Steroid Injections

A time and a place

Greetings, Austin neighbors! After a long Labor Day Weekend full of BBQs, we are setting our focus on September’s theme of Injury Prevention. The weather is a touch cooler and it’s more manageable to get out and golf, cycle, run, etc. In order to get in shape and stay in shape is to train intentionally and prevent injury. The next month is focused on helping you stay in tip-top shape.

A hot topic when an injury presents itself is Steroid Injections. You may be wondering, is this the right choice? Is this worth it? Are there downsides? Let us share some valuable information with you!

In October of 2019, The Boston University School of Medicine released a study that is turning traditional hip and knee pain treatment on its head.

The healthcare world has known for a long time that continued corticosteroid use is not good for us. In fact, it is one of the few drugs we regularly use that, without a doubt, causes at least some damage to the body.

It was believed the accepted standard of care (an injection of corticosteroids into the joint space of the knee or hip every 3-4 months) didn’t do enough damage to outweigh the benefits.

This made sense … sort of.

After all, an injection is far less invasive than surgery and especially in cases dealing with arthritic pain, there aren’t many surgical solutions available other than total joint replacement.

How do corticosteroids work?

The way these powerful drugs work is by mimicking the effects of cortisol, your body’s long-lasting fight-or-flight hormone. This is the stuff that is released after you have escaped from the lion, but when you know he is still out there hunting for you. It’s often referred to as our stress hormone.

Cortisol (and corticosteroids) affect everything from brain chemistry to immune system function. In the case of joint tissue, it suppresses the body’s inflammatory response and immune functions. This anti-inflammatory effect is what makes it so effective at treating arthritic joint pain.

The problem arises with the fact that it also suppresses the normal repair mechanisms which allow our bodies to heal damaged cells in our bones, cartilage and ligaments.

The Boston University study shows the side effects and complications with these drugs appears to be far worse and more common than we originally thought.

The most common complications seen were rapidly increased arthritic changes like degeneration of the bone and cartilage. Osteonecrosis which is a dying off of the cells in the bone was also seen along with fracture due to loss of bone density.

What does this all mean as a patient?

The big takeaway from this is that you need to be proactive in discussing the pros and cons of any medical procedure with your doctor. That doesn’t just go for steroid injections. As we have seen in the news over the last decade, there are quite a few other medical treatments that turned out to be more dangerous than previously thought, such as the use of opioid pain medication.

This does not mean steroid injections are never an option for some people. There is a time and a place for corticosteroid injections. Luckily for the majority of knee and hip pain sufferers, there are other less-invasive therapy approaches available today than ever before. In response to the opioid epidemic, there is momentum at the national level to make these treatments more known and easier to access. In many states, insurance companies are enacting policies that will allow patients to see their chiropractor or physical therapist with no out-of-pocket expense in an effort to promote the use of safe alternatives to drugs and surgery.