At its simplest, 140 characters is enough to explain how Stephen Curry was able to get back on the floor for Game 4 as the Warriors tied up their Western Conference playoff series with the San Antonio Spurs:
Steph Curry says he had to take another painkilling injection to play today.— Sam Amick (@sam_amick) May 12, 2013
Painkilling injections are not new and have roots in sport that go all the way back to the ancient Greek Olympics. While the Greeks didn't have needles, they did regularly take hallucinogenic concoctions that made runners faster and wrestlers go berserk.
In modern sports, the image of a needle going into the injured space is usually wrong, as noted in a landmark study of painkillers. Keeping that in mind, it is very unlikely that Curry is taking a cortisone shot into his ankle. Instead, he's most likely taking a Toradol shot in his backside.
Besides Curry for his ankle, candidates for this treatment also include the Chicago Bull's Joakim Noah (foot) and the New York Knicks' Amar'e Stoudemire (knee).
Toradol is a non-steroidal anti-inflammatory (NSAID) in the same category as Motrin or aspirin that has become very popular in professional sports. The drug has become very controversial due to this widespread usage, with players in the NFL saying as many as half the roster was lined up before a game for a shot of "Vitamin T."
However, the drug itself is not controversial—just the usage patterns associated with it. Toradol is effective, non-addicting and perfectly legal when administered by a doctor.
The administration is as simple as any injection. Whether it's for the ankle, foot or knee, the injection would be done in the buttocks, and it has a general effect. While euphoria is listed as a potential side effect, there are no known effects that would match the opiates that have often been used in sports prior to Toradol's existence.
There are concerns in the short and long term with Toradol usage. Athletes can injure themselves further by blocking pain signals. By being allowed to play on a damaged body part, they can expose themselves to re-injury or exacerbation.
The NFL tried to have players sign an informed consent waiver before allowing Toradol injections, but that move was blocked by the union. Some athletes have gone the other way, refusing painkiller injections even if that decision keeps them out of a game.
Even the World Anti-Doping Agency is taking a hard look at the usage of this drug. While the "non-steroidal" part is highlighted by those using the drugs and there are no real connections between corticosteroids and anabolic steroids, that hasn't stopped some from calling it a performance-enhancer.
Hans Geyer, the deputy director of WADA, said that he considered anti-inflammatories a "doping substance."
While there are options, such as going backward to opiates or corticosteroids, there are no similar painkillers on the horizon without the same sort of issues. Selective pain inhibitors are a major area of research, as they have been for years, but there are no known breakthroughs on the horizon.
Drugs such as Prexige and Arcoxia were removed from use in the mid-2000s due to side effects, while drugs such as Zohydro are too effective for use in sports.
As I mentioned before, the image of a needle going into the injured space does not apply for these specific drugs. Those types of injections usually involved cortisone and a local anesthetic, such as Lidocaine.
Studies have shown that repeated injections of cortisone can have a deleterious effect, actually damaging the tissue, especially ligaments and tendons that are already causing issues. While its common use in professional sports is still assumed, the actual use of cortisone has faded to a small percentage.
For now, the use of injectible Toradol is keeping the NBA running, literally.
You have probably heard your mother tell you that you have to walk before you can run. In the NBA, sometimes the stars have to bend over before they can play.