Cortisone Injection For Tendon Pain | Does It Work?

Tuesday, March 26, 2024

Everyone has heard of a corticosteroid, or cortisone injection. They're so often recommended as a first line of treatment for Achilles tendonitis, rotator cuff tendon pain, shoulder and hip bursitis, tennis elbow, heel (plantar fascia) pain, and much more. However, the efficacy of cortisone injections on tendon pain have been the subject of much debate and research in recent years.


How does cortisone work? Cortisone works by suppressing inflammation and reducing immune system activity in the targeted area. When injected directly into a tendon sheath, or around a tendon, cortisone aims to decrease swelling, alleviate pain and improve function. The anti-inflammatory properties of cortisone make it an attractive option for managing tendon pain.  The problem is, there is very strong evidence that:

  1. Cortisone injections provide temporary relief (4-8 weeks): Recent Studies have shown that cortisone injections can only provide temporary relief from tendon pain. Cortisone shots work on reducing inflammation, so using them for overuse disorders like tennis elbow and rotator cuff pain or tears shows inconsistent effects and may indeed cause more pain.
  2. Cortisone injections have limited long term efficacy: While cortisone injections may offer short-term pain relief, their long-term efficacy for managing tendon pain remains uncertain. A study published in the American Journal of Sports Medicine in 2019 followed patients with Achilles tendinopathy who received corticosteroid injections and found that while pain decreased initially, it often returned within six months, with some patients experiencing tendon degeneration.
  3. Cortisone injections may cause tendon weakening: One of the concerns associated with cortisone injections is the potential for tendon weakening or degeneration. Recent studies have highlighted that repeated cortisone injections (particularly when injected directly into the tendon), may compromise tendon integrity and increase the likelihood of tendon ruptures.
  4. Cortisone injections delay recovery: Recent studies have shown that patients who receive a cortisone injection have a higher probability of recurrence of the injury within 1 year compared to “wait and see”. In other words, long-term outcomes at a 1-year follow up after a shot are WORSE than if you did absolutely nothing.

Cortisone injections represent a commonly used intervention for managing tendon pain, offering short-term relief by reducing inflammation and alleviating symptoms. However, recent research has highlighted limitations and potential drawbacks associated with their use, including limited long-term efficacy and the risk of tendon weakening or degeneration. Everyone agrees that exercise or physiotherapy is the gold standard treatment for chronic tendon injury, and should be the first line of attack. This applies whether you have a cortisone injection or not.

Chronic tendon injuries are not easy to treat. Each injury is unique, even within the same tendon, and practitioners have to address the pain and the disruption at a cellular level. But  good clinicians, like our team of Physiotherapists, will be able to give you the exercises and education to improve. Please get in touch on 02 8417 2978, or book directly here.

This article was originally written by Tom Hol (Senior Physiotherapist and Clinic Owner)

This article was updated by Jana Liaros (Physiotherapist) in March 2024

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