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Tuesday, May 22, 2012

A fresh warning about the dangers of cortisone injections

I continue to receive inquiries from people who have had cortisone injections to treat injuries to joints, tendons and ligaments, or have recommended that they undergo such treatment. This type of treatment remains disturbingly common and the consequences can be catastrophic.

Photo: Example of chemical excision by cortisone injection causing permanent damage to the ankle joint (note the large indentation where the lateral ligaments of the ankle once were). Only one injection is required to cripple the recipient.

Cortisone is a form of chemical excision. It kills living cells, dissolving living tissue, killing off everything it has contact with. While the relief from pain may be immediate and lasting, the adverse consequences may not appear for weeks or months or even years later. The consequences may be the catastrophic snapping of a tendon or muscle, loss of protective ligaments or the loss of protective cushioning tissue, such as that found in the heel pad. While many people get away without apparent long term consequences, I can tell you that many people definitely are not so fortunate.

Why is it that cortisone continues to be used to widely and for so many different musculoskeletal problems?

  • It is cheap, quick and easy and can be done in any medical consulting room
  • Relief from pain is instant and it tends to lastJust 1-4 injections seem to do the job which is usually much better and quicker than one would get than other therapies like physio
  • If there are any catastrophic consequences, the association with the cortisone injections may never be known and the injecting Dr will never be any the wiser
When a Dr tells you the "risk is 1/1000" bear in mind that this estimation may be based on worthless stats that do not take account the dozens and dozens of unreported adverse side effects that run parallel to each reported case!

If you have an injury that fails to respond to rest and/or medical treatment, or are bothered by chronic pain and treatment with cortisone has been recommended, you are welcome to write to me and I will do my best to assist with helping you with deciding on what is the best course of action to take.


Anonymous said...

I have metatarsalgia in my middle metatarsal joint in my foot. It only hurts every now and then. The day I went to see a podiatrist, my foot wasn't even hurting that bad, but I wanted to get treatment anyway before my condition got worse. In my mind, I was thinking that all I needed was rest and maybe a shoe insole to provide some relief, since nothing came up abnormal on my foot x-ray. The doc said he was going to treat me with cortisone injections every 2 weeks. I knew nothing of the dangers of cortisone at the time, so I agreed to the shot. About 3 hours after the shot, my foot was in more pain than when I first went to see the doctor. Then on top of my cortisone injections, the doc gave me a bag full of Celebrex to take every day. I just learned about the dangerous side effects of Celebrex, which is a non-steroidal anti-inflammatory. I've only had that 1 injection, and I've already made up my mind that I will never get another one. I can only hope and pray that the 1 injection I did have doesn't permanantly damage my body in any way. Why are doctors still giving cortisone shots with all of the info on how dangerous they are? It frustrates me that I had to pay a $40 copay to this doctor who put me in more pain than when I first came in to his office. Why isn't there a recall on cortisone like other drugs such as Vioxx?

Gary Moller said...

While NSA's may reduce pain and inflammation, they may in fact inhibit proper healing and speed the progress of the very arthritic processes that they were prescribed for.

If a company is making, say, 500 million per year profits from a drug and the consequent litigation from those who are harmed is, say, $700 million that may not be paid out until at least another 10-15 years, I would say that is pretty damn good for the shareholders!

We are seeing similar horrific scenarios with the class of biphoshenate drugs that are harming countless thousands of people.

The downside of cortisone injections is seldom seen until many months or even years later, so the association is seldom made in the official records of adverse reactions.

Unknown said...

I have had a trochanteric bursitis on my right hip for about 20 years. I cannot think of any one specific instance that may have caused this.

Treatment so far for this EXTREMELY painful condition has been intermittant physio or a total of a couple of cortisone shots taken over 5 yrs. I'm getting older and the pian is getting worse. Should i keep with cortisone shots at slow intervals ?

Gary Moller said...

Al, if you live in Wellington, you can come and see me. If not we could have a chat online using Skype. Set it up with a cheap web camera and we are in action. This is easy to set up. Go to and download the free software

Jan Spencer said...

Thank you in advance for a balanced perspective on the positives and negatives associated with a cortizone injection. I am a 28 year old male who has been dealing with shoulder bursitus for almost 3 months now. I originally dislocated this shoulder about 6 years ago and hadn't had any problem since. Recently I have become an avid salsa dancer often spinning girls 3 or 4 times within just a few beats. After a dificult practice I lifted my arm up in my car and felt a ting. I continued to dance that evening and things got worse the next morning... weakness and heaviness pain through certain movements. I've been limiting activities and have been on a constant rehab program for the past month but have made very little progress. I want to dance, go to the gym, do yoga and my shoulder is limiting all of these social and athletic activities.

At this point I'd like to try 1 shot to see if it can reduce the impingment and allow me to continue strenthening/streching. Thank you again for your advice and assistance with this matter.
Mr. Jan

Gary Moller said...

Jan, please let us know how you get on with the shot over the long term thanks

Unknown said...

perhaps the reason for future injuries after cortisone injections is a combination of 1) weakening of local structures near the injection site and 2) never actually treating the underlying cause of the problem. I wonder if it is the case that if 2 is treated, then perhaps 1 would play a minimal role?

Anonymous said...

For the past two years I've had countless sprains in both my ankles. It all started about two years ago when I got hurt during a soccer game where the opponent slid missed the ball and hit my ankle. It was a provincial game and never had an injury of that nature before so I kept playing through the pain for the next 2 weeks. After about a month I sprained it again, this time it was so bad I needed crutches, and went to the medicentre and my doctor and they said that it was just a sprain RICE it. So I rested it for a while and then got back into sports. 3 to 4 sprains later I'm at a point where I always have a dull ache/pain when im in motion. My left ankle feels fine and the pain is in the right. I went to my doctor and after saying that its just a sprain he decided that just in case we should do an xray. The xray showed that I have a very old avulsion fracture in my right foot. My doc wanted me to see a specialist but the wait in my city is about a year to two years. I took physio before I knew it was an avulsion fracture and it didnt help. Nonetheless he referred me again and I will probably be doing it again. I just want to know whats wrong with my foot. I dont think that its the fracture that causes this dull pain that increases after I play or workout and it doesnt really hurt unless I jog on it or run. It almost feels like I have a clump of something stuck near the ball of my ankle. I just want to play soccer without any pain. Do you have any idea on what it could be and how I can fix it.
1) Hurts when I jog or run and really feels weak when its inflammed inflammed.
2) No swelling and tenderness after sport
3)Had an avulsion fracture that my doctor diagnosed years after
4)Ankle range of motion is fine and I dont think the ankle itself is weak

Gary Moller said...

The avulsion injury is probably well in the past and you are now dealing with secondary injuries

You might want to invest in a wobble board and practice balancing on it daily. When you suffer sprains, you upset the sensors in the leg that control refelxes. This explains the repeat sprains.

Practice balancing on one leg and then the other aiming to be able to balance on the weak leg as long as on the other.

Find a low fence and practice walking along it. Stand and balance on it.

Go to the beach and walk and run barefoot in the sand and the shallows.

Have a look at my video about how to strengthen the tiabilis posterior muscles and do the exercise every 2nd day.

You have probably damaged the joint surface, especially the joint margins from the repeated sprains and you may have some scarring of the ankle ligaments. You need to help these settle down.

I recommend that you get a pair of Formthotics Active Shock Stop heat moulded inner soles off my web store. These are brand new and I love them. They reduce the shack wave as your foot hits the ground. Wear these all the time, swapping between shoes

You should definitely be doing at least 3 months of glucosamine and chondroitin with MSM. If you are over 40 years take Nutra Life Joint Factors 4500. If younger then take Balance Joint and Cartilage Reapair for Atheletes. Both available off my site and damn good prices for overseas delivery.

I think you should get an Elastrap elastic sports ankle support. While this does not prevent firrther sprains, it helps prevent any swelling and keeps the ankle in the neutral position during the plant phase of walking and running. You can get these off my website. Here is the link:

You might want to enlist the services of an experienced sports masseur and get the ankles massaged and mobilised. There are likley to be a number of tender spots that indicate unhealthy tissue and these need to be massaged. Start the massage about 2-4 weeks after you have commenced the other recommendations. You should do both legs while you are at it and have 4-8 sessions.

Do not be in a hurry to recommence risky activities or ones that irritate the ankle. Be methodical and time will heal.

If all fails you will have the surgical option and will go into that in much better shape! Your surgeon will love you for the fact.

Anonymous said...

I sprained my ankle badly about 5 months ago and, figuring it would get better on it's own, I did not seek treatment until 2 months later. Now for the last 3 months I have had physical therapy, boot cast, Prednisone, etc to no avail.

Finally a couple weeks ago an MRI was done and I was diagnosed with a bone contusion. A foot and ankle specialist has told me only that there is some inflammation in the joint and that there is a place where the cartilage has been removed.

Today, that same Dr. gave me a shot of cortisone and lidocaine. The lidocaine only lasted a half hour as compared to the 2-3 hours the Dr. told me that it would last and now I am in more pain then before. I understand this added pain should be short term.

My concern is weather or not the cortisone will be a short term treatment. If Prednisone didn't work, nor did immobility, what are the chances that the shot will be the answer? Now that I've had it done I'm concerned about future complications as well, but for now I just want to get another opinion as to weather or not I should expect permanent results from this or just short term????


Gary Moller said...

The cortisone has been done and can not be withdrawn. But if the pain does not abate, I think you have every right to challenge the Dr about the wisdom of the therapy. I am sure you have gathered my opinion of these injections form reading these articles.

The focus must go on restoring joint health and this is done through nutrition, massage and gentle exercise.

Please read the many articles on this blog about joint pain and arthritis, using the key words tab in the right hand column. Take a good joint food supplement at the maximum dose for 3 months, get going with the Active Elements, boost your vitamin D and other fat soluble vitamins, take 2,000mg vit C per day. Get in a pool with a pair of fins and flipper lengths lying on your back and do this every 2-3 days. Get a thorough sports massage of the ankles and legs every week, concentrating on the tender joint margins.

Avoid all medications, including painkillers, anti inflammatories and even aspirin.

Review everything after about 3 months. And keep in touch.

Unknown said...

I have chronic pain in my left hip and a point in my lower back, also to the left hand side. I am very bendy and long limbed, which apparantly doesn't help. I have had this pain for two years now. It was at first very painful deep in my hip, i couldn't walk. It then started healing until i had to do an emergency stop in my car. This flared it up, and has also left me with reoccurring groin strain.
When i was pregnant with my daughter i got very painful pelvic displacement, which did clear about a month after the birth. (that was nearly four years ago) Could this be a factor?
MRI scans and X-rays haven't shown any damage or anything, and now they want to try cortisone injections! I am 27 and very scared!! I have acupuncture which helps a little, i take anti inflammatories and amitryptiline 10mg for the pain, but cortisone...really don't want to 'try' that!!!
Could you give any advice? any would be appreciated :-)

Gary Moller said...

the most common cause of this pain is the combination of spasm of the backside muscles and strain to the sacroiliac joint on the same side. The solution is deep tissue massage of the affected gluteals and the low back. Both sides should be massaged, each for about 30 minutes. This can be quite unpleasant but should subside within a few sessions. Do so once a week for several sessions.

I strongly recommend that you get a hair tissue mineral analysis. There is always a biochemical driver as well.

A cortisone injection may give relief but does nothing at all to address any of the underlying causes and may end up doing more harm than good.

El said...

I got overdosed with cortisone. I was at an MD's office getting a treatment on an Accuspina machine when the machine malfunctioned. I developed a huge muscle spasm in my left spinal erector muscle. The shot me up with cortisone and marcaine and I had a full blown panic attack. For years I would get pimples on the various injection sites. I was on cortico steroid inhaler and suppositories. For then next year and 1/2 I had panic attacks, tinitus, vertigo, night sweats chills and hives and I am still not right.

Non of the idiot doctors I saw could connect the dots. The gave me Paxil that actually causes panic attacks. I didn't take it because it is highly addictive and dangerous. I finally got a doctor to prescribe me Ativan and Valium which helped take the edge off.

Cotisone is a small part of the problem. The problem is the medical industry that is beyond unethical and greedy. Bad medicine is far more lucrative than good medicine.


Fat Bastardo said...

Corisone is their answer for everything. They know how bad it can be but they give it anyway. One would think by now that there would be a a safer and better alternative. Doctors give it becasue it creates more business.

Gary Moller said...

You are right about one thing, FB: Cortisone Injection is one of the most profitable medical procedures in your Dr's tool kit.