So What’s So Bad About Corticosteroids Anyway?

Many people seek out reflexology when they have foot pain from plantar fasciitis, arthritis, gout or other painful maladies. Some of these people may be undergoing corticosteroid treatments, or be considering it, when they show up in your office. Here are some useful facts for you to know before you touch these folks.

Corticosteroids are steroid hormones naturally produced by the body in response to pain and other health imbalances. Cortisone, prednisone, dexamethasone, triamcinolone and methylprednisolone are artificial steroids prescribed to mimic the body’s natural analgesic. Steroids are used to treat many health conditions; this article will focus on their ability to help manage pain by reducing inflammation in tissue.

Although I had heard about steroids for most of my adult life, I really became aware of the positive (and negative) repercussions of steroids, when working with a massage client in the 1990’s. He was middle-aged, 5’6” and really into bodybuilding. He had come to me because of shoulder pain, that I was convinced was a result of his continual attempts at bench-pressing 450 lb of weight. He ignored my advice against lifting so much weight and continued his practice. (The shoulder is not a weight-bearing joint; it’s not meant to bear that much weight.) One day he appeared for his weekly session and stated that his shoulder felt fine – he had had a steroid shot. For a couple of months he reported no complaints, until the pain slowly started to re-appear. He again ignored my advice and had another cortisone shot. This cycle  played out for almost a year, until he had to stop weight-training completely and have major shoulder replacement surgery.

Steroids can be administered orally, topically, through specific site injection, inhalation, or intravenously. Information regarding medications as they relate to medical conditions can be found at drugs.com and mayoclinic.com. These sites provide easy to understand information that you may want to read and pass onto clients considering corticosteroids or other medications. Effects (and this varies according to dosage, type of steroid, length of treatment) can include:

• a decrease in inflammation by reducing the production of inflammatory chemicals that cause tissue damage. This is good – inflammation causes pain;
• relief from itching;
• a decrease in the immune system’s ability to create white blood cells, resulting in a reduced immune function;
• wakefulness, agitation, nervousness, restlessness;
• increased appetite and weight gain;
• a susceptibility to bruising;
• water retention, swelling;
• thinner skin;
• red streaking or spotting of the skin;
• higher blood pressure;
• development of blurred vision, cataracts or glaucoma;
• worsening of or development of diabetes;
• muscle weakness, myopathy (disease of muscles);
• osteoporosis.

Reflexologists need to be aware of the specific effects of steroids on tissue and bone so as to design a safe and appropriate level of touch for clients. Pressure, range-of-motion and thermal applications all may have to be adjusted.

High dosage cortisone is the second most common cause of osteoporosis. Steroids inhibit the intestine’s ability to absorb calcium and vitamin D; the body is forced to eliminate these necessary bone-building elements through the urine, resulting in inevitable bone loss. My client mentioned above learned this the hard way.

Although steroids can be very effective as a one-time shot at reducing inflammation resulting from sudden trauma to the tissue, they should not be considered until other avenues of treatment have been exhausted. Repeated use destroys the connective tissue in the body, as my former client sadly discovered.

The key, as I see it, is to reduce the inflammation, discover the true origin of the malady and then correct that. That’s why, when treating plantar fasciitis for example, steroids sit seventh on my list of options.

How do you address pain due to inflammation?