For myofascial problems, in a word, ‘yes’! Cortisone is ineffective for these conditions and can be harmful.

Yet, today cortisone shots remain a standard, much-requested treatment for tennis elbow and other tendon problems. Cortisone is a powerful anti-inflammatory. However, the nature of myofascial pain, taut band development, trigger point formation and referral is much more complex than localized inflammation.

Cortisone will not provide lasting relief of ‘tendinitis’ in your shoulder, Achilles tendon, elbow – or anywhere else. It cannot and does not work as many believe it does. Cortisone should never be used in trigger point injections directly into muscles.

Cortisone has no legitimate use in the treatment of tendonopathies or other myofascial problems.

In the late 1940s, the steroid cortisone, an anti-inflammatory drug, was first synthesized and hailed as a landmark. Cortisone shots became one of the preferred treatments for overuse injuries of tendons, like tennis elbow or an aching Achilles, which had been notoriously resistant to treatment. The shots seemed to provide rapid relief of pain.

Then came the earliest clinical trials, including one, published in 1954, that raised incipient doubts about cortisone’s powers. In that early experiment, more than half the patients who received a cortisone shot for tennis elbow or other tendon pain suffered a relapse of the injury within six months.

We now understand how a cortisone shot, which is a powerful an anti-inflammatory, works in the short term in noninflammatory injuries, providing undeniable but brief pain relief.

Cortisone changes the pain biology in the short term. However cortisone shots do not heal the structural damage underlying the pain. Instead, they actually impede the structural healing.

It is not just that cortisone doesn’t work over time for myofascial injuries. It simply not possible for it to work that way.

For many years it was widely believed that tendon-overuse injuries were caused by inflammation. But numerous studies have shown clearly that these overuse injuries do not usually involve inflammation as the primary cause of pain and dysfunction. This was formerly called tendinitis. Note that tendinitis is no longer a valid medical diagnosis.

When animal or human tissues from these types of injuries are examined, they do not contain the usual biochemical markers of inflammation. Instead, the injury seems to be degenerative.

The fibers within the tendons fray. This is cumulative damage from countless microtears. Today, the correct term for these injuries is tendinopathy, or a diseased tendon. The term tendinitis is incorrect and should not be used. The other term in prior use was tendinosis is also nominally correct, but is an older way of referring to a damaged or diseased tendon.

Because this is not an inflammatory process, there is no possible mechanism of action that could ever allow cortisone to assist in healing the underlying injury. However, physcians who have not kept up with the data and patients looking for a quick fix remain attracted to the short-term pain relieving quality of cortisone.

Cortisone is often referred as “meat tenderizer for humans” because of the reduction in stiffness and density inflamed tissue. Cortisone is myotoxic and should be injected into muscles. It is also worth noting that some tendons treated with cortisone are notoriously likely to rupture.

For instance, the primary cause os Achilles tendon ruptures is prior cortisone injections. It’s not just that it doesn’t work for myofascial problems. It can actually damage your body’s tissues. That is why there is a limit to how many cortisone injections you can receive in a period of time.

In the Lancet review of multiple studies, when re-examined at 6-12 months later, many patients treated wirth cortisone injections actually got worse.

Over all, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. The evidence for cortisone as a treatment for some aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting.

But for tennis elbow, the cortisone shots impede full recovery and those getting the shots “are worse off.” Those people receiving multiple injections may be at particularly high risk for continuing damage. In one study  “an average of four injections resulted in a 57 percent worse outcome when compared to one injection,” Dr. Vicenzino said.

syringe with vial

There is no such treatment!

Trigger point injections are placed directly into the trigger points deep within muscles. Injecting cortisone directly into a muscles has always been inappropriate and counterproductive. It is an impoper and incorrect procedure that should never be confused with an actual trigger point injection.

If a physician suggests a “trigger point injection” you must ask what is in it. If it contains cortisone, you should probably politely get up and leave. You could request that the cortisone be eliminated. However, the problem is that the doctor has already revealed that they don’t understand how trigger point injections work. No one who has been properly trained in this procedure would ever use cortisone.

Trigger point injections consist of normal saline and a local anesthetic, primarily for comfort. The active ingredient is the saline itself. Even the anesthetic can be problematic. Lidocaine, for instance, is somewhat toxic to muscles. Repeated injections or injections that contain too much lidocaine can damage muscles. Ideally, the proper local anesthetic for these injections is procaine but it the numbness lasts longer and the medication is more expensive. Both physicians and patients tend to prefer lidocaine.

There will always be a longing for a magical pill, the quick fix, especially when the other widely accepted and studied alternatives require the active involvement of the patient in their own rehab. And just as surely, that desire will always be mis-placed.

True recovery from any chronic condition requires understanding how you got there (it usually didn’t just happen to you) and a plan for how you are going to work through it. No one can “fix” a chronic problem for you, regardless of how it happened. But if you embrace the opportunity to explore, rebalance and rehabilitate your body, you can achieve amazing and lasting results!

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The lady that assisted me was awesome! I suffer from fibromyalgia and when I left I felt like a brand new person! I plan to return when I get time!

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Janet was great – knowledgeable and she found all my “hot spots.”

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Seriously, if you are looking for massage therapy that actually does your body good–that changes its function for the better and actually makes pain go away–then this is the place you need to come. Not Massage Envy. Not a chiropractor. You need trigger point from knowledgeable experts in the craft.

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If your have pain in any part of your body this is the place to go. It focus on the muscles where the pain is. you will feel like a new person. Awesome will be returning. Thanks nice friendly and attentive

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Highly recommended!

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What a great experience. The provider was able to recommend things I can do to improve my pain. Address issues I didn’t even share with her that she was able to tell just by her exam and treating me for what i went for. Will be back. Feeling grateful

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Beautiful, relaxing setting. Therapist was knowledgable and professional. I’ll be going back. Thank you.

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Janet is very informative. I loved that she explained which muscles/groups she was working on. I learned a lot about my posture and why some of my muscles are not activating. She also provided me with a list of considerations and excercises to improve my posture. I will be back!

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It’s like an hour of physical therapy (the good parts of P.T. where they massage you and stretch you). She also takes time to explain some ways to help your specific issues. Highly recommend!

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Janet is very knowledgeable and informative. She thoroughly explains where you have weakness and what muscles are over compensating. She gives exercises, stretches, or everyday changes you can make to help you are progress on your own. I highly recommend a visit!

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What About My Pain?

Clearly, everyone is different. Many of us have additional challenges and complications. Naturally, we tailor our treatment plans to the individual. However, there are common foundations in this work with everyone.

Fortunately, if you are having similar issues, you may find that a just few treatment sessions helps! We will identify and treat root causes of your individual case.

Clearly, everyone is different. Many of us have additional challenges and complications. Naturally, we tailor our treatment plans to the individual. However, there are common foundations in this work with everyone.

We are licensed professionals. In addition, we all have additional training and certifications in advanced techniques. For instance, this includes trigger point therapy, fascial stretching, neuromuscular and movement therapy. Also we offer kinesio taping, myofascial release, cupping, acoustic compression, self-care classes and more. In fact, we often combine several of these techniques into a single session..

Of course, no one wants chronic pain! Fortunately,  can work together with you to help sort out the issues.

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