One of the more common modes of musculoskeletal pain treatment these days is that of an injection. While various variations and alterations are made regarding the exact content and site of injection, in the majority of cases the basic formula remains the same.
There are two main components to an injection. First we have the corticosteroid in which cortisone is commonly utilized. The role of the steroid is to aggressively attenuate inflammation by dampening the immune system. When you are inflamed, you will usually be feeling some level of pain or discomfort as the chemical mediators involved in the inflammatory process stimulate the pain pathways of your nervous system, and thus the perception of pain is experienced.
While this may effectively address a compartmentalized target, it does so at the expense of the rest of the body. Inflammation is a main and necessary component of the immune system. A steroid dampens the immune system, lessening the inflammation, but also compromising overall immune function which is kind of important.
The widespread effects of steroids are seen when they are utilized as a method of control for an autoimmune condition. In an autoimmune disease, the immune system has become imbalanced and has turned against the body that houses it, causing tissue destruction. Patients who find themselves in this predicament often find relief with the use of corticosteroids as it knocks the entire immune system down a level, thus temporarily lessening the self destruction (rather than rebalancing the immune system, addressing the root of the dysfunction).
Some other side effects of corticosteroid injections include risk of infection, hyperglycemia (elevated blood sugar), peripheral nerve damage (median nerve commonly injured in carpal tunnel injections) adrenal insufficiency (adding dysfunction to the commonly over worked “stress glands), immunosuppression, osteoporosis, and actual TENDON RUPTURE.
The tendon element can get dicey, as injections are now commonly utilized for such a wide range of sport type injuries including sprains and strains, bursitis, tendonitis, plantar fasciitis, etc. The logic behind aiming an injected dose of a corticosteroid at what is presumed to be a tendon issue comes into question when we discover the tendon doesn’t actually succumb to inflammation.
The term tendonitis (meaning inflammation of the tendon) is actually a misnomer due to the lack of inflammation. The proper term for the reduced mobility, strength and discomfort originating in the tendon is actually tendinosis but many clinicians (present company included) continue to use the outdated, falsely descriptive term.
As we explained above, the therapeutic property of the corticosteroid intended to be utilized in this instance is that of an anti-inflammatory agent. If the tendon is incapable of becoming inflamed this is a poorly misguided effort. Additionally, studies have shown that injections weaken the tendon and can actually lead to eventual rupture.
The other commonly used component of these injections is a local anesthetic like lidocaine. This provides immediate relief to the area as the pain signals are silenced by this chemical agent.
The dangerous aspect of using this or any numbing, pain blocking agent is that it puts a gag on the body as it tries to convey the idea that something isn’t right. The underlying dysfunction persists, but miraculously you feel fine. This creates a false sense of security and can lead to doing too much, too soon causing re-injury, escalation of the injury or a new injury.
Injections for common musculoskeletal injuries have become so popular due to our constant demand for the quick, easy fix. The inflammation; the pain; they came about for a reason. Something isn’t right in the way we move, our strength, stability or mobility and it has manifested in the irritation of a particular and tissue and now you and your potentially reduced training load.
If you want to be in this thing for the long haul, capture this opportunity to discover the breakdown, remedy the issue, and make your parts happy (and quiet) again. As annoying, nagging, uncomfortable, disruptive, (insert adjective) as pain can be, it truly is a gift from the body letting you know to knock it off or make a change. Simply silencing this signal may get you through temporarily. It may even provide lasting relief.
However, it may not. It may actually leave you right where you started or worse. The alternative can be more time consuming. The alternative may take a little trial and error to find a unique to you treatment program, rather than a one size fits all remedy. The alternative may involve looking beyond an injection site for pain and addressing the whole person and kinematic chain.
To me this non-invasive approach logically makes more sense as the primary mode of intervention. If it does to you as well, and you’d like to give it a shot before getting a shot, we are ready and waiting to collaborate with you.
REFERENCES
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084363/
http://www.m.webmd.com/a-to-z-guides/cortisone-injection-soft-tissues-joints
Clarke Chiropractic and Wellness 