Considering a corticosteroid injections for chronic pain?
Chronic pain can be a significant barrier to leading an active and fulfilling life. For many, the discomfort can make it challenging to engage in the very activities that might promote healing, such as physical rehabilitation exercises. At Pittwater Chiro, we advise a trial of conservative care for most injuries, aches, or pains. However, if you’re stuck in a rut and think there might be other options for alleviating your pain, then corticosteroid injections may be recommended. What are corticosteroid injections? Corticosteroid injections are a prevalent non-surgical treatment option for various musculoskeletal conditions, providing significant pain relief. These injections utilise corticosteroids, such as dexamethasone and triamcinolone acetonide, to reduce inflammation and improve function in affected areas. Your GP will determine the site of injection based on your symptomatology and the specific condition being treated. Imaging techniques, such as fluoroscopy or ultrasound, are often used to ensure accurate placement of the needle. Common conditions where corticosteroid injections may be recommended include tendinitis, bursitis, or spinal conditions like herniated discs. While effective, the implications of corticosteroids short-term and long-term warrant careful consideration. The effects of corticosteroids are not permanent, but they can last for weeks or even months, depending on the condition and individual response. If there’s a risk, what’s the reward? One of the key benefits of corticosteroid injections is their ability to mask pain enough to enable you to do your rehabilitation exercises. Chronic pain often creates a cycle where pain limits movement, leading to muscle weakness, stiffness, and further pain. By providing temporary relief, corticosteroid injections can help break this cycle. With reduced pain, individuals can focus on strengthening muscles, improving joint stability, and restoring mobility through a carefully designed rehabilitation program. This approach not only addresses the immediate symptoms but also targets the root causes of chronic pain, aiming for long-term improvement. For more information on the benefits of exercise rehabilitation, read Jess’s blog. Are corticosteroid injections right for you? It’s important to note that corticosteroid injections are not a cure for chronic pain or its underlying conditions. They should be seen as a tool that allows for more flexibility within a broader treatment plan. Ideal candidates are individuals who: Limitations and Risks While corticosteroid injections can be effective, they come with limitations and potential risks. This is why these are not recommended as a first line of treatment and you should consult your GP if this is an option you are considering. Overuse of these injections can weaken tissues which may cause further dysfunction and pain, and in some extreme cases can lead to ruptured tendons or ligaments. These injections can also lower your immune response, which increases the risk of infection especially if they are applied before other surgical interventions. The relief they provide is temporary, and repeated use should be carefully managed by a healthcare professional. Following a corticosteroid injection, several recommendations are crucial to optimise recovery and minimise potential adverse effects. These include: Building a Long-Term Strategy Chronic pain management is most effective when approached holistically. Corticosteroid injections may serve as a stepping stone toward recovery, but sustainable improvement requires a commitment to lifestyle changes, such as: Corticosteroid injections can be a valuable option for individuals suffering from chronic pain, particularly when the pain hinders progress in rehabilitation. By providing temporary relief, these injections can pave the way for effective rehabilitation and long-term recovery. If you’re considering this treatment, consult with your GP to develop a comprehensive understanding and plan. References A References B
Is surgery for a rotator cuff tear necessary?
When it comes to a rotator cuff tear, one of the most common questions patients and healthcare providers grapple with is: should we opt for shoulder surgery or stick with conservative care (chiropractic/physiotherapy/massage/osteopathy)? The answer can be more complex and depends on various factors, including the severity of the tear, patient preferences, and long-term goals. Let’s dive into the current recommendations and evidence to help guide this decision. First off, let’s break down what a rotator cuff tear means A rotator cuff tear is damage to the tendons and muscles that stabilise the shoulder joint. These tears can be traumatic (caused by an injury) or degenerative (resulting from wear and tear over time). Symptoms can include pain, weakness, and limited range of motion, however, some individuals may have a tear in their rotator cuff without any significant symptoms. Research suggests the most commonly torn tendon is the supraspinatus tendon 70 – 85% of the time. Do I have to go under the knife? Many people believe that a rotator cuff tear means either undergoing surgery or living a life of pain and disability. Realistically this isn’t true. Rotator cuff tears are common and should be seen as a normal part of aging, like wrinkles and grey hair. Research shows that rotator cuff tears can be present without causing any symptoms, especially in individuals over 50. One study found that if you are over the age of 50, a rotator cuff tear seen on a scan is twice as likely not to cause symptoms, and this increases to four times as likely by the age of 80. Progressions vs. Stability Research suggests that roughly 50% of rotator cuff tears progress in size over 5 years, full thickness tears are more likely to progress in size when compared to partial thickness tears. Partial tears are relatively stable in the short to intermediate term. There is a growing body of evidence to suggest that small full-thickness tears can remain stable and even heal over 3 – 4 years. Tear progression is shown to be negatively impacted by the following things: Another common misconception regarding rotator cuff tears is the way these tears look. Many people believe all tendons are thick rope-like structures at the end of all our muscles, while this is true for some tendons, like those in our forearms and biceps, it is not true for all tendons. In reality, tendons vary in shape and structure, and some are a lot flatter, broader and thicker than others, like those of the rotator cuff. The rotator cuff tendons form a broad, continuous structure around the shoulder joint. This is where a helpful analogy to explain rotator cuff tears plays a role, which is the “hole in a blanket”. Because the tendon is so thick and broad, when a tear occurs, it is like a hole in a large blanket. Just because there is a hole, it doesn’t mean the rest of the blanket is useless. This analogy helps to visualise and understand that the rest of your tendon can still function well, and can be strengthened without creating further damage. Now let’s compare conservative care and surgery Conservative care includes chiropractic care, physiotherapy, osteopathy, exercise physiology, or any other allied health practitioners who can help with your injury without operating on you. At Pittwater Chiro, our treatment would involve a blend of hands-on techniques to assist with pain reduction alongside at-home pain management strategies, exercise prescription to help strengthen the rotator cuff and its surrounding muscles, advice on temporary modifications to work, sports or hobbies which may be aggravating the pain, and advice on how to return to your normal activities in the future. The hands-on treatment we provide can include massage and other soft tissue release techniques, joint mobilisations and manipulations, shockwave therapy, dry needling, and cupping Shoulder surgery is usually considered when conservative care fails to provide adequate relief or when the tear is severe. Surgical options include: Rotator Cuff Tear Summary When considering if surgery can alter the progression of a rotator cuff tear, research has found that surgery does not change the underlying tendon biology which causes the rotator cuff to tear. Therefore, the likelihood of recurrent symptoms and poor functioning of the rotator cuff following surgery can be similar to the likelihood of progression without surgery. Research also suggests that the traumatic onset of a rotator cuff tear is not a sufficient reason to choose surgery over non-operative care. Regardless of whether your tear is non-traumatic or traumatic onset, the first line of care for anyone with partial or full-thickness tears according to the evidence is a period of non-surgical conservative care. For those suffering from a non-traumatic partial or full-thickness tear, individuals benefit from activity modification, chiropractic care, and therapeutic exercise, and if this fails then there is the consideration for a corticosteroid injection. References A B C
