Well Being

When Runners Should (And Should Not) Get Cortisone Shots

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Cortisone shots are well-known within the running world. Runners often turn to them when knee pain, foot pain or hip pain strikes. And when some runners get cortisone–and feel back to their old running selves again–these shots can become their new best friend. But are they really beneficial? Are they good for all types of running-related injuries? Or are they sometimes doing more harm than good by simply covering up a bigger underlying problem?

To find out, we talked with Dr. David Geier, Director of MUSC Sports Medicine and Assistant Professor of Orthopaedic Surgery at the Medical University of South Carolina.

First of all, what exactly is a cortisone shot and how do they work?

A cortisone shot is a generic term for an injection of an anti-inflammatory steroid (not an anabolic steroid) into a joint to decrease inflammation, and hopefully pain, within that joint.

Why are they so popular with runners?

Cortisone injections are popular with runners and other athletes because they often provide a quick relief of symptoms. They often take effect within two to three days, and depending on the underlying problem, they might provide relief for several months to even a year.

What types of running injuries are they most effective with?

Cortisone injections can provide pain relief for athletes with pain related to some form of inflammation. Early arthritis changes could be a good example.

What types of running injuries are the least effective with?

Cortisone injections do not typically provide relief from pain caused by underlying structural damage within the joint. Knees, where they are most often used, are a good example of this issue. If a runner has a meniscus tear or ligament tear, the cortisone injection is unlikely to provide significant relief.

What about other common running injuries like plantar fasciitis, achilles tendonitis, shin splints or a pulled hamstring?

Not really indicated for any of those. Shin splints are a bone problem, so there would be no way to inject cortisone. For the others, it would be more likely harmful than helpful.

Who should and should not consider a cortisone shot?

There is concern with cortisone injections that the steroid can soften the articular cartilage of the joint and theoretically cause it to break down faster. This is probably more of a risk with multiple injections over time rather than one injection. Having said that, because of the concern for wear of the articular cartilage, many sports medicine surgeons are reluctant to perform cortisone injections in younger athletes. Once an athlete has more significant arthritis, meaning that articular cartilage has already broken down to a large extent, then that risk is less of a concern. A cortisone injection can be a good option in those runners.

Don't they just mask the symptoms of a bigger underlying problem?

Cortisone injections are simply an injection of an anti-inflammatory into the joint. They do not actually fix the underlying problem if there is structural damage. For example, in arthritis, the problem is a breakdown of the articular cartilage of the joint. The cortisone can help decrease the pain from that problem but it does not rebuild the cartilage. They are intended to be pain relief measures and not definitive treatments for most problems.

What are the risks of getting one? Can't they weaken surrounding tissues and tendons?

Into a joint, cortisone injections can theoretically soften the articular cartilage. We rarely inject them directly into tendons or muscle, as it is believed that the steroid can be somewhat detrimental to the healing of those tissues. Also in theory, injecting a steroid into a tendon can theoretically weaken it and potentially cause it to rupture later.

How can someone tell if their doctor is qualified to give a cortisone shot?

In general orthopaedic surgeons and sports medicine surgeons and physicians are qualified to give cortisone injections. If a runner has a knee injury or injury to another joint were he or she is considering a cortisone injection, it is probably a good idea to have their primary care doctor refer them to a sports medicine surgeon. Rather than just receiving an injection to temporarily decrease the pain, it is often a good idea to undergo a workup including history, physical examination, and x-rays to try to find the underlying cause of the problems first.

Anything else you want to tell runners about cortisone shots?

I think it's important for runners that have a lingering cause of knee or other joint pain to have it evaluated. Very frequently there are other measures that can both provide pain relief and actually get rid of the underlying problem. Physical therapy, for example, is often much more effective at correcting the underlying issues, decreasing pain, and preventing it from coming back than injections. Knowing what the actual diagnosis is can help guide the treatment and return to running.

Follow Dr. Geier on his sports medicine blog.

Photo: shutterstock.com