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What is a cortisone injection?
A physician may recommend a cortisone injection for your meniscus tear if it is very painful or persistently swollen. This may leave you wondering, what is cortisone, how does it work and is it good for me?
Cortisone, also called a steroid or corticosteroid, is a medicine that helps to decrease pain, inflammation and swelling. It does this by reducing blood flow and calming the immune system.
This medication is usually injected by a trained professional under ultrasound guidance to ensure it reaches as close as possible to the target area in your knee. This improves the chances that it will effectively reduce your pain.
There are different types of corticosteroid medications, used for different conditions and delivered in different ways.
- Systemic corticosteroids are used to affect many areas of your body. They are usually taken orally (as pills) or injected into a vein or muscle (as injections).
- Local corticosteroids are used to affect specific areas of your body. They can be given as an injection into a joint; or for other types of health issues, they can also be delivered as skin creams, eye drops, or ear drops.
Does a cortisone injection help for a meniscus tear?
Cortisone injections may help reduce pain, inflammation and swelling related to your meniscus injury. However, inflammation actually plays a very important part in the healing process and suppressing it unnecessarily may delay your healing.
These injections should therefore only be used when no other treatment or therapy has worked and it should be part of your overall treatment plan, not a standalone treatment.
If pain is preventing you from doing everyday activities like going to work or doing your rehab exercises, it may be worth considering a cortisone shot.
Keep in mind though, corticosteroids are not appropriate for everyone with a meniscus tear.
Pros of a cortisone injection for meniscus tears
1. It's a fast and effective way to treat knee pain and excessive inflammation
A cortisone injection usually takes two to seven days to take effect. The change is gradual, and it might take up to three weeks for the inflammation to decrease fully. Pain relief from a cortisone shot can last anywhere from three months to a year.
2. It has a lower risk of side effects than oral corticosteroids
Systemic side effects are uncommon because the medicine is injected directly into your joint and doesn’t pass to the rest of your body.
With small and infrequent doses, the risk of serious side effects with cortisone injections is low.
3. It helps you to get on with your life
– Help with everyday activities
Your knees help you move every day and knee discomfort can be debilitating and distressing. If you have intense pain, a cortisone shot can calm your symptoms and help you carry on with your daily activities.
It can give you a break from the pain while you develop a long-term treatment plan for your meniscus tear.
– Preventing other joint issues
Limping to guard your knee is a typical problem experienced with meniscus injuries. If you limp on a daily basis, you may start to develop problems in other areas of your body, like your back and hips.
A cortisone injection can help you walk in a more normal way – protecting your other joints in the process.
– Supporting your rehab program
A structured strengthening and rehabilitation program is one of the best ways to treat and prevent meniscus tears. Stronger muscles, improved posture and better patterns of movement help reduce the strain on your knees and take the pressure off your meniscus.
Having less pain can make your rehab more effective and exercise more enjoyable.
Cons of a cortisone injection for a meniscus tear
1. A cortisone injection is not a guaranteed or permanent cure for pain from a meniscus tear
With a cortisone injection, the duration of pain relief varies. In some people, it works for a few months, in others, a single injection can give relief for more than a year.
The other downside is that once the medicine wears off, you’ll probably feel pain again.
2. It doesn't heal the meniscus and doesn't always help
A cortisone injection cannot heal your meniscus tear. In most cases your body will heal it over time. Cortisone only helps with reducing the pain and inflammation from meniscal injuries.
If the primary issue with your meniscus tear is mechanical (like if your knee catches or locks because of it), a cortisone shot will not help. Surgery and a good rehabilitation program will be better to free your knee movement, reduce your pain and improve your function.
3. Cortisone injections may make your condition worse
Some clinicians argue that cortisone may stop your meniscus from healing. This is why.
For your meniscus to heal itself, you need a healthy blood supply and a good local immune response. A good blood flow brings oxygen-rich blood and immune cells into the area and moves damaged cells out.
Cortisone does the opposite of what tissues need to heal. It slows down the blood flow and release of immune cells. This stunts the healing process and can weaken the tissues in the area over time.
For this reason, it may not be the best treatment option for meniscus tears that need to heal naturally. Nor after surgery, where recovery depends on how well one can heal.
4. Side effects with high or multiple doses
As with all medical treatments there are some negative effects from cortisone.
After a single dose, systemic side effects are uncommon. With regular or high dosages of cortisone however, there’s a chance you may experience more serious side effects.
Some side effects develop soon after, others may develop over time. Since these may be different for each person, you should discuss any side effects associated with a medical treatment with your doctor before going ahead with it.
Side effects include:
- Pain, swelling and bruising where the injection was given (this usually gets better after a couple of days)
- An allergic reaction to the medication
- Skin infection at the injection site
- Skin thinning at the injection site
- Tendon weakening
- Cartilage damage
Cortisone injections can cause temporary spikes in blood sugar and blood pressure levels. If you have diabetes or high blood pressure, your doctor should monitor you closely.
If you have a weak immune system, you should avoid cortisone injections. They can increase your risk of infection.
How often can you get a cortisone injection?
Doctors limit the number of steroid injections to three or four per year. This depends on your overall health, level of pain, and any other therapies you’re having.
Over time, pain relief with cortisone injections may become less effective.
How long should you wait to exercise after a cortisone injection for a torn meniscus?
Your pain may increase in the first few days after getting a cortisone shot. This is called a cortisone flare. It’s crucial to rest and restrict normal activities during this time.
You may feel tempted to get back to your exercise and activity routines once your pain feels better. It’s best to return to previous activities gradually.
As a guide, it’s usually recommended you do minimal activity for the first 10 days. After that you should slowly reintroduce more and more activities, building up the intensity little by little. This allows your body to adapt to the movement and recover better.
It’s important to ease slowly back into activity. Cortisone only decreases the symptoms, it doesn’t strengthen your knee.
Are there alternatives to cortisone injections for a meniscus tear?
Cortisone treatment is not recommended for everyone with a meniscus tear. It should only be used if you have persistent pain and swelling and when other medications and therapy have not been effective.
Remember, pain and swelling are common and normal symptoms in the early stages of a meniscus tear. These symptoms can remain for several weeks before they begin to subside.
Only if you have given it enough time and you haven’t made any progress, should you consider a cortisone injection to help get your rehab and recovery on its way.
There’s a growing body of evidence emerging that suggests that acupuncture is a safe and effective treatment for knee pain and swelling. Some studies even suggests that it can promote cartilage healing. We’ve discussed this research and the use of acupuncture for meniscus tears in a previous article.
Over the counter medications
Paracetamol and ibuprofen can help control your pain and swelling. Ibuprofen, although not as potent as corticosteroids, is also an anti-inflammatory drug and may therefore also impact your healing. Please check with your doctor before taking any medications.
Hyaluronic Acid and Platelet-rich Plasma
Other substances like hyaluronic acid and platelet-rich plasma may improve the health of your knee joint and reduce the pain and inflammation associated with meniscus tears.
What is hyaluronic acid?
Hyaluronic acid injections are thought to improve the lubrication in your knee joint and nourish the existing cartilage (remember your meniscus is a type of cartilage tissue).
In your joints you have synovial fluid. This fluid helps lubricate and cushion the joint surfaces and keeps your bones from rubbing against each other. In this way it reduces wear and tear, pain and inflammation.
Synovial fluid is rich in hyaluronic acid (HA). HA is a natural substance in your body that breaks down over time. A breakdown of HA causes your synovial fluid to become thinner and less effective at protecting your knee.
With HA injections you ‘top up’ your HA levels in your synovial fluid, which may promote the overall health of your joint.
What are platelet-rich plasma (PRP) injections?
Some doctors believe PRP can help stimulate your body’s natural healing processes, help maintain healthy knee cartilage and reduce pain.
Platelet-rich plasma injections are a type of minimally invasive therapy in which your blood is drawn and used to make a PRP solution. This solution is injected into your knee.
PRP is thought to attract stem cells to an injured area like a magnet, generating a healing environment where damaged tissues can be repaired.
PRP injections are often given together with cortisone injections.
Meniscus tear treatment: Where cortisone injections fit in
A cortisone injection can effectively reduce pain and inflammation in your knee, as in the case of a torn meniscus. It’s only a temporary solution to your pain, though. It can’t heal your meniscus and may even delay your healing. It also can’t prevent you from injuring it again in the future.
If pain-free running and having no future meniscus injuries are your goals, you need a longer-term solution.
Recovery from a meniscus tear without invasive treatments or strong medications is possible! In most cases a well-designed, progressive strengthening and rehab program is all you need.
The Exakt Health App contains an evidence based treatment plan for meniscus tears. The app adapts the program intensity according to your feedback and helps you know exactly what exercises to do and when. Download the app (it’s free) to get started!
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