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.
CORTISONE, ARTHRITIS, AND PROLOTHERAPY
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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