I think that the Lancet findings are definitely believable in that cortisone injections are effective in acute symptom management of certain overuse tendinopathies such as lateral "epicondylitis"; short term but effective option for a chronic problem
Things to keep in mind:
- overuse injuries are probably the "victim" so the main part of the treatment is to find the "culprit"
- cortisone is great for managing the symptoms that should allow the patient to perform the proper rehabilitation and equipment adjustment that is causing/contributing to the problem; essentially it's a bandaid for relief
- patients who do respond well to cortisone injections may feel so good that they go back to their activity at 110% and re-trigger the cycle; therefore educating the patient about level of activity they can return to is key
So things that make tendinopathies worse:
- misdiagnosing (make sure an elbow problem is really an elbow problem)
- overtreating a symptom (i.e. multiple steroid injections)
- not treating the underlying problem (i.e. training errors, kinetic chain)
- patient education
