Reprinted without permission from
[email protected] (Ross Hauser, M.D., and Marion Hauser, M.S,R.D.).
YOUR QUESTIONS ABOUT STEROIDS AND CORTISONE ANSWERED
The quickest way for an athlete to lose strength in a joint is to inject cortisone in it.
Corticosteroids, such as cortisone and Prednisone, have an adverse effect on bone and soft tissue healing, they inactivate vitamin D, limiting calcium absorption by the gastrointestinal tract, and increasing the urinary excretion of calcium. Bone shows a decrease in calcium uptake with cortisone use, 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 in articular cartilage, by inhibiting chondrocyte production, the cells that comprise and produce 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. Although anti-inflammatory medications and steroid injections reduce pain, they do so at the cost of destroying tissue.
The problem with athletes is that they look for quick relief. The problem with cortisone is that the athlete may get pain relief, but it may be at the expense of permanent inability to participate in athletics. Athletes often receive cortisone shots in order to play. They go onto the playing field with an injury of such significant magnitude that they received a cortisone shot to relieve the pain. Unfortunately, they cannot feel the pain anymore so they play as if there was no injury. We know that the injury could not possibly be healed because of the tremendous anti-healing properties of cortisone. Thus the athlete is further injured from the cortisone, as well as playing with an injury, thereby worsening the already bad injury.
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