Cortisone Shots and their side effects
Cortisone can be a ‘magic pill’ for some people but be very careful.
I was speaking to a good friend of mine who was in a great deal of pain. I asked him what had happened and he told me that a rather small problem that he had had was now a big problem. He explained to me that he had had been suffering from pain in his Achilles tendon. The doctor didn’t seem to know why he had this pain so he recommended that he get a series of cortisone injections to ‘see how that went’. After the first one he felt a bit better, then the next he felt better again and a few days before he was scheduled for his third injection he felt ‘like someone hit him in the back of the calf’ and now he had severe bruising in and around his Achilles tendon and ankle and was no longer able to walk without the aid of crutches. The doctor took a look at him and couldn’t understand what had happened so sent him off to get some physiotherapy for his ankle. This is where he should have gone to in the first place
So what is wrong with this picture?
Why don’t we first take a look at cortisone injections themselves? They have been around since the 1950s and are used to decrease tissue inflammation so that the area can then heal. This is the theory. But why is the area inflamed? This is the number one priority-getting to the cause of the problem not just treating the symptoms. Let’s take a look at another example.
I will use and example of a new client who came to see me last week. This person was suffering from neck pain and had tried everything from prolotherapy to acupuncture to chiropractic to Rolfing. However, his pain still existed. The whole time he was speaking to me he was sitting in a slouched forward head posture. I could see by his posture that this was his major problem and would be our first area to look at. The thing about poor posture and particularly a forward head posture is that it affects the upper back, neck, shoulders, lower back and so on and so forth. A forward head posture has a huge knock-on effect throughout the rest of the body. In other words, many of your problems will be caused (and fixed) by addressing this first.
I knew by looking at him that his shoulders were also forward and internally rotated which will impinged the shoulder joint and set him up for shoulder problems. I asked him if he had had shoulder problems in the past and he said ‘oh sure, I have had 3 cortisone injections in the left shoulder and 2 in the right but they didn’t really work’.
Of course they ‘didn’t really work’ because the cortisone injections will never fix the cause of the problem which is known as ‘upper crossed syndrome’ or ’rounded shoulders’ or ‘shoulders that are too far forward and internally rotated which lessen the space in the shoulder joint and cause impingement or better put, constant mashing of the soft tissues.’ The cortisone may have had a temporary effect as it reduced the inflammation and impingement but the cause of the problem was never addressed (i.e. shoulders too far forward and internally rotated causing pain and inflammation) and therefore after a short while the pain returned.
The story doesn’t end there. Not only do cortisone injections hurt but they have a corrosive effect on the cartilage and soft tissues. This, I don’t need to tell you, is NOT GOOD!
This brings me back to my friend with the Achilles tendon problem.
The major cause of prolonged pain and dysfunction from injuries is from lack of appropriate rehabilitative exercises. If you have an injury you MUST do stretching and strengthening exercises as soon as possible. (After the initial 48 hour inflammatory phase).
So my friend has, in my opinion, been getting treatment in ‘backwards- forwards land.’ He has come to see the doctor and instead of getting treatment for it such as physical therapy, which means stretching and strengthening exercises and soft tissue/joint therapies he was given cortisone injections. Here was a person who needed to strengthen his tendon and stretch it out to recover it to full function but what he got instead was something that masked the problem. He should have been getting therapy to allow the fibers to knit into a strong and flexible repair so that he could regain his strength in the soft tissues. However, instead he was now walking and running around with a torn tendon but now he could apply more pressure through the tendon thanks to the analgesic properties of the cortisone. Now, he could walk harder and faster which enabled him to damage his tendon further. Every pain free step would enable him to tear those tiny fibers more and more until finally something had to give- and it did. His tendon, thanks to the deadening effects of the cortisone and the added benefits of the corrosive properties of the cortisone pushed his Achilles tendon past breaking point and it snapped. Where is my friend now? He is getting physiotherapy 3 times a week to try to heal the area which is now much worse than the original problem.
So my advice to you is this. Just because your doctor or therapist doesn’t know why you have pain is no reason to jump into a series of cortisone injections. They are not good for your body, they are a corticosteroid. There is no reason to start putting more chemicals into your body when you may not have to. Seek another opinion. More than that, make sure that the cause is being addressed not just the symptoms. Are your shoulders painful because of major muscular and structural imbalances? Can you stop your osteoarthritis getting worse simply by postural and structural modifications?
If a person has sciatica and back pain because they have disc bulges in their lower back and need surgery I would want to see first why they have disc bulges in the first place. Is it because they sit slouched at their desk all day and night? Is it because they lift things poorly? If this is the case, and they elect to have surgery and do not stop these bad habits, what is stopping the next weakest links above and below the fusion from doing the same thing? Nothing. If you have blown your L5-S1 disc because of these very reasons and then after surgery( all going well) you feel better but continue to sit, stand and lift poorly you will put these same forces on your discs AGAIN and the problems will still be there. You are still causing your discs to be pushed backwards, straining your ligaments and soft tissues. Likewise, a cortisone shot will not fix your back pain from bad lifting techniques if you continue to lift badly
Your neck is no different. You MUST remove the cause of your neck pain.
Whiplash Injuries-what you must avoid doing
Have you suffered from a Whiplash injury and still have neck pain?
Here is some very good news.
It could be simply because of one very simple thing that you are doing that is causing your pain. Over the Past twenty years I have seen hundreds of people who have had whiplash injuries and they had pretty much given up all hope of removing their neck pain and suffering. However, after I showed them how to reduce the strains on their necks which would allow their necks to heal completely-their symptoms disappeared. That is, their neck pain that they had been suffering from for so long was no more. It is not a magic trick, as you will see; it’s just simple body mechanics.
I won’t bore you with the basic facts in regards to a whiplash injury because if you have it I am sure you have read volumes on the internet about ‘acceleration-decceleration’injuries. Of course, the most common reason people have whiplash injuries is from car accidents and the forces generated can be as much as 15 G forces through the neck. This amount of force can damage the capsules, ligaments and other soft tissues and even the vertebrae and discs. Then after time the neck should heal. However, many people put enormous forces on their necks all day every day which causes their neck pain. Remember, over 80% of neck pain is postural. I put that estimate at a very conservative level because many people with neck pain who have been diagnosed with pain from whiplash or arthritis can still have pain from their posture, not their arthritis!
Let me explain. If you have arthritis or a whiplash injury that is now chronic and you continue to sit with poor posture, namely the ‘forward head posture’ how will you ever know if your whiplash or arthritis pain is coming from your whiplash or arthritis? If over 80% of people have neck pain from their posture( look around your office or workplace, bus stops, your home and nearly everyone who uses a computer and you will see people who are slouching with their heads in a forward head posture.) it is endemic in our society and is getting worse! Now with teenagers sending text messages all day and when they are not doing that they tend to be slumped over their laptops for hours on end the problem in the next ten years will escalate enormously. A year ago in December in the United States, Americans sent 48 billion text messages- in the month of December alone! Last December, it increased to 110 billion. That means a lot of happy telecom companies, physical therapists, massage therapists etc and a lot of unhappy people with neck pain.
The mayo clinic state that the forward head posture leads to long term muscle strain, disc herniations and pinched nerves. So here you are with an already injured neck and injuring it further, or at the very least- not allowing it to heal- because you are constantly straining the soft and hard tissues.
A forward head posture is what produces over 80% of neck pain. It is THE cause. Don’t believe me? Go back to Google and check out the major cause if neck pain and you will see that it is postural. What does postural mean? A forward head posture. So, if you spend most of your day sitting and standing like this, how will you ever know if your pain is simply coming from your posture? You won’t until you fix it. You must fix the cause to remove the symptom-pain.
This is how I have helped hundreds of people who felt that they had to live with their pain forever. People with arthritis who were simply sitting poorly and compressing their joint capsules and facet joints became pain free almost instantly. People with whiplash injuries who addressed their posture day in and day out saw their pain subside and leave them permanently.
As I said, this is not a magic trick or some ‘new fabulous wonder technique’. It is basic mechanics. This is the exact reason why millions of people suffer from neck pain daily. This is the exact reason why the mayo clinic state that it leads to ‘long term muscle strains, disc herniations and pinched nerves’ and the exact reason why you too can become pain free.
Neck Pain-what is wrong with this picture?
If you suffer from neck pain or perhaps even pinched nerves I suggest that you read this.
A very common scenario:
You spend all day slouched in front of a computer, slouched watching television, sew, write, eat and drink with poor posture and even drive with your head protracted forwards. You also ‘mysteriously’ suffer from neck pain. You are completely unaware that this ‘forward head posture’ not only causes neck pain, (and is in fact the major cause of neck pain) but also causes great strains on your discs. Then one day your disc finally can no longer resist the tremendous forces being applied by your prolonged poor posture, gives way and herniates(bulges) and then presses on a nerve. This then causes you immense pain and or weakness and or numbness in your arm and or hand.
You go to a surgeon and he tells you to take some muscle relaxants and some painkillers. You do this and it gives you some temporary relief however you continue to slouch at your computer, whilst driving your car and when you read your favorite book in bed at night. Unbeknownst to you, the discs are still continually being forced backwards towards the nerve again. It is only the anti-inflammatory effects of the drugs that you are taking that is keeping the nerve from being pinched severely once again.
After your ten day course of drugs from the surgeon you feel a bit better (if you’re lucky) but another week goes by and your problem comes back again. Why? because you continued to slouch and sit and stand with a forward head posture and thus continued to exacerbate your problem. You never once removed the cause of your problem. Just like having a sore thumb from hitting it with a brick, its not until you stop hitting your thumb with the brick and remove the cause of your pain will you be pain free and allow the area to heal.
However, you are not told that the forward head posture is the cause of your disc protrusions and pinched nerve. You are scheduled for surgery because the numbness has become worse and the pain is now also much worse. Your sleep is also badly affected. You buy pillows to help your neck but of course it is nothing more than a bandaid because the majority of damage is being done during the day because of your poor posture. You spend thousands of dollars on chiropractic, massage and acupuncture treatments and never get anything more than temporary relief at best. Why? The cause has still not been addressed.
You finally commit to surgery. However, even after surgery you have not been told that the forward head posture is the main cause of neck pain. You, if you are lucky, are told that you should sit at your computer in good posture but it is nothing you really spend much time thinking about. After all, you have just had your neck fixed from the surgeon right? (At this point, lets assume that the operation was successful-meaning you are not paralysed and/or the pain is not worse or the same as it was before).
You have your surgery, you do your rehab and then go about your daily life again. The area where you had your problem is OK now( as such) because it is fixed by titanium. However, you go back to your slouching at the computer again, spending long hours reading and writing your books, sewing, driving, and doing crosswords all with a forward head posture once again. Now, the strains are being put back onto your neck once again. This time its on the areas above and below your vertebrae that were operated on. Are you headed on exactly the same course as you were before?
Absolutely! Your neck pain, disc bulges and pinched nerves due to the forward head posture are completely avoidable.
Two of the worst exercises for your neck
This is probably not good for your neck but it's not on my list
There are a few exercises that do your body more harm than good. Here are two of the worst exercises for your neck you could possibly do to wreck your backs, shoulders and neck. Do not do these ever!
1. Lat pull downs behind your head
Here is an exercise that you see people doing often in the gynasium and it’s very damaging to both the shoulders and the neck. When you do this exercise you end up haviong to pull the shoulders too far back which overstretches the ligaments and capsule. You definitely do not want this! Ligaments should be tight to keep the joints stable and once they are over stretched they don’t tend to shrink back. Ligament laxity can then easily lead to rotator cuff problems.
I am sure many of you know of someone who has dislocated his shoulder not once but 2 or 3 times and then eventually needed surgery; this is because the joint has become very unstable due to the ligament laxity. You want tight ligaments but flexible muscles and tendons.
The other problem with doing lat pull downs behind your head is that it puts your neck in a forward position which is exactly what you do not want. This creates great strain on the cervical discs and ligaments and can lead to neck pain, shoulder pain, rotator cuff tears, impingements etc. If ‘putting your head in a ‘forward head position is a new term then look at the major cause of neck pain. The alternative to this is doing the lat pull downs in front of your head, bringing the bar to your chest. Remember though to keep your back in a neutral position. To do this you need to use your abdominal muscles which means you are now also activating you core. The majority of people do this exercise with their back over arched and that puts pressure on the lower back tissues and facet joints leading to lower back problems. I wrote about the core muscle in a previous blog and it’s especially important that you are using your core muscles when doing your workout.
Remember, for a healthy lower back its vital that you have a strong and stable lower back and flexible mid back and hips, not the other way around.
2. Sit-ups 
First of all, if you are doing sit-ups to strengthen your core-STOP! I will not go into great detail in this post about the correct way to strengthen your core., thats for another post.
Remember also that your core muscles are not just your stomach muscles. In order to strengthen your core to stabilize and protect your back there are two other extremely important muscle groups that also need to be addressed. If you are just strengthening your stomach muscles you are setting yourself up for imbalances in the area where it is imperative that you have balance, stability and muscle endurance.
The main reason you should not be doing sit-ups is because it damages your back!
The posterior forces that are produced on your lower back discs are enormous! What this means is, do enough sit-ups and you will be on a short course to lower back pain and if enough damage is done you will more than likely get sciatica. Sciatica is where the nerve is being pressed or ‘impinged’. You already know that you should bend forwards with a straight back so that you don’t cause damage however a sit-up is doing the same motion as what you try to avoid when standing and bending.
The National Institute for Occupational Health and Safety recommends that no more than 3400 newtons should be placed on the lower back because this or more than this amount of force is harmful to the lower back. Well guess what, a sit-up produces 3413 newtons of force. This means that every sit-up that you do is potentially damaging your back!
So what are great core strengtheners without damaging your back? Stay tuned…
Read MoreIs your Upper Back and Neck Pain from trigger points? Find out here.
Your secret weapon against knots
The majority of upper back pain and neck pain is from trigger points. That is, it is muscular in nature. But how can you tell if you have trigger point pain? Have a look at the typical signs of upper back and neck trigger points below and see if this is the pain that you have, after that you are going to learn a great way to help it.
- A Tight,stiff and Inflexible Neck. You crave stretch, because you feel stiff, tight and inflexible however the stretching rarely does anything more than give you temporary relief at best. You stretch and stretch and stretch but this really does nothing more than ‘take the edge off your pain’. This tends to be a classic sign of trigger point related pain and in my experience, the one above all else that tells me it’s from trigger points. I used to have this type of neck pain 20 years ago, and it would drive me crazy, very much like a smoker needs more and more cigarettes to ‘get his fill’, I found myself needing to stretch more and more to try to ease my aching neck-but with very limited results.
- Your Neck feels better in the shower Trigger points generally like heat and not cold.In fact, necks as a whole dont like cold winds and drafts but you will find that putting warmth on your neck (such as warm baths, hot showers and heat packs) will be helpful.
- Very Tender Points You will probably find that if you press around the base of the skull and along the sides of your neck you will discover , as i call them, ‘exquisitely tender points’. These will be areas, some tiny areas, that when you press on them will be unbelievably sensitive to relatively light touch. These will almost certainly be trigger points. You may even find that by pressing on some of these, such as under the base of the skull, you recreate that headache over the eye you suffer from, or by pressing around your base of your neck and top of your shoulder area you get that shoulder and arm pain again. These are classic referral signs from trigger points. Trigger points are well known to refer pain to other areas of the body.
- Headaches You may or may not have headaches but these can be very common with neck trigger points.
- Pain comes on after sitting at the computer or driving Trigger points are located in muscle tissue and do not like sustained muscle contraction which is exactly what happens when you sit poorly at your computer with poor posture, or driving with a forward head posture. Remember that every inch your head is forward of good postural position, creates an extra 10 pounds of stress on your neck structures and none moreso than the levator scapulae muscles. These are those big ropy muscles that you can feel as you put your fingers onto the sides of the base of your neck which join to the shoulder blades. They are commonly involved in that aching feeling between your shoulder blades when you are working at the computer and especially involved in problems turning your head.( eg. turning your head to the left produces pain on your left side of your neck)
So what should you do to get rid of your trigger points?
If your wallet is very full then you can get massages every day, if not, i suggest that you make a tennis ball your new best friend. Have a look at this video from my DVD to see how you can help your pain, it works I absolutely guarantee it.http://www.youtube.com/watch?v=WZokan5cldE
Read MoreNeck Exercises to fix Disc Bulges and Pinched Nerves
this is the feeling that you need, being pulled up from the top of your head by a string
Here are what i consider to be the best neck exercises for disc bulges and pinched nerves and the major problems causing disc bulges. The major cause of neck pain and disc bulges is the forward head posture. This is because your head weighs 8-10 lbs and when you sit and stand poorly( ie. a slouched posture with your head protracted AKA forward head posture) you put enormous stresses on your neck structures( muscles, discs, tendons and capsules). In fact, if you sit and stand in correct posture your head should be sitting on top of your shoulders very much like a golf ball sits on top of a tee.
However, when you start to sit forward( Probably like just like many of you are sitting at the computer right now) you then require your muscles, tendons and other parts of your back and neck to ‘hold you up’ against gravity. This not only fatigues your muscles but also produces pain.
This is not just me saying this, the mayo clinic states that ‘prolonged forward head posture leads to long term muscle strains, disc herniations and pinched nerves’.
This is also why getting treatments or doing stretches or taking pain killers or even having surgery is ridiculous if you dont remove the major cause to your neck pain.
One of the major reasons that people who have had back surgery require more back surgery later on is because they never removed the causes that damaged their backs in the first place.
Why you can have back or neck surgery but the problem comes back.
Imagine this, you spend all day slouched in front of a computer and this causes great strains on your discs. Then your disc finally gives way and herniates or bulges and presses on a nerve. This then causes you immense pain and or weakness and or numbness in your arm and or hand.
So off you go to a surgeon and he tells you to take some muscle relaxants and some painkillers. You do this and it gives you some temporary relief however you continue to slouch at your computer, whilst driving your car, when you read your newspapers and your book in bed at night.
The Problem- The discs are still continually being forced backwards towards the nerve again.
So, after your ten day course of muscle relaxants and steroidals strong enought to knock out a bull from the surgeon you feel reasonably well( if your’e lucky) but another week goes by and your problem comes back again. Why is this so? Its because you never removed the cause to your problem, you continued to slouch and sit and stand with a forward head posture and thus continued to exacerbate your problem.
BUT, you are never told that the forward head posture is the cause of your disc protrusions and pinched nerve.
Now you are scheduled for surgery because the numbness has become worse and the pain is now also much worse.
You can no longer sleep. You buy special contoured pillows to help your neck but of course it is nothing more than a bandaid because the majority of damage is being done during the day because of your poor posture.
You spend thousands of dollars on chiropractic, massage, acupuncture treatments, zero point wands, crystals, kiniesiologists, osteopaths and just about any one else that you get recommended to see but never get anything more than temporary relief at best. Why? The cause has still not been addressed.
You finally commit to surgery.
Unfortunately, even after surgery you have not been told that the forward head posture is the main cause of neck pain and you have no guarantee that the surgery will make you better, it could even make you worse.
Only by removing the causes of your neck pain, disc bulges and pinched nerves and by doing very specific exercises can you hope to remove your pain and symptoms.
The best exercises to do for neck pain and especially disc bulges and pinched nerves in my opinion and experience are the McKenzie Neck exercises
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