Shockwave Therapy vs. Cortisone Injections for Pain in Jacksonville

They work through completely different mechanisms and they are appropriate for different stages of the same problem. Cortisone suppresses inflammation. Shockwave restarts the repair process. For acute inflammatory conditions, cortisone can be the right tool. For chronic tendinopathy, it is often the wrong one, and shockwave is usually more appropriate.

When Cortisone Makes Sense

Acute inflammatory conditions respond to cortisone because the problem is excess inflammation and cortisone directly suppresses it. A fresh bursitis flare, an acute inflammatory arthritis episode, post-surgical inflammation. The effect is temporary because cortisone does not repair damaged tissue, but in those situations the goal is to calm the inflammatory response quickly, which cortisone does well.

Where Cortisone Falls Short

Chronic tendinopathy is not an inflammatory condition. It is a degenerative one. The tissue has moved past the inflammatory phase into a state where the collagen is disorganized, the vascularity is poor, and the normal signals for repair have downregulated. Cortisone suppresses the symptoms of that state without addressing the underlying degeneration. The pain returns. A second injection helps less. A third helps less than the second. Multiple injections into the same tendon carry documented risks of further tissue weakening.

A Patient Who Had Been Through the Cycle

A patient came to us after his third cortisone injection for plantar fasciitis in 18 months. The first injection gave him six weeks of relief. The second gave three. The third barely made a difference. His orthopedist had told him more injections were not advisable. He found us through a friend who had used shockwave for an Achilles problem. After five sessions, the morning heel pain that had defined his mornings for a year and a half was resolved. The tissue had repaired. Cortisone had been managing his symptoms. Shockwave changed the underlying condition.

Using Both

There is some evidence that cortisone administered shortly before shockwave may reduce its effectiveness by dampening the inflammatory response that shockwave is designed to initiate. If you have had a recent injection, we generally recommend waiting before starting shockwave. How long depends on the site and timing. Call us and we can discuss your specific situation.

(904) 539-3352. 13770 Beach Blvd #4, Jacksonville FL 32224.

Written by

Dr. Cody Muren, DC

Doctor of Chiropractic · Certified Acupuncturist