Friday, October 29, 2010

Do You Need That Cortisone (Steroid) Injection?

Have you got any pain in your elbow, patella or Achilles tendon? I've seen many cases of what used be called tennis elbow or lateral epicondylitis and Achilles tendinitis in our clinics recently. What is now known as tendinopathy (or diseased tendon) of the elbow or Achilles as these cases are actually due to degenerative change rather than inflammation as numerous studies have shown.

Most of the time patients with tendon problems were given a cortisone (or corticosteroid) injection to treat the pain (rather than treating what caused the pain). Cortisone, an anti-inflammatory agent used to be one of the preferred treatments for overuse injuries of tendons (like tennis elbow, patella and Achilles tendinitis) which were notoriously resistant to treatment. Cortisone is often used to treat plantar fasciitis too. 

Pain wise the injections were effective, but as soon as the patients returned to the their sporting activity or even their daily activities, the pain returned. In adverse cases the tendons can even rupture. This happened on a few occasions when I was working at my previous job at the Singapore Sports Council with our national athletes after receiving the corticosteroid injections. They subsequently needed surgery to repair their ruptured tendons resulting in more time off. So for all you athletes out there, think three, four or five times and not just twice about taking that cortisone injection.

A major new review article published in the Lancet just last week raised major doubts on the efficacy (or wisdom) of using cortisone on tendon problems. Yes, the authors found plenty of evidence (in over 4 dozen high quality randomized controlled trials) that corticosteroid injections reduced patients' pain in the short term, but the effects were not great in the intermediate and long term. In fact patients receiving the injections had a much lower rate of recovery than those who did nothing or received physiotherapy (at 6 and 12 months). This was especially true for patients with tennis elbow pain, rotator cuff (swimmer's shoulder) pain and Achilles tendon pain.

There are more evidenced-based treatment for tendinopathy other than cortisone injections, ultrasound, massage, interferential currents etc. We at Physio and Sports Solutions practice evidenced-based physiotherapy (neural stretching, Mulligan MWM's, eccentric muscles strengthening exercises and Maitland joint mobilizations etc) to treat you. Come let us help you with your tendon injuries.


Coombes BK, Bisset L, Vicenzino B (2010). Efficacy And Safety Of Corticosteroid Injections And Other Injections For Management of Tendinopathy: A Systematic Review of Randomised Controlled Trials. The Lancet. Epub on 22 October 2010.

*Picture by Ballyscanion/Getty Images.

Monday, October 25, 2010

ST 251010 Knowing Your Pain Part II

After yesterday's topic (in the New Paper) on the recovery effects of Sports massage after cycling (or any other exercise),  go take a look at page B11 under the Sports section in today's (251010) Straits Times to find out more on the 2nd part of understanding or decoding your pain.

It's just under 6 weeks to your race day, not a good time to get injured. If you do, please come and see us quickly.

TNP on 241010

Sports Solutions was quoted in yesterday's Sunday edition of the New Paper on the recovery process after cycling (so you can train harder again quicker), specifically on Sports Massage and DOMs (we've written on the topic before

The recovery process applies to all sports, not just to cycling. It's in page 26 and 27 in yesterday's (241010) paper, go take a look.

Both our clinics are open on weekends and public holidays, please call to make your appointment.

Monday, October 18, 2010

ST Article On Knowing Your Pain 181010

After a few weeks break from the ST Sweet 16 Marathon Training plan, Sports Solutions is back in the news in today's Straits Times (181010) under the Sports section on page B11 on understanding or decoding your pain.

This is what we at Physio and Sports Solutions are good at, treating the root cause of your problems instead of just treating your pain to allow you to run pain free. Our many patients can testify to that.

Go take a look.

Friday, October 8, 2010

The Underpants Run In Hawaii

For those of you who are into triathlons, well, tomorrow (or 091010 in Hawaii) will be the holy grail and grand daddy of all triathlons. The Ford Ironman World Championships, held on the big island Kona in Hawaii on every full moon in October.

Why full moon every year you may wonder? You get 17 hours to make the finish line, to be an Ironman, and the full moon will offer some light to those out on the course battling to make the time cut.

Above is a picture I found in the pre race festivities, the underpants run.

All the best to all our patients taking part.

*Picture from