UMMC Team Reports Innovative Work for Hamstring Injuries

For immediate release: June 13, 2000

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The Sports Medicine Team at the University of Maryland Medical Center reports that cortisone injections are safe for facilitating rehabilitation and decreasing pain in the treatment of severe muscle injuries. Their findings are presented in the May/June issue of the American Journal of Sports Medicine.

The article is based on experience over the last 13 years of NFL players who suffered hamstring injuries on the playing field. But the findings are just as applicable to "weekend warriors" and represent a significant advance in treatment options, according to Claude T. Moorman III, M.D., director of University of Maryland Sports Medicine and assistant professor of surgery at the University of Maryland School of Medicine.

Dr. Moorman reports that 58 NFL players received the cortisone injections for hamstring injuries during the 13-year study period. All but nine were able to return immediately to play and only one missed more than one game. Traditionally, hamstring injuries of this severity would have sidelined a player for at least six weeks.

Dr. Moorman said there also were no infections, no re-ruptures, no increase in the re-injury rate and that all the players said they would consent to cortisone injections again if they were the recommended treatment.

"It's such a powerful anti-inflammatory that it helps people feel better so that they can get on with their rehabilitation. We had guys with major injuries playing a week later," said Dr. Moorman. The University of Maryland study, though it does not establish the efficacy of cortisone as a treatment option for muscle injuries, paves the way for further study.

"This information should be helpful for practitioners," Dr. Moorman says. "It's been almost taboo to even consider the use of cortisone because it is a powerful anti-inflammatory known to have negative side effects. Our goal now is to further evaluate cortisone injections as an effective treatment option."

Cortisone most often is used orally for inflammation, allergies and asthma and topically for some skin conditions such as psoriasis. Used long-term for severe debilitating conditions such as lupus and rheumatoid arthritis, however, the drug can cause glaucoma, depression and osteonecrosis of the hip requiring total hip replacement. In the University of Maryland study, a cortisone injection was a treatment option for NFL players who suffered acute hamstring injuries if the pain could be pinpointed to a specific area, the injury site was located between the joints instead of at a joint, and the injection could be administered within 48 hours of the injury. The cortisone injection makes it possible for medical staff to administer pain relief directly to the injury site; whereas oral steroids are absorbed and interact anywhere a patient has inflammation. That means, for instance, that if a football player with a hamstring injury had lifted weights targeting the upper body, oral treatments would have targeted those areas as well. A more targeted application, Dr. Moorman says, minimizes risk of systemic complications.

"This is intended as a one-time intervention for acute muscle injury," Moorman says. "Used in this way, cortisone offers relief of pain and quick recovery time. This is important not only to today's athletes but to people of all ages who are trying to get fit, stay fit through running or other popular sports activities or just enjoy an active lifestyle."

Strains, sprains and muscle injuries are the most common injuries sustained in all sports, according to Dr. Moorman. The hamstring muscles, those that run from the back of the knee to the top of the thigh, cause the knee to bend and the thigh to move backwards. Hamstring injuries are particularly common as a result of sprinting, jumping and other activities where quick starts and stops are required. High-risk sports for hamstring strains are soccer, football, baseball, basketball and many track and field events. Runners are especially susceptible to chronic hamstring strains due to the repetitive nature of the sport.

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