Why Exercise is Better Than Cortisone

Overuse injuries are common in this day and age given that most of our jobs demand repetitive movement. Tendinopathies (more commonly known as “tendonitis”) occur when the tendon is overused and therefore becomes inflamed, painful and sometimes tethered or torn. Those who suffer from these injuries usually take anti-inflammatory medicine to manage the pain, seek physiotherapy, and some even look to getting a cortisone shot into the tendon to manage the pain. Of these therapies, cortisone shots are very effective short term for pain management but will it help you in the long run in managing your aggravated tendon?

Cortisone is a natural hormone released short term in the body as a response to stress. The cortisone shot you receive however is more effective in managing pain since it is injected into a localized area, as well as has longer lasting effects. It is synthetic, but highly mimics what we produce naturally in our body.

A common misconception with cortisone is that it reduces pain, when in-fact it reduces inflammation which in turn reduces pain. Cortisone injections are not a long-term way to reduce inflammation and pain, but will wear off in time and you will be back at square one. 

While you are in this “no pain” state, you feel as if you can continue to overuse the damaged tendon which in fact is making the injury worse. When the cortisone shot wears off, your tendon is back to a painful, possible worse state. Despite being a beneficial form of therapy, cortisone shots are worse than other treatment options when looking long term. Current studies have looked at how effective cortisone shots are for tennis elbow and rotator cuff tendonopathies. Short term benefits were seen with the tennis elbow, but had negative outcome 6 months to a year after the injection. Minimal benefits were seen with the rotator cuff injections.

It is important to mechanically stimulate the healing process through either exercise therapy or physical therapy. Despite being potentially painful, it can help strengthen the tendon as well as promote healing. Stimulation brings blood flow to the damaged area, which brings all the repair tools with it, such as collagen, to help repair the tendon. Eccentric exercises have been shown to be a very effective way to treat tendinopathies. Eccentric exercises involve loading the tendon with a sudden force increasing the tension on the tendon. This then leads to the protective effect of the tendon by providing cellular, mechanical and neural adaptations to the damaged tendon. These exercises are reportedly painful initially, but those participating feel much better in the long run. Eccentric exercises therefore provide benefits opposite to those of the cortisone injection.

Cortisone treatment should not be the first line of defence when looking for treatment of tendinopathy. Rather, start with manual therapy such as trigger point techniques. Then hire a Kinesiologist to assist you with an active rehabilitation program to strengthen the affected muscle(s) and tendon(s). Conservative management is a great way to feel better without pharmacological intervention.

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