They should always be a very last resort. I had one in my hip and it didn't do much for me. The problem is that you can do more damage to your knee because you don't feel it.

My sports doc told me a few things on the latest 'thoughts' on cortisone. The larger the tendon/muscle region that is injected, the less problematic the long term effects. For example, I received a cortisone shot in my wrist. All very small tendons/ligaments, my doctor told he himself would not, and would not recommend, I get the same area injected again. That said, after about 2 weeks the pain was gone....the 'masking' lasted 10 weeks and then returned. Served its purpose as I had an motorcycle endurance event planned that I could not have participated in without intervention. Similar to your situation, I'd invested a lot of time and money and was willing to take some aggresive measures to insure my participation.

I don't think cortisone has universal results, I was told the effects usually take about 2 weeks to show up, and then you'll find out if its going to help out. The patellar tendon is fairly robust, so it shouldn't be worrisome as far as damaging because of the injection. Finally, the bad rap cortisone received appears largely to be because of abuse, re-injected a particular region over and over again to the point where the damage (that is masked by the drug) finally brings the tissue to the point of failure.

I'm not a doctor, just passing along what I've been told.

Best of luck to you, I hope it helps and have a great race!

b-

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"I spent a lot of money on booze, birds and fast cars, the rest I just squandered" -George Best

Thanks berti.

If the fluid build-up is in the back of your knee..its mostly likely a Baker's Cist...probably needs to be drained after IMAZ.
I got Cortisone shots on both my knees last year when I had some nagging outer PT pain...I was very reluctant,but, got it after I researched all the side effects of todays Steroidal Cortisones.
All info claimed that if not abused, there would be no long term degeneration of cartilage in the knee cap region.

I was treated at very well known Bone & Joint Center here in the East Coast.
My Ortho was a marathoner himself.

BUT..in retrospect...I wish I didn't do it.
I only had this done once..so I think I'm OK..haven't had a re-occurance of knee pain, in fact I feel so strong this season..it looks like a PR year in the making., but I attribute it more to laying off for a while and spending some serious time w/ leg strenght development.
My legs now look so different with all the muscle development..albeit,picked up some muscle weight along the way(4-5 lbs compared to last season),,..but the stability I gained is worth the added weight ..my 1/2 marathon time has improved by 15 mins!! WHICH IS HUGE in my book.,and my wattage on the bike is up too,which has been pretty much the same for the last 2 seasons.

With IMAZ so close..not sure what I would do if I were in the same situtation..and if you do decide to get the Cortisone shot, ask for the version that begins with the letter K..can't remember the full product name, there are about 4 or 5 variants.

It needs a few weeks to take full hold, so get it now if you are going to do it.
The biggest Caveat , which you need to consider is that each person handles the numbing level differently, so bear in mind that if you feel real good..its a sign that you can do some REAL serious long term damage if you go too hard.

You won't feel that until the Cortisone subsides..it could be weeks, or months.

Monk-- Good Luck though..and I wish you well -as this is a very serious matter and one I can certainly sympathize with.

PS- After the injection..ICE immediately with your leg elevated for as long as you can stand it.
This keeps the cortisone concentrated in your knee region,as opposed to standing with a ice pack taped to your knee.

..and if your HMO covers it..ask for a shot of EPO too..tell them Nina sent you! LOL

And of course you can still do long distance.
At last years IMLP..we met a 70 yr old with metal screws in both his knees,got it during the war..before any hi tech surgery.
It was his 6th IM!
The guy was larger than life! He finished under 16 hrs.

You're a Monk for goodness sake!..just go back to the Monastery and get some of that secret wine those guys make and you'll be good to go.

Be Good

Fish

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_______________________________________________________

Seeing him in deep torment, I said. " You can have my last GU , but its been down my pants for most of the run". - John Hirsch

Take care of your body, its by far the coolest thing you're going to ever own.- Can't remember who told me this, but I love it.

Cortisone is a Faustian bargain for sure. I had three in my elbow, each 3 months apart, to mask medial epiconditis and get me through a year of races. Short term - no pain during the races. Long term - did me no good, maybe some harm. Would I do it again? Probably not, but ask me again right before a big race...
:-)

Thanks fish--thanks everybody who has responded. Sorry to hear it takes a few weeks to take hold--can you train through that? We are down to the wire. Things were going very well until this happened.

I would RestIceCompressionElevation as much as possible in between workouts, perhaps back off from really higher threshold/lower cadence work that might be even more taxing then the regular training you're doing. My mobility wasn't restricted at all immediately following the injection, perhaps different for different locales, but I'd be surprised to hear that you're not allowed to train...the couple of weeks to effectiveness is a rough guide, while there is appears to be a lot of science and investigation into the perils/pros of cortisone, it also appears that 'results may vary' is a fairly standard disclaimer.

b-

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"I spent a lot of money on booze, birds and fast cars, the rest I just squandered" -George Best

Running has been such a good thing for me, I would be very sad to have it be over. So many sad things. Much greater than this, but this freed my mind from the sad things.

Last year - unemployed and miserable - I was relying on training to get me through (ease the stress); but within three weeks my ITB stopped me cycling and then I was told I needed a knee operation to remove a cyst!

Needless to say, I was fairly down in the mouth after that. Sorry about the knee, brother.

I have not and probably won't have one as my "big" races are behind me. I have had several friends who got them before Ironman, Boston Marathon ect. I think as a one shot (no pun intended) deal it is probably ok, because I also have some old college and pro football friends that got multiple shot and pretty much wasted their knees or shoulders.
As a short term solution they are antinflammitories and do that very well. They are usually work well for acute inflammation, but don't removed the cause .. You may want to reevaluate and do some serious rehab when you get back from New Zed. Best wishes and sorry to hear you have a crumby problem this close. G

bump

I did in August, the injection cut the pain down by 50% but I could not run on it for another two months. Time is the greatest healer.

Dave in VA

Did it stop the water on the knee thing?

look at it this way you'll have plenty of time to post photo shop cut ups on slowtwich.

good luck my friend whatever you decide. perhaps I will open a store where a person can buy replacement robotic parts for their hands, knees, hips and such. I'll let you know when I have the grand opening and that knee will be a thing of the past.

meow.

kittycat

Back in 1991 I fell on a bridge grate at the nine mile mark of the Chicago Marathon. Nasty cut on the knee, along with swelling etc. I had the ortho doc look at it a few days later. Rest/Ice/NSAID. He then sent me for physical therapy for the fluid buildup/swelling that was present. I went religiously for weeks, did the ultrasound, everything. Wasn't helping much at all. Couldn't really do any of the sports without pain. 6 weeks after first seeing him he gave me a shot of cortisone in the area. 3 days later I was fine. Fluid gone, no pain etc. Not saying, I'm just saying...

I don't know if I would do it very often, and everyone tolerates things differently, but it worked and I have never had a problem related to that area again.

Thanks Mark--I have been working RICE, and Chiro, and stretching and strengthening the little muscles around the knee (which don't seem to be strengthened by running/biking). Sounds like we both tried to do it right. I hope I have your results.

Thinking with you on this...My doc (runner) put me on 1,200 mg of Advil daily for a week for a neuritis. Of course it was not the patella tendon. We talked cortisone and he said 50/50 chance of working. RICE of course. If you've got swelling inside the knee seems like you may need a tap. Outside the joint...no experience there.

Symtoms come with running and cycling?

Unless it was a true once-in-a-lifetime opportunity like the Olympics, I would not get a Cortisone injection to train or race through pain. Personally, I do triathlons for fun and fitness so the idea of potentially damaging my body while training for a race, even my annual "A" race, is not acceptable.

I vote for dropping out of IM AZ, re-evaluating your racing schedule for this season, sticking with RICE, and taking some Yoga classes from a good Yogi who is experienced with athletes who have knee problems.

IM races can be life changing in many ways. One way is that you can truly break your body training or racing for them and end up being out of competition for years. Knee problems can stick with you for a long time, so I'd be extremely prudent.

-Marc

Marc--I know that is good advice--but it ain't gonna happen, brother, assuming I can be pain-free.

Okay, Monk--- I hate to push the point, but my training partner is still rehabbing from a quad/IT band problem he developed training for and racing in the 1999 Ironman Canada and another close friend of mine had knee problems that caused her to miss all of last season and probably part of this season as well.

The problem with cortisone is you're not going to feel pain that you would feel if you were drug free. If you're psyched for this race why not just compete without drugs and deal with the pain issues. At least that way you will receive the natural signals from your knee and be able to make accurate decisions about how to treat your body during racing and training.

Best of luck rehabbing it.

-Marc

I do take and appreciate your point, and I do thank you for your concern. In the posts above, though, and elsewhere, I have seen a lot of positive feedback. So I am trying to get as much information as I can. Are you saying that the people you refer to had Cortisone shots, or just that they trained and ran through the pain?

I got a cortisone injection in my knee in November. I had been hobbled by knee pain for about four months and my Dr. and I couldn't figure out what was causing it; there was no ITBS, no tendonitis, and no ligament damage. There was bit of fluid build up in the joint and my MRIs didn't show anything that should be causing the pain. I tried rest and ice for more then a month with no help and then the Dr. said if you want we can try a cortisone injection to see if it will reduce the swelling of whatever in your knee is causing the pain. At first I didn't like the idea, since ten years ago I had a bad experience (entirely my fault when I continued to train) with a cortisone injection in my ankle, So it took me a while to agree, but in hindsight it worked great. I took 2 weeks off after the shot and I have been pain free ever since. Was it the shot or the extra rest or a combination of the two that eliminated my pain? I don't know and at this point I really don't care; I'm just glad to feel better.

Would I get a second injection? Not a chance. If the pain were to reoccur I would need to figure out the cause of the problem not just cover it up.

Just my 2 cents, take it for what its worth.

I would recommend you use other cross-training options for a few weeks, and then slowly resume normal running. Try water running, more biking, bricks with long bike and short run at the end, ...

The cortisone is not the problem in itself. The problem is that you train through your injury, and by having a cortisone injection your body is not able to tell you that something is wrong the same way, and you train through this, and it gets aggravated.