CORTISONE SHOTS
Ross Hauser, M.D.
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In my opinion, receiving a
cortisone shot is one of the quickest
ways to lose strength at the ligament-bone junction (fibro-osseous
junction).
Cortisone and other steroid
injections have the same detrimental
effects on anticular
cartilage
healing.
Corticosteroids, such as cortisone and Prednisone. have adverse effects on
bone and soft tissue healing. Corticosteroids inactivate vitamin D, limiting
calcium absorption by the gastrointestinal tract and increasing the urinary
excretion of calcium. Bone also shows a decrease in calcium uptake,
ultimately leading to weakness at the fibro-osseous junction.
Corticosteroids also inhibit the release of
Growth Hormone, which further decreases
soft tissue and bone repair. Ultimately, corticosteroids lead to a decrease
in bone,
ligament, and tendon strength.
Corticosteroids inhibit the synthesis of proteins,
collagen,
and Proteoglycans,
particularly cartilage, by inhibiting chondrocyte production which are the
cells that comprise the articular
cartilage. The net catabolic effect
(weakening) of corticosteroids is inhibition of
fibroblast production of collagen,
ground substance, and angiogenesis (new blood vessel formation). The result
is weakened synovial joints, supporting structures, articular cartilage
ligaments, and tendons. This weakness increases the pain and the increased
pain leads to more steroid injections. Cortisone injections should play
almost no role in sports injury care or pain management.
Although anti-inflammatory medications
and steroid injections reduce pain, they do so at the cost of destroying
tissue. In a study conducted by Siraya Chunekamrai, D.V.M., Ph.D., steroid
shots were given to horses with a substance commonly used in humans. The
injected tissue was examined under the microscope. The steroid shots induced
a tremendous amount of damage including chondrocyte necrosis (cartilage cell
damage), hypocellularity (decreased number of cells) in the joint. decreased
proteoglycan content and synthesis, and decreased collagen synthesis in the
joint All of these effects were permanent.
Dr. Chunekamrai concluded, "The effects on cartilage of intra-articular
injections of methylprednisol one acetate (steroid) were not ameliorated at
eight weeks after eight weekly injections, or sixteen weeks after a single
injection. Cartilage remained biochemically and metobolic impaired." In
this study, some of the joints were injected only one time. Even after one
steroid injection, cartilage remained biochemically and metabolic impaired.
Other studies have confirmed similar harmful effects of steroids on joint
and cartilage tissue. A cortisone shot can permanently damage joints.
Prolotherapy injections have the opposite effect, they permanently
strengthen joints.
Unfortunately, many athletes or people suffering with
chronic pain
look for quick relief without thinking about the long term, potentially
harmful side effects that could occur The problem with cortisone is that
immediate pain relief is possible, but in reality it may be permanently
reducing the ability to play sports long-term. Athletes often receive
cortisone shots in order to he able to play. They then go onto the playing
field with severe injuries that required cortisone shots to relieve the
pain. Because they fed no pain, they play as if the injury does not exist.
The injury will unfortunately never heal because of the tremendous
anti-healing properties of cortisone The athlete is therefore further
injuring himself by playing. The same goes for the chronic pain sufferer who
is trying to be able to return to normal function.
Cortisone is dangerous because it inhibits just about every aspect of
healing. Cortisone inhibits prostaglandin and leukotriene productions. They
also inhibit chondrocyte production of protein polysaccharides (proteoglycans),
which are the major constituents of articular ground substance. Behrens and
colleagues reported a persistent and highly significant reduction in the
synthesis of proteins, collagen. and proteoglycans in the articular
cartilage of rabbits who received weekly injections of glucocorticoids.
HOW CAN YOU SAY CORTISONE SHOTS ARE BAD WHEN
THESE ARE COMMONLY GIVEN TO ATHLETES?
Athletes are primarily given NSAIDS
(nonsteroidal anti-inflammatory drugs)
and steroid injections because it is the standard of care. Just because
something is the standard does not mean it is correct. Cortisone and other
steroid shots are given to athletes joints, especially the knees, when
exercise and NSAIDs don’t relieve the pain. In essence, they are given
because the family physician, team physician, or orthopedic surgeon has no
more treatment options. As depicted in Prolo Your Sports Injuries Away!,
continued pain in the athlete signifies that a structure is still injured.
Nutritional supplements such as glucosamine, MSM, bromelaines and others
help athletes heal sports injuries. In addition, the athlete may need
Prolotherapy to directly stimulate the joint or joint structures to heal.
WHAT CAUSES ARTHRITIS?
It is commonplace of an athlete to have a sports injuries and go through
exercise, physical therapy, NSAIDs, then a stronger NSAID, and eventually
progress to cortisone shots. Once this level of care is reached it is only a
matter of time before arthroscopies follow. Arthroscopies are offered to
‘clean up’ the area. They do not repair anything typically just scrape away
damaged tissue. Well the athlete should be asking “why is the damage there?”
It is there because of all the NSAIDs and steroid injections, which were
given by the same physician that is going to the
arthroscopy
and eventually the joint replacement.
If one looks at the pathophysiology of arthritis it is clearly a condition
that occurs when a joint becomes loose because of
ligament injury.
Non-healed ligament injury causes an excessive amount of pressure on the
other joint tissues such as the
menisci.
Once these go, the cartilage deteriorates. Arthritis means that the joint is
deteriorated as manifested by a thinning or degeneration of the joint.
Excessive bone forms to try and stabilize the joint which is loose from the
underlying
ligament laxity.
Ligament laxity or weakness is thus the underlying problem in most
degenerated joints. Because Prolotherapy gets at the root cause of arthritis
it is very successfully in treating this disorder. Prolotherapy helps all
stages of arthritis but is best done as early as possible. Prolotherapy can
help stimulate the repair of all the structures inside the joint including
the ligaments, tendons, menisci, cartilage, and joint capsule. Prolotherapy
is the future of sports medicine and eventually will be the future of
arthritis care.
AS AN ATHLETE CAN I PREVENT MYSELF FROM GETTING ARTHRITIS?
It is extremely easy to prevent arthritis from forming. All an athlete has
to do is heal completely all sports injuries. Since physicians who utilize
Prolotherapy are experts in ligament injuries it is best to have one of them
on the athletes treatment team. Prolotherapy physicians can help an athlete
determine when complete healing has occurred. If an athletes ligaments and
tendons are as strong or stronger than before the injury there is no risk
for arthritis forming in the future. If an athlete continues to play on an
injured joint or ligament then arthritis is sure to form. It has to!
Arthritis is the bodies response to stabilize a loose joint. A bone spur or
bone overgrowth is occurring because the underlying joint and joint
stabilizing structures (ligaments) are still weakened and stretched. By
obtaining Prolotherapy and strengthening the weakened structures, the
impetus for the arthritis forming stops and so does the pain.
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