If you’ve ever complained about a painful “tennis elbow” or other tendon injury, it’s likely that someone urged you to get a cortisone shot for immediate relief. The belief has been that this works because inflammation accompanies an injured tendon — and, since cortisone is an anti-inflammatory steroid, it reduces the inflammation and banishes the pain. But there have been some interesting developments regarding this “sure-fire” cure!
Researchers discovered a few years ago that most tendon injuries actually do not involve inflammation. Instead what happens is that these injuries occur over time… and as that happens, vital tendon tissue is gradually replaced with scar tissue (the process is called “micro-tear formation”). Ultimately, it is the built-up scar tissue that brings the intense pain and not the inflammation surrounding it.
Name Change Is a Game Changer
Accordingly, doctors changed the name of tendon injury from tendonitis (the “itis” ending referring to inflammation) to “tendinopathy,” which literally means “disease of the tendon.”
When researchers examined data from 2,672 tendinopathy patients, they discovered that, in the long run, those who had been treated with cortisone shots ended up with more pain and less healing! While the shots did ease pain at first (for as long as eight weeks), the pain came back — worse. After six months to a year, these patients hurt more… had a lower rate of full recovery… and had a 63% greater risk for relapse.
I spoke with Karim Khan, MD, PhD, a professor in the department of human kinetics at the University of British Columbia in Vancouver, who was coauthor of a commentary on the study, both of which were published recently in The Lancet.
Why did cortisone soothe pain at first? Dr. Khan told me that cortisone curbs pain in the early weeks because it influences local pain receptors, but it doesn’t actually help heal the tendon. He said that research shows that it takes six to eight weeks for the local pain receptors to get back to normal, and then the spiral of pain begins anew.
Try This Instead
According to Dr. Khan, there is a more certain path to healing tendon injuries, but, alas, it takes longer. Here are his up-to-date recommendations for treating tendon injuries:
- Move quickly to ice the injury — at the first hint of tendinopathy pain. If you catch it relatively early, icing for 15 minutes twice a day can help to minimize the long-term effects of a tendon injury… but, said Dr. Khan, the unfortunate truth is that tendon problems often sneak up gradually, so this advice may not prove so helpful.
- Exercise the injured tendon, adding weight gradually. Previous advice emphasized complete rest for the joint, but doctors now know that exercise will repair the tendon and rebuild strength. Seek advice from a physical therapist to learn the proper exercises to bring about gradual healing.
- Make a modified return to the activity that triggered your injury. Most tendon injuries are caused by repetitive sports, such as tennis or golf, or other activities (like gardening) that strain the joints. Dr. Khan said it is often helpful to continue the activity, but at a greatly reduced level. For example, if you injured yourself playing tennis, hit the ball gently but for only about 10 to 20 minutes a day. Focus on how the injury feels, Dr. Khan suggests, and stop the activity if pain reaches what you’d consider a “five” on a pain scale of one to 10.
- Consider medication for pain relief. Avoid anti-inflammatory drugs. If you need a pain reliever, Dr. Khan considers acetaminophen (Tylenol) a good choice.
- Identify and correct the problems that caused the injury in the first place. This is most important, according to Dr. Khan. If a sport is the cause, work with an instructor to identify and correct your form… and if it’s just a life activity that gives you tendon pain, see a physical therapist to learn how to avoid straining your joint. Be patient. Dr. Khan said this process may take three to six months if started early and as many as eight to 12 months for “chronic” problems that have been painful for six months or more.