Many patients in chronic pain ask me whether they should get a cortisone injection. In some cases a cortisone injection can be helpful to break a vicious pain cycle. I recommend it as a last resort, as long as it is followed up with a thorough evaluation and treatment of the causes of the pain and dysfunction. Simply decreasing inflammation isn’t going to solve a problem long term.
I caution against multiple cortisone injections as it can break down connective tissues (muscle, tendon, ligament and nerve). As you can imagine, this can lead to worse problems down the road. Before a cortisone injection is entertained, I recommend dry needling. With dry needling there are biochemical changes that occur resulting in an increase of blood flow to the treated area, including white blood cells which is our bodies’ natural healing agent. Dry needling acts as a non-pharmacological anti-inflammatory.
In a study released in 2017 in the Journal of Orthopedic Sports Physical Therapy*, researchers treated 50 painful hips. Patients were randomly assigned to receive either a cortisone injection or dry needling. During the 6-week study no other forms of treatment were provided. At the end of the study, patients in both groups had the same results for pain relief, ability to move and perform daily activities, and medication use. Patients who went to physical therapy for dry needling had the same outcomes as those who received a cortisone injection.
The results of this study show that patients can get similar results from dry needling as from a corticosteroid injection. Both groups experienced a decrease in pain and an improved ability to move and complete daily activities. Because the outcomes were similar, dry needling may be a good option for those worried about the potential side effects and risks of a steroid injection, or who want to try a lower-risk treatment.
*J Orthop. Sports Phys. Ther. 2017;47(4):240. doi:10.2519/jospt.2017.0504