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Students question use of cortisone in college athletics

Right before a crucial football game in the movie Varsity Blues, the star quarterback receives an injection of cortisone in his knee to continue playing.

Determination shines through the painful grimace on his face as he takes one for the team, and he leads them to victory. But the quarterback is sidelined for the rest of the season when the steroids he injected magnify his knee injury.

Cortisone is a steroid injected locally, or directly into an injured joint, to stop inflammation, said Dr. David Romness, the assistant clinical professor of Orthopedic Surgery at Georgetown Medical School.

The most common use of cortisone involves the treatment of chronic injuries, according to the National Collegiate Athletic Association Web site.

While its effects can be as adverse as those portrayed in Varsity Blues, cortisone still remains a prevalent treatment for the injuries of young athletes, including athletes at GW. Its use still remains a point of contention among doctors, coaches and student-athletes.

Freshman Abby Ernst, a volleyball player, said she was encouraged to use cortisone when a shoulder injury flared up. She said trainers recommended she use cortisone injections to treat her tendonitis

It’s been a problem for awhile, she said. The trainers just encouraged (the shot). They thought it would be a good idea.

She received a shot of cortisone at the end of August as the volleyball season began. The results were less than favorable, she said.

I had a rare reaction to it, Ernst said. My shoulder flared up really bad, and I couldn’t move my arm for three days.

Ernst said she continued to play most of the volleyball season with pain, refusing to use the controversial steroid again.

I know people it has worked for, but it didn’t work for me, she said.

The question of cortisone’s side effects stems from inconclusive research on the subject. Romness said several animal studies have shown the injected cortisone causes the breakdown of cartilage, but another shows that it protects cartilage. There are no conclusive human studies, and side effects of cortisone can be unpredictable, Romness said.

We don’t fully understand the adverse effects, he said. Often times, it allows the area to heal.

Despite the possibility of its healing ability, Romness said the use of cortisone with younger patients should be restricted to cases where it is absolutely necessary.

It’s controversial, there’s no question, he said. I’m kind of in the middle – I will use it if other treatments have failed, and if it’s not overdone.

Jackie Jenkins, GW’s head athletic trainer, said she recommends cortisone for some student-athletes.

Cortisone definitely can be a good thing if it’s used properly and not overused, she said.

Some athletes have refused cortisone injections offered by GW trainers.

A men’s crew team member, who wished to remain anonymous, said he was shocked when GW trainers offered him cortisone to treat a chronic knee injury.

I have been offered (cortisone), but my doctors told me to never, ever use it, he said. All it does is mask the pain. I’m shocked that the training office even uses cortisone, because I’ve always been told by doctors to never use it.

Jenkins said cortisone could be dangerous if applied too many times to the same injured area.

If it’s overused, then it can be detrimental to the ligament and the area that you inject, she said. Several injections can be detrimental to one area.

Dr. Kenneth Fine, the head doctor at the GW Medical Center Department of Orthopedic Surgery, makes the decision to offer a student patient cortisone.

We try to use it judiciously to get things to feel better or improve, he said. We try to use it as rarely as possible. We know there are side effects.

Romness said the danger from cortisone is minimal, depending on the circumstances.

It depends on the patient, Romness said. In certain areas, we don’t think there’s much damage that can be done.

The NCAA recommends guidelines in the use of injected cortisone. The treatment should not be administered until after more conservative treatments have been attempted and should not be used on a regular basis unless the consequences and benefits of the injections have been evaluated at length, according to the organization’s guidelines.

The GW trainers do not treat every case of inflammation with cortisone.

Freshman Ria Freydberg, a member of the crew team, was recently diagnosed with laterally tilted knee caps, which causes pain and swelling in both knees. The GW training department gave her Naproxen, an anti-inflammatory medicine but did not offer cortisone.

They’ve never offered me cortisone, she said. I had my doubts at first, but in the long run, they’ve helped me out.

She said she would probably not accept a cortisone injection.

Bad things happen, Freydberg said. Just watch Varsity Blues.

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