In this video, I'm going to talk about steroid injections and what to expect if you've been told
that you need a steroid injection. Hi, I'm Steph, and I'm one of the physios from online physio
clinic sports-injury-physio.com, where you can get an online individual assessment for your injury
and a rehab plan to help you get to where you want to get to. If this is something that interests
you, then have a look at our website – the link to the website is in the Description of this video.
So, what is a steroid injection? It's usually corticosteroid. There are different types of
corticosteroid: some are shorter acting some are longer acting. And corticosteroid, or cortisone,
is based upon … is a synthetically produced version of what we produce – which is
cortisol – as a response to stress. So, it's actually a naturally occurring hormone,
but they've then synthesised it for injection purposes. And what does it
do? It dampens down your immune response and it dampens down your inflammatory response,
which means that it's a very good anti-inflammatory. So, if you have a very inflamed
problem or inflammatory problem, then it can be a good way to dampen down that unwanted inflammation
in order to reduce pain and also reduce any issues that are being caused by that inflammation.
A lot of musculoskeletal injuries are not actually truly inflammatory,
so the effect of cortisone on these conditions will be a little bit less. For example,
if you've got a mild bit of arthritis, which is commonly injected with a corticosteroid,
you would only expect a very short-term pain relief if it's going to work. So, it'll be
between six weeks and six months of short-term pain relief, but then the effect will wear off,
and actually it's not a long-term solution. So, why would you want to have it done? Well, it
might be that it's too painful to do any of your exercises, and it may be the exercises that will
get it better in the long term. But then, if you have an injection to provide you with a short-term
pain relief, it might mean that you can do your exercises better then, so that makes sense.
What you shouldn't be doing it for, is a long-term fix, because that's not what it's for.
Now, it's usually also injected – or not always, but sometimes injected – with local anaesthetic,
which is obviously a pain relief as well. So, if you get a good response
to the injection and they've injected local anaesthetic, so, immediate pain relief, that is,
then it's a good indicator that actually that is where your pain was coming from. So, for example,
if they inject it into the joint then and you get immediate pain relief,
then it is the joint that is causing your issue, not any of the structures around it.
Tendons are interesting. It's not a good idea actually to inject corticosteroid into
a tendon … Very different to a bursa; a bursa can be inflamed. A tendon tends not to be so
inflammatory. Some things are, but most the time, if you've been told that you have a tendinopathy,
it is not a good idea. Because one of the side effects of steroids – and it's only a
very small side effect and it doesn't affect all people – but there is a risk of tendon rupture,
which is why it's much better for a tendon not to inject it at all and actually to address
things like the loading that you're doing and strengthening, and getting it better that way
without injecting it with something that could potentially rupture it. There are side effects to
steroids that are worth considering: It's obviously an immunosuppressive, so it reduces your
immune response and inflammatory response; so, you would not want to have it before you were having
a vaccine, for example, or if you were ill or had some sort of infection, that would be a big no-no.
Likewise, you wouldn't want it after any sort of trauma, because when you've had a trauma,
in order to heal, you need an inflammatory response; so, you don't want to dampen your
inflammatory response down if you've already had some sort of trauma that needs to heal.
You wouldn't want to have it done if you have any medications that it's likely to interact with,
because obviously steroid is a medication, so it's a drug; it can interact with some other medicines.
For example, quite often, diabetic medicines … it will fluctuate your blood sugars for a while
after, so it's worth bearing that in mind. And then you also have the risk of having an injection
at all; so obviously, an injection breaks the skin, so there's a little tiny risk of infection;
it's not a big risk, but it's one that you need to bear in mind. It's very common to have a bit
of redness and soreness – that's okay – but if it becomes more … more of a … you know,
worsening redness, worsening pain, after 24 hours it gets worse and worse, then obviously
that is a sign that there's an infection that needs immediate medical treatment.
There are other strange but possible side effects, such as fat atrophy. So, the skin has a layer of
fat just beneath it; sometimes that fat, after an injection, can leave you with … can disappear,
and leave you with a little bit of a dent there. Or you can sometimes get a bit of whiteness, so,
skin depigmentation, which can happen because of steroid – particularly in people with darker skin.
And then you also have things like the effects of just bleeding and bruising.
And just … If you have an allergy to any of those things, and that's no good either. So,
there are things to consider. It's not just a case of turning up at the GP clinic,
having an injection, and happy days! You do need to think about all the things that,
why are you having in the first place? Is it to provide you short-term pain relief in order to
do your exercises, or are you expecting some miracle cure? Because if it's the second one,
then it's probably not exactly quite right. But in the main, it is … it can be really helpful
for short-term pain relief. And what you need to do then, is provide yourself with
the right plan after you've had the injection to keep the benefits of it for longer and try
and help … use it as an adjunct to helping you get better. It isn't a magic fix. If you've got,
for example, a tendon loading issue, then you need to address the loading, the exercises,
the strength, the activities that you're doing; you need to address all those things
whether you have an injection or not. So yeah, if you have been told you need a steroid injection,
please consider all these things. I hope that's been helpful, and if you want any more info,
please do get in touch or have a look at our website, where we've got lots of information
about all sorts of conditions, and hopefully you can find what you're looking for there. Bye!