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KNEE INJURY AND CORTISONE 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 (see research paper), 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. In a study conducted by
Siraya Chunekamrai, D.V.M., Ph.D.,
steroid shots, of a substance commonly used in humans, were given to horses.
The injected tissue was looked at 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 methylprednisolone acetate (steroid) were not ameliorated at
eight weeks after eight weekly injections, or 16 weeks after a single
injection. Cartilage remained biochemically and metabolically impaired.”
In this study, some of the joints were injected only one time. Even after one
steroid injection, cartilage remained biochemically and metabolically
impaired. Other studies have confirmed similar harmful effects of
steroids on
joint and cartilage tissue. A cortisone shot can permanently damage joints.
Prolotherapy injections,
(Watch where do
Prolotherapy injections go and do they hurt?)
have the opposite effect—they permanently strengthen
joints, ligaments, and tendons. 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. Cortisone is so dangerous to
the athlete because it inhibits just about every aspect of healing. Cortisone
inhibits prostaglandin and leukotriene production. It also inhibits
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. They also reported a
progressive loss of endoplasmic reticulum, mitochondria, and Golgi apparatus,
as the number of injections increased. Exercise has the opposite
effect. Exercise has been shown to positively affect articular cartilage by
increasing its thickness, enhancing the infusion of nutrients, and increasing
matrix synthesis. However, the effects of doing them together were not studied
until recently. Dr. Prem Gogia and
associates at the Washington University School of Medicine in St. Louis,
Missouri, did an excellent study bringing out the dangers of an athlete
exercising after receiving a cortisone shot. They divided animals into three
groups: 1. Group One: received a cortisone shot 2. Group Two: received a cortisone shot and exercised 3. Group Three: control group, received no
treatment This study was done in 1993
and was the first study to look at the effects of exercising after receiving a
cortisone shot. The authors performed this study because it is common practice
in sports medicine to give an athlete a cortisone shot for an acute or chronic
injury. Athletes are typically returning to full-intensity sports activities
within a few hours to one to two days after receiving the shot. The results of
the study were unbelievable. The animals receiving the cortisone shots showed
a decrease in
chondrocytes, but when they received the cortisone shot and
exercised, the chondrocyte cell count decreased by another 25 percent.
Degenerated cartilage was seen in all of the cortisone-injected animals, but
severe cartilage damage was seen in 67 percent of the animals that exercised
and received cortisone. The cortisone and exercise group also showed a
significant decline in glycosaminoglycan synthesis compared to the other
groups. The authors concluded, “...the results suggest that running exercise
in combination with intra-articular
injections results in damage to the
femoral articular cartilage.”
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information only and not a self-help guide NOR AS SPECIFIC HEALTH
RECOMMENDATIONS. Never alter or change your health management or begin
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