Extracorporeal Shockwave Therapy (ESWT) vs. Cortisone Injections: Which One Offers Long-Term Relief?

If you’re dealing with persistent joint pain, tendonitis, or inflammation, you’ve likely been presented with various treatment options. Two common approaches that patients often compare are cortisone injections and extracorporeal shockwave therapy (ESWT). While both aim to reduce pain and improve function, they work in fundamentally different ways and produce dramatically different long-term outcomes.

At Serenity Health Care Center in Waukesha, Wisconsin, we believe in empowering our patients with clear, evidence-based information to make informed decisions about their care. Let’s dive into a comprehensive comparison of these two popular treatments.

Understanding the Approaches: Fundamentally Different Philosophies

Cortisone Injections: The Symptom Suppressor

Cortisone injections involve injecting a synthetic form of cortisol (a stress hormone) directly into a painful or inflamed area. Here’s how they work:

• Primary mechanism: Powerfully suppresses inflammation by inhibiting inflammatory cells and mediators
• Treatment goal: Reduce pain and inflammation temporarily
• Philosophy: Mask symptoms to provide relief
• Tissue effect: Anti-inflammatory but potentially degenerative to tissues over time

Shockwave Therapy: The Tissue Regenerator

Extracorporeal shockwave therapy (ESWT) uses acoustic waves delivered to injured tissues through the skin. Here’s how it works:

• Primary mechanism: Stimulates the body’s natural healing response through controlled microtrauma
• Treatment goal: Promote actual healing and tissue regeneration
• Philosophy: Address the underlying cause of pain
• Tissue effect: Pro-inflammatory initially (triggering healing), then regenerative

Short-Term Results: What to Expect Initially

Cortisone Injections: The Quick Fix

Many patients choose cortisone injections because they can provide rapid relief:

• Speed of relief: Often very quick, sometimes within 24-48 hours
• Initial effectiveness: Usually highly effective at reducing pain and inflammation
• Immediate side effects: Possible “cortisone flare” (temporary increase in pain), skin discoloration, elevated blood sugar
• Procedure experience: Single injection, moderate discomfort during the procedure

Extracorporeal Shockwave Therapy (ESWT): The Progressive Improver

Extracorporeal shockwave therapy (ESWT) typically shows results more gradually:

• Speed of relief: Progressive improvement, often beginning after 1-3 treatments
• Initial effectiveness: Builds over time with each treatment session
• Immediate side effects: Mild discomfort during treatment, occasional minor bruising or swelling
• Procedure experience: Series of 6 non-invasive treatments (2x/week for first two weeks, 1x/week for two more weeks)

Long-Term Outcomes: The Critical Difference

The most significant differences between these treatments emerge when we look at long-term outcomes:

Cortisone Injections: Diminishing Returns

Research has consistently shown concerning long-term effects from repeated cortisone use:

• Duration of relief: Typically 4-8 weeks before symptoms return
• Repeated treatments: Effectiveness tends to decrease with subsequent injections
• Tissue impact: Studies show potential acceleration of cartilage breakdown, tendon weakening, and increased risk of tendon rupture
• Long-term complications: Potential for tendon atrophy, fat pad atrophy, cartilage degradation, and weakened immune response in the area
• Treatment limitations: Most doctors recommend no more than 3-4 injections per year in the same area due to tissue damage concerns

A 2017 study in JAMA found that patients receiving regular cortisone injections for knee osteoarthritis had greater cartilage loss over two years compared to those receiving placebo injections.

Extracorporeal Shockwave Therapy (ESWT): Cumulative Healing

The long-term profile of shockwave therapy tells a very different story:

• Duration of relief: Often long-lasting or permanent as the underlying tissue actually heals
• Repeated treatments: Results tend to improve and stabilize with the complete treatment protocol
• Tissue impact: Studies show improved tissue quality, increased collagen production, and enhanced blood flow
• Long-term benefits: Strengthened tendons, reduced calcifications, improved joint function, and increased tissue resilience
• Treatment limitations: Can be repeated as needed without tissue damage concerns

A 2019 systematic review in the British Medical Journal found that extracorporeal shockwave therapy (ESWT) provided significant long-term benefits for chronic tendinopathies, with effects lasting 12+ months after treatment completion.

Comparing Healing Mechanisms: Suppression vs. Stimulation

To truly understand the difference in long-term outcomes, it’s important to understand how these treatments affect the healing process:

Cortisone’s Double-Edged Sword

• Anti-inflammatory effects: While reducing inflammation provides pain relief, some inflammation is actually necessary for healing
• Cellular effects: Cortisone inhibits fibroblast proliferation (cells that produce collagen)
• Metabolic effects: Reduces protein synthesis needed for repair
• Circulatory effects: Can cause localized vasoconstriction, limiting blood flow to the area

In essence, cortisone sacrifices healing for symptom relief.

Shockwave’s Regenerative Approach

• Pro-healing inflammation: Creates a precise, controlled inflammatory response that triggers repair
• Cellular activation: Stimulates fibroblasts to produce new collagen
• Growth factor release: Increases production of healing compounds like VEGF and eNOS
• Circulatory improvement: Promotes angiogenesis (new blood vessel formation)

Extracorporeal shockwave therapy (ESWT) essentially kickstarts and accelerates your body’s natural healing mechanisms.

Who Is the Ideal Candidate for Each Treatment?

Based on these differences, certain patients may be better suited for one treatment over the other:

Consider Cortisone Injections When:

• You need very rapid pain relief for a short-term, high-priority event
• You have an acute inflammatory flare that needs immediate management
• Conservative treatments have failed and surgery is the next option
• You understand and accept the potential long-term tissue effects

Consider Extracorporeal Shockwave Therapy (ESWT) When:

• You’re seeking a solution that addresses the underlying cause, not just symptoms
• You want sustainable, long-term relief
• You’re concerned about the potential negative effects of cortisone
• You have chronic conditions that haven’t responded to other treatments
• You’re looking to avoid surgery or more invasive procedures
• You’re willing to commit to a complete treatment protocol for optimal results

Real Patient Outcomes: What We See in Practice

At Serenity Health Care Center, we’ve worked with thousands of patients dealing with musculoskeletal pain. Here’s what we’ve observed in comparing these treatments:

The Cortisone Cycle

Many patients come to us after years in what we call the “cortisone cycle”:

• Initial injection provides excellent relief
• Relief fades after 1-2 months
• Return for another injection, but with less dramatic results
• Relief period shortens with each injection
• Eventually, pain becomes resistant to cortisone
• Tissue quality has degraded, making recovery more difficult

The Extracorporeal Shockwave Therapy (ESWT) Success Pattern

Patients who choose extracorporeal shockwave therapy (ESWT) typically experience:

• Gradual improvement during the 4-6 week treatment protocol
• Continued improvement for 2-3 months after completion
• Sustained relief without the need for ongoing treatments
• Improved function and return to activities they enjoy
• Better long-term tissue quality and reduced risk of re-injury

Cost Comparison: Short-Term Expense vs. Long-Term Value

When comparing treatment costs, it’s important to consider both immediate and long-term financial implications:

Cortisone Injection Costs:

• Initial cost: Generally lower per injection
• Long-term cost: Multiple injections over years, potential costs of treating side effects, possible eventual surgery
• Insurance coverage: Often covered by insurance, with typical co-pays or coinsurance

Extracorporeal Shockwave Therapy (ESWT) Costs:

• Initial cost: Higher initial investment for the complete treatment series
• Long-term cost: Often less expensive over time due to durability of results and avoided future treatments
• Insurance coverage: Coverage varies; many patients use HSA/FSA funds or payment plans

The Hybrid Approach: When Combination Makes Sense

In some cases, a strategic combination of treatments may offer the best outcomes:

• Acute pain management: Occasional use of cortisone for severe flares, followed by shockwave therapy to address underlying issues
• Pre-regenerative preparation: Using extracorporeal shockwave therapy (ESWT) to prepare tissues before regenerative treatments like PRP
• Post-cortisone rehabilitation: Extracorporeal shockwave therapy (ESWT) to strengthen tissues after cortisone treatment
• Comprehensive protocol: Integrating both treatments as part of a broader approach that may include physical therapy, nutritional support, and activity modification

Making Your Decision: Important Questions to Ask

When deciding between these treatments, consider asking your healthcare provider these questions:

1. What is causing my pain, and which treatment better addresses the root cause?
2. What are the potential long-term effects of each treatment option on my specific tissues?
3. How many treatments will I likely need, and over what timeframe?
4. What is your experience with patients with my specific condition and each treatment?
5. Are there any specific factors in my case that make me a better candidate for one treatment over the other?
6. What complementary approaches should I consider alongside either treatment?

Our Approach at Serenity Health Care Center

At our Waukesha clinic, we take a comprehensive approach to musculoskeletal pain:

1. Thorough assessment: We begin with a detailed evaluation to understand the root cause of your pain
2. Education: We ensure you understand all treatment options and their expected outcomes
3. Personalized planning: We create customized treatment protocols based on your specific condition, goals, and preferences
4. Integrated care: We may recommend complementary approaches to enhance your results
5. Long-term perspective: We focus on sustainable solutions that provide lasting relief and improved function

While we offer both cortisone injections and extracorporeal shockwave therapy (ESWT), our emphasis is on regenerative approaches that address the underlying cause of pain rather than merely masking symptoms.

Take the Next Step Toward Lasting Relief

If you’re weighing your options between cortisone injections and extracorporeal shockwave therapy (ESWT), we invite you to schedule a consultation with Dr. Chong at Serenity Health Care Center. Our team will help you understand which approach is best suited for your specific condition and goals.

Don’t settle for temporary solutions that may compromise your long-term tissue health. Explore treatments that can provide sustainable relief by addressing the root cause of your pain.

Call 262-522-8640 to schedule your consultation today and take the first step toward lasting pain relief and improved function.

This article is for informational purposes only and does not constitute medical advice. Please consult with a qualified healthcare provider to determine the best treatment approach for your specific condition.

*References:

1. McAlindon TE, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-1975.
2. Mani-Babu S, et al. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015;43(3):752-761.
3. Dean BJF, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570-576.*