Joints/Tendons/Bone

[Michael Scally MD]

AAS Improve Rehabilitation After Surgery

Acute distal biceps rupture poses a devastating injury associated with athletes following high-resistance-training regimens. It usually occurs in the dominant extremity during excessive eccentric tension and is mainly observed in sports including high resistance and/or full body contact. Numerous articles report the benefits of different acute repair operative techniques. Regardless of incision or fixation type, the goal of any repair is to promote tendon ingrowth into bone while preventing range of motion (ROM) deficits and heterotopic ossification.

Currently there is little consensus on post-operative rehabilitation guidelines. Early active or passive ROM has been suggested to facilitate tendon reattachment into bone at the repair site with papers reporting on the safety of early active ROM after repair via single anterior incision. This helps with another problem the physician has to deal with when treating high resistance training individuals; highly variable compliance to postoperative regimens, with many of these patients returning to aggressive sports or occupational activities earlier than recommended. Recognizing this patient-specific peculiarity, we followed an immediate active ROM protocol after repair via the modified single incision repair thus helping patients regain ROM comparable to the uninjured side without deleterious effects on neither the reconstruction’s healing nor the operated extremity’s flexion and supination strength.

The fact that an increasing number of high-resistance-training individuals abuse AAS complicates treatment. AAS have a proven substantial protein anabolic effect on contractile proteins, increasing structural integrity and size of existing and/or newly regenerating muscle fibers. It has been proven that AAS enhance remodelling and improve biomechanical properties of bioartificially engineered human tendons, suggesting that they may enhance tendon-healing in vivo. Latest developments indicate that androgens are important for male bone metabolism and homeostasis, increasing radial growth via maintenance of cancellous bone mass and expansion of cortical bone. This may influence incorporation of the newly attached tendon in the radial bone but may also affect heterotopic ossification in a non-favourable manner. There is an increasing need to further delineate the effects of this kind of pharmacological agent abuse on the anatomic reconstruction of the musculotendinous injury.

The aim of this study was to observe and report all possible effects the AAS abuse patterns might have on the healing and recuperation of anatomic reconstruction of the ruptured distal biceps tendon and on heterotopic ossification, comparing these results to a similar group of surgically treated individuals.


Pagonis T, Givissis P, Ditsios K, Pagonis A, Petsatodis G, Christodoulou A. The effect of steroid-abuse on anatomic reinsertion of ruptured distal biceps brachii tendon. Injury. The effect of steroid-abuse on anatomic reinsertio... [Injury. 2011] - PubMed result

INTRODUCTION: There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group.

PURPOSE: The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol.

METHODS: We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52weeks postoperatively, with a final follow-up at 24 months.

RESULTS: Follow-up at 4, 16 and 52 weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score.

DISCUSSION: The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.

 

[Millard]

METHODS: We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11).

[...]

DISCUSSION: The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.

Anabolic steroid use may actually be a good thing for rehabilitation of tendon rupture, so they can't demonize them for that but they can still call them "anabolic steroid ABusers"!

 

[GeorgeWBush]

i've ran nearly 2 grams of both deca and eq combined and still had horrible shoulder problems to the point of it effecting my strength and lifting ability significantly. no real injuries to speak of just have really awful shoulders, fuck my life

 

[OhNoYo]

i've ran nearly 2 grams of both deca and eq combined and still had horrible shoulder problems to the point of it effecting my strength and lifting ability significantly. no real injuries to speak of just have really awful shoulders, fuck my life

U ever considered getting an MRI on both shoulders, Sir?

 

[GeorgeWBush]

doctors cant do anything about shoulder impingement except surgically reattach your rotator cuff once you cleave it clean off your shoulder from excessive lifting. i suppose i can give cortisol shots a try though they aren't real remedy. it has more to do with bad posture during sleep, as sleeping on my back, stomach or side all aggravate my shoulders and i don't know what to do, though some days are better than others.

 

[OhNoYo]

doctors cant do anything about shoulder impingement except surgically reattach your rotator cuff once you cleave it clean off your shoulder from excessive lifting. i suppose i can give cortisol shots a try though they aren't real remedy. it has more to do with bad posture during sleep, as sleeping on my back, stomach or side all aggravate my shoulders and i don't know what to do, though some days are better than others.

I actually heard cortisone shots can sometimes be counterproductive in the long run

 

[CubbieBlue]

Bump - Namely, does anyone have any anecdotal reports on tendon healing and AAS? I'm specifically interested in nandrolone. On a second look at all of this stuff I am wondering if there is some threshold that is indeed helpful.

I do know of one individual effected by quinolones who trialed a small cycle of testosterone (300mg I believe) and it caused a great relapse in tendon pain.

 

[james 1974]

i had a bottle of sustos on the top medicine cabinet an my wife turned the drier on an i didn't no until after the drier was done can that make it go bad???the color hasn't changed or anything so i am unsure..

 

[BfB]

Deca-Durabolin Weakens Tendons and Collagen!

You can also find the below article in the December 2011 issue of Muscular Development on pages 198-200.

DECA-DURABOLIN Weakens Tendons and Collagen

If you are not visiting musculardevelopment.com on a daily basis, you are not getting breaking news and up-to-the-minute information. In a recent thread started in the NO BULL forums a person wrote, “How come people don’t train like Ronnie anymore?” The thread talked about the change in the training style of all the bodybuilders to more high-volume training and less high-intensity training. With the exception of Branch Warren, there are not many pros who are training with high intensity. It may be because today’s bodybuilders don’t want to risk injury. Here is a list of some of the top bodybuilders who have suffered major injuries or tears during their training careers, off the top of my head:

• Dorian Yates: tricep/bicep
• Kevin Levrone: pec
• Rich Gaspari: pec
• Ronnie Coleman: tricep
• Berry de May: pec
• Chris Dickerson: pec
• Tom Platz: bicep
• Branch Warren: tricep/quad tendon

Is it just a coincidence that bodybuilders are more likely to suffer injuries because of heavy training, or does the use of anabolic-androgenic steroids (AAS) have any impact on tendon/collagen strength? The research is very preliminary, as only a few studies have examined the effects of AAS on tendon and collagen strength. It was shown that anabolic steroids alter the biomechanical properties of tendons and reduce tendon flexibility.(1,2,3)

Some interesting theories have been suggested as why heavy anabolic steroid use can cause tendon injury, which is based around cortisol production and AAS. Researches have demonstrated that AAS combined with tension overload reduced MMP2 activity (MMP2 is a gene responsible for collagen production) and increased serum values of cortisol.(4) During cortisol treatment, the serum levels of genes responsible for collagen production decrease, suggesting that cortisol suppresses the synthesis of collagen production.(5) The reduction in genes for collagen and tendons have been speculated as to why AAS makes bodybuilders susceptible to injuries. New research links the use of high doses of anabolic steroids to tendon and collagen dysfunction, which may make a bodybuilder think twice about training heavily while using anabolics.

GENE EXPRESSION IN TENDONS/COLLAGEN AFTER HEAVY AAS USE

Researchers in the European Journal of Applied Physiology examined how heavy use of the anabolic steroid Deca-Durabolin affected collagen strength in rats. The rats were separated into two groups: natural training and training with heavy anabolic steroid use. The dose the researchers administered to the rats was considered supra-physiological – Deca-Durabolin (nandrolone decanoate) 5mg/kg of bodyweight.

The rats were cleverly forced to perform resistance exercise, but you can’t just tell a rat to start benching – so the researchers attached weights to the rats’ backs. They dropped the rats into a tank of water and the rats immediately jumped out of the water as soon as they were dunked. Every week, the researchers gradually made the weight on the rats’ backs heavier and heavier until at the end of seven weeks the weight was 80 percent of their bodyweight. The researchers dropped the rats in the tank so that they performed this for 4 sets x 10 repetitions of “jumps” with 30-second rest periods. After that, they rats were sacrificed and the rats’ tendons and collagen were examined for gene expression.

There were some very interesting findings after seven weeks of training with anabolic steroids, compared with the natty (natural) group of rats. The natty group did not have any biochemical changes in the rat tendon/collagen properties, while the anabolic steroid group had major changes.(6) The Deca-Durabolin group had reduced biochemical properties of genes involving tendon and collagen strength.

It is interesting to note that AAS administration reduced the accumulation of IGF-1 mRNA levels in some tendon regions, compared to the non-treated, trained group. This decrease of IGF-1 mRNA levels induced by AAS administration may be related to the observed decreases collagen expression when considering the possible connection between IGF-1 and collagen synthesis.(8) The AAS treatment also decreased the MMP-2 mRNA expression (this gene encodes an enzyme for collagen).

The above study is similar to another recently published study, which showed that nandrolone impaired the healing of rotator cuffs of rabbits. In the latter study, male rabbits underwent an incision in the rotator cuff and were divided into groups with anabolic steroids (nandrolone decanoate, 10mg/kg) and natural recovery. Groups that did not receive anabolic steroids showed better healing and more tendon strength compared to groups that received anabolic steroids. Microscopic examination of specimens from the groups with anabolic steroid use showed focal fibroblastic reaction and inflammation, suggesting an impaired healing response.(7)

The key point is that many of these studies were using supraphysiological dosages of steroids that could be like the typical Olympia stack – but the new research suggests that a high-volume approach to training with less weight may be a better approach to use for a bodybuilder than a high-intensity, heavy weight program that puts more stress on the tendons and makes them more susceptible to injury.

By Robbie Durand, M.A., Senior Science Editor of Muscular Development


References:

1. Evans NA, Bowrey DJ, Newman GR (1998) Ultrastructural analysis of ruptured tendon from anabolic steroid users. Injury, 29:769-773.
2: Marqueti RC, Prestes J, Paschoal M, Ramos OH, Perez SE, Carvalho HF, Selistre-de-Araujo HS (2008) Matrix metallopeptidase 2 activity in tendon regions: effects of mechanical loading exercise associated to anabolic-androgenic steroids, Eur J Appl Physiol, 104:1087-1093.
3: Marqueti RC, Prestes J, Wang CC, Ramos OH, Perez SE, Nakagaki WR, Carvalho HF, Selistre-de-Araujo HS (2010). Biomechanical responses of different rat tendons to nandrolone decanoate and load exercise. Scand J Med Sci Sports, 29.
4: Marqueti RC, Parizotto NA, Chriguer RS, Perez SEA, Selistre-de-Araujo HS (2006) Androgenic-anabolic steroids associated with mechanical loading inhibit matrix metallopeptidase activity and affect the remodeling of the Achilles tendon in rats. Am J Sport Med, 34:1274-1280.
5: Oikarinen A, Autio P, Vuori J, Va¨a¨na¨nen K, Risteli L, Kiistala U, Risteli J (1992) Systemic glucocorticoid treatment decreases serum concentrations of carboxyterminal propeptide of type I procollagen and aminoterminal propeptide of type III procollagen. Br J Dermatol, 126:172-178.
6: Marqueti RC, Heinemeier KM, Durigan JL, de Andrade Perez SE, Schjerling P, Kjaer M, Carvalho HF, Selistre-de-Araujo HS. Erratum to: Gene expression in distinct regions of rat tendons in response to jump training combined with anabolic androgenic steroid administration. Eur J Appl Physiol, 2011 Sep 8.
7: Papaspiliopoulos A, Papaparaskeva K, Papadopoulou E, Feroussis J, Papalois A, Zoubos A. The effect of local use of nandrolone decanoate on rotator cuff repair in rabbits. J Invest Surg, 2010 Aug;23(4):204-7.
8: Heinemeier KM, Olesen JL, Schjerling P, Hassad F, Langberg H, Baldwin KM, Kjaer M (2007b) Short-term strength training and the expression of myostatin and IGF-1 isoforms in rat muscle and tendon: differential effects of specific contraction types. J Appl Physiol, 102:573-581.

 

[Michael Scally MD]

A recent animal study along with commentary. The links are to the full-text.

Gerber C, Meyer DC, Nuss KM, Farshad M. Anabolic steroids reduce muscle damage caused by rotator cuff tendon release in an experimental study in rabbits. J Bone Joint Surg Am 2011;93(23):2189-95. http://www.zora.uzh.ch/59534/1/2011_GER_et_al_Anabolic_Steroids_Muscle_Damage_RC_JBJS.pdf

BACKGROUND: Muscles of the rotator cuff undergo retraction, atrophy, and fatty infiltration after a chronic tear, and a rabbit model has been used to investigate these changes. The purpose of this study was to test the hypothesis that the administration of anabolic steroids can diminish these muscular changes following experimental supraspinatus tendon release in the rabbit.

METHODS: The supraspinatus tendon was released in twenty New Zealand White rabbits. Musculotendinous retraction was monitored over a period of six weeks. The seven animals in group I had no additional intervention, the six animals in group II had local and systemic administration of nandrolone decanoate, and the seven animals in group III had systemic administration of nandrolone decanoate during the six weeks. Two animals (group III) developed a postoperative infection and were excluded from the analysis. At the time that the animals were killed, in vivo muscle performance as well as imaging and histological muscle changes were investigated.

RESULTS: The mean supraspinatus retraction was higher in group I (1.8 cm; 95% confidence interval: 1.64, 2.02 cm) than in group II (1.5 cm; 95% confidence interval: 1.29, 1.81 cm) or III (1.2 cm; 95% confidence interval: 0.86, 1.54 cm). Histologically, no fatty infiltration was measured in either treated group II (mean, 2.2%; range, 0% to 8%) or III (mean, 1%; range, 0% to 3.4%), but it was measured in the untreated group I (mean, 5.9%; range, 0% to 14.1%; p = 0.031). The radiographic cross-sectional area indicating atrophy and the work of the respective muscle during one standardized contraction with supramaximal stimulation decreased in all groups, but the work of the muscle was ultimately highest in group III.

CONCLUSIONS: To our knowledge, this is the first documentation of partial prevention of important muscle alterations after retraction of the supraspinatus musculotendinous unit caused by tendon disruption. Nandrolone decanoate administration in the phase after tendon release prevented fatty infiltration of the supraspinatus muscle and reduced functional muscle impairment caused by myotendinous retraction in this rabbit rotator cuff model, but two of seven rabbits that received the drug developed infections.


Wang VM. Important preliminary findings on the potential role for nandrolone decanoate in the treatment of chronic rotator cuff tears. J Bone Joint Surg Am 2011;93(23):e1441-2. http://www.jbjs.org/pdfaccess.ashx?ResourceID=242250&PDFSource=0

 

[Russ]

I dunno if I agree with this guys... For medical reasons, I've been on testosterone for 18 years at doses that replicate what they should be otherwise (once/wk injection). In the past six months, I switched from indoor climbing (because of finger ligament/tendon injuries, and a QL back muscle pull that won't heal) to lifting and running. Increasing my workouts gently, I still managed to pull both calves, strain one pateller, and pull tendons/ligaments in my forearms, elbows, biceps, deltoids, and rotators. Despite massage, ice, and several months of total rest, only the calves, patellar, and fingers are healing properly. This is all anecdotal of course, but it seems to me that long-term use such as mine is damaging even at normalized levels. So this may have implications for higher dosage rates for shorter durations.

Btw, if anyone has any other advice on healing the arm/shoulder/back stuff, please let me know.

 

[Michael Scally MD]

Serra C, Tangherlini F, Rudy S, et al. Testosterone Improves the Regeneration of Old and Young Mouse Skeletal Muscle. J Gerontol A Biol Sci Med Sci. Testosterone Improves the Regeneration of Old and Young Mouse Skeletal Muscle

Aging is associated with loss of muscle mass and strength, reduced satellite cell number, and lower regenerative potential. Testosterone increases muscle mass, strength, and satellite cell number in humans; however, the effects of testosterone on the regenerative potential of skeletal muscle are unclear. Here, we investigated the effect of testosterone on the skeletal muscle regeneration of young (2-month-old) and aged (24-month-old) male mice. We show that testosterone increases the number of proliferating satellite cells in regenerating "tibialis anterior" muscle of young and aged castrated mice 2 and 4 days postinjury. Testosterone supplementation increases the number and the cross-sectional area of regenerating fibers in both classes of age 4 days postinjury. Testosterone increases satellite cell activation and proliferation and the regeneration of both young and aged mouse muscle. These data suggest prospective application of androgens to improve the regenerating potential of the aged human skeletal muscle.

 

[hotterr]

do you have any references to back up your hypothesis? from where you get those numberS? YES i have seen studies where nandralone at 50mg/week in women increased type-3 collagen synthesis by 50% .I dont know about equipoise

 

[BBC3]

The incideous thing about shitass shoulder injuries, is that we tend to re-injure them every night when sleeping. I kinda find it odd that there is no kind of protective device for this on these recoveries !!? But still it would pose odd to day he least on acdouble shoulder situation... But every day just waking up after tweaking the bastard again on the mattress.. Really!!

 

[punkguitarist]

The incideous thing about shitass shoulder injuries, is that we tend to re-injure them every night when sleeping. I kinda find it odd that there is no kind of protective device for this on these recoveries !!? But still it would pose odd to day he least on acdouble shoulder situation... But every day just waking up after tweaking the bastard again on the mattress.. Really!!

I bought this at home shoulder rehab kit called the "Rotator Reliever". Part of the rehab kit is a shouler brace you wear at night because you're right sleeping on your shoulder wrong can really fuck it up and prevent healing. The brace provides a small amount of traction and lets more blood flow go into your shoulder while you sleep.

After the first night of sleeping with it my shoulder felt sooo much better. If I forgot to wear it one night my shoulder feels like shit the next day.

 

[Julcello17]

I'm sorry for jumping in with a question out the blue, I don't know how to start a new thread.
I did some research for awhile, and wanted to know some ideas some of you may have about my first cycle that I want to run.
I have super t 400, deca 300 and equpoise 200.
I want to run them for 10 weeks like so.
1-10 super t @ 400
1-8 deca @ 300
1-8 equpoise@ 200
With an anti estro from day one
Pct with hgc and cloud 2 weeks after last injection

Please give thoughts looking for great advice only.

 

[OhNoYo]

Ok, this whole thread pisses me off, plus makes me mad at myself for NOT reading into this further. The initial post that started this thread by pauladrive has been posted in numerous other internet sites/forums as well, and though it looks legit, no one really knows for sure. I though, speculated that it is taken as true, since the percentage numbers didn't seem made up, as they weren't rounded to straight up 100 numbers, for example nandrolone & 270%. Now though, reading other studies in this thread, Idk if I can take this stuff as true. I attempted to find something that related to pauladrive's initial post in peer-review literature, but couldn't find shit. The reason I may get back on if I decide to, especially w/ nandrolone, is cuz of "supposed" tendon healing properties. BUT, if ALL of that post is made-up BULLSHIT from some fucking douche, then s/he has had many ppl tricked for a longass time. I mean, why if what the studies posted in this thread about nandrolone are true, that this AAS may actually be DETRIMENTAL to the tendons??

If ANYONE can find references to the pauladrive's initial post that started this thread, PLEASE post them!!

 

[BBC3]

I thought I read a post in here last night where Scally posed a study stating positure corrolation with knee replacements, but then cited decreased bone density in lower back and something. I was kinda gathering it was tendon/ligament directed at knees on read? But not sure no recalling. Its in here somewhere... But I dont know if that gets to your point??

And I must say its refreshing to see a little NASTY in ya...

Ok, this whole thread pisses me off, plus makes me mad at myself for NOT reading into this further. The initial post that started this thread by pauladrive has been posted in numerous other internet sites/forums as well, and though it looks legit, no one really knows for sure. I though, speculated that it is taken as true, since the percentage numbers didn't seem made up, as they weren't rounded to straight up 100 numbers, for example nandrolone & 270%. Now though, reading other studies in this thread, Idk if I can take this stuff as true. I attempted to find something that related to pauladrive's initial post in peer-review literature, but couldn't find shit. The reason I may get back on if I decide to, especially w/ nandrolone, is cuz of "supposed" tendon healing properties. BUT, if ALL of that post is made-up BULLSHIT from some fucking douche, then s/he has had many ppl tricked for a longass time. I mean, why if what the studies posted in this thread about nandrolone are true, that this AAS may actually be DETRIMENTAL to the tendons??

If ANYONE can find references to the pauladrive's initial post that started this thread, PLEASE post them!!

 

[Andrew Androgen]

Ok, this whole thread pisses me off, plus makes me mad at myself for NOT reading into this further. The initial post that started this thread by pauladrive has been posted in numerous other internet sites/forums as well, and though it looks legit, no one really knows for sure. I though, speculated that it is taken as true, since the percentage numbers didn't seem made up, as they weren't rounded to straight up 100 numbers, for example nandrolone & 270%. Now though, reading other studies in this thread, Idk if I can take this stuff as true. I attempted to find something that related to pauladrive's initial post in peer-review literature, but couldn't find shit. The reason I may get back on if I decide to, especially w/ nandrolone, is cuz of "supposed" tendon healing properties. BUT, if ALL of that post is made-up BULLSHIT from some fucking douche, then s/he has had many ppl tricked for a longass time. I mean, why if what the studies posted in this thread about nandrolone are true, that this AAS may actually be DETRIMENTAL to the tendons??

If ANYONE can find references to the pauladrive's initial post that started this thread, PLEASE post them!!

I believe this was written by Real Gains who posts on this site. I don't know where he plucked those percentages from...

 

[mands]

I thought I read a post in here last night where Scally posed a study stating positure corrolation with knee replacements, but then cited decreased bone density in lower back and something. I was kinda gathering it was tendon/ligament directed at knees on read? But not sure no recalling. Its in here somewhere... But I dont know if that gets to your point??

And I must say its refreshing to see a little NASTY in ya...

Bump!! Dr. Scally posted on page 1 of this thread about the nandrolone study and it's effects to which you are referring.

mands