Cortisone Injections

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Over the past eleven years of my career as a physiotherapist, I have met many different people, of varying origins and ethnicities.  Some clients have consulted me for sports related injuries, while others for problems resulting from rapid growth spurts and yet others for degenerative changes encountered during the aging process.  Evidently, the range in ages of these patients has been quite vast, from the very young to the very old. Although the differences between these individuals is quite astounding, each with differing pathologies and causes of injury, the common complaint and concern displayed by all has been the fact that they have all encountered pain, in varying intensities, and the need to rid themselves of it.  For this reason, it is of no surprise that I have been asked on numerous occasions whether or not a cortisone injection would be appropriate to help alleviate their pain and accelerate their healing process.

Let us begin with the history of cortisone.  Cortisone is a corticosteroid. Corticosteroids are a class of medication that very powerfully and effectively decrease inflammation.  Inflammation may be present in the body as the result of a variety of diseases and disorders. Cortisone is just one of many drugs that are considered to be corticosteroids.  Other common corticosteroids include Prednisone and Prednisolone. Corticosteroids actually appear in a variety of formats including those that are ingested (via the mouth), inhaled, applied locally to the skin, given intravenously, as well as those that are injected into a specific bodily tissue.  What must be understood is the fact that corticosteroids, such as cortisone, are not analgesics in and of themselves-meaning that they do not first handedly relieve pain.  They merely reduce swelling.  If a corticosteroid “relieves pain”, it is secondary to a decrease in the pain that has been caused by the inflammation.

A cortisone injection is in fact a hybrid, as it is a combination of the corticosteroid cortisone and a local anesthetic (local pain reliever) such as lidocaine.  The local anesthetic is simply used to decrease the pain associated with the injection of the corticosteroid.  The most common sites of injection include the muscles, tendons, bursae and joints.




Common pathologies treated by cortisone shots include but are not limited to:


  • Baker’s cyst
  • bursitis
  • carpal tunnel syndrome
  • chondromalacia patella
  • De Quervain’s tenosynovitis
  • frozen shoulder
  • gout
  • juvenile rheumatoid arthritis
  • lupus
  • Morton’s neuroma
  • osteoarthritis & rheumatoid arthritis
  • plantar fascitis
  • psoriatic arthritis
  • muscle & tendon problems: tendinitis, tendinopathies.

Although cortisone injections tend to carry a negative connotation, one must take into consideration their main benefits.  These injections provide the most powerful and rapid relief to counteract any localized inflammation when compared to traditional anti-inflammatories.  They are also free of the common side effects that conventional oral anti-inflammatories offer, most notably stomach and digestive tract irritations, fluid retention, weight gain and mood swings.  Similar to any prescription medication, cortisone injections have some undesirable secondary effects.

Most are related to repetitive use and include:

  • osteonecrosis (death of surrounding bone tissues)
  • joint infection
  • nerve damage
  • skin and soft tissue thinning around the injection site
  • tendon and muscle weakening or rupture
  • thinning of the nearby bone (osteoporosis)
  • whitening/lightening of the skin around the injection site
  • cataracts

In order to minimize the negative effects that can be produced by this powerful drug, it is understood that most doctors administer a maximum of 3-4 injections into any body part.

Before completely disregarding a suggested cortisone injection, it is advisable to consult with a qualified health care professional, such as a doctor, a physiotherapist or an occupational therapist, all of whom can help weigh out the pros and cons that this injection may offer.


Meet Kelly…one of Cappino’s skilled physiotherapists.   

After graduating from McGill University in 2002 with a degree in Physiotherapy, Kelly began her career working as a physiotherapist in the hospital setting and one year later joined one of Montreal’s largest private physiotherapy clinics. During her time there, Kelly attended over 30 post-graduate courses, taught several physiotherapy classes and was responsible for mentoring all new recruits. In the fall of 2004, she became a Credentialed McKenzie Therapist, making her a specialist in back and neck care.

Kelly is truly passionate about health and nutrition. She is an avid athlete who enjoys downhill skiing, swimming, cycling, and running. This in combination with her background as a prior ski instructor, competitive swimmer, synchronized swimmer and gymnast enables Kelly to understand both the physical and psychological demands that sports place on the body of her patients. Kelly has worked with many high performance athletes over the years, including many nationally ranked swimmers, divers, synchronized swimmers and Irish dancers, helping them recover properly in order to return to their sport and competition as quickly as possible. To book with Kelly, click here.

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Cappino Physiotherapy and Wellness Center offers innovative, hands-on treatment techniques to heal injuries faster and to improve quality of life.

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