Steroid/ Cortisone Injections Significantly Increase Risk Of Tendon Tears

Picture from BuzzRx

I was asked to do a home visit for a patient who was having some pain in his hip 2 days ago. The patient hurt his knee last year while playing golf and the doctor he consulted did a steroid/ cortisone injection for him. His knee was better for a while but some of the pain came back a short while later. 

Perhaps my patient was not able to weight bear well on that right knee since then and subsequently that caused his right hip to act up. After assessing him, I found that his sore knee was not the main cause of his hip pain, but definitely a contributing factor. 

I shared an article (referenced below) that I just read just a few days ago with my patient and his family regarding steroid/ cortisone injections. There were 1025 patients with shoulder pain in that hospital study. 205 patients received a steroid/ cortisone while 820 did not (they acted as the control group).

Patients in that study who received a steroid/ cortisone injection (for their shoulder pain) significantly increased the risk of having a shoulder tendon tear by 7.44 times compared to those who did not receive a steroid/ cortisone injection! 

Those who had concurrent chronic liver disease were 3.25 times more likely to have a torn tendon while those who smoked by 2.4 times. Another reason to stop drinking and smoking too.

Since my patient is an avid golfer and still very active, I told him he definitely does not need to have any more steroid/ cortisone injections anywhere else on his body. There are high chances of degenerative changes in the surrounding areas where the steroid/ cortisone is injected.

Remember my true story when I used to work at the Singapore Sports Institute (formerly Singapore Sports Council). Back then, I used to treat the badminton players frequently and traveled with them on most of their training trips and competitions. (Ronald Susilo and I pictured below after he beat world number one Lin Dan at the Athens 2004 Olympics).

I'm more excited than Ronald

In 2006-2007, Ronald Susilo had on and off right elbow pain, in his playing arm. He was subsequently injected with steroids (cortisone) a few times to help with the pain so he could train and compete.

Tragedy struck at the 2007 SEA Games in Thailand. He tore a forearm muscle while playing at the Games. I was tasked with accompanying him back to Singapore for a visit to the surgeon to repair it.

I've accompanied Ronald for all his sporting surgeries. His shoulder in 2004, Achilles in 2005 and right forearm in 2007. These were his words to the operating surgeon, "Gino knows my body better than I, he's been around for all my operations."

As usual I was waiting outside the operating theater for Ronald when they operated on his forearm. The first words the surgeon said to me when he came out of the operating theatre was, "We found cortisone still in his arm." My interpretation was that he meant too much steroid/ cortisone had been injected into Ronald's forearm. That probably caused the muscle to tear. Just like what the study by Lin et al (2022) had found.

Yes, there would definitely be occasions where a steroid/ cortisone injection is needed.  However, speaking from personal experience, if you're an athlete or participating in sports regularly like my patient, please reconsider if your doctor suggests a steroid/ cortisone injection. There are definitely other ways to treat your pain/injury besides getting a steroid/ cortisone injection. You definitely do not want to risk tearing any muscle or tendon after that.

Reference

Lin CY, Huang SC, Tzou SJ et al (2022). A Positive Correlation Between Steroid Injections And Cuff Tendon Tears: A Cohort Study Using A Clinical Database. Int J Environ Res Pub Health. 19(8): 4520. DOI: 10.3390/ijerph19084520.

Never Give Up!

Chapeau to  Ronald Susilo. This guy just keeps on going and going. After suffering many potential badminton career ending injuries while at the top of his game, he has always managed to bounce back.

After winning the Japan Open Grand Prix and then beating World Number One Lin Dan at the 2004 Athens Olympics with a torn shoulder labrum, he went under the knife.

More heartbreak followed after coming back from that when he tore his achilles tendon at the World Badminton Championships in 2005.

Yet he persisted. Tragedy again at the 2007 Sea Games when he tore his right forearm muscles playing against Vietnam. Again he managed to bounce back and we went to our second consecutive Olympics together in Beijing in 2008.

His wife sent him to Sports Solutions in this 

Even after retiring from national duty, he kept playing after he started coaching. And subsequently ruptured his patella tendon while tearing his ACL and medial meniscus at the same time. He needed 2 operations after this. Attaching the patella tendon first before repairing the ACL almost a year later.

And now this right shoulder again .....

Well, Ronald we've done this together too many times before. But I know you'll be back once more. You can do this!! Want to be a champion? Passion for the sport and persistence is what you'll need. Lots of it.

In the picture below, you see me celebrating and more excited than Ronald Susilo himself after he defeated Lin Dan in the 2004 Athens Olympics.

Yes, I used to sit on court with him and his coach every time he played.

What? $3000 For A Steroid Jab!

Straits Times 030819, page B5, home section

Wow, that's very expensive for a steroid/ cortisone injection! What shocked me was that some doctors actually charged more as a result of the court case against an orthopaedic surgeon whose patient complained to the Singapore Medical Council after she developed side effects. 

On the flip side, some doctors stopped giving the steroid/ cortisone injections after that case.

As an athlete or as someone who is actively exercising, you definitely do not want to have a steroid/ cortisone injection. There are high chances of degenerative changes in the surrounding area where the  steroid is injected.

Here's a true story when I was working at the Singapore Sports Institute (formerly Singapore Sports Council). I've never written about this before and I guess it's time to put it on record. Back then, I used to treat the badminton players frequently and followed them on training trips and competitions.

In 2006-2007, Ronald Susilo was having right elbow pain, his playing arm. He was subsequently injected with steroids (cortisone) to help with the pain so he could train and compete.

Tragedy struck at the 2007 SEA Games in Thailand. He tore a forearm muscle while playing at the Games. I was tasked with accompanying him back to Singapore for a visit to the surgeon to repair it.

I've accompanied Ronald for all his sporting surgeries. His shoulder in 2004, Achilles in 2005 and right forearm in 2007. These were his words to the surgeon, "Gino knows my body better than I, he's been around for all my operations."

As usual I was waiting outside the operating theater for Ronald when they operated on his forearm. The first words the surgeon said to me when he came out of the operating theatre was, "We found cortisone still in his arm." My interpretation was that he meant too much steroid/ cortisone had been injected into Ronald's forearm. That probably caused the muscle to tear.

Granted, there would definitely be occasions where a steroid/ cortisone injection is needed.  However, speaking from experience, if you're an athlete or participating in sports regularly, please reconsider if your doctor suggests a steroid/ cortisone injection. There are definitely other ways to treat your pain/injury besides getting a steroid/ cortisone injection.

Here's a picture of Ronald after his left Achilles tendon rupture in 2005 at the World Badminton Championships. Kudos to him for coming back to play after each and every badminton career threatening surgery.

After Rupturing His Patella Tendon .....

Nice leather seats ....

This is how Ronald Susilo came to our clinic after surgery to re-attach his patella tendon - his wife drove him while he sat in the back seat. Besides rupturing his patella tendon, he also tore his ACL and his meniscus.

With the Floss band

Last Saturday (20/02/16)  you saw him struggling to turn the pedals a full round while on the stationary bike. Only with the Floss band he managed to go one full round albeit with lots of shouting (in pain of course)!

On Monday (22/2/16), we went to the pool for hydrotherapy. 

And yesterday he saw his surgeon for a review. His surgeon told him "good progress". Little did the surgeon know he couldn't bend his knee more than 60 degrees last Saturday!

Today we got him on the Bongo board. Yes, both side to side and front and back. A board developed to challenge even professional athletes.

Check this out!

Holding on for dear life

What I'm trying to say is we didn't achieved this progress just because of the Floss band. Yes maybe the Floss band did kick start his rehab last Saturday by allowing him to turn the stationary bike pedals a full round. He began to believe in himself after that.

We did lots of other things along the way too, (I've left out the other rehab details of course, come talk to me if you wanna know). 

Use your Floss band as part of the treatment strategies you have to treat your patients. It's not a magic bullet. It's certainly not the only treatment aid/ tool you should be using.

To Jane Fong, Danny Ho, Sven Kruse and Sanctband, thank you for introducing to me the Floss band. It's definitely a tool I use in my bag of tools to treat my patients.

Ronald Susilo going down stairs

Who Came For Hydrotherapy Today?

Who's that jumping?

I've been going to the pool fairly regularly (especially since that's the safest exercise/ rehabilitation I can do after my bike accident and often alone too.

Occasionally I get Ronald Susilo (former Olympian, Sportsman of the Year) joining me. Recently he was actually planning to play in the current ongoing Li Ning Singapore Super Series Badminton Open and he requested joining me at hydrotherapy to do some conditioning. (Alas, he did not get his chance, but that's a different story).

Now, Ronald and I go back a long way, I've been treating Ronald since the late 1990's, way before he became a household name in badminton. We've done hydrotherapy previously while he and the rest of the Singapore Badminton team were preparing for the Olympics.

And, surprise surprise, he showed up with 2 of his young charges today at the pool for some conditioning with him, with me taking charge - just like the old days.

Ronald taking a rest

Now, it was with dismay that I read in the papers today that all 3 of our male local shuttlers were knocked in the qualifiers yesterday and so Singapore will not have any representation in the main draw of the Men Singles today.

So hopefully, with today's session and more, Ronald's young players will do well enough to do us proud at subsequent Singapore Open's and more.

All the best at the tournament, Team Singapore.

Guess Who Dropped By During Kinesio Taping KT Level 1 On 160313?

We had our first Kinesio Taping KT Level 1 and 2 course of the year in Singapore today @ Progress Healthcare. We had a great group of participants in this current course. Most were local participants although we had an overseas participant from India.

The boys testing gluteus medius

Taping the Gluteus Medius

Can you guess who else dropped by during the course?

Guess who showed up near the end of  today?

Yes, you guessed correctly. Ronald Susilo (retired former national shuttler) played in the National Badminton  Championships today. Despite having retired a few years ago, he was still good enough to win his quarter and semi finals today against current national players and qualifies for the finals tomorrow. As a result he needed some help from Gino and Kinesio taping of course. (Dalong was extra happy to have Ronald drop by of course).

Treating Ronald after Kinesio taping

Must be Dalong who was star strucked...... and wanted a picture.

All set for tomorrow's finals

Stay tuned for updates on KT 2 tomorrow.

Aqua Based Rehabilitation (Deep Water Running)

Recognize anyone?

If you've ever wondered how our injured national athletes still keep most of their hard gained fitness, read on.

Their pool based water work is often the key to a quick return. For those not injured, the swimming pool can also be used as a great training tool in addition to your other workouts. Look closer at the 2nd picture and you may recognize some of our badminton players who have been to the last 2 Olympics- Ronald Susilo, Kendrick Lee, Xing Aiying and Li li etc. Our Singapore badminton team went to the pool once a week at least during periods when they were training at their hardest so they can train in a setting with little or no impact to minimize injuries with yours truly leading the session in the water with them.

Now, this is not a typical swim training session like you might think. As most land based athletes are not good swimmers, I often use aqua running techniques (or deep water running) to produce a valuable training effect for them. It would take a far longer time to get them to be of a good swimming standard to get the same effect from swimming and since time is a precious commodity in sports rehabilitation hence the use of deep water running. Moreover, most of these athletes or patients are involved in some land based or running sports, so swimming offers less transferable benefits or movements that are similar to their land based activities.

Done right it is a full body workout involving the legs, arms, shoulders and core muscles.It is also a good alternative to pounding the streets day after day. A study comparing a group doing deep water running versus another group road running found both training programmes produced similiar improvements in V02 max levels.

Water is about 773 times more resistant than air, so it can strengthen all key running muscles. Water is also isokinetic, meaning the water resists you as much as you resist it. The harder you move your arms or legs through the water, the more drag force or resistance you encounter. What's more challenging? Doing the workout without a flotation device or belt. I often get my athletes to do the entire session without one to push them harder.

The pool is a very good and versatile environment for rehabilitation work and training for athletes and patients. By including this session, you can allow for injured athletes or patients to recover quicker and allow others to undertake higher intensity water based training. It will not do the aqua training technique justice for me to describe how you do it in just a few short sentences, please contact us know if you need more advice on this. Physio Solutions conducts deep water running classes, give us a ring to find out more.

References

Davidson, K (2000). Deep Water Running Training Improve V02 max in Untrained Women. Journal of Strength and Conditioning Research. 14 (2) 191-195

Dowzer, CN and Reilly, T (1998). Deep Water Running. Sports Exercise and Injury. 4: 56-61