I cannot tell you how many people I have met over the past 18 years who have come to see me for help with a chronic hip or shoulder problem that had evolved into a much bigger problem that it should have. These were mainly due to treatments that focused on pain relief instead of correcting the underlying cause. In almost every one of these cases the treatment consisted of cortisone injections into the injured area followed by rest. Some were told to see a physio for some treatment but many were told that they will need a few injections over the coming months to get rid of the inflammation and the hip or shoulder would be “fixed”. I am astounded that with all the advancements in modern technology and science, and the ability to access information that can provide great insights into what causes injuries that this is the most consistent course of action. Very rarely does this work and if anything all it is likely to achieve is make the injury worse! In this article, I will explain why this approach to shoulder and hip pain is flawed and what approach is more effective in the long term.
Firstly, I do not claim to know everything about injuries and rehabilitation or believe I know more than doctors who are doing their best to treat their patients. I regularly refer people to specialists when I can see the problem is outside my area of expertise for I acknowledge that the injury needs more specialized care than a corrective exercise program.
However, where I have concerns is where the treatment for an injury in a complex area like the shoulder is given a one size fits all approach that seeks to reduce inflammation and take away the pain. While it is a great idea to reduce inflammation it is never a good idea to do this without first asking why it is inflamed in the first place. Much of the information discussed in this article I looked at in more detail a year ago in the article about what to focus on for joint inflammation instead of pain relief and I highly suggest to go and check out that article.
What I only briefly touched on in that article was the impact cortisone injections had on the body so I wanted to go into more detail about what happens when you have this procedure complete.
Using cortisone injections without addressing the cause of the inflammation is a recipe for more compensation and eventually more pain which I will explain shortly.
But first what exactly is a cortisone injection?
What Is The Purpose Of A Cortisone Injection?
Cortisone is a potent anti-inflammatory medication. It was only discovered as recently as 1950 (earning a Nobel Prize for medicine for Hench and his co-workers), and has been available in an injectable form since 1951. It acts on both acute and chronic phases of inflammation to reduce both tissue swelling and subsequent scar formation.
Cortisone injections are often used to treat inflammatory arthritis conditions like Rheumatoid arthritis and Psoriatic Arthritis and the purpose of this is not just to relieve the person of pain but to prevent bone damage and permanent disfigurement.
I myself had 3 injections into my hand in 2022 to reduce massive swelling from the Psoriatic arthritis disease that I was diagnosed with last year. The pain was crippling my hand and the Rheumatologist wanted to use something that would act very fast as the medication would take a long time to kick in. I had two injections into the same finger (my left tall finger) within 3 months and also one in my thumb and I was able to reduce the swelling and prevent any further damage.
It is important to understand that I was using (still are), specific medication to treat the problem and I made some nutrition and lifestyle adjustments to address the cause of my condition. I was not relying solely on an injection to make my pain go away.
While these injections may be very helpful in treating auto-immune diseases and preventing further destruction of bone, they are not a good solution for treating osteoarthritis and musculoskeletal type injuries that they are also commonly used for. If anything, they are more likely to cause more problems which I will explain shortly.
You must remember while the pain in the affected area may look and feel the same, but the reason for the pain is present is completely different. This is something I have discussed numerous times in articles over the past few years as I see so many people using treatments to get rid of pain but not addressing the reason the cause of the pain at all.
With inflammatory arthritis conditions the cause of the pain is due to a fault within the immune system, but with osteoarthritis and common injuries the pain is due to the way the person moves and their inability to effectively stabilise their joints. Until they are taught how to move more effectively and stabilize the affected joints nothing will change.
The purpose of a cortisone injections in both instances is to help the person reduce some of the inflammation to reduce any significant destruction of the connective tissue or bone, but more importantly allow for the corrective treatment to work more effectively.
The worst thing that can happen is relying on the cortisone injection to make everything go away. The other thing to consider is the side effects of doing this which can be more problematic in the long term, especially with multiple injections.
Cortisone Weakens Tendons and Accelerates Cartilage Breakdown
Cortisone is a type of steroid and while it helps to reduce pain in the affected joint by decreasing the inflammation it also has some negative side effects. They inhibit the cells that can help repair damaged tissue and therefore may weaken tendons. Cortisone has been shown, in many studies, to accelerate degenerative osteoarthritis through cartilage breakdown.
The fact that cortisone is a poor solution is not something that I just made up or based solely on my opinion. This information has been around for some time and many health organizations are very aware of this problem, which is even more baffling for me as I see people every week given this type of treatment for a shoulder or hip problem that is caused by the way they move.
In the article by CNN health they discussed this exact topic and this is what they found.
In a new study published in the journal Radiology, researchers looked at 459 patients in a US hospital who had received one to three corticosteroid injections into a knee or hip.
Of those patients, 36 of them, or 8%, experienced adverse events in their joints, as shown on medical imaging tests. Researchers saw acceleration of the patients’ osteoarthritis progression, as well as other negative effects including subchondral insufficiency fracture, osteonecrosis and rapid joint destruction with bone loss.
Ali Guermazi, a radiology professor at Boston University and a co-author of the study, told CNN the paper built on another 2019 study that showed similar results. The evidence is stacking up, and the negative effects might have actually extended higher than the 8% of patients with complications seen in the study so far, he said.
Another factor to consider is the impact medications have on your gut health. I won’t go into too much detail on this as this is a massive topic in its own right and this article would take up another 5000 words to go into all the things that gut health is involved with. Just be sure you understand that poor gut health is likely to increase inflammation and anti-inflammatory medications and cortisone compromise this health significantly. Interestingly this is something that relates more specifically to the auto-immune diseases, for over 70% of the immune system is in the gut!
You can read more about gut health in this article – A healthy gut equals a healthy body
Getting back to the subject of weakening connective tissue, if you have a problem with the integrity and strength of a tendon why would you use something that would make it worse? It makes no sense to me. Yet this is what happens when you use treatment that only attempts to take the pain signal away, and not the reason for the pain.
Always remember this quote by Gray Cook.
Joint instability comes from ligaments that become weak and overstretched that forces the body to react by sending fluid into the joint in an attempt to correctly stabilize it from further damage. The weakness is the end result of poor movement strategies and destructive forces creating the instability resulting in extra fluid being pushed through small cracks in the articular cartilage. If the instability is left unchecked it eventually causes the knee cartilage and meniscal cells to drown to death. This is the beginning of osteoarthritis.
This also helps to explain another massive difference with inflammatory arthritis and osteoarthritis and that is the role of synovial fluid.
- With auto-immune conditions the body tends to send excessive amounts of synovial fluid to the joint causing it to swell and become inflamed.
- With osteoarthritis it is the exact opposite as there is a decrease in synovial fluid causing the joint to have this feeling of bones rubbing together as seen in the picture below.
Many people believe it is the osteoarthritis causing the pain and inflammation and that this is the end result of getting old. Both of these assumptions are false. Inactivity and poor movement causes the inflammation, not old age. The osteoarthritis is the end result of the pain, not the reason for it.
This shows how a lack of synovial fluid causes the joints to grind together causing more inflammation and pain. The increased pain and inflammation leads to a reduction in mobility and range of motion with movement. As an end result the reduced mobility and pain leads to less movement and more inactivity that leads to even more pain and less synovial fluid. This cycle continues to repeat over and over until the condition becomes extremely chronic and debilitating.
When this happens is when surgery is often discussed as the next solution which is even worse and more destructive as there is no going back once this has been done. Once again this is something prescribed far too often, and too early in most cases for treating injuries caused by poor movements. When you consider all the risks associated with surgery and that it once again does not address the reason for the injury it makes you wonder why people still prefer to go this route.
You can read more about this in the article – Do we rely too much on surgery to treat chronic pain?
In the book "Surgery the Ultimate Placebo" by Dr Ian Harris on page 175 he makes an interesting observation.
“At the heart of this question is a reflection of society’s overreliance on surgery as the preferred way of fixing the physical breakdowns that occur in our body. We look at the body like a car in need of a mechanic. And I must admit that it still surprises me when I discover that treating the body like a machine, by removing torn cartilages, repairing torn tendons, unblocking arteries and veins and catching clots in a next, patching holes in the heart, either doesn’t work, or doesn’t work any better than leaving it to the body to sort it out.”
Another great example is from arguably the world’s leading back pain researcher Dr Stuart McGill about the danger or using surgery for back pain. In his most recent book "Back Mechanic" in the chapter Is Surgery For You? He says, - "Ninety Five Percent of the challenging patients see do NOT need surgery, even thought they were told that was their only cure. My opinion based on three decades of experience, working with patients who have been successful with surgical avoidance and in dealing with the "failed backs" caused by unsuccessful surgery."
I have met many people not wanting to make any effort to change their diet or exercise habits and look for a doctor to fix them, even if there was a poor chance of success and massive risks in doing so.
If you have read this article this far it is fair to say you are not someone looking for the quick fix and but a person who will try everything they can to do it naturally and you take responsibility for the health of your body.
Unfortunately, I think you may be in the minority as the picture below would sum up most people’s approach to dealing with pain.
Another great insight from this book by Dr Ian Harris is how the media portrays modern science with medicine. Almost every day on the news you will see some report about some breakthrough in science for treating some type of injury or illness. Rarely do we question these and we place so much faith in this research that it is true.
Again Dr Harris says this best in his book on page 56, “The over representation of good news from medicine is a problem in the scientific literature, but that bias is magnified manifold in the media. I have seen media reports of supposed cures for things as cancer, dementia, and paraplegia. And the more advanced the science seems to be, the more the media love it.”
Two More Examples Where Reducing Pain Inhibits The Body’s Ability To Repair Damage
In recent times there has been much more of discussion around our obsession with stopping the body’s natural processes of dealing with pain or inflammation by blocking it with medications and treatment methods to make us feel better. While we may get some relief from the inflammation it comes at a big price in the long term and is more likely to make matters worse.
Two examples of this is are our instinctive reactions to dealing with a fever and the age old philosophy of placing ice on an injured muscle after a sprain or traumatic injury. I think both of these topics show that there is a natural healing mechanism used by the body to heal itself and by letting it take action is more important than reducing the uncomfortable pain and inflammation it produces. As you will see how these both relate to our use of cortisone injections and NSAID’s for healing injuries.
Firstly, let’s take a quick look at how our way of treating a fever has changed.
We have always been told that a high fever can be dangerous to your health and many health professionals would suggest to drink plenty of fluids and take fever-reducing medications, like acetaminophen, ibuprofen or aspirin to get your temperature down.
Fevers are a regulated increase in core body temperature as a response to unwanted microbial invaders. The more severe the infection, the higher the fever. You can understand why we see a high temperature as a bad thing for it can be deadly to the body if it gets too high. Plus it feels terrible when you are in this state and it seems logical to provide relief and with medications, fluids and other means to lower your temperature.
While these medications may give you some relief and make you feel better they may be causing you more trouble in the long term as it suppresses the immune response from dealing with the infection.
Blocking fever can be harmful because fever, along with other sickness symptoms, evolved as a defence against infection. Fever works by causing more damage to pathogens and infected cells than it does to healthy cells in the body. During pandemic COVID-19, the benefits of allowing fever to occur probably outweigh its harms, for individuals and for the public at large.
Click here to read the detailed study by Oxford Academic titled – Let Fever Do Its Job!
The second topic I want to discuss is the use of ice for injury management.
For many years we have all been taught that if we sprain a muscle or a joint we should ice it and rest. If you sprain your ankle the normal thing to do straight away is to grab an ice pack or the frozen peas and place it around the area. It’s always been thought that this will help reduce the “harmful” swelling as well as reducing the pain.
We have been taught this from an early age and it is still something taught in First Aid courses today to use the RICE method which is
- Rest
- Ice
- Compression
- Elevation
I completed my yearly first aid course only 3 months ago and this is still a big part of course today.
However, there is not much research to support that ice actually helps the healing process but there is a large amount of evidence suggesting the exact opposite in that it is detrimental to the healing process.
When there is tissue damage, the immune system responds by sending inflammatory cells to the damaged tissue, this catalyses a process to rebuild, repair and heal the injured tissue. Ice application may actually reduce protein synthesis, which is important for tissue healing.
Just to prove how far we have come with our understanding of using ice on an injury the guy who actually invented the RICE method Dr Mirkin has changed his own thinking on this by stating, “both ice and complete rest may delay healing, instead of helping”. He even wrote a book with Gary Reinl and Dr Kelly Starret titled “ICED! The illusionary treatment option”.
There is also a great study you can read with great deal of information on this by clicking here.
Compression and immobilising a joint is another age old belief that is also being challenged and something that many physiotherapists haven’t been doing clinically for quite some time. There is tons of evidence for exercise based therapy and that loading damaged tissues with proper exercises as soon as possible following injury actually accelerates healing of both muscles and bone. The muscle activation helps the lymphatic system to clear any excessive swelling, reduces joint stiffness and prevents disuse atrophy of the muscles.
One of the best methods I have seen used these days is called Peace and Love. There is a great article by Grand Slam Physio that describes how it works which is shown below.
You can start to see how our way of looking at pain and inflammation is flawed and how we could be making our bodies more vulnerable to bigger problems in the long term.
Okay, this all makes sense but what do you do instead? Do you just have to put up with it? Surely, that is not a good strategy so how do you break free from the pain?
The True Cause Of Pain
As I have mentioned several times in this article to find a long term solution to your pain you need to find what the underlying cause is. As you can imagine this can be quite tricky for there are many things to consider and you need a detailed assessment and review of all the things that you do or do not do to find this.
I did a very detailed article about my assessment process for knee injuries that discussed the various factors I must take into consideration when trying to find the cause of a knee problem.
Having said that there is a really simple way of looking for the underlying cause. If your injury was not due to a traumatic accident and was something that evolved over time you can categorize your problem into two main areas.
- Muscular imbalances causing compensation and compression of joints.
- Long periods of soft tissue degeneration and atrophy of muscles and tendon strength.
Until these problems are identified and changed you will get stuck in a constant cycle of pain. The picture below explains what the ongoing cycle many people are stuck in looks like.
The only way to break free of this cycle is to learn how to move more effectively and be able to stabilize and strengthen the joints that are creating the damage to the cartilage and connective tissue. A cortisone injection WILL NOT address this problem at all leaving the body to continue to find ways to compensate around the affected area.
Okay so it is clear that cortisone injections are not good for correcting the problem what should you do instead?
Unfortunately, it is impossible for me to give you a template to follow with all the exact exercises or strategies to use to overcome this as each person is unique with the way they move, their anatomy, age, occupations, hobbies, previous injury etc. Also you cannot ignore the role nutrition, stress, and sleep play in this process. To get the more detailed overview of this and breakdown of these factors I suggest to read this article about joint inflammation and chronic pain.
However, as most of the people I see getting cortisone injections are for shoulder or hip problems I will go into more specific details for both of these areas and give you some specific ideas to explore that may lead you to the answer that is best for you.
How To Use Exercises To Reduce Shoulder Inflammation
While we have made it clear that cortisone injections are not a good solution pain relief is still something that can be very useful, especially in the early stages of rehabilitation.
Reducing inflammations allows the corrective rehabilitation exercises that will “fix” the injury to be performed more effectively, improving joint motion and muscle strength and function, which ultimately prevent the condition from recurring later on. Failure to combine an exercise program is pointless for the reason for the injury is still at large and as soon as the injection wears off the person is back to where they started, and in many cases worse off!
Why?
Reducing the pain sensation without any corrective exercise will allow the person to continue moving in the same ways that created their injury in the first place, and force the body to compensate further or create more wear and tear on other tendons and ligaments within the joint.
“Intra-articular corticosteroid injections were more effective in pain relief in the short term, but this pain relief did not sustain in the long term. Intra-articular corticosteroid injection resulted in greater improvement in passive ROM both in the short and the long terms.” – source NIH
Another factor to consider is poor diagnosis from a lack of thorough assessment. A rotator cuff injection will not help an acromioclavicular joint problem. Even though the pain may be felt in the same area, the reason for the pain is completely different. This is best addressed by careful taking a careful history and examination, as well as supporting the diagnosis with tests.
Inadequate follow-up rehabilitation and activity modification is another common reason for failure or limited success of cortisone injections. In the sporting field sometimes athletes see this as a quicker way to continue competing without missing any games for they simply don’t want to rest! Unfortunately, trying to find a short cut always ends up creating bigger problems and effective rehabilitation programs are usually very slow to produce results. This means you need to have some patience to allow the body to adapt to what you are doing and ensure you do not aggravate the area more.
There is more movement possible at the shoulder joint than at any other joint in the body and research shows that it has over 1,600 positions it can obtain! Unfortunately, this dynamic mobility with extreme ranges of movement comes at a price and exposes the joint to lack of stability. There is a constant balancing act between mobility and stability whenever we talk about the health of the shoulder
While the specific exercises I may use will differ depending on the injury the process I follow for restoring function back to the shoulder is the same. The order I use is very important to follow and this is how it works.
- Improve mobility and release trigger points
- Improve joint stability
- Improve isolated strength
- Improve functional strength
Paul Chek refers to this as the success formula and is a great way to approach an injury from a conservative approach before taking on exercises that may cause more harm or damage.
The mobility stage is often where you are able to reduce some of the pain sensitivity which is the main reason it is the very first thing you need to do. Just make sure you don’t fall into the trap of thinking you have finished the job when the pain reduces for you will still have a lot of work to do.
The big mistake people make in rehab is trying to strengthen the weak muscles first. Sure they need to be strengthened, but they can never achieve their potential while they lack range of motion, timing and freedom of movement that can only be restored using flexibility and mobility methods. Tight and dominating muscles, also known as Tonic muscles inhibit weak lazy muscles, known as Phasic muscles from firing. This is called muscle inhibition and is a massive problem to contend with for many rehabilitation programs.
The first thing to do is complete a stretch assessment of the muscles that may need to be mobilized and stretched. Never follow a template or assume muscles need to be stretched for you may be causing more harm to the joint. Having said that some of the main areas I come across are stiffness in the pecs and the infraspinatus.
You can see videos of how to release these below.
I would also include mobility work for the thoracic region as this is another hidden source of stiffness that robs the shoulder of its stability and something that is regularly missed in rehabilitation programs.
Once I have implemented a mobility program I can immediately begin working on the next phase being improving the joint stability of the shoulder. The sooner I start this the better as this is going to be addressing the underlying problem at the source.
The scapula is often the key here. There are 3 key concepts specific to ALL shoulder injuries that must be addressed. These really relate to relearning movement patterns that coordinate and sequence ideal and optimal movement mechanics.
These 3 key concepts specific to the shoulder are:
- Optimal Thoracic extension and rotation mobility
- Posterior tilt of the scapula
- Upward rotation of the scapula
The best exercises in this stage are usually body-weight resistance and very low intensity type of drills although don’t be fooled into thinking they are going to be easy as they can be very difficult to get right. One of my favourite drills is the wall slides drill shown below. This is a fantastic exercise for targeting the often very lazy and weak serratus anterior muscle that plays a pivotal role in stabilizing the scapula and shoulder.
Other variations of serratus anterior strengthening exercises in isolation along with lower trapezius exercises will also be used at this point to help set the foundation for the more integrated strengthening exercises you need to do to finish the job.
You can check out several versions of these in the article – 10 ways to strengthen serratus anterior
One exercise that is regularly used at this point in time is external rotation of the rotator cuff muscles and this is one that I tend to avoid. This is an exercise that is over-used and not fully understood and in my experience it creates more problems than it solves.
You can watch the video below with a visual of how this works or you can read more about this in the article – How good is external rotation for the shoulder?
Only mild contractions of the rotator cuff is necessary for stability and therefor rotator cuff strengthening programs DO NOT need to fatigue these muscles to improve their function. They are not designed the same as other muscles and should not be trained the same. In fact fatigue of the rotator cuff muscles can cause as much as 2.5mm of unwanted migration of the humeral head during abduction (Chen et al. 1999).
This is a big mistake often made when people use the external rotation exercises that can very quickly overload the rotator cuff muscles that may already be fatigued. When this happens they set themselves up for trigger points and a host of compensatory movements that will inhibit muscles like serratus anterior and lower trapezius.
This is particularly true of the glenohumeral joint where the primary source of stability are the rotator-cuff muscles working in conjunction with other soft-tissue structures such as the capsule, ligaments and cartilage. Strengthening is very important but you must be careful how you approach this.
Lastly, I will begin to look at integrated movements and this is where you are able to finish the job and restore full function and strength to the shoulder.
Exercises like the push-up, single cable push, rowing movements, and overhead exercises are used to complete this stage. The push-up is one of the most under-rated upper body exercises and also one of the best ways to fully strengthen the shoulder, especially serratus anterior as seen in the video below.
You will find other great exercises in the articles below.
How To Use Exercises To Reduce Hip Inflammation
Once again it is impossible for me to give you an exact recipe for every type of hip injury but I will give you an overview of exercises and methods I might use for the most common hip problem being hip bursitis and piriformis syndrome.
The first thing to look for are mobility restrictions and there could be many to investigate. The hips are designed to be very mobile and withstand both direct loading stresses and large rotational forces with weight-bearing activities, whereas the pelvis is more concerned with stability in order to preserve neutral alignment of the spine and lower limbs.
This constant interaction between these two joints can very easily be disrupted by poor movement strategies or inactivity. When this happens we often see a loss of hip mobility first, and pelvic weakness following almost instantly. Restoring the muscles involved in these regions back to normal takes more than just a hip flexor stretch and some planks. In some cases it is the hip flexor stretching causing all the trouble!
The hips are a real concern for they will steal work from the abdominal stabilizers and the glutes at the same time as they go into workaholic mode. It is not hard to see how easily back and hip problems worsen when the hips are taking over work that they are not designed to do.
Below is a great video with ideas for improving hip mobility.
I also encourage you to check out this article to get other ideas and more detailed explanations – 10 ways to improve hip mobility
The stability stage is where you may need to use a variety of exercises to target specific areas of the hips and also the core muscles. Once again I will say it is very difficult for me to give you an exact recipe or template of exercises to use here as it can vary a lot from person to person.
Most of the floor exercises are great choices to use as the person will have a better chance of achieving control over the hip joint and be able to make some progress towards better movement.
The posterior chain muscles which are made up with the glutes, hamstrings, and back extensors provide the major torque-producing capacity of the body during the activity of walking and running.
From hip extension in walking, to powerful hip extension in sprinting, these are the key muscles in use. They work very closely with the abdominal muscles, to provide core stability for the low back and importantly the hip. A strong focus on posterior chain exercises will help to address some of the typical muscle imbalances that people tend to have and one of the contributing factors to developing tight hips.
Two of the most common isolated glute strengthening exercises are the hip extension and the horse-stance or bird dog exercises as shown in the videos below.
Once I have begun working on the mobility, stability, and isolated strength of the muscles around the hip and the core I must begin working on functional movement and strength. Using a variety of glute strengthening exercises is highly recommended here as you need to ensure that the muscles are activated in several different positions to guarantee they fire correctly. A big mistake many people make is concluding they have improved their strength based on the results of one or two exercises. They may be strong in these but it does not mean it is strong in other positions that require a different type of stability and where the muscle fibres are placed in a less favourable angle to fire at their full potential.
This is where the value of the Romanian Deadlift comes into action and something I have discussed numerous times in articles about injury and movement.
I will not go into too much detail about the deadlift as you can check it out in the more detailed article – Why the Romanian Deadlift is the key to treating hip and back injuries
With most common hip problems such as femoral acetabulum impingement (FAI) and Piriformis Syndrome, you will find weakness in the posterior muscles of the glutes and the beginning of what is referred to “anterior femoral glide syndrome". This is where the femoral head has moved excessively forward and is overly compressed in the acetabulum, creating the impingement feeling at the front of the hip and a reaction of trigger points in the glutes to try to restore the lost stability.
Many back pain sufferers will find it is in this movement that their back injury occurred. In particular with a disc bulge or herniated disc injury it is the FAULTY BENDING ACTION that created the pain. This exercise requires massive mobility of the hips, known as the hip hinge to protect the lumbar spine from flexing and squashing the discs and facet joints of the spine.
Learning the skill of how to do this comes first but then applying loads and developing strength is what makes this movement so strong. The glutes become more powerful and no longer do you need your hips and lower back to produce the necessary power for lifting objects that we do in daily life every day.
Using Slow Training Tempos To Increase Connective Tissue Strength
Now that you have all the exercises in place it is time to rebuild the strength of the injured tendon as much as the muscles that support the joint. The first thing most people think about when trying to get stronger is to increase loads on various exercises. The bigger the load the stronger you will become is the thinking. While this is definitely one way to increase strength and something we all should aspire to, it does pose serious risks to the joints if the exercise is not controlled correctly. Secondly, this type of thinking does not consider the role our connective tissue plays in providing structural integrity to protect our joints from injury.
One part of the strengthening process that is overlooked is the importance of using exercise methods to improve your collagen levels. Collagen is the second most abundant substance in the human body (water is number one). It provides structural support for our organs and soft tissue and as you age your body produces less collagen. By age 60 your body produces 50% less collagen which is related to saggy skin, aching joints, and muscle tissue loss. We cannot change the aging process but we can prevent it from accelerating or beginning too early in our body due to inactivity or injury.
Our joints and muscles are bound together by connective tissue and this tissue consists of tendons, ligaments, cartilage, intramuscular, and fascia.
When we apply muscular force we tend to think it is all due to the muscle fibres contracting, when in reality a lot of this has to do with the ability of connective tissue to transfer the force. Research indicates it is as much as 80% of muscular force transfers to the connective tissue. Connective tissue acts like a shock absorber to the joints, and the more you have the better. All of these connective tissues are all primarily made of type 1 collagen.
If you lift weights with deliberate slow movements you can improve the strength of individual collagen fibres and allow your body to rebuild much stronger and resilient connective tissue structures. This is extremely important for those suffering with chronic joint pain and osteoarthritis for it can be very tough trying to restore stability to the joint improving mobility and function.
If you are someone who is constantly getting injured it is often due to the fact that your collagen fibres are not correctly aligned to form a basket weave pattern in the connective tissue that provides a strong and healthy structure for movement. The collagen that is impaired by scar tissue tends to heal in a parallel pattern as opposed to the cross weaving pattern that is significantly stronger.
The reasons for the poor healing could be due to several factors ranging from poor movement patterns, poor nutrition, lack of sleep, poor recovery after the injury, or introducing loads too soon. Anyone of these factors will not allow for the fibres to heal correctly leaving the connective tissue weak and prone to re-injury.
This is where you can use various strength training methods such as isometric and eccentric training to not only deliver massive strength gains with little risk of more damage, but also improve the collagen fibre alignment that may be leaving your joint exposed to further injury.
The videos below show several versions of how to do this for upper body and lower body exercises.
Do You Need More Help?
If you currently suffer with knee, back or shoulder injuries you will find our online programs shown below a great resource that take you through all of the assessments and corrective exercises to get you back to full strength and out of pain. You will find a lot of the exercises in the first phases of the rehab programs feature several of the relief exercises discussed in this article.
Summary
I apologize for the length of this article as I wanted to leave you with some ideas of what to do instead of having a cortisone injection instead of just telling you why it is not a good idea to take this path. I only briefly touched on these concepts so I encourage you to click the links to the more detailed information and exercise variations you need to use for your current problem.
The main thing to understand is that a cortisone injection WILL NOT address the source of the problem, or the reason for your pain. If you are using a lot of NSAID’s as well as this you are most likely going to further weaken the tendons and connective tissue resulting in more weakness, stiffness, and pain.
While it is a slower process of trying to address mobility, stability, and strength deficits it is a much better outcome long term. I hope this article gives you some ideas and helps you break free of a vicious pain cycle.
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.
If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 18 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Built From Broken - Scott Hogan CPT, COES
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Surgery The Ultimate Placebo - by Dr Ian Harris
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Core Stability - by Peak Performance
- Athletic Body in Balance - by Gray Cook
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek
- Twist Conditioning Sports Strength - By Peter Twist
- Twist Conditioning Sports Movement - By Peter Twist
- Functional Training For Sports - By Mike Boyle