Steroid Injections: Helpful or Placebo?
As always in medicine (and in life), the answer to this million dollar question is… it depends.
Steroids can be extremely helpful and it also depends what we are trying to treat. It is virtually impossible to say that steroid injections are always helpful. It depends fully on the person, the injury or pain source, and the goal.
In today’s newsletter, I want to break down the evidence along with my thoughts (and even experience as a patient) on a couple common steroid injection locations.
What Is A Steroid Injection?
Also known as a cortisone or corticosteroid. It is an anti-inflammatory medication, usually mixed with a little numbing medicine. The goal is to decrease inflammation, which can act as a big pain generator. So, the idea is that if we can decrease inflammation then we can decrease pain. It often provides short term relief and can aid in the long term too, especially when paired with the appropriate recovery techniques (ie: physical therapy and modified activity).
For Joints
Arthritis is commonly treated symptomatically with steroid injections. This is often a good short term helper rather than a long term fix when it comes to arthritis. The goal being to keep people out of surgery such as joint replacement. Evidence is mixed on whether or not repeated steroid injections cause cartilage wear. I often tell patients, if you already have significant arthritis (which means cartilage wear) then there is less cartilage left to worry about protecting. So, get them if they help you with pain!
If you have a younger, healthier knee, then I do not advise frequent steroid injections. For these, it is often smarter to get down to the root cause of the pain.
For Tendons
Grapplers have an insane amount of tendinitis with the volume we train. The grips especially. Ever have the naggy elbow pain? It is probably tendinitis. Pain in the front of the shoulder? Likely biceps tendinitis.
I often caution against the use of steroid into high loaded tendons such as the patella tendon or achilles tendon. There is the risk of weakening the tendon and potential rupture.
The biceps tendon tends to tolerate peritendinous injections better, and can give good relief. The overall goal is to inject around the tendon and almost bath the tendon in the anti-inflammatory elixir rather than going directly into the tendon, which can weaken it.
For The Spine
This is called an “epidural spine injection” or ESI. The injections bathe the area surrounding nerves causing numbness, tingling, and pain into the arms or legs. These produce great relief although typically only short term like most steroids.
I have had 2 of these (spread out) for neck and left arm issues that I’ve had for years. With a negative EMG (nerve study) and little strength deficit, ESI is an excellent option.
Final Thoughts
Steroid injections are a tool, not a cure. They decrease inflammation and can help with pain, but they might not always fix why the pain showed up in the first place. Used well, that window of relief lets you sleep, move, and actually do the rehab that can solve the problem longterm. Used as a way to keep grinding on an injury that needs rest, they can set you up for something much worse. Pair the shot with the work, and it can be a great addition to the treatment plan.
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Dr. Megan Lisset Jimenez
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References:
McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-1975. PMID: 28510679
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. PMID: 20970844
