Prolotherapy Newsletter | Ten Reasons Not To Get Cortisone | Ross Hauser, M.D., Marion Hauser, M.S,R.D.

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Caring Medical and Rehabilitation Services Oak Park 708-848-7789

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

“My doctor wants to give me a cortisone shot. What do you think?” “Cortisone helped me before, why shouldn’t I get another shot?” “Is Prolotherapy going to hurt like a cortisone shot?"” The questions go on and on. The mighty cortisone shot has its supporters, but they are rapidly declining. As books such as Prolo Your Pain Away! and Prolo Your Sports Injuries Away! gain in popularity, and when people finally realize what cortisone is doing to their bodies, they will revolt and seek out alternatives such as Prolotherapy. Below are my top ten reasons for not getting a cortisone shot. For those desiring scientific support for this, please read the two books mentioned above.

Reason #1: Cortisone Inhibits the Healing of Injured Connective Tissue

Pathophysiology 101 is that the body heals by inflammation. No inflammation, no healing. It is that simple. When a person sprains an ankle, the persistent swelling for one to three days is the body’s attempt to heal the area. If you want to stop healing, just stop inflammation. This is exactly what cortisone does.

One of the first people to determine the effects of cortisone on ligament, tendon, and joint healing was George S. Hackett, M.D., who coined the term “Prolotherapy”. In the mid- 1950s, he did studies where he injected injured ligaments, tendons, and joints with various agents, including cortisone. He found that cortisone inhibited the healing of these stretched and torn connective tissues, but that if it was mixed with a proliferant (Prolotherapy) it was strong enough to even inhibit the healing from Prolotherapy.

Reason #2: Cortisone Inhibits the Healing of Prolotherapy

Modern medicine has forgotten the first rule of healing: The body heals by inflammation. The whole inflammatory cascade, including phagocytosis (immune cells cleaning up the area), angiogenesis (new blood vessel formation), and fibroblast formation (new collagen formation) is inhibited by cortisone. Cortisone also inhibits the migration of the immune cells to the injured area. This migration and repair process is what causes the pain. Cortisone inhibits this repair, so the person feels better. The person getting a cortisone shot sacrifices healing for pain control. This is a bad choice because they now have a weakened structure that they think is fine - so they continue to do sports and activities, not realizing that they are accelerating the degenerative process.

Reason #3: Cortisone Accelerates the Degenerative Process

Cortisone, by inhibiting the normal healing inflammatory reaction, accelerates the degenerative process in the tendons, ligaments, and joints in which it is injected. It also gives the person a false sense of security that the area is healed, when it is not. The combination of a cortisone shot and follow-up exercise is an exceptionally deadly combination for cartilage. Nothing but arthroscopic shaving will degenerate cartilage quicker. If you don’t believe it, look at the studies in the book Prolo Your Sports Injuries Away! Curing Sports Injuries and Enhancing Athletic Performance with Prolotherapy. Studies on animals have shown that even one cortisone shot into an area has been shown to cause irreversible biochemical damage to joints and cartilage. One of the quickest ways to cartilage deterioration and/or a hip or knee replacement is a cortisone shot into these areas.

Reason #4: Cortisone Shots Mask the Pain and Injury

Cortisone, by blocking the healing, does not allow the injured structure to send off a pain signal that something is wrong and needs to be fixed. Cortisone, at best, then just masks the pain and injury. The injury continues, but because there is no pain signal, the person thinks everything is okay, when it is not. The only thing that can occur is that the injury continues and accelerates. If the cortisone shot was really “successful,” the injured structure may be permanently unable to fire a pain signal, and thus will not hurt anymore. What more commonly happens is that the structure further deteriorates to the point that it overcomes the inhibitory effects of the cortisone shot and starts to hurt. The problem is that the person runs back to their Orthopedist for another one of those “wonderful” cortisone shots; never realizing that the very shot is what is causing their pain and accelerated joint destruction. Such a person is on a slippery slope that could end their athletic career. What is forgotten are the thousands of people who are unable to enjoy their retirements and are in nursing homes because they have lost the ability to walk because of severe hip, back, and knee arthritis. The cause is never spoken about - except here and in our books. The cause of most unhappy retirements is because of Cortisone Shots! Their cousins the anti-inflammatories, of course, are also to blame.

Reason #5: Cortisone Shots Cause People to Need Joint Replacements

Nothing can degenerate a joint quicker than a cortisone shot (except, perhaps, arthroscopy with cartilage and meniscus shaving). The number of joint replacements in this country will soon reach 1 million per year. Your risk of needing a joint replacement is about one in ten. Ten percent of people in the US will get a joint replacement. Guess what the percentage of those needing a joint replacement are those who have had a cortisone shot? Correct, just about 100%. You want a joint replacement? Just keep having cortisone or its cousins injected into your joints, ligaments, and tendons. Cortisone is a poison to the connective tissues of the body, including cartilage, muscles, ligaments, menisci, and tendons. Thus, when cortisone is injected into these structures the death of cells is seen. You want to see the death, read Prolo Your Sports Injuries Away!. What, are you chicken? Don’t like to see death? I don’t blame you, but I do blame cortisone.

Reason #6: Cortisone Shots Cause People to Need Surgeries by the Same People That Gave the Shot!

Most cortisone shots for pain are given by Orthopedic Surgeons. Surgeons love surgery! When they give people cortisone shots, they are doing it in good faith, never realizing that the very shot they are giving will help land the person in the surgical suite. Cortisone helps land people in the arthroscopy suite to get their “damaged” menisci, ligaments, tendons, and cartilage shaved. The orthopedist and the patient never have a clue that it was the anti-inflammatories prescribed by the orthopedist and cortisone shots given by him/her that was the cause of the damage. You have a damaged joint or spine! Wake up before it is too late. Anti-inflammatories and cortisone shots are what are causing people to need laminectomies, discectomies, fusions, tendon repairs, and other salvage operations. Salvage your spine and joints before it is too late. Just say “no” to cortisone.

Reason #7: Cortisone Shots Cause Premature Aging

Healthy aging involves being active for life. It means being like the Walgreens who saw me the other day. The Mr. Walgreens I saw was the son of the founders of the Walgreens Pharmacy chain. He ran the company for 25 years. The first Walgreens pharmacy store was in the Chicagoland area. When I saw him the other day, he was 94 years old. This time he brought in his bride (his wife of decades) who was 92. They still travel around the world. Mr. Walgreens had such a good response to his first set of Prolotherapy injections that he wanted his wife to experience the power. They are still active in their community, family, and life in general. They were committed to being active for life! Being 70, 80, or 90 does not mean “nursing home time.” As long as a person makes sure that injuries heal, there is no reason they cannot be active for life! Once cortisone enters a joint, tendon, ligament, cartilage, or menisci, then complete healing is inhibited. Suppressing an injury is a great prescription for later-in-life immobility, pain, anti-inflammatories, surgery, or in summation, premature aging.

Reason #8: Cortisone Shots End Dreams

They come in every day to Caring Medical in Oak Park. Men and women who now can’t even walk without pain, but yet in their day they were “dream makers”. The superstars of yesteryear are now left hobbling along. Even sadder are the elite atheletes who come in to have their dreams dashed by a degenerated joint caused at the hands of their “team physician”. Everybody loves a star athlete, but take away that athletic prowess and then who loves them? Nobody, except mom, dad, significant other, and Prolotherapist. That is it.

Prolotherapists love to help people regain their dreams. The dream is playing in the NBA, PGA tour, or perhaps just getting back to the high school team pick-up games on the weekend, or the tennis matches on the weekend. Whether we want to admit it or not, athletic activities, exercise, and being active are very important to all of us. Sure guys watch too many athletic events on T.V. But take away the ability to be active for any of us, and panic hits. Most of the time this inability to play sports or exercise is in part due to a cortisone shot. Show me a chronically injured joint and I’ll show you where cortisone has been. Don’t end your dreams by getting a cortisone shot. You can do better. You have to, your future activity level depends on it.

Reason #9: Cortisone Shots Keep People From Getting Healing Therapies

People want the easy way out. We have instant oatmeal, drive-up lunch stops, drive-up espresso, soon we will have drive-up bathrooms. Don’t ask me how the latter will work. What is easier than getting a cortisone shot? “Why not? Insurance will pick it up.” Yeah, right buddy, they will pick up your future hip replacement too!

By getting a cortisone shot and masking the pain, people do not get the healing therapies they need. Any therapy that helps increase circulation to the area, helps healing. Therapies such as exercise, myofascial release, rolfing, magnets, massage, chiropractic physiotherapy, kinesiotherapy, acupuncture, herbs, vitamins, and a host of others help people truly heal injuries. When people pop anti-inflammatories and get cortisone shots - it is like taking the battery out of a blaring fire alarm while a fire is blazing. “No problem here.” “What do you mean? You dope, the alarm means there’s a fire!” This illustration seems silly. Who would take the batteries out of the fire alarm during a blazing fire and state “no problem here.”

Yeah, stupid, huh? Well, what could be stupider than have a fire blazing in a tendon, ligament, or joint and stomping out the healing with a cortisone shot? Don’t take the “alarm signalers” out of your injured structures. Obey thier wishes and get help. You may need a shot, but not one filled with cortisone, but one juiced up with healing!

Reason #10: Cortisone Shots Keep People From Getting Prolotherapy

Cortisone and Prolotherapy shots are the opposite. Consider the following:

PROLOTHERAPY VS. CORTISONE
	PROLOTHERAPY	CORTISONE
EFFECT ON HEALING	ENHANCED	INHIBITED
EFFECT ON REPAIR	ENHANCED	INHIBITED
EFFECT ON COLLAGEN GROWTH	ENHANCED	INHIBITED
EFFECT ON TENDON GROWTH	ENHANCED	INHIBITED
EFFECT ON LIGAMENT STRENGTH	ENHANCED	INHIBITED
EFFECT ON CARTILAGE GROWTH	ENHANCED	INHIBITED

To heal an injury, a person needs to receive Prolotherapy. Perhaps this is why I dislike cortisone shots the most. They keep people from healing their injuries. The only way healing can take place is if they allow the body to heal the area via inflammation. If the body can’t do it, then one has to receive Prolotherapy, which will simulate the normal healing inflammatory reaction. The repair mechanisms of the body are thus stimulated and ultimately the traumatic, joint, spine, or sports injury is healed. Prolotherapy stimulates the body to heal the injured area. This is why people get shots. Make sure this is the action of the shot you are about to receive. If it is not, say, “Thanks, but not thanks. I’m going to get healed. I’m going to get Prolotherapy!”

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.

CORTISONE SHOTS
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 shots 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.

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Ross Hauser, M.D. Dr. Hauser received his M.D. from the University of Illinois, Chicago; completed his residency at Loyola-Hines VA-Marianjoy Hospitals in Physical Medicine and Rehabilitation; and received his Bachelor of Science degree from the University of Illinois, Urbana-Champaign. Dr. Hauser is the Medical Director and co-founder of the physician-run, comprehensive natural medicine clinic, Caring Medical & Rehabilitation Services in Oak Park, Illinois. Dr. Hauser is one of the leading experts in the treatment of chronic pain and sports injuries with Prolotherapy. He, along with his wife Marion, have written seven books on the topic of Prolotherapy, a comprehensive book on the natural medicine approach to cancer, as well as a myriad of articles and newsletters for the general public. Read more Ask A QUESTION
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