to Dr. Vicenzino, one study showed that "an average of four injections resulted in a 57 percent worse outcome when compared to one injection."

Cortisone is an anti-inflammatory, so it was logical that it would help reduce pain from the inflammation of tendinitis. However, many studies have shown that injuries from overuse, such as tendinitis, do not involve inflammation, but rather are due to the fraying of fibres in the tendons. According to Dr. Karim Khan, a professor at the School of Human Kinetics at the University of British Columbia, cortisone appears to have "an effect on the neural receptors" related to pain that "change the pain biology in the short term." But it does nothing to heal the damage, and actually "impede the structural healing."

Therefore, athletes may wish to decide if the short-term pain relief is worth the possible long-term damage that can result from cortisone injections.

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