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Cortisone?
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toj
Jan 5, 04 7:59
Post #1 of 5 (1278 views)
Dear Slowtwitch Forum,

I am curious about everyone's thoughts on cortisone injections.

I have had what I THINK is an ITB injury for about 6 months now -- aggravated by excessive downhill running with my son in a baby-jogger.

I have tried chiropractic, acupuncture, and PT (ultrasound, electric stimulation, etc.) The injury was progressing until Thanksgiving when I got a little too aggressive with my “comeback” and now 20 – 30 minutes running hurts again.

None of the specialists can duplicate the pain in the clinical setting… it’s only running that causes the pain. There seems to be some tightness in the tendons BEHIND my knee, but that is not the area of pain when running. The pain is more on the outside of the knee. (Earlier in the injury, the pain would spread up my outer thigh to the hip, but that has subsided over the months.)

My head tells me to just rest (and I have tried several weeks off at a time) but my heart wants to be out running NOW.

Is cortisone a realistic option? Should I request x-ray or MRI even though there is absolutely no evidence of a traumatic injury, other than one day of excessive overuse.

Thanks,
Ray
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Re: Cortisone? [toj] [ In reply to ]
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Johnny99
Jan 5, 04 11:32
Post #2 of 5 (1262 views)
I think cortisone is a bad idea. Cortisone has been around a long time. Remember the movie 'North Dallas Forty' with Nick Nolte? That's been long enough ago that Nolte could still get away with playing a football player. They were getting cortisone shots in one scene (I think). The problem is the shot only treats the symptom, not the cause. Take away the pain and you'll likely just hurt yourself even more. I approach triathlon alot differently than I did college sports. Back in college it was tempting to do whatever it took to limp through the season and help out the team. Then I could recover over the first part of summer. Now I would consider the long-term implications of the treatment. Why are you in such a hurry to train again? Take the time to recover completely. Even if it slows you down next summer, there is always the next year. Limping along and dealing with the pain may seem like the courageous thing to do but you are probably accumulating scar tissue and setting up big problems for the future.
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Re: Cortisone? [toj] [ In reply to ]
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snepper
Jan 5, 04 14:23
Post #3 of 5 (1245 views)
Bad idea. A cortizone shot only prolongs the inevitable and will ward off short term swelling but long term you will have cartilidge damage or worse. Sounds like you have patella tendonitis. You need to lay off the running / pounding and be diligent about therapy. Ice and ibuprophen as recommended by a healthcare professional. Any physical therapist can show you some basic band excercises that will help you heal your affected tendons, but a big part of recovery is to stop the pounding on already beat up tendons, ligaments and muscles around your knee joints.

If you could get an MRI I think this would show your injury quite plainly, but you have to basically lie about your symptoms or situation, just a plain old fact of our great health care system.

Try a week of no running and spend extra workouts in the pool. Swimming is great cardio work with no impact on your joints. Who couldn't use a few extra swim workouts? Cortizone shots lead to arthoscopic surguries to clear out cartilidge and assess if there are any tears in your tendons and ligaments...how do you feel about several months of no running and tons of physical therapy?
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Re: Cortisone? [toj] [ In reply to ]
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iamslowsteve
Jan 5, 04 17:01
Post #4 of 5 (1220 views)
As a 1 year ITB problem which seems to be turning the corner now, here are my thoughts.

I've heard of really successful Injections, and also really successful Surgery, but I've also heard they can be a waste of time.

What worked for me (I ran for over 2 hours this weekend without pain, or tightness, over hilly terrain)
  • Stretch 3 times daily, morning in midday and evening. Stretch your glut's and ITB
  • Once a day, get a rolling pin and lie on your side rolling you leg up and down the rolling pin, it hurts so good.
  • Use a Antiinflamatory such as voltarin on the days of you long runs as you get back into it.
  • Ice you ITB across the knee for 15 mins either side after every run!!!
  • Strengthen and strengthen and strengthen your hip stabilisers. The Study I read had a 75% successful return to running following the administration of this protocol after 4-6 weeks. Strengthen every day, cut your run short to make time if you have to. The strengthening ex's: Side lying leg raise with you foot turned towards the ground at the bottom and to the ceiling at the top. Build up to doing 2x 30 reps a day. Steppping from a step down to the other leg, keeping your pelvis level build to same reps after you hit 2 x 20 of the previous ex. And standing over a step lowering your foot to the lower step (standing side on) and then "hitching" it back up. Do this after you have progressed to 2 x 15 of the other ex, with out pain.


This is what seems to work for me, but make sure you are in the right running shoes and that you don't completely overpronate (podiartrist) as well.

Finally, rest then return to running by running every second day and avoid hills at first. Don't add too much time onto a run either, just gradually increase the distances. BTW: Fast running, ie doing sprints or stride outs is actually better than continuous jogging because of the angle of the knee.

Good Luck,

Steve
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Disagree [ In reply to ]
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G-man
Jan 5, 04 17:17
Post #5 of 5 (1217 views)
 Well, the other posters probably weren't MD's and neither am I. I think a one time Cortisone shot may be a helpful option. Yes it has been around forever, and yes it has been abused just about as long as it has been around. Why? Because it works.
Steriod injections and oral steriods are very strong antinflamatory agents. Sometimes they provide just enough relief to get the healing process going in the right direction. Of course overuse can be a real problem. I would let a good ortho doc decide what may be the best direction. There are also some new nonsteriodal meds out there too. G
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