Injury therapy might be just a simple shot away. Read on for the needle know-how.

by John Post, MD

Some triathletes mistakenly equate training with pain. Although we’re surrounded by adages like « no pain, no gain, » we’ve long ago discerned the difference between training discomfort and real, physical pain. We’ve also learned that there isn’t a quick fix, for every ache or distress. When we’re in pain, our bodies are trying to tell us something.

For some triathlon-related injuries, however, an injection can be just what the doctor ordered. Take Dean, a 54-year-old athlete who’s stronger and swifter than most, but who has a spot of arthritis in his left knee. Not to mention the fact that he’s allergic to needles. At a recent orthopedic visit, Dean’s doctor asked him to think about cortisone, to which he replied with concerns about looking like Arnold Schwarzeneger after the shot. Clearly, Dean needed an education on cortisone, or corticosteroids, as they’re known in the trade.

Cortisone and you

Corticosteroids are natural hormones produced by the adrenal glands. They work in a variety of ways in your body including suppressing inflammation and boosting the immune system. This class of drugs reduces the inflammation caused by arthritis, joint pain, swollen bursae or tendon sheaths (in the case of bursitis or tendonitis). In other disease processes such as Lupus or Rheumatoid Arthritis, the immune system actually attacks itself leading to damaged connective tissue and organs. In these cases, cortisone helps decrease immune system activity, but also diminishes the body’s normal immune response which can increase the risk of infection. Unlike anabolic steroids, they won’t turn you into Adonis. (But, hey, you’re a triathlete, Adonis has nothing on you.)

Dean has been using a nonsteroidal anti-inflammatory drug (NSAID), but just hasn’t seen the level of relief he’s desired. He knows that for many forms of arthritis, a low dose of oral corticosteroid is prescribed. He also knows that for swollen joints, tendon problems or bursitis (inflammation of a tiny sac found between a bone, tendon, muscle or skin that permits these parts to glide smoothly) the corticosteroid is injected directly into the joint or bursa. Dean’s response to this? « Yikes! »

Side effects

As with any drug or procedure, the potential for side effects exists. With these drugs, however, it’s much more common in those who take large doses for extended periods. Those placed on a longer course of these agents occasionally complain of mood swings, weight gain, acne and slow healing of wounds or cuts. These side effects are quite unlikely, however, in the athlete who only has the occasional treatment.

How many is too many?

Many of my patients tell me they’ve heard that they can only have a certain number of cortisone injections per year. There actually is no limit, but there are, however, concerns about repeated injections into the same bodily area. Generally speaking, if one or two treatments in one spot aren’t helpful, it’s not likely that further injections will be beneficial. It’s also important to specify what body location is being injected, be it an already arthritic joint in an elderly individual, versus an athlete with rotator cuff tendonitis where the shoulder is otherwise healthy.

Meanwhile, back to Dean, nervous and about to meet the business end of a 23 gauge needle. And just like that, it’s over. “That’s it? That’s all there is to it?” he exclaims. “Heck, my transitions should be so fast.”

John Post is a six-time IRONMAN World Championship finisher and serves as the medical advisor for Training Bible Coaching and The Rock Star Triathlete Academy.