Steroids users nine times more likely to rupture tendons

Strength athletes who use anabolic steroids rupture their tendons a whopping 9 times more often than strength athletes who stay clean, write researchers at McLean Hospital, Boston in the American Journal of Sports Medicine. Interestingly, according to the study, most tendons are not ruptured in the gym but outside it.

The researchers derived information from a group of 142 bodybuilders (88 users and 54 natural athletes, who had been training for an average of 20 years) on how often they had ruptured a tendon. The participants were aged 35 to 55.

Of the diehard steroids users in their fifties, 60 percent had never torn a tendon. Among the natural bodybuilders the figure was 94 percent.

The chance of rupturing a tendon is 9 times bigger among pharmacologically supported bodybuilders than among bodybuilders who stay away from chemical muscle strengtheners.

For the steroids users who refuse to give up their gear, the study reveals a couple of interesting things. To start with, it is mainly tendons in the upper body that get torn in steroids users. Ruptured tendons in the upper body were not found at all in the natural athletes.

Secondly, eighty percent of the injuries occurred while they were doing another sport or at work. So most of the unlucky ones who ruptured a tendon were not training in the gym when the injury happened.

The amount of steroids the users dosed themselves up with varied a lot. The study was too small to be able to detect a relationship between the dosages and the risk of injury.

“We present the first quantitative study, to our knowledge, examining the frequency and characteristics of tendon rupture in a large cohort of anabolic-androgenic steroid users as compared to a group of age-matched experienced male bodybuilders who reported no anabolic-androgenic steroid use,” the researchers write.

“Our findings provide persuasive evidence that the risk of tendon rupture is strikingly higher among anabolic-androgenic steroid users than among equally experienced weightlifters who have not used these drugs.”

“Perhaps most notably, anabolic-androgenic steroid users frequently reported a history of upper body tendon rupture, but we found no cases of upper body tendon rupture among 54 otherwise similar non-using weightlifters.”

“These findings would suggest that if a muscular man presents with a ruptured tendon, perhaps especially an upper body tendon, the clinician should strongly suspect anabolic-androgenic steroid use as a contributing factor.”

“Given the high prevalence of anabolic-androgenic steroid use and dependence in the United States and other Western countries, it appears that anabolic-androgenic steroid-associated tendon rupture represents a significant public health problem, creating substantial costs in medical care, lost productivity, and reduced quality of life.”

Ruptured Tendons in Anabolic-Androgenic Steroid Users


Accumulating case reports have described tendon rupture in men who use anabolic-androgenic steroids (AAS). However, no controlled study has assessed the history of tendon rupture in a large cohort of AAS users and comparison nonusers.

Men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture compared with non–AAS-using bodybuilders.

Study Design:
Cohort study; Level of evidence, 3.

Medical histories were obtained from 142 experienced male bodybuilders aged 35 to 55 years recruited in the course of 2 studies. Of these men, 88 reported at least 2 years of cumulative lifetime AAS use, and 54 reported no history of AAS use. In men reporting a history of tendon rupture, the circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use (if applicable) were recorded. Surgical records were obtained for most participants.

Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers, reported at least 1 lifetime tendon rupture. The hazard ratio for a first ruptured tendon in AAS users versus nonusers was 9.0 (95% CI, 2.5-32.3; P < .001). Several men reported 2 or more independent lifetime tendon ruptures. Interestingly, upper-body tendon ruptures occurred exclusively in the AAS group (15 [17%] AAS users vs 0 nonusers; risk difference, 0.17 [95% CI, 0.09-0.25]; P < .001 [hazard ratio not estimable]), whereas there was no significant difference between users and nonusers in risk for lower-body ruptures (6 [7%] AAS users, 3 [6%] nonusers; hazard ratio, 3.1 [95% CI, 0.7-13.8]; P = .13). Of 31 individual tendon ruptures assessed, only 6 (19%) occurred while weightlifting, with the majority occurring during other sports activities. Eight (26%) ruptures followed prodromal symptoms of nonspecific pain in the region. Virtually all ruptures were treated surgically, with complete or near-complete ultimate restoration of function. Conclusion: AAS abusers, compared with otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper-body tendon rupture. Source: