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I have a knee that did not like this summer's ramp up in training. I have lost about ~15% of my range of motion and the pain is in the front, inside of the knee. There is a limited swelling, if any.
My orthopedic doctor seems quick to suggest a cortisone injection upon confirmation from X-ray that there is nothing structurally wrong with the knee. So here is my question : I had a cortisone injection in that knee about 9 months ago for a similar but different issue / symptoms. How bad are cortisone injections into the knee? is 1 a year OK? Or do these injections have a cumulative (negative) effect ?
Some of the folks I train with are totally opposed to any cortisone injections. Others, less so. Welcome your collective insights. Thanks.
I've only had them in my hand, but I would not get more then 1/yr personally. It will breakdown tissue in the knee... that is a given.
I was having a hard time with a tendon in my hand, I needed to get the swelling down.. isolation and rest were not enough. One shot and isolation+rest did the trick.
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spntrxi: Sep 20, 17 16:47
Slippery slope that one is. I am not opposed to an occasional injection. But compound injections over the years on a particular joint/are can have some pretty serious adversity to a joint. Sort of a risk/ reward continuum. If you have a obvious gain like financial security over a few injections and don't mind retiring and not running on a knee the rest of your life, take what you need. The world is full of retired football and soccer players with really bad joints from aggressive therapy.
I used to be very serious about my training and started cycling, running and then when it was invented, triathlons. Now that I am of medicare age, I look back and sort of wonder if all the miles on the ankles,back, hips and knees was all worth it. Not many, not many of my marathon running buddies from the 70s are racing or even running any more. I often wonder if I would creak and groan as much as I do if I would have done less mileage.
I think you need to look at your age, your long term goals, the rewards you get from sport vs the wear and tear the training or over training costs.
I personally would like to be riding as much as I want, swimming a couple days a week, and hiking/dog walking occasional trail running when I am 80.
My orthopod told me if I wanted to be walking at 80, I would think of not running very much when I was 55. He did X-rays of a painful ankle and saw a lot of wear when I was 50 ish. That was with averaging 20-30 miles a week running for 25 years. I just sort of wore out my ankle. Like I said slippery slope.
as a sport medicine doc (not a surgeon) I will reinforce the above post...an occasional injection is OK and you can theoretically have an injection in a given joint about every 3 months but I personally limit my patients to 10-12 injections per joint per lifetime. There is some loose science based on animal studies from a long time ago that found that cartilage degeneration can be accelerated by too many or too frequent use of corticosteroids. When you apply this guideline to older patients, say 50-60 and up we are usually dealing with arthritis and the injections are part of a bigger treatment plan...if you start using them for what is likely biomechanical but not structural (ie runner's knee in a triathlete) you are indeed starting down a slippery slope. I would advise you to use an injection only to salvage your effort and time invested in a race you already have trained for and don't think you can complete without the shot. Otherwise, PT, stretching, modalities (heat, ice, massage etc) is a better short and long term plan.
Kyle
Thanks for the input. Much appreciated with 50 just around the corner.