In the late 1940s, the steroid cortisone, an anti-inflammatory drug, was first synthesized and hailed as a landmark. It soon became a safe, reliable means to treat the pain and inflammation associated with sports injuries (as well as other conditions). Cortisone shots became one of the preferred treatments for overuse injuries of tendons, like tennis elbow or an aching Achilles, which had been notoriously resistant to treatment. The shots were quite effective, providing rapid relief of pain.
Then came the earliest clinical trials, including one, published in 1954, that raised incipient doubts about cortisone’s powers. In that early experiment, more than half the patients who received a cortisone shot for tennis elbow or other tendon pain suffered a relapse of the injury within six months.
But that cautionary experiment and others didn’t slow the ascent of cortisone (also known as corticosteroids). It had such a magical, immediate effect against pain. Today cortisone shots remain a standard, much-requested treatment for tennis elbow and other tendon problems.
But a major new review article, published last Friday in The Lancet, should revive and intensify the doubts about cortisone’s efficacy. The review examined the results of nearly four dozen randomized trials, which enrolled thousands of people with tendon injuries, particularly tennis elbow, but also shoulder and Achilles-tendon pain. The reviewers determined that, for most of those who suffered from tennis elbow, cortisone injections did, as promised, bring fast and significant pain relief, compared with doing nothing or following a regimen of physical therapy. The pain relief could last for weeks.
But when the patients were re-examined at 6 and 12 months, the results were substantially different. Over all, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. The evidence for cortisone as a treatment for other aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting, the review found. But in terms of tennis elbow, the shots seemed to actually be counterproductive. As Bill Vicenzino, the chairman of sports physiotherapy at the University of Queensland in Australia and senior author of the review, said in an e-mail response to questions, “There is a tendency” among tennis-elbow sufferers “for the majority (70-90 percent) of those following a wait-and-see policy to get better” after six months to a year. But this is not the case for those getting cortisone shots, he wrote; they “tend to lag behind significantly at those time frames.” In other words, in some way, the cortisone shots impede full recovery, and compared with those adopting a wait-and-see policy, those getting the shots “are worse off.” Those people receiving multiple injections may be at particularly high risk for continuing damage. In one study that the researchers reviewed, “an average of four injections resulted in a 57 percent worse outcome when compared to one injection,” Dr. Vicenzino said.
Why cortisone shots should slow the healing of tennis elbow is a good question. An even better one, though, is why they help in the first place. For many years it was widely believed that tendon-overuse injuries were caused by inflammation, said Dr. Karim Khan, a professor at the School of Human Kinetics at the University of British Columbia and the co-author of a commentary in The Lancet accompanying the new review article. The injuries were, as a group, given the name tendinitis, since the suffix “-itis” means inflammation. Cortisone is an anti-inflammatory medication. Using it against an inflammation injury was logical.
But in the decades since, numerous studies have shown, persuasively, that these overuse injuries do not involve inflammation. When animal or human tissues from these types of injuries are examined, they do not contain the usual biochemical markers of inflammation. Instead, the injury seems to be degenerative. The fibers within the tendons fray. Today the injuries usually are referred to as tendinopathies, or diseased tendons.
Why then does a cortisone shot, an anti-inflammatory, work in the short term in noninflammatory injuries, providing undeniable if ephemeral pain relief? The injections seem to have “an effect on the neural receptors” involved in creating the pain in the sore tendon, Dr. Khan said. “They change the pain biology in the short term.” But, he said, cortisone shots do “not heal the structural damage” underlying the pain. Instead, they actually “impede the structural healing.”
Still, relief of pain might be a sufficient reason to champion the injections, if the pain “were severe,” Dr. Khan said. “But it’s not.” The pain associated with tendinopathies tends to fall somewhere around a 7 or so on a 10-point scale of pain. “It’s not insignificant, but it’s not kidney stones.”
So the question of whether cortisone shots still make sense as a treatment for tendinopathies, especially tennis elbow, depends, Dr. Khan said, on how you choose “to balance short-term pain relief versus the likelihood” of longer-term negative outcomes. In other words, is reducing soreness now worth an increased risk of delayed healing and possible relapse within the year?
Some people, including physicians, may decide that the answer remains yes. There will always be a longing for a magical pill, the quick fix, especially when the other widely accepted and studied alternatives for treating sore tendons are to do nothing or, more onerous to some people, to rigorously exercise the sore joint during physical therapy. But if he were to dispense advice based on his findings and that of his colleagues’ systematic review, Dr. Vicenzino said, he would suggest that athletes with tennis elbow (and possibly other tendinopathies) think not just once or twice about the wisdom of cortisone shots but “three or four times.”
Over the last several decades, over-use of antibiotics has reached an all-time high. The result has been drug-resistant bacteria and “superbugs” that evolve faster than scientists can figure out how to fight them. A future where bacteria are at the top of the food chain is not unheard of.
Long before there were pharmaceutical antibiotics – developed in the 1940s - there were foods and herbs that helped guard against infection and disease on a daily basis. Many of these natural defenders are still in use today with holistic healers around the globe.
Our ancestors also had a solution for healing, using antibiotics from nature and it would be good to remind ourselves who these antibiotics are and possibly think about using them in case of an illness.
Oregano and the oil of oregano
You’ve probably used oregano as a flavoring in your favorite Italian dishes without even realizing the health benefits that it contains. Beyond its antibacterial properties, oregano can help with digestion and aid in weight loss. An oil that is found in oregano, Carvacrol, has been found to fight the bacteria that can lead to infections. The oil of oregano has been found to treat digestive infections, and even one particular yeast infection. It is more than just a food flavoring.
Raw Apple Cider Vinegar (ACV)
The far-reaching benefits of daily doses of apple cider vinegar (ACV) include antibiotic and antiseptic properties, naturally alkalizing your system, and can aid you in everything from managing your weight to lowering cholesterol and your risk of cancer.
A chemical-free astringent, ACV can be used topically to disinfect and sterilize.
Ancient Romans used honey on the battlefield to treat wounds and prevent infection.
Civilizations all over the world continue to consider honey one of the best natural antibiotics, antimicrobials, anti-inflammatories, and antiseptics known to man after thousands of years.
New Zealand’s Manuka honey has been proven to have the highest levels of antioxidants and curative powers.
An enzyme found in honey releases hydrogen peroxide. This process helps your body fight infection and prevents the growth of bacteria. Soothing to the digestive system, honey removes toxins from the blood and helps your liver operate more efficiently.
A great boost to the immune system, consider combining honey with cinnamon to strengthen your white blood cells! Raw, organic honey is the best option since most pasteurization methods kills the antioxidant effects.
This spice isn’t just rich in color and flavor, but it also protects your body against harm. Turmeric can be both consumed and applied externally, making it a great choice for fighting against bacteria. For extra benefit, from combining two bacteria fighting substances, you can mix turmeric with honey and create a paste to apply to infected areas on your skin.
You can protect your body against infections and bacteria based sicknesses by taking advantage of these safe and natural remedies that are available in the average kitchen. Protect your body without the use of prescription drugs by using honey, oregano, garlic, echinacea, and turmeric.
Flavorful and wonderful on a piece of butter toast, this plant also has very powerful qualities to it. Garlic can fight simple infections such as the common cold, pushing the germs away before they have a change to disrupt your life. Using the allicin that it contains, garlic protects against yeast, parasites, bacteria, and more. If you are looking for a simple way to live healthier, add more garlic to your diet.
Grapefruit Seed Extract
The Journal of Alternative and Complementary Medicine published a study that found grapefruit seed extract (GSE) effective against more than 800 forms of viruses and bacteria, more than a hundred strains of fungus, and many parasites.
High in many antioxidants, GSE boosts immunity, alkalizes the body naturally, and aids in digestion by improving your beneficial gut flora.
There are sulfur compounds found in cabbage – a member of the cruciferous family that includes broccoli and kale – that have been shown effective as cancer fighters. What many people don’t realize is how much vitamin C is found in cabbage. One cup provides 75% of what you need every day. Naturally antibacterial, adding shredded raw cabbage to your salad, or as a side dish in the form of slaw, or drinking fresh cabbage juice (with honey added to sweeten) is an excellent way to improve digestion, prevent disease, and even manage your weight!
There is not enough that can be said for the benefits of coconut oil. It has naturally occurring anti-fungal and anti-microbial properties and is packed with antioxidants you can’t find anywhere else in nature. Use it to boost your immune system, balance your thyroid, cholesterol, blood sugar levels, and even improve your brain function. Safe to use internally and externally, coconut oil is one of the most versatile and unique gifts from Mother Nature.
Unpasteurized cabbage, homemade pickles, kefir and probiotic yogurts, all of these renew our intestinal flora, protects us from cancer and keeps our body fit to fight off infections.
If Nsaids, or nonsteroidal anti-inflammatory drugs, like aspirin, ibuprofen and naproxen are taken too long, they can pose dangers, including bleeding ulcers, kidney or liver damage and an increased risk of a heart attack or stroke.
Switch to these spices to reduce pain and inflammation from exercise, arthritis or after your surgery. They provide powerful anti-inflammatory properties without any unwanted side effects.
They'll help your swelling, too.