Should you choose cortisone or slow strength work?

What does cortisone change?

Cortisone can lower elbow soreness for a while. It doesn't rebuild the grip needed for lifting or racquet play.

Early relief can make the old workload seem safe too soon. The tendon, the band joining muscle to bone, may still be too sore.

Before another shot, ask what the doctor found during the exam. Also ask how earlier shots changed the ache and what care would follow.

How can slow strength work help?

For tennis elbow treatment, one slow wrist exercise may be useful. Rest the sore forearm on a table with the palm down.

With the other hand, you can raise the sore wrist and lower it slowly. Begin without a hand weight, and stop if pain turns sharp or grip weakens.

Don't repeat the exercise that day if the elbow stays more sore afterward. A doctor or physical therapist can set the right weight and amount.

Once each week, lift the same empty mug from the same table. Stop that check if you can't hold the mug safely.

An exam is worthwhile when weak grip still makes daily work difficult. Bring notes about motions that hurt you and how the elbow felt next morning.

QC Kinetix can discuss biologic therapies, meaning shots prepared from your blood and given by licensed clinic staff to seek less soreness without an operation.

Sources

1. Across 41 randomised trials and 2,672 participants, corticosteroid injection reduced tendinopathy pain in the SHORT term but the effect reversed later. For lateral epicondylalgia, corticosteroid had a large short-term effect versus no intervention (SMD 1.44, 95% CI 1.17-1.71), but no intervention was FAVOURED at intermediate term (SMD -0.40, -0.67 to -0.14) and long term (-0.31, -0.61 to -0.01). Of 991 participants injected with corticosteroid in trials reporting adverse events, one (0.1%) had a tendon rupture. Platelet-rich plasma was not more efficacious than placebo for Achilles tendinopathy in the trials available at that time.

   Coombes BK, et al. — Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.. Lancet, 2010. DOI: 10.1016/S0140-6736(10)61160-9.

2. Thirty-nine men with patellar tendinopathy were randomised to peritendinous corticosteroid injection, eccentric decline squats or heavy slow resistance training for 12 weeks. All three improved at 12 weeks - but at the half-year follow-up the gains were MAINTAINED in the two exercise groups and had DETERIORATED in the corticosteroid group. Heavy slow resistance also produced elevated collagen network turnover and the highest treatment satisfaction at follow-up.

   Kongsgaard M, et al. — Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy.. Scand J Med Sci Sports, 2009. DOI: 10.1111/j.1600-0838.2009.00949.x.

3. Twenty-one patients with chronic lateral epicondylosis were randomised to standard physiotherapy alone or standard physiotherapy plus an isolated eccentric wrist extensor exercise done with an inexpensive rubber bar. Every outcome favoured the eccentric group: DASH improved 76% versus 13%, pain 81% versus 22%, tenderness 71% versus 5%, and strength 79% versus 15%.

   Tyler TF, et al. — Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial.. J Shoulder Elbow Surg, 2010. DOI: 10.1016/j.jse.2010.04.041.

4. In a 165-patient, injection-blinded, placebo-controlled factorial trial of unilateral lateral epicondylalgia, corticosteroid injection produced LOWER complete recovery or much improvement at one year than placebo injection (83% vs 96%; RR 0.86, 99% CI 0.75-0.99) and far higher one-year recurrence (54% vs 12%; RR 0.23, 99% CI 0.10-0.51). At 26 weeks the gap was wider still (55% vs 85%). Physiotherapy did not change one-year outcomes but did improve the 4-week picture when given with a placebo injection (39% vs 10%).

   Coombes BK, et al. — Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial.. JAMA, 2013. DOI: 10.1001/jama.2013.129.

5. In 198 people with tennis elbow randomised to eight physiotherapy sessions, corticosteroid injection or wait-and-see, corticosteroid was significantly better at six weeks and then significantly WORSE in the long term: 47 of 65 initial successes subsequently regressed. Physiotherapy beat wait-and-see in the short term, but by 52 weeks most participants in both of those groups reported a successful outcome.

   Bisset L, et al. — Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.. BMJ, 2006. DOI: 10.1136/bmj.38961.584653.AE.

6. In 185 primary-care patients with lateral epicondylitis, corticosteroid injection had a 92% success rate at six weeks versus 47% for physiotherapy and 32% for wait-and-see - and then reversed. At 52 weeks the success rates were 69% for injections, 91% for physiotherapy and 83% for wait-and-see. The relative gain of physiotherapy over simply waiting was small.

   Smidt N, et al. — Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.. Lancet, 2002. DOI: 10.1016/S0140-6736(02)07811-X.

7. A systematic review of 50 studies of locally administered glucocorticoid on tendon tissue found loss of collagen organisation, increased collagen necrosis, reduced fibroblast proliferation and viability, decreased collagen synthesis in 17 studies, and a meta-analysis of the mechanical data showing significant deterioration in tendon mechanical properties (effect size -0.67, 95% CI 0.01 to -1.33). The authors state this supports the emerging clinical evidence of long-term harm from glucocorticoid injection into tendon.

   Dean BJ, et al. — The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon.. Semin Arthritis Rheum, 2014. DOI: 10.1016/j.semarthrit.2013.08.006.

8. The Cochrane review of injected corticosteroids for plantar heel pain pooled 39 studies and 2,492 adults. Against placebo or no treatment, steroid injection MAY produce a small short-term (under one month) reduction in heel pain (MD -6.38 on a 0-100 scale, 95% CI -11.13 to -1.64) - a confidence interval that only marginally includes the minimal clinically important difference of 8 - and made no difference at 1 to 6 months (MD -3.47, -8.43 to 1.48). Nearly all trials were at high risk of bias and most evidence was rated very low quality.

   David JA, et al. — Injected corticosteroids for treating plantar heel pain in adults.. Cochrane Database Syst Rev, 2017. DOI: 10.1002/14651858.CD009348.pub2.