Cortisone shots...more harm than help in many cases.

[Pedaling Fool]

Maybe everyone knows this, but I didn't, despite seeing the word "cortisone" numerous times on here, I just never paid much attention to it, since I'm kind of closed-minded on preventing injury --- physically condition the body.

However, I was reading something that talked about cotisone shots and turns out they are just pain relievers (simply by reducing inflamation -- not true pain relievers), period. http://www.caringmedical.com/media_articles/MY_TEN_REASONS_NOT_TO_GET_A_CORTISONE_SHOT.htm

I know the first link is not medical and probably not entirely accurate in all the reasoning, but after reading other things on Cortisone, including here on WebMd, http://arthritis.webmd.com/cortisone-injection-soft-tissues-joints I'd never get it and if I were I'd never do any exercise (***Including a Hike on the AT, even a day hike in a mountainous section) while the stuff is active in my body.

Mother Natue has got us by the balls. You want health, you gotta work for it;)

[FarmerChef]

I hear you John. I'm not a fan of pills or shots for managing inflammation as I've bene swayed to more fully understand the role that fats and hormones play in how our body responds with inflammation/anti-inflammation after injury. The first article you cited was an interesting read and, as you said, probably not entirely accurate. However, the underlying philosophy is fairly sound. Why do we treat injury to remove the pain of the injury and then don't treat the cause of the injury? Our medical system (ok, maybe our drug system) is significantly based on this concept. As a runner, the first place I look when I experience pain is my running form, my posture, muscle weakness, other causes. I don't run for the ibuprofen or the aspirin. The pain is also my cue to take it easy for a bit, assess what's going wrong and give my body some time to heal while I fix what caused the pain in the first place.

Unfortunately for many, from what I've read, a diet lacking specific fats that occur naturally in an unprocessed foods diet (or as a supplement to a processed foods diet), we can skew the body's inflammation response to over or under inflame. Since trying to be more cognizant of this one happy side effect I've noticed is that I've gone from 1 headache a week to rarely having one. I also feel (totally subjective here) that I heal faster. Could by psychosomatic but I haven't had any of the initial injuries or pain I had while hiking (ITBS, tendinitis, muscle pulls, etc.) and running in the past. Of course, balancing fats and moderating form/habits won't work for trauma and I'm not commenting on that here with the exception that even then our bodies natural response can be enhanced or degraded based on our lifestyle.

I really wish this kind of thinking would take hold more mainstream. Treating symptoms to the exclusion of the cause makes drug companies richer but makes us unhealthier! In other words, pain relievers/anti-inflammatories mask the pain so we think we're ok while our body's mouth has been gagged trying to scream at us to stop doing the thing that hurt in the first place. We injure ourselves further and further as we medicate more and more to cover it up. Sigh. Rant over.

Thanks for posting this.

[MuddyWaters]

People generally want immediate solutions to their problems, that require minimal effort on their part.
Drug companies and doctors have a field day with this flaw in human nature.
History is filled with examples where the cure is worse than the disease.
It continues today, especially in the field of cancer treatment.
Just recently recognized that prostate cancer grows so slowly, you will probably die of other natural causes first.
Never was a need to chop out many prostates of 70 yr old men .

What happened to "First, do no harm."?

People created this by expecting doctors to do something , for every ailment.
When they take a child with sniffels to doctor, they expect a prescription for something, whether needed or not.
Doctors freely admit this, their patients would leave angry if they told them just to go home, and didnt prescribe something.

[Chuckie V]

I hear you John. I'm not a fan of pills or shots for managing inflammation as I've bene swayed to more fully understand the role that fats and hormones play in how our body responds with inflammation/anti-inflammation after injury. The first article you cited was an interesting read and, as you said, probably not entirely accurate. However, the underlying philosophy is fairly sound. Why do we treat injury to remove the pain of the injury and then don't treat the cause of the injury? Our medical system (ok, maybe our drug system) is significantly based on this concept. As a runner, the first place I look when I experience pain is my running form, my posture, muscle weakness, other causes. I don't run for the ibuprofen or the aspirin. The pain is also my cue to take it easy for a bit, assess what's going wrong and give my body some time to heal while I fix what caused the pain in the first place.

Unfortunately for many, from what I've read, a diet lacking specific fats that occur naturally in an unprocessed foods diet (or as a supplement to a processed foods diet), we can skew the body's inflammation response to over or under inflame. Since trying to be more cognizant of this one happy side effect I've noticed is that I've gone from 1 headache a week to rarely having one. I also feel (totally subjective here) that I heal faster. Could by psychosomatic but I haven't had any of the initial injuries or pain I had while hiking (ITBS, tendinitis, muscle pulls, etc.) and running in the past. Of course, balancing fats and moderating form/habits won't work for trauma and I'm not commenting on that here with the exception that even then our bodies natural response can be enhanced or degraded based on our lifestyle.

I really wish this kind of thinking would take hold more mainstream. Treating symptoms to the exclusion of the cause makes drug companies richer but makes us unhealthier! In other words, pain relievers/anti-inflammatories mask the pain so we think we're ok while our body's mouth has been gagged trying to scream at us to stop doing the thing that hurt in the first place. We injure ourselves further and further as we medicate more and more to cover it up. Sigh. Rant over. Thanks for posting this.

There are so many nuggets in your response, FarmerChef! So many! People often don't realize that few things in the body work in isolation; everything is intertwined and everything can (and tends to) affect everything else, in one degree or another (sometimes directly---"Doc, it hurts when I do this"---but most often indirectly, though it's all direct, as again, everything we do affects us and everything else we do). And chronic or recurrent type of pain is almost always a response to more than one thing going on, an imbalance or a weakness or a lifestyle choice of sorts.

A lazy irresponsible lifestyle (nutritional, sedentary, placing "blame" outside ourselves, etc) can and does cause breakdown, and everyone has a weak link somewhere inside them, be it a pancreas or a knee joint or a chemical imbalance that may affect thought patterns and induce headaches, migraines, and so forth. Hell, one guy here on WB got a single diagnosis that he has "tendinitis" and thus drops out of his hike before it even begins. He blames the "itis" (as though it's not a part of him or that he had any involvement!) and not on his choice to do dumb things and weigh too much. "Itis" is just a term for inflammation, which can easily be assuaged or managed with a wholistic approach (and possibly a holistic one too), not by reducing the resultant swelling. Chronic/recurrent pain is our body's way of sending us a message and protecting ourselves, and to block that signal is the last thing we should be doing...it's not really protection.

[Wise Old Owl]

Six months of bliss of a shot to avoid a surgery? Its good to know there are options. The stuff works.

[jimmyjam]

I used to be one of those that would take a pill if something hurt, but stopped that years ago after I educated myself on the dangers of pain meds. And I've managed to overcome "tennis elbow" , "runner's knee", and for now a bone spur on my hip- all by exercise and building up the muscles that support these joints. I rarely ever take a nsaid. Glucosame and Omega 3, now I take those and they seem to help.

[Chuckie V]

Six months of bliss of a shot to avoid a surgery? Its good to know there are options. The stuff works.

For a while anyway. And it "works" on many levels. You should see a cadaver who's had multiple cortisone shots; the effects are wide-ranging and not always merely positive. But I see your point...anything we can do to allow us to do the things we love to do is worthwhile. This, I agree with. But if I have to rob Peter to pay Paul, I'll find something else worthwhile.

[BirdBrain]

There are people who cannot have a cortisone shot. I am one of those people. I have had one and will never do it again. I have had multiple surgeries on my left hand. Between surgeries a cortisone shot was suggested. Within seconds my hand felt like it was being dissected from the inside out. I was in agony for about 4 hours. It was the most intense pain I have ever experienced and it did not wane during the duration. My intolerance to the injection is rare, but very real. And yes, the doctor who gave it to me knew what he was doing. He is the foremost hand specialist of Maine. Just something else to consider. Had I known this kind of pain was a possible side effect, I would not have run the risk.

[Malto]

One event, two different uses of anti-inflamatories, one proper and one improper.

Background
Prior to my PCT hike I did many long distance days up on the AT in N. Ga. Six weeks prior to the start of my thru I did a "graduation hike" which was intended to cap off what had been a year and a half training in preparation for my very aggressive planned schedule. My graduation hike was the Georgia Loop which ended up being a 57+mile hike with almost 16k feet of elevation gain completed in about 19 hours. This was by far the most challenging hike of my training and was 8 miles further than my previous high day. Bottom line it was a couple of ridges too far.

Improper use
after an early start I stopped at noon at the 26.2 mile point and had a bit of pain in my right ankle. Soreness is very common and occasional pain so I took a couple of Advils and continued on my way. I credit the Advil with reducing the inflammation which allowed me to finish the day but it also masked and aggravated a problem that I should have addressed. A couple of weeks later I did a shorter 30 mile day in the smokies and barely was able to hobble back to my car, clearly there was a problem

Proper use
After going to a couple of docs I was told about the potential of a cortisone shot. I did it and then avoided all hiking until I left for my trip. The shot quickly reduced the swelling and the pain. I resisted the urge to hike and rested the ankle even though it was pain free. This resting allowed my ankle to heal up and I completed my thru hike with only one day of return pain months later. Since that time I have continued to do similar long mile days and have had no issue with the ankle. I believe once that injury occurred and was aggravated by my bone headed drugging and continuing the cortisone shot was probably breeder to reduce further aggravation and allow my ankle to heal.

Lao bottom line for me..... Avoid the anti-inflamatories to mask pain but they can be a valuable tool in combine with rest to get an injury healed. This event is also why I caution folks against doing the hero or challenge days as part of their thru hike. No way could I have healed up from that injury if I had to hike day after day.

[Chuckie V]

One thing I'll add, and why NSAIDS (or steroidal ones, in the case of this thread) are sometimes prescribed (though they're often over-prescribed, as is the American way)...

The medications/injections can indeed help our own body's anti-inflammatory responses---a sort-of kick-start, if you will. And this is highly desirable when the body has lost its ability to do it on its own.

But the ultimate end is to allow and teach our bodies to work optimally on their own accord, without external assistance (i.e., drugs), as nearly every pill or injection or medication out there comes with additional effects (just listen to those stupid prescription ads on the telly!), few of which are desirable. Of course, most these side-effects take a long time to show, and, as such, are deemed worth the trade-off (i.e., be happy now vs. later!). If I needed medicating (and this is debatable, but never mind that!), I'd take it. But I'd also study it in depth first, and learn any such trade-offs or possible trade-offs or other options.

As adults, we're all responsible for our own well-being, our own health, our own fitness. There's a lot of neglect and misinformation out there, some politically-motivated, most $$$-motivated and a whole lot of laziness and ignorance and apathy (the ol' "I don't know and I don't care" attitude). It's our job as individuals to learn what works for us, both now and in the long haul.

The nice thing is that it's not too entirely difficult. Most of us here, though, know more about the AT or our automobiles than we do our own bodies! Strange, that.

Tell me...what does your spleen do?!

[JAK]

This is a good read, and explains how the body responds to exericise very well....
http://www.amazon.com/Runners-World-The-Body-Exercise/dp/1605298611

After reading it I would not use any anti-inflamatories unless something was seriously out of control and I saw my Doctor first.
Don't take anything if I can help it. Just real food, real exercise, and real rest and sleep.

[BirdBrain]

This is a good read, and explains how the body responds to exericise very well....
http://www.amazon.com/Runners-World-The-Body-Exercise/dp/1605298611

After reading it I would not use any anti-inflamatories unless something was seriously out of control and I saw my Doctor first.
Don't take anything if I can help it. Just real food, real exercise, and real rest and sleep.

I take glucosamine, fishing oil, and will soon start taking turmeric. Prescribed medicine and/or surgeries are an if all else fails desperation time event for me. Doctors are hazardous to your health. Diet, exercise, and supplements for me.

[rocketsocks]

I've had them...they worked for me, and the alternative was bleak.

[Ktaadn]

I’ve had two cortisone shots in my lower back for a herniated disc that was causing severe sciatic pain. Initially my doctor prescribed NSAID’s and exercise. After several weeks of this without much in the way of results, the more aggressive treatment was chosen. The first shot was amazing and I was immediately pain free. About a year later the pain returned and I went back for another. This one was less effective but still helpful. Since then I have been more dedicated to the exercises to strengthen my core and I have been relatively pain free for about a year and a half.

To sum it up, the cortisone shots allowed me to function in my daily life while the disc in my back healed. The herniated disc was likely caused by a combination of bad posture and weak muscles. Long-term, the problem seems to have been solved with the exercise and clean living that many of you have mentioned. Surprisingly backpacking and sleeping on the ground has never caused any pain to reoccur. It’s only when I’m laying around on the couch at home that the pain will sometimes return. This has convinced me that exercise truly is the key.

I am concerned about the long-term problems associated with multiple injections and I will be doing all that I can to avoid ever needing/wanting another cortisone shot.

[Cookerhiker]

Good posting. I had a cortisone shot - recommended and administered by the hand surgeon - in late December in the joint behind my left ring finger. It wasn't the pain per se that bothered me but how sometimes I had trouble bending and flexing the joint. The pain subsided and flexibility returned for about 2 weeks but now it feels like it did before - less than 2 months later! No more cortisone shots for me!

I had stopped taking glucosomine/chondroiton a few months ago - coincidence? I'm back to it now and also taking ginger tablets as well as flavoring my oatmeal with ginger several times a week.

I also wonder: last summer, I reluctantly resumed taking a statin drug for high LDL chloresterol. Another coincidence? About 10 years ago, I started having leg and knee pain after taking a stronger dose of Lipitor.

[MuddyWaters]

With a few exceptions, such as antibiotics, and surgical repairs, doctors largely treat symptoms. Your body itself, does any healing.

[JAK]

I used to eat sardines regularly. Full of Omega 3 and bones and stuff, and probably BPA from the can lining.
It's hard to win. I try to eat real food with minimal processing and packaging. Still, it's hard to have it all.

[Pedaling Fool]

I used to eat sardines regularly. Full of Omega 3 and bones and stuff, and probably BPA from the can lining.
It's hard to win. I try to eat real food with minimal processing and packaging. Still, it's hard to have it all.Well JAK, you still got horse meat and seal meat to fall back on http://www.youtube.com/watch?v=pOtCkD0NbYk :)

[Blissful]

Treating symptoms to the exclusion of the cause makes drug companies richer but makes us unhealthier! In other words, pain relievers/anti-inflammatories mask the pain so we think we're ok while our body's mouth has been gagged trying to scream at us to stop doing the thing that hurt in the first place. We injure ourselves further and further as we medicate more and more to cover it up. Sigh. Rant over.

Thanks for posting this.

Good post. That is excatly the problem. We are Way over medicated due to poor diet and not treating the cause of pain but symptoms only. Much of inflammation issue can be treated by a good diet.

I am not a fan of the cortisone injection myself.

[Blissful]

I'm back to it now and also taking ginger tablets as well as flavoring my oatmeal with ginger several times a week.



Good ones for inflammation response

Tumeric
Ginger
Boswellia
Green Tea
Flax
Aloe Vera Gel
Cat's Claw
Honey and Cinnamon (also a good antiviral)
Licorice (DGL)

[JAK]

Thanks for that Blissful. Good stuff.
Leafy green herbs are great for soup also.
Herbs and Spices. Not just for flavour.

[Don H]

I would have never been able to finish my thru in without a Cortisone shot in my ankle.

[gunner76]

I have had one cortisone shot when my back went out and the pain would not go away like it normally does after a couple of days. The shot location hurt like hell for about an hour and then the relief kicked in, after a about 1/2 day some pain returned but nothing like I had before the shot and my back went back to normal (for me) in a few days.

[Wise Old Owl]

Had an interesting discussion with my Orthopedic Reconstructive Surgeon, and his take on this subject was illuminating.. the average body years ago lived to be 45 - now its 85 for some... knees, feet, and other joints haven't really caught up... the shots have their place.

[fiddlehead]

Had hives a few years ago and went to 3 (western) doctors.
They all said cortisone.
I refused to do it.
Went to Bangkok and saw one of those old Chinese guys with the hundreds of jars all around with bat wings and whatnot in them.
Showed him my hands and told him about the problem through an interpreter.
He gave me something that looked and tasted like black licorice.
Took the hives away in about 3 days (after I had them for months)

Worked for me.

[SunDancer]

The medications/injections can indeed help our own body's anti-inflammatory responses---a sort-of kick-start, if you will. And this is highly desirable when the body has lost its ability to do it on its own.
But the ultimate end is to allow and teach our bodies to work optimally on their own accord,
Tell me...what does your spleen do?!

You're absolutely right, in the case of cortisone, it provides temporary relief with long term damage...get the relief while you're young and suffer the agony when you're old. Homeopathic remedies may not provide instant relief but help in the long term, i.e. yarrow tea and green tea (high in anti-inflammatory properties) - kelp is another anti-inflammatory powerhouse...things to consider when fighting mr. pain.
the answer to today's question: the spleen acts as a blood filter - it works on red blood cells by refrubishing hemoglobin, among other things.
Hike healthy!

[Pedaling Fool]

Had an interesting discussion with my Orthopedic Reconstructive Surgeon, and his take on this subject was illuminating.. the average body years ago lived to be 45 - now its 85 for some... knees, feet, and other joints haven't really caught up... the shots have their place.
I've given that some thought, but there is one problem with that and that is that while we do live much longer today we have not extended our natural lifespan, not yet atleast. People died because of many problems, but not from old age, per se. I'm closing in on 50 and I don't have any problems with my joints and I'm no super human, I've seen them and I'm not one of them.

Although, I do have problems with my right knee. That is based on two factors. One, when I was very young (back in the days when moms threw you out of the house:D) I was playing with the neighbor hood kids and we were climbing the roof of this house and I shimmied down one of them old-fashioned TV antenna when I slipped and fell stabbing my knee (directly under the knee cap) with a spigot (without the handwheel) on the side of the house. And I severly aggitated it on a bike tour around the east coast in 1993, which I wish I would have conditioned myself (specifically my right knee) for.

To this day when my knee is hurting you can see part of the patellar tendon pushing through the skin when it's inflammed.


You want a healthy strong body, you must do vigours exercise, period. I just can't believe people believe all they need to do is eat healthy, that doesn't work. You take all the calcium you want but your bones will still get weaker with age if you don't put resistance on them. That's just the way nature is; you don't use it, you lose it. Mother Nature's rule, not mine.

[Stepinwolfe]

In 2011, I was stopped dead on the AT in Maine with a bout of peripheral neuropathy--the pain in one of my toes was so severe I couldn't walk, even without a load. Another over 60 hiker I met at a shelter that night recommended cortisone and told he would not be able to hike at all with out it. Since that incident, I have been getting annual injection of cortisone (in May), which have carried me through section hikes during May-Sept. I believe there is probably significant cortisone use among some hikers, especially the older ones. My podiatrist says as long as the cortisone is not abused, it shouldn't be a problem.

[Coosa]

There is a place for cortisone use for backpackers ... Maybe not for the youngsters, but definitely for us Senior citizens.

I use Cortisone for my Morton's Neuroma & for the arthritis in my left knee. My Sports Med Doc says he'll keep me on the Trail for as long as possible before we do surgery & knee replacement. I'm 68 1/2.

Coosa

[Wise Old Owl]

Read your post John, I have to go with the registered expert.. thanks for the good information, it was an eye opener.