Originally Posted by Steven Low
Well, here's what happens.
When you overwork or trauma injure something usually there's inflammation. But in the case of chronic tendonitis after a certain period there's no inflammation anymore and it becomes a chronic degenerative disease (hence tendinosis).
When this occurs, since some inflammation is necessary for healing process even when you decrease pain to the area it's still not healing.
That's what eccetrics or nitric oxide or prolotherapy, etc. are for. YOu get inflammation back into the area for the cases where there's chronic degenerative to stimulate healing process.
ART and other manual techniques obviously help decrease the pain because of overuse. Some of the overuse usualyl comes from gummed up and tight tissues in the elbow area constantly pulling/contracting on the tendon not allow it to heal properly.
So when you release that tension it feels better. But if the case is chronic it's not necessarily going to be healed. Hence, why you need eccentric exercises and stuff.
Cortisone does the same thing -- blocks the pain (or rather relieves it). Studies have shown it doesn't increase healing and that over 9-12 month periods result in no greater healing than placebos.
My understanding of cortisone injections is that they relieve pain precisely because they are anti-inflammatory, not because of any anesthetic effect (which is why anesthetic is added to the shot, because the cortisone initially hurts like hell).
Cortisone shots plus exercise afterwards are bad news:
Dr. Prem Gogia and associates at the Washington University School of Medicine in St. Louis, Missouri, did an excellent study bringing out the dangers of an athlete exercising after receiving a cortisone shot. They divided animals into three groups:
1. Group One: received a cortisone shot
2. Group Two: received a cortisone shot and exercised
3. Group Three: control group, received no treatment
This study was done in 1993 and was the first study to look at the effects of exercising after receiving a cortisone shot. The authors performed this study because it is common practice in sports medicine to give an athlete a cortisone shot for an acute or chronic injury. Athletes are typically returning to full-intensity sports activities within a few hours to one to two days after receiving the shot. The results of the study were unbelievable. The animals receiving the cortisone shots showed a decrease in chondrocytes, but when they received the cortisone shot and exercised, the chondrocyte cell count decreased by another 25 percent. Degenerated cartilage was seen in all of the cortisone-injected animals, but severe cartilage damage was seen in 67 percent of the animals that exercised and received cortisone. The cortisone and exercise group also showed a significant decline in glycosaminoglycan synthesis compared to the other groups. The authors concluded, “...the results suggest that running exercise in combination with intra-articular injections results in damage to the femoral articular cartilage.”
Put simply, a corticosteroid injected tendon/ligament/cartilage will end up worse off structurally than it was before the injection, hence the tendon blowouts after corticosteroid injections.
You're likely right about the ART mechanism though.