TEN REASONS NOT TO GET A CORTISONE SHOT
Ross A. Hauser, M.D.
“My doctor wants to give me a cortisone shot. What do you think?” “Cortisone helped me before, why shouldn’t I get another shot?” “Is Prolotherapy going to hurt like a cortisone shot?"” The questions go on and on. The mighty cortisone shot has its supporters, but they are rapidly declining. As books such as Prolo Your Pain Away! and Prolo Your Sports Injuries Away! gain in popularity, and when people finally realize what cortisone is doing to their bodies, they will revolt and seek out alternatives such as Prolotherapy. Below are my top ten reasons for not getting a cortisone shot. For those desiring scientific support for this, please read the two books mentioned above.
Reason #1: Cortisone Inhibits the Healing of Injured Connective Tissues
Pathophysiology 101 is that the body heals by inflammation. No inflammation, no healing. It is that simple. When a person sprains an ankle, the persistent swelling for one to three days is the body’s attempt to heal the area. If you want to stop healing, just stop inflammation. This is exactly what cortisone does.
One of the first people to determine the effects of cortisone on ligament, tendon, and joint healing was George S. Hackett, M.D., who coined the term “Prolotherapy”. In the mid- 1950s, he did studies where he injected injured ligaments, tendons, and joints with various agents, including cortisone. He found that cortisone inhibited the healing of these stretched and torn connective tissues, but that if it was mixed with a proliferant (Prolotherapy) it was strong enough to even inhibit the healing from Prolotherapy.
Reason #2: Cortisone Inhibits the Healing of Prolotherapy
Modern medicine has forgotten the first rule of healing: The body heals by inflammation. The whole inflammatory cascade, including phagocytosis (immune cells cleaning up the area), angiogenesis (new blood vessel formation), and fibroblast formation (new collagen formation) is inhibited by cortisone. Cortisone also inhibits the migration of the immune cells to the injured area. This migration and repair process is what causes the pain. Cortisone inhibits this repair, so the person feels better. The person getting a cortisone shot sacrifices healing for pain control. This is a bad choice because they now have a weakened structure that they think is fine - so they continue to do sports and activities, not realizing that they are accelerating the degenerative process.
Reason #3: Cortisone Accelerates the Degenerative Process
Cortisone, by inhibiting the normal healing inflammatory reaction, accelerates the degenerative process in the tendons, ligaments, and joints in which it is injected. It also gives the person a false sense of security that the area is healed, when it is not. The combination of a cortisone shot and follow-up exercise is an exceptionally deadly combination for cartilage. Nothing but arthroscopic shaving will degenerate cartilage quicker. If you don’t believe it, look at the studies in the book Prolo Your Sports Injuries Away! Curing Sports Injuries and Enhancing Athletic Performance with Prolotherapy. Studies on animals have shown that even one cortisone shot into an area has been shown to cause irreversible biochemical damage to joints and cartilage. One of the quickest ways to cartilage deterioration and/or a hip or knee replacement is a cortisone shot into these areas.
Reason #4: Cortisone Shots Mask the Pain and Injury
Cortisone, by blocking the healing, does not allow the injured structure to send off a pain signal that something is wrong and needs to be fixed. Cortisone, at best, then just masks the pain and injury. The injury continues, but because there is no pain signal, the person thinks everything is okay, when it is not. The only thing that can occur is that the injury continues and accelerates. If the cortisone shot was really “successful,” the injured structure may be permanently unable to fire a pain signal, and thus will not hurt anymore. What more commonly happens is that the structure further deteriorates to the point that it overcomes the inhibitory effects of the cortisone shot and starts to hurt. The problem is that the person runs back to their Orthopedist for another one of those “wonderful” cortisone shots; never realizing that the very shot is what is causing their pain and accelerated joint destruction. Such a person is on a slippery slope that could end their athletic career. What is forgotten are the thousands of people who are unable to enjoy their retirements and are in nursing homes because they have lost the ability to walk because of severe hip, back, and knee arthritis. The cause is never spoken about - except here and in our books. The cause of most unhappy retirements is because of Cortisone Shots! Their cousins the anti-inflammatories, of course, are also to blame.
Reason #5: Cortisone Shots Cause People to Need Joint Replacements
Nothing can degenerate a joint quicker than a cortisone shot (except, perhaps, arthroscopy with cartilage and meniscus shaving). The number of joint replacements in this country will soon reach 1 million per year. Your risk of needing a joint replacement is about one in ten. Ten percent of people in the US will get a joint replacement. Guess what the percentage of those needing a joint replacement are those who have had a cortisone shot? Correct, just about 100%. You want a joint replacement? Just keep having cortisone or its cousins injected into your joints, ligaments, and tendons. Cortisone is a poison to the connective tissues of the body, including cartilage, muscles, ligaments, menisci, and tendons. Thus, when cortisone is injected into these structures the death of cells is seen. You want to see the death, read Prolo Your Sports Injuries Away!. What, are you chicken? Don’t like to see death? I don’t blame you, but I do blame cortisone.
Reason #6: Cortisone Shots Cause People to Need Surgeries by the Same People That Gave the Shot!
Most cortisone shots for pain are given by Orthopedic Surgeons. Surgeons love surgery! When they give people cortisone shots, they are doing it in good faith, never realizing that the very shot they are giving will help land the person in the surgical suite. Cortisone helps land people in the arthroscopy suite to get their “damaged” menisci, ligaments, tendons, and cartilage shaved. The orthopedist and the patient never have a clue that it was the anti-inflammatories prescribed by the orthopedist and cortisone shots given by him/her that was the cause of the damage. You have a damaged joint or spine! Wake up before it is too late. Anti-inflammatories and cortisone shots are what are causing people to need laminectomies, discectomies, fusions, tendon repairs, and other salvage operations. Salvage your spine and joints before it is too late. Just say “no” to cortisone.
Reason #7: Cortisone Shots Cause Premature Aging
Healthy aging involves being active for life. It means being like the Walgreens who saw me the other day. The Mr. Walgreens I saw was the son of the founders of the Walgreens Pharmacy chain. He ran the company for 25 years. The first Walgreens pharmacy store was in the Chicagoland area. When I saw him the other day, he was 94 years old. This time he brought in his bride (his wife of decades) who was 92. They still travel around the world. Mr. Walgreens had such a good response to his first set of Prolotherapy injections that he wanted his wife to experience the power. They are still active in their community, family, and life in general. They were committed to being active for life! Being 70, 80, or 90 does not mean “nursing home time.” As long as a person makes sure that injuries heal, there is no reason they cannot be active for life! Once cortisone enters a joint, tendon, ligament, cartilage, or menisci, then complete healing is inhibited. Suppressing an injury is a great prescription for later-in-life immobility, pain, anti-inflammatories, surgery, or in summation, premature aging.
Reason #8: Cortisone Shots End Dreams
They come in every day to Caring Medical in Oak Park. Men and women who now can’t even walk without pain, but yet in their day they were “dream makers”. The superstars of yesteryear are now left hobbling along. Even sadder are the elite atheletes who come in to have their dreams dashed by a degenerated joint caused at the hands of their “team physician”. Everybody loves a star athlete, but take away that athletic prowess and then who loves them? Nobody, except mom, dad, significant other, and Prolotherapist. That is it.
Prolotherapists love to help people regain their dreams. The dream is playing in the NBA, PGA tour, or perhaps just getting back to the high school team pick-up games on the weekend, or the tennis matches on the weekend. Whether we want to admit it or not, athletic activities, exercise, and being active are very important to all of us. Sure guys watch too many athletic events on T.V. But take away the ability to be active for any of us, and panic hits. Most of the time this inability to play sports or exercise is in part due to a cortisone shot. Show me a chronically injured joint and I’ll show you where cortisone has been. Don’t end your dreams by getting a cortisone shot. You can do better. You have to, your future activity level depends on it.
Reason #9: Cortisone Shots Keep People From Getting Healing Therapies
People want the easy way out. We have instant oatmeal, drive-up lunch stops, drive-up espresso, soon we will have drive-up bathrooms. Don’t ask me how the latter will work. What is easier than getting a cortisone shot? “Why not? Insurance will pick it up.” Yeah, right buddy, they will pick up your future hip replacement too!
By getting a cortisone shot and masking the pain, people do not get the healing therapies they need. Any therapy that helps increase circulation to the area, helps healing. Therapies such as exercise, myofascial release, rolfing, magnets, massage, chiropractic physiotherapy, kinesiotherapy, acupuncture, herbs, vitamins, and a host of others help people truly heal injuries. When people pop anti-inflammatories and get cortisone shots - it is like taking the battery out of a blaring fire alarm while a fire is blazing. “No problem here.” “What do you mean? You dope, the alarm means there’s a fire!” This illustration seems silly. Who would take the batteries out of the fire alarm during a blazing fire and state “no problem here.”
Yeah, stupid, huh? Well, what could be stupider than have a fire blazing in a tendon, ligament, or joint and stomping out the healing with a cortisone shot? Don’t take the “alarm signalers” out of your injured structures. Obey their wishes and get help. You may need a shot, but not one filled with cortisone, but one juiced up with healing!
Reason #10: Cortisone Shots Keep People From Getting Prolotherapy
Cortisone and Prolotherapy shots are the opposite. Consider the following:
PROLOTHERAPY VS. CORTISONE
PROLOTHERAPY CORTISONE
EFFECT ON HEALING ENHANCED INHIBITED
EFFECT ON REPAIR ENHANCED INHIBITED
EFFECT ON COLLAGEN GROWTH ENHANCED INHIBITED
EFFECT ON TENDON GROWTH ENHANCED INHIBITED
EFFECT ON LIGAMENT STRENGTH ENHANCED INHIBITED
EFFECT ON CARTILAGE GROWTH ENHANCED INHIBITED
To heal an injury, a person needs to receive Prolotherapy. Perhaps this is why I dislike cortisone shots the most. They keep people from healing their injuries. The only way healing can take place is if they allow the body to heal the area via inflammation. If the body can’t do it, then one has to receive Prolotherapy, which will simulate the normal healing inflammatory reaction. The repair mechanisms of the body are thus stimulated and ultimately the traumatic, joint, spine, or sports injury is healed. Prolotherapy stimulates the body to heal the injured area. This is why people get shots. Make sure this is the action of the shot you are about to receive. If it is not, say, “Thanks, but not thanks. I’m going to get healed. I’m going to get Prolotherapy!”
ROTATOR CUFF AND SHOULDER PAIN
The most common cause of chronic shoulder pain is not shoulder instability but supraspinatus tendon weakness, also known as rotator cuff tendonitis. If full range of movement in the shoulder is compromised, the supraspinatus tendon works harder to provide the motion support needed. This tendon eventually weakens and laxity develops. A supraspinatus tendon problem is manifested by pain with abduction and external rotation of the shoulder, especially when reaching for things above shoulder level, or pain in the shoulder after sleeping due to compression of the supraspinatus tendon.
The supraspinatus tendon often refers pain to the back of the shoulder. Sleeping on the shoulder causes a pinching of the rotator cuff muscles and can lead to rotator cuff weakness. There are cases where the cause of the rotator cuff tendon laxity was due to years of sleeping on the shoulder.
In most cases, traditional therapies such as exercise and physical therapy will resolve rotator cuff tendonitis. It is not uncommon, however, for rotator cuff injuries to linger because blood supply to the rotator cuff tendons is poor. Poor blood supply is a reason the rotator cuff is so commonly injured. In chronic cases of shoulder pain due to rotator cuff weakness, Prolotherapy is the treatment of choice. Prolotherapy will cause the rotator cuff to strengthen and eliminate shoulder pain. If rotator cuff weakness is not corrected, the shoulder's range of motion will deteriorate. Rapid deterioration can occur, especially in people over 60 years of age.
When shoulder muscle weakens, movement becomes painful. Those who have supraspinatus tendon laxity causing pain will stop moving their arms into the painful position. Though they may not realize it, they are slowly but surely losing shoulder movement. What begins as a simple rotator cuff muscle weakness easily treated with Prolotherapy, has the potential to become a frozen shoulder because of scar tissue formation inside the shoulder that was left untreated. The scar tissue formation causing a decrease in the ability to move the shoulder is called adhesive capsulitis.
