Injections are commonly used for management of conditions such as joint inflammation, bursitis, low back pain, tendinopathy, frozen shoulder, heel pain and more.
But are they always the best course of action when it comes to reducing pain and improving function? And what are the dangers?
An injection can take a number or forms - cortisone (CSI), plasma rich protein (PRP) and hydrodilitation are an example of a few common ones.
A recent report looked at ultrasound guided injections for tendon conditions. They concluded that when considering an injection for a tendon problem, potential medium to long term risks need to be weight against any short-term benefit. In other words, you may have a worse outcome in six months time if you get in injection today, even if you may feel improvement for the next six weeks. This no doubt will leave you feeling frustrated at best. They suggest load-based rehabilitation is still the cornerstone of tendinopathy mangement.
Studies show that injection for tennis elbow with cortisone vs a placebo injection has a negative effect from 3 to up to 6 months time. So, when going for your injection, you would likely be better off asking the physician to inject you with a non therapeutic solution. Another example of potential harm is if you inject a shoulder with cortisone that has a rotator cuff tear, that tear can worsen significantly.
What about that injection for my persistent low back pain? Or the stiff and sore shoulder I have been struggling with for 3 months with no relief? Or to improve movement and reduce pain in my ankle so I can play in the grand final in 2 weeks?
While there can be short term benefit that has been published in research and what we see clinically, perhaps there is too much haste to find that magic cure and resolve pain without taking a more robust and long term outlook approach.
If we look at musculoskelatal conditions comprehensively - to understand your pain, have guidance to move appropriately for your current level of function, increase general activity levels, eat less junk, get more sleep, and find pain relief in less invasive ways, the long term benefits will likely be far greater.
Orchard, J.W., Saw, R. & Masci, L. Curr Radiol Rep (2018) 6: 38. https://doi.org/10.1007/s40134-018-0296-2