teamCSSM - Camberwell Sports and Spinal Medicine
Cortisone was discovered in the late 1940s as a revolutionary means of treating the pain and inflammation associated with overuse injuries, particularly tendinopathies, such as tennis elbow or achilles pain. More recent evidence however, expresses serious doubts over the efficacy of cortisone in the long-term treatment of tendinopathies and suggests the consideration of other treatments such PRP as a viable treatment option.
What is the difference between cortisone and PRP?
Corticosteroid injections stop the inflammatory process cold. If the goal is to remove pain, swelling and inflammation, cortisone injections are the perfect instrument. The danger is if there is a tear in the tissue, this needs to heal, and you have in essence stopped that healing process.
The other issue with corticosteroid injections is their predisposition to breaking up collagen bonds. As tendons are made up of 70- 80% collagen, corticosteroid injections (particularly prolonged use) can weaken the tendon and make it more likely to rupture or completely tear.
In a recent systematic review of tennis elbow sufferers, cortisone was successful in bringing about fast and significant pain relief in the short term, for up to several weeks. However, after 12 months, the cortisone group had 63% higher chance of relapse when compared to those sought physiotherapy or tried the wait-and-see approach.
PRP injections on the other hand, work in the opposite way. The growth factors that are present in the blood stream are concentrated many times, then injected directly into the injured tissue. This stimulates fresh blood flow, unlocking the body�s natural healing response, stimulating healing of the injured tissue.
Cortisone and PRP are both very effective at reducing pain but for conflicting reasons. In short, one injection switches off the inflammatory process whilst the other switches on the healing process. Each treatment method has its place however, specifically for the treatment of tendinopathies, PRP is far superior long term.
Finally, it is important to remember that the management of tendinopathies is not as simple as choosing which injection to undergo. It involves diligence and commitment to the rehabilitation process in order to ensure full recovery.
Coombes, B.K., 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. 376 (9754), pp. 1751-1767.
Harmon, K., Drezner, J. & Rao, A. (2013) Platelet rich plasma for chronic tendinopathy. British Journal of Sports Medicine. 47 (9), e2
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