TheUniversity of North Carolina School of Medicine conducted a research lead by senior author Kevin Guskiewicz, PhD, ATC and lead author Scott Horn, DO regarding the relationship between the use of performance enhancing steroids or AAS and muskulo-skeletal injuries among retired members of the National Football League. Majority of the respondents had an average age of 54 years and 6.6 average playing career.

The study surprisingly showed that tendon-related injuries were not associated with AAS use contrary to previous studies wherein researchers suspected that an increase in the muscle mass and strength might be too strenuous for the tendons. The study led to new conclusions that ligaments and cartilage might be the ones that cannot adapt to steroid-induced muscle changes and might be the “weakest links” in the chain rather than tendons. This evidence is seen among retired NFL players who admitted to using steroids. They reportedly had higher rates of herniated spinal disks, neck “stinger” or “burner” injuries, elbow injuries, knee menisci and ligament injuries, and injuries to the ankle, foot and toes.More data on dose, type and length of steroids use are needed to further establish and prove the relationship between AAS and muskulo-skeletal injuries.

From the American Journal of Physical Medicine and Rehabilitation:

“Steroid users also had an increased risk of osteoarthritis, depression and increased alcohol use later in life. In general, they were less able to maintain physically active lifestyles after retirement. The report found that players who used AAS actually had lower rates of diseases such as diabetes and cancer. However, there were only limited cases and they may reflect the fact that most of the players who used steroids have yet to reach old age, rather than any true decrease among steroid users.

The effects of AAS in increasing muscle size and strength are well known. Amid concerns about the risk of serious health effects, there are little or no data on how steroids affect the risk of musculoskeletal injuries. The NFL began enforcing its ban on AAS use by players in 1989. The athletes in the new survey were asked about their use of steroids “when it was acceptable.”

The results lend new insights into the risks of musculoskeletal injury associated with AAS use. The injury patterns suggest that joint ligaments and cartilage may not adapt to steroid-induced muscle changes. It may be that ligaments and cartilage, rather than tendons, are the “weakest link in the chain” leading to injury, according to Dr. Horn and colleagues.

The negative effect on joint health may be only the start of the adverse health effects of steroid use, Dr. Guskiewicz believes. “I call it a snowball effect, with joint injuries contributing to the gradual development of other medical problems, such as osteoarthritis, physical inactivity, depression, obesity, and diabetes.”

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