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Cortisone Injections for Runners: Yea or Nay?

Cortisone is a corticosteroid anti-inflammatory delivered through an injection that goes directly to the site of inflammation in your body. It differs from Aleve, Advil or any other over-the-counter anti-inflammatories in that it has a higher concentration of painkillers. This means it will pack a quicker punch, getting rid of the pain faster, than will an oral anti-inflammatory you take by mouth.

We use cortisone injections for pain and inflammation that doesn’t respond to normal conservative standard treatments (which besides oral medications can include ice, stretching and physical therapy). Corticosteroids can be a very effective method to get rid of pain, useful for conditions including bursitis, carpal tunnel syndrome, tendonitis, rotator cuff issues and particularly arthritis. But it’s always best to let the body heal itself naturally, and that’s what we first try to do when working with an injury. For runners, there is likely an underlying issue with biomechanics, strength or muscle flexibility, with the pain being the secondary problem. 

Many running injuries are training errors – running too quickly or too frequently, and increasing mileage too quickly. When you run, your lower half is constantly using your quadriceps, hamstrings, glutes, calves and the network of muscles, joints, ligaments and tendons around them, putting you at risk of acute or overuse injuries.

In my practice we use cortisone only after people fail normal treatment for running injuries. Whether or not cortisone is the right treatment for you will depend on what the injury is. When used appropriately, cortisone can have a powerful impact getting rid of pain, at least in the short run. But corticosteroids carry some risk for complications such as joint cartilage weakening, thinning of nearby bone, skin and soft tissue, and joint infection. We generally use cortisone for acute injuries, not chronic, long-term pain. 

We don’t use cortisone around tendons, because it can weaken and even rupture them. Runner’s knee (patellofemoral pain) is typically tendonitis, and we don’t use cortisone to treat it because it can debilitate the tendon and predispose it to injury.

These are some of the more common running injuries I treat with cortisone injections, when conservative treatment such as stretching, activity modification and physical therapy doesn’t work:

  • Illitobial Band (IT Band) syndrome – inflammation of the illitobial band, or fascia that runs from the pelvis and hip down to the knee;
  • Trochanteric bursitis - inflammation of the hip
  • Pes anserine bursitis – medial hamstring tendonitis often experienced as knee pain where the hamstrings insert on the tibia.
  • Chondromalacia – breakdown of the articular cartilage of the knee, which feels like pain under the patella (kneecap).

A good training regimen is one of the first steps to ward off running injuries, as well as having the right shoes and being aware of the surface you’re running on. Any time your pain hasn’t gotten better in three days, it’s a good idea to see a medical provider.

When it comes to cortisone, there can be too much of a good thing – multiple injections can risk weakening the surrounding tissue. Therefore while they may be an effective part of a treatment program, we don’t perform them frequently in the same affected area.

James Fleischli, MD, is fellowship-trained in Sports Medicine. He is the team physician for UNC Charlotte athletic teams, the Charlotte Knights, East Mecklenburg High School and Myers Park High School, and is the Director of the OrthoCarolina Sports Medicine Fellowship Program.

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