A recent study by Coombes et al. in the Journal of the American Medical Association raises concerns on the effect of using a one-time cortisone injection in subjects with lateral epicondylitis.

 

The randomized control trial compared cortisone injections to placebo injections both with and without physiotherapy.  The study found that people receiving cortisone had an initial short-term reduction in pain, however, at 6 months post-injection, these patients actually had worse outcomes in terms of pain, disability, and quality of life.

 

The cortisone group had higher numbers of recurrences and fewer reported being completely recovered when compared to the placebo group.  Eight weeks of physiotherapy also provided short-term benefits in this study.

 

The results of this study may be surprising to most.  However, the term lateral epicondylitis (which infers an inflammatory component to the condition) has often been considered a misnomer.  It is now widely accepted that lateral epicondylitis is actually a tendonosis not a tendonitis, meaning that the inflammatory component in this condition is minimal.  Since cortisone is a strong anti-inflammatory it often has minimal effect on conditions such as these.

 

So, instead of a cortisone injection, ask to be referred to a physiotherapist.  There are many physiotherapy treatments that can help with lateral epicondylitis.  Friction massage to break down scar tissue, mulligan mobilizations (http://www.bmulligan.com/), eccentric strengthening, acupuncture, IMS (http://www.istop.org/), and cervical mobilizations can all be used as part of an effective treatment approach.

 

Please feel free to call us and get started on the road to recovery!

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