Cortisol shots not so hot. Avoid them, a lot.

Several years ago, a doctor gave me a cortisol injection to deal with a rotator cuff injury that had kicked into high gear. To my complete wonderment, the pain vanished. "Am I cured?" I weeped. "Will I be able to resume my full-tilt, radical, extreme sport lifestyle?"

"Oh no," responded the doctor. "It's just reducing inflammation. Your injury is still there."

I was baffled. What's the point in that? It hurt, but it didn't hurt that bad. I had been using the pain as a barometer for exercise. When it started to bug me, I knew it was time to paddle in or get off the wall. Now, I could no longer do that. What was I going to do?

As my tears turned from those of joy to those of bafflement, I blurted out these questions. The doctor became flustered and reminded me that my young, sports-addled mind could never grasp all the medically medical science he'd need to throw down for me to understand. In other words, "Just trust me, I'm the doctor."

But at that point, my trust for him was down to about 56% and about the time he proposed shaving my bone to make my arm fit better into my shoulder, my trust dropped to .5%, give or take half a percent. Eventually, I learned to manage the problem with a combination of acupuncture and stretching.

Over the years, I've had several other doctors, some of them quite good, and I've brought up my simplistic cortisol dilemma with every one. Each time, I get that same, flustered response. I know there are times when reducing the swelling is important for healing, but when you look at cortisol in a larger context, unlike an icepack, which offers temporary relief, the shot creates the illusion that you're healed, which can cause more trouble than good, especially if your injection coincides with the arrival of the first northerly winter swell.

The reason that I'm telling you this is that, again to my complete wonderment, I was right... kind of. From the New York Times:

But a major new review article, published last Friday in The Lancet, should revive and intensify the doubts about cortisone’s efficacy. The review examined the results of nearly four dozen randomized trials, which enrolled thousands of people with tendon injuries, particularly tennis elbow, but also shoulder and Achilles-tendon pain. The reviewers determined that, for most of those who suffered from tennis elbow, cortisone injections did, as promised, bring fast and significant pain relief, compared with doing nothing or following a regimen of physical therapy. The pain relief could last for weeks.

But when the patients were re-examined at 6 and 12 months, the results were substantially different. Overall, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach.

That said, the so-called "researchers" eschewed my theory that the type of people who get tennis elbow, present company included, are also the type of people who will stupidly resume their sport of choice, even against doctor's orders, if the pain is gone. Instead, the "scientists," as they like to be called, referred to something called "science," as if it were somehow more authoritative than my blind hunches.

Why then does a cortisone shot, an anti-inflammatory, work in the short term in noninflammatory injuries, providing undeniable if ephemeral pain relief? The injections seem to have “an effect on the neural receptors” involved in creating the pain in the sore tendon, Dr. Khan said. “They change the pain biology in the short term.” But, he said, cortisone shots do “not heal the structural damage” underlying the pain. Instead, they actually “impede the structural healing.”

As the article goes on to point out, everyone wants a magic pill, and by all outward appearances, that's what cortisol seems to be. But in reality, it's not. It's a blast of steroids that offers short-term relief while potentially creating long-term problems. Pain happens for reason. It sucks, but it's there to help. Sometimes, it's important to embrace it.