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CORTISONE SHOTS
Ross Hauser, M.D.
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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MY TOP TEN REASONS NOT TO GET A
CORTISONE SHOT
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