Cortisone: The "magic shot" that has been crucial to Nats' success

Throughout much of the first half of the season, Ryan Zimmerman wasn't himself. Inflammation in the AC joint in his right shoulder sapped his bat speed and quickly increased his frustration level.

After yet another 0-for-4 in a game against the Orioles on June 23, Zimmerman was hitting .218 and slugging a lowly .305.

"I don't miss fastballs like I've been missing fastballs," Zimmerman said that night. "If things keep going the way they have been going, we're going to have to do something."

That "something" would have been surgery. Zimmerman would have been knocked out of the Nationals' lineup for an extended period, and he would've needed to spend his summer days rehabbing instead of taking his usual spot at third base and hitting third for a contending Nationals team.

The next morning, Zimmerman received a cortisone shot in his shoulder. He'd had two of them previously, but one was ineffective and one missed the mark. This shot was the final thing standing between Zimmerman and an operating table. He went out that afternoon, had two hits and drove in a run.

Over the rest of the season, in the 90 games that followed the shot in Baltimore, Zimmerman hit .321 with 22 home runs, 73 RBIs and a .584 slugging percentage. He was a new man. He was himself again.

"(The cortisone) saved me being able to turn my season around, and it also saved me losing about maybe two months," Zimmerman said. "So, yeah, you can definitely say for sure it had a huge part in it."

Zimmerman wasn't alone. Second baseman Danny Espinosa bruised the capsule in his left shoulder while trying to make a diving play against the Marlins on Sept. 8, and went 1-for-21 with 11 strikeouts over his next six games.

Like Zimmerman, he didn't feel pain when playing, but the inflammation in his shoulder was making a huge impact on his performance level on the field.

"Putting my t-shirt on hurt. Washing my hair hurt," Espinosa said last week. "Playing didn't hurt, I was just weak. I felt just helpless at the plate because you feel like you can't do anything. You've tried to do everything in the world to do it and you can't, and then once you can't do that, you try to cheat to get to different pitches, and you're screwed."

Danny-Espinosa-watching-ball-out-of-box.jpgIn the seven games after his cortisone shot on Sept. 17, Espinosa batted .400 and slugged .550.

"For me, it helped me out because it really got in there and did what it was supposed to do," Espinosa said. "It worked the right way and allowed me to get back to where I could be."

Espinosa's numbers came back down over the final nine games of the season (he batted .103 over that stretch), but he's been able to play without the weakness in his shoulder which hindered him at the plate. The effects of cortisone are clear.

"It cleared it up, the inflammation went way down," Espinosa said.

So what exactly is this drug which magically allows players to return to their pre-injury form? Technically, cortisone is a steroid, just not the type that is banned throughout professional sports. Anabolic steroids infiltrated Major League Baseball in the 1980s and '90s, but cortisone is a type of corticosteroid, which is completely legal and only related to anabolic steroids on a chemical level.

Cortisone is used not to heal tendons or ligaments, but instead to clear up inflammation, which is what causes us to feel pain or just an overall weakness in the affected area.

"We have pain so that when we have an injury, we stop doing what we do so we can't get a permanent injury from it," said Dr. William Howard, Director of the Arnold Palmer SportsHealth Center at Union Memorial Hospital in Baltimore. "The things we treat with cortisone are relatively minor injuries in the grand scheme of things, but painful injuries.

"If you take an athlete and he has a sore shoulder and you give him a shot, he feels like this is a magic pill or magic shot. I've had a couple, and they really work, no doubt about it. It's pretty much an instant cure."

Over the years, cortisone has become an important medical tool both in sports and for average citizens battling common ailments like arthritis or tendinitis. It might not be the first option for athletes who are in pain because of the long-term effects if overused (effects which include weakening of the ligaments and tendons in the injected area), but both Zimmerman and Espinosa have seen the benefits first-hand.

"I think it's crucial," Dr. Howard said. "If you have a sore shoulder, and that usually is a tendinitis, what you do is you inject cortisone not into the tendon but the area around it. And the cortisone infiltrates into the tendon and it clears up the inflammation and allows the injured person to either play or at least start active physically therapy. Sometimes, they hurt so bad, they can't even do good PT. So this benefits them."

Since the steroid era, there's been a bit of a stigma in professional sports attached to any type of drug which improves an athlete's performance. That's only been perpetuated in recent years by players abusing human growth hormone and testosterone in an effort to boost performance or recover from injuries quicker.

What sets cortisone apart from those drugs when it comes to the world of professional sports, Dr. Howard says, is that it in no way improves an athlete. It only allows him to play through pain or discomfort.

"You could say that it takes away your pain and helps you feel better. But that's all it does," Dr. Howard said. "It's not an enhancer. It's not a PED. You could take that all day, every day and it wouldn't speed you up a fraction of a second. You can use cortisone and it doesn't make you bigger, stronger, quicker."

Would the Nationals be playoff-bound if not for the effects cortisone had on Zimmerman and Espinosa? Probably, yes.

Would they be as dangerous a team entering the postseason if cortisone hadn't done the trick for their two injured infielders? Maybe not.

"I've had hundreds, and I don't know where I'd have been," said Nats manager and baseball lifer Davey Johnson. "It's a great drug, just can't overuse it."

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