- Steroid injection directly into a tendon weakens it
while injection of the paratenon does not appear to
have that effect. - Long-term therapy or extremely high dosages of
steroids may cause avascular necrosis, adrenal sup-
pression, GI ulcer, diabetes, cataracts, and hyperten-
sion.
STRATEGIES TOLIMITSIDEEFFECTS
- Limit usage, usual practice limit is 2–3 times per year
for joint injections.
•Treat the underlying cause. - Direct injection into tendon should probably be avoided
although injection into paratenon appears safe.
ERGOGENIC AIDS
DEFINITION
•Ergogenic aids are defined as items designed to increase
work or improve performance above that of regular
training and diet. Ergogenic aids are usually classified
into five groups: mechanical aids such as running shoes,
psychologic aids, physiologic aids such as fluids and
blood, pharmacologic aids that generally are thought of
as requiring a prescription, and nutritional aids.
HISTORY
- In 1994, Congress passed the Dietary Health and
Supplement Health Education Act (DHSEA) which
substantially changed the regulation and marketing of
dietary supplements (Glade, 1997). Essentially, sub-
stances can be sold without U.S. Food and Drug
Administration (FDA) approval as long as the prod-
ucts are labeled and sold as dietary supplements and
the label makes no claim as a drug. These supple-
ments are not held to the same quality control stan-
dards as FDA approved drugs; the content and purity
of these products is not regulated and may contain too
much of the product to none at all (Butterfield, 1996).
Furthermore, these substances do not require evalua-
tion for safety or efficacy. - Despite all this, ergogenic aids are commonly used,
sometimes with cataclysmic consequences.
EVALUATING ERGOGENIC AIDS
•Evaluation of ergogenic aids are often difficult to per-
form. Additionally, the scientific literature usually dif-
fers significantly from the advertising on many
products (Butterfield, 1996).
- There is no burden of proof on the manufacturer to
prove efficacy or product content like there is for
drugs (Glade, 1997). - Products may contain lower amounts of the product
than that listed on the label, with some products
having zero amount of the supposedly ergogenic
substance and while others may be contaminated by
the previous drug manufactured in the equipment
(Schardt, 1998). - Furthermore, the placebo effect can have a huge
impact on the perceived benefits derived by the user.
EFFICACY OF ERGOGENIC AIDS•Ergogenic aids can affect various aspects of physical
fitness to improve performance. Six components of
fitness that may be affected include aerobic fitness,
anaerobic fitness, strength, body composition, psy-
chologic factors, and healing of injuries.- Aerobic metabolism uses oxygen while anaerobic
metabolism does not. - Aerobic fitness is the ability to produce work using
aerobic metabolism, generally lasting longer than
1 min and often lasting for hours and is important
especially to distance runners. It comprises two
parts, maximal aerobic power and aerobic capacity. - Anaerobic fitness is important in activities generally
lasting less than 1 min and are fueled primarily
through anaerobic metabolism. - Maximum strength, usually measured by the one
repetition maximum, refers to the amount of power
that can be generated in a brief burst fueled by
anaerobic metabolism. - Body composition can effect performance by
increasing lean muscle mass to produce more mus-
cles to do the work and by decreasing body fat to
decrease the weight that has to be carried through
space to the finish line. - Psychologic factors may affect performance
through various mind-body mechanisms including
decreased perceptions of fatigue and pain. - Enhancing the healing of injuries and soreness pro-
motes a more rapid return to training and mainte-
nance of fitness.
SAFETY CONSIDERATIONS•Ergogenic aids can have side effects like any other
substance.- Heart attacks, seizures, strokes, coma, and death
have been attributed to the use of ergogenic products
(Butterfield, 1996).
418 SECTION 5 • PRINCIPLES OF REHABILITATION