DEAL WITH IT the tattoo reads. Pretty easy to say when you're 30 years old, in perfect health, after a morning practice swim where everything goes well. But how about the rest of us? What about those of us with shoulder bursitis, a touch of arthritis in the knee, plantar faciitis, those of us whose training - and therefore performance - are limited by injury or age?
With age/pain/injury/wear and tear occasionally comes the visit to the doctors office, and when deemed appropriate the physician may recommend a cortisone injection. Should you find yourself in this situation, this piece may help you work with your medical team to determine if this is the best treatment for you.
So, first, what is cortisone? It's a corticosteroid, a natural hormone made by the adrenal glands. OK, so what's an adrenal gland? Humans have two adrenal glands, or supra-renal glands as they're sometimes called, secondary to their being located on top of the kidneys. This would be near your 12th rib in your back. Like the thyroid, pituitary and pancreas, the adrenals are part of the endocrine system.
Credit for initial synthesis of synthetic cortisone goes to an African-American researcher named Percy Julian. He accomplished this almost 80 years ago.
Cortisone, like aspirin and Advil (ibuprofen), functions as an anti-inflammatory agent. When these drugs are taken orally, the effect is systemic, seen in the whole body. Even when injected into a joint cavity there can be a systemic distribution of the substance. The advantage of injectable cortisone is obvious in that when a particular inflammatory condition is diagnosed, a high concentration of the anti-inflammatory medication can be placed at the identical location.
I'm always asked if these injections hurt. Well, it is a needle but if your skin is "numbed up" first, you hardly feel it. I've been told countless times "That wasn't so bad" by folks who were prepared for the worst. And, the educated triathlete also asks about the potential for side effects and yes there are a few. Although quite rare, infection following a cortisone shot could be quite serious. However, your physician will thoroughly cleanse your skin with alcohol and betadine to reduce this possibility. Folks with an iodine allergy are cleansed differently. If my office is an example, I'd estimate that I give almost 2,000 of these injections each year, and have for a number of years, but have never had one get infected. Not only that, I know of none occurring in patients of my peers at our hospital. Diabetics should be told that they may see a short term rise in their blood glucose and it's been reported that very occasionally patients with darker complexions can see a whitening of the skin at the injection site.
The most common negative would be what's called a cortisone flare, a short term painful reaction which spontaneously resolves in a day or two.
So, who is a candidate for a cortisone shot? In my practice, the most common indication is arthritis, particularly of the knee (see previous blog), followed by bursitis of the shoulder. It's also used very commonly in Tennis Elbow (see previous blog), Morton's neuroma of the foot, carpal tunnel and trigger fingers just to name a few. Also, they can be repeated if required although again the intelligent athlete thinks before acting. In my office, except for knee joint arthritis in the elderly where the plan includes eventual replacement, the limit is usually three. More than this and you actually run the risk of doing more harm than good by sometimes weakening the soft tissue of softening the joint lining cartilage.
So, the take away is that cortisone injections are not an instrument of the devil and when used judiciously with the right indications and diagnostic acumen, they can be quite beneficial to the triathlete.
Finally this quote: You never get tired of winning, thus you should never get tired of what it takes to win.