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

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 Nutritional supplements such as glucosamine, MSM, bromelaines and others help athletes heal sports injuries.

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.