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The answer to this question leans heavily towards no, but there may be some exceptions. Let me explain why cortisone shots should not be a first line treatment for tennis elbow and what to do if you do decide to have one. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
Check out this video of the livestream I did in the Sports Injury Group about Tennis Elbow:
Why are steroid injections used for tennis elbow?
They are really good at relieving pain. Clinicians therefore often use them because they know they will likely have a happy patient … in the short term.
Short term gain vs. long term harm
The research shows that steroid injections provide better pain relief than other treatments for the first six weeks.
The problem is, when researchers looked at the same patients 3, 6, and 12 months later, the ones who’ve had steroid injections are actually not doing as well as the ones who’ve not had steroid injections.
So, steroid injections decrease your initial tennis elbow pain quicker, but after six weeks it then seems to slow your recovery down.
Other treatments like load management, physiotherapy exercises, shockwave, and injections such as PRP may not reduce your pain as quickly, but they seem to allow your injury to heal better in the long run.
There is also evidence to suggest that people who have had more than one corticosteroid injection for their tennis elbow are more likely to have surgery later on. And steroid injections may also increase your chances of tearing your wrist extensor tendons; this is a small risk and it can be reduced by following a sensible rehab plan after your injection.
What if I combine a steroid injection with physiotherapy?
This has been tried, and it seems that the negative long term effect of the steroid injection still persists despite following it up with physiotherapy.
When could steroid injections be useful?
If the benefits of short term pain relief outweighs the negative effect of slower healing.
For instance, if someone has to complete an important test or exam that can significantly impact their life.
Also if the pain is totally unbearable and not reacting to any other treatments, one could argue that a steroid injection may be an option.
It is also something I would try before heading for surgery.
Is a cortisone injection for tennis elbow painful?
Doctors often add a small amount of local anaesthetic to the injection, which means that you may experience immediate pain relief. However, it is not uncommon for a steroid injection to cause a significant pain flare-up the next day.
The person injecting you will usually warn you about this and provide advice on what to do if it aggravates your pain. Icing the area for 10 minutes at a time can often help to relieve the pain.
What should I do after I have a steroid shot?
Do NOT jump into strenuous activity as soon as your pain subsides! The injection only took your pain away, it hasn’t strengthened your tendon.
If you’ve had your elbow pain for quite a while, your muscles and tendons would have lost quite a bit of strength. So, it will be very easy to overload them and cause your pain to flare back up or worse, cause a tear.
Instead, slowly ease back into activity and rehab exercises and slowly and progressively strengthen your arm to the level you need for your sport or daily tasks. We’ll discuss how to do this in a future article.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
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