Hip Pain - sorted with a cortisone injection anyone?

Cortisone is a trash intervention, sorry. It will temporarily treat symptoms at the expense of further damage in the long term.

My opinion only, I'm sure a medical pro will come along to tell me why I'm wrong shortly and how it can help calm down inflation. Meanwhile my big toe is still ****ed from being subject to a lazy cortisone approach (rather than trying to diagnose the root cause of the problem) a decade ago.

@finbar surely the correct approach would be deal with the short term pain and at the same time beginning the journey of diagnosis and hopefully treatment.

Following this as similar injection is on the roadmap for me.

My mate was warned of cortisone for his hip problem as it can cause more issues long term.

I also get similar pain as you describe and find plenty of hamstring stretching really helps, as well as core exercises. Ask a professional to suggest specific stretches rather than the basics.

@goldfish24 - but if cortisone helps short term while longer-term doing more damage (which you can find [url= https://www.thesportsmedcenter.com/blog/cortisone-injections-the-good-and-bad#:~:text=When%20used%20in%20a%20controlled,can%20damage%20cartilage%20and%20tendons. ]information[/url] about online), I - personally - would rather just grit my teeth in the short term while I hopefully find a proper solution.

Unfortunately I didn't know that when I had my big toe injected and I think that's why its arthritic now age 40.

Any one had a cortisone injection and has it helped?

Yes, but shoulder not hip, after six weeks, as predicted, the pain returned.

Not in my hip, but in general they've helped me:
Heel; seemed to solve the actual issue (bursitis iirc)
Knee; really helped with the pain leading up to my knee replacement.
Wrists; been having them for a handful of years now for OA, I've been told when they stop helping they'll get fused.

But I think you need to have some proper diagnosis of what your issue is before you know if you need an injection or if it's even appropriate for the issue?

I’m waiting for an injection in my hip, but that’s after being diagnosed with labral tears in both hips, over growth of bone, and my cartlidge generally being knackered.

And hip bursitis

All this was diagnosed with X-ray and MRI.

Injections are not great in the long term, something that I asked my consultant and he said true but your hips are on the way out anyhow.

Go for a consultation with a consultant, get the right diagnosis and then see what the consultant says needs  doing

You've jumped quite a few steps by going straight to a cortisone injection after one month of pain, tbh. With any patients I've treated who have been referred for one it's been administered much further down the line, after more conservative approaches (ie exercise etc) have failed. Always struck me as a bit if a last ditch 'well we've tried everything else, let's hope this works well enough to avoid surgery' kind of a solution.
Results are really varied, sometimes it works wonders, other times patients end up blaming all their problems on it. Simply put, it's a powerful anti-inlammatory which lasts a couple of weeks, and that's pretty much it. Any long term relief is theorised to be due to the patient being able to be more active again, with all the benedits that that will provide. I don't know why some patients end up in such a bad way afterwards, it is possible that they were heading that way anyway, and the injection is something tangible that they can hang their blame on, but I'm not aware of an evidence base to suppport that. Maybe there is someone with better knowledge than me who has a more confident explanation for that one

Your money would be more effectively spent on a physio, especially as you have already paid for an NHS one

Injections are a 'sticking plaster' - you reay need to find the cause. And it's not pleasant. I've had them in my shoulder before needing surgery, and in my back (this was following a broken spine though as part of the treatment - that worked in one treatment)

Any one had a cortisone injection and has it helped?

Yes, a few. I  also had surgery on both hips prior to this (one twice) the injection helped it settle down a few time after so that I could actually do some physio

I have suffered similar transient hip and groin pain in the past and it has normally been a psoas or piriformis problem that has gone away after doing some pressure release exercises. The piriformis in particular has caused some very odd discomforts in hip and knees, and it is very easy to interpret them as the result of something very different.

There's plenty of you tube tutorials on how to release the two muscles.

Whats the jab fixing?

Go get a scan, see a good physio

@finbar yep totally fair, I have no relevant experience other than knowing not to shy away from pain relief when needed. But wise words if, indeed, this is the case

it can cause more issues long term.

I had one in the past but it was a temporary measure and to be honest the only time my hip has felt strong has been after regular physio and doing some regular glute and mobility exercises.

I've got a torn labrum in left side. It gets aggravated at times but I really feel I'm to blame a lot of the time for neglecting good physio exercises.

Sorry, can't help with the injection thing (I'm actually waiting for an NHS physio appointment precisely because I was pushing my doctor for an injection, they want to start with physio).

But I do recognise virtually all your symptoms as being similar to mine and whilst waiting for the NHS physio I've grudgingly come round to the conclusion I suspect my doctor had reached which is basically it's muscular, not an inflamed S.I. joint like I was sure it was.

Quadratus lumborum, piriformis and TFL all do funny things to the hip and low back and all get overworked and tight if the glutes aren't doing their job. It's amazing how much I have to focus just to get my right glute in particular to engage AT ALL when deadlifting, my body just seems to resort to using low back muscles or the piriformis.

I also wonder how much money I've spent on saddles to resolve what feels like chafing at the 'crease' at the top of the thigh but which I'm now sure is something to do with the piriformis trapping the sciatic nerve 🙄

Thanks for the input folks. The guy I’m going to see is an NHS physio who also has a private practice. He was recommended to my wife for a frozen shoulder. He does a bit of cycling himself so hoping he can pinpoint the issue. If it doesn’t need an injection I’m pretty certain he won’t do it but will point me in the right direction for the treatment/ care I’ll need to put it right. Appt is next Tuesday so I’ll update after that.

Yeah, had it in the hip and shoulder, i'm getting my hip replaced in 4 weeks, hence why i was down for the injections, they only last a few weeks though, and basically just hide the underlying issue, i stopped after one as it was just pointless, as it's also done under X-Ray it means it runs out long before you get another injection.

The one good thing about it is if it doesn't work, then they are able to work out better what is wrong, as it only works in certain injuries.

Reducing inflammation can buy you a few weeks to do the physio and exercises to address the root cause. Is the thinking, but there should be a fair bit of physio before you get there. Had it on my ****ed shoulder after bouldering wall on top of mtb, surfing and weights just tipped it over the edge basically (and yeah I've done all the rotator cuff stuff, pilates etc forever). Didn't want to do it, but good physios also sometimes give cortisone injections (actually it was my bodybuilding gp after I'd said no to the physio).

And so far so good. Just wanted to give a counter view. Could be worth a try basically if you're in too much pain to do the exercises to address whatever the issue is. Does sound a bit early for the OP, but physio should know rather better than me.

Long and short of it is that they can be helpful, but it depends on the condition.

If it’s Trochanteric bursitis, AFAIK (not a musculoskeletal specialist) then I believe it’s the first line treatment of choice, followed by physio if not effective.

Trochanteric bursitis can occur in cyclists if the saddle is too low.

If it’s osteoarthritis (wear and tear), then it’s a stop gap, with the proviso that it can then accelerate further deterioration (although not necessarily pain) in the joint.

If it’s an inflammatory arthritis (rheumatoid, psoriatic or undefined) then I believe that they can be helpful in quieting the inflammatory process, but that’s quite a specialise area, usually done in consultation between rheumatologist and specialist orthopaedic surgeons.

Trochanteric bursitis can occur in cyclists if the saddle is too low.

Because the hip is too flexed?

I was doing some more reading on this yesterday and began to wonder if that was my issue, general advice seems to be adapting the tendons to load with lots of low intensity glute stuff.

@13thfloormonk

Because the hip is too flexed?

I believe so, yes. Usual caveats apply, I’m not a specialist in this area.

I think that one of the problems is that part of cycling is turning off the pain. When we’re young we can get away with a poor bike fit because we do this, and recover quickly. As we get older, not much.

I keep thinking about trying shorter cranks to reduce hip flexion but I've got at least 3 bikes in constant rotation, would get expensive! 🙄

Following with interest, similar pains and physio exercise don't seem to sort it (but I have basically given up as it wasn't giving any results, so now I do little)

Recently stuck a shorter +16 stem on the road bike.  Looks dorky, but instantly felt more comfortable then when stretched out with a negative stem.  Hoping this may translate into less pain

@shermer75

I don’t know why some patients end up in such a bad way afterwards, it is possible that they were heading that way anyway, and the injection is something tangible that they can hang their blame on, but I’m not aware of an evidence base to suppport that.

There is evidence indicating that long-term damage from cortisone injections isn't just psychosomatic e.g.
https://pubs.rsna.org/doi/10.1148/radiol.2019190341

Update: So I had my appt and after talking to the physio ( who was quite a competitive cyclists in his day and still does triathlons) and having an ultrasound scan it seems I have hip impingement. It is a CAM type so basically the ball on the top of my femur that fits into my hip socket has a slight deformity which means that as my leg/knee moves up as I pedal this cam is agitating the edge of hip socket. It’s not too bad and staying off the bike for 6 weeks has meant it has settled down a lot. I didn’t need an injection as there doesn’t seem to be too much inflammation. He says it is something that can be common with cyclists and could either be a result of  years of cycling or a natural deformity ( he scanned both hips and they are the same). He manipulated my hip joint and was happy I had plenty of movement but my legs/hip area is very very tight. He has given me some stretching exercises to do. Also thought it might be useful to try some shorter cranks and reduce stack and reach on bikes. ie: more upright position. Overall I’m very happy with him and glad it’s something I can probably manage myself at the moment.

thats good news.

Don't suppose the physio is anywhere near southampton?

Unfortunatley he's in Wakefield, West Yorkshire. I believe he has a clinic in Sheffield too.

So my next question is, I've ridden 175mm cranks on mtb and 172.5 on road bike forever. If I change to 170mm will i be able to tell?. From what I've read it will open out my hips a little but how much difference can 5mm make?

Just make sure to keep it monitored for the flexibility in the joint, if it's getting more restricted then you may need more checks, i started out like you, hip impingement, bone spur, then over a few years it got more and more locked in, full hip replacement in a couple of weeks will fix it, but not going to be pleasant, so keep an eye on any deterioration through the physio.

You'll not really tell. 3 of mine are 170mm (road and CX) and two 175mm (MTBs) - difference not noticed in pedal stroke but Q factor is when switching to road shoes/pedals, rather than SPD.

Before spending on kit, get those stretches done, see Physio again.

Great to hear it went so well! FAI is one of those things that need to be managed, rather than cured (there isn't really a cure, you're just unlucky that your bones are shaped that way). Sounds like the physio gave really sound advice, you should be in good hands there. As explained, with FAI there is a bit less space than is ideal bewteen your femur and your pelvis when in hip flexion (knee moving towards chest), so any repetitive movements in that direction is risking irritating that area, and therefore anything that reduces that repetitive compression will help (hence the shorter pedals, increased stack height, etc)

Cortisone is a trash intervention, sorry.

+1

 I didn’t need an injection as there doesn’t seem to be too much inflammation. He says it is something that can be common with cyclists and could either be a result of  years of cycling or a natural deformity ( he scanned both hips and they are the same).

You will have to just hope you dont start getting a labral tear.

How much did he charge for all this?

Cortisone is a trash intervention, sorry.

But his hip is on its way out anyhow so its just how much pain is he really in as to does it warrant an injection.

Cortisone is like fixing a knocking engine by turning up the radio.

Lots of cortisone haters eh?

Well I'm not saying it's right for the OP and neither is his physio, but if you were in pain all the time with knackered joints you may have a different view.

In my case it's done a great job of managing pain until a knee replacement and it's managing wrist pain until radius ulnar fusions some where down the road. The alternative being naproxen which is horrendous for your gut.

I'm not saying it's great, but neither is it evil, it has its place.

Cortisone is like fixing a knocking engine by turning up the radio.

Well, maybe if it's a knocking engine that has been doing your head in for months or even years, and numerous mechanics have struggled to diagnose or fix it, and you suspect it will take many more months of tedious home mechaniccing to fix (stretching the analogy a bit here...) then perhaps turning up the radio for some blessed distraction for a wee while is no bad thing.

I pushed the NHS hard for a steroid injection on my S.I. joint as the pain was just constant and really affecting my quality of life. Thankfully up where I am you are required to jump through all sorts of hoops to get a steroid injection and private is too £££ so I've stuck with the physio and am finally getting somewhere...

Cortisone injections have IIRC a rather poor evidence base - and hugely depends on the skill of the person doing it.

I was offered one - I refused

FunkyDunc - he charged £90.  I was in there for about an hour and ten minutes. Never felt rushed or under any sort of time pressure. As stated in original post he was recommended to my wife so it seemed logical to give him a try. I think I’m just happy that it’s not falling apart and I can manage it at this stage.  I’ve started to adjust a few things on bike and had a spin on turbo. Hip seems to be ok. Didn’t feel any discomfort but was only very low watts.
The pain I was in when it really flared up was agony. My back was in spasm and I was hobbling round like a robot. I couldn’t sleep properly so if an injection would have brought some relief I would have taken it and will if I need one in the future.  The physio does guided injections and I’m pretty sure he knows what he’s on with. His clients include footballers, boxers and cyclists so he’s got some experience.

The injection for the hip was great, it removed the constant pain, that caused imbalance, lack of mobility, etc, but it only lasts 6-8 weeks, and requires being done under X-Ray and has a long wait list. When my first (and only) injection stopped working after about 6 weeks, it was another 50 odd weeks later that i got offered the chance of another, so i'd say definitely not trash, but don't expect it to do anything but short term relief, and as others say, it's best done on a hip that's on its way out, to have it as pain relief for something that's just inflammation or the likes, i wouldn't even contemplate it, you just have to look at a lot of older footballers and other sportspeople to see the damage cortisone did to them over the years.

Good news you're diagnosed and exercises recommended, hope they help manage any pain. I've got FAI and a labrum tear - just the way my hips developed (or didn't!) as both the same. It was Professor Tim Board (Wrightington) who finally got to the root cause. Do manage it, does worsen if overloaded, do need to get back swimming as non load bearing exercise helps. Cortisone didn't touch it TBH...though that was a different consultant.

I swam from being 3 years old and til I was 21 it was my thing. I reckon I could still knock out a sub 35 sec 50metre crawl. Might have to dust off the budgie smugglers..

I think I’m just happy that it’s not falling apart and I can manage it at this stage

FAI is not progressive, no reason why you shouldn't comfortably be able to make that hip outlast the rest of you