Injection Therapy

Steroid Injections

Steroid (corticosteroid) injections are given to provide pain relief and reduce inflammation in the joints and soft tissues of the body.

Cortisone is used which is a powerful anti-inflammatory medicine that works to break the cycle of pain and swelling in the joint.

Once pain is reduced a graduated return to normal exercise can be supervised by one of our physiotherapists.

Conditions treated by Steroid Injections

Steroid injections are effective in treatment of inflammatory conditions such as osteoarthritis (wear and tear, arthritis), rheumatoid arthritis and sudden painful attacks caused by gout. Sports injuries, ankle sprains, Achilles tendonitis, knee ligament sprains and bursitis can all be treated by steroid injections.

It is most important to have an accurate diagnosis of the injury or condition and our clinicians are experts in diagnosis.  They will examine you thoroughly and may use ultrasound to assist the diagnosis. If necessary, you will be referred for an MRI or to a surgeon if surgery is indicated.

Frequently asked questions about Steroid Injections

The cortisone injected only lasts in the body for around 2 weeks after which, occasionally the pain can return. This occurs when the underlying cause of the pain has not been addressed. At Core Physio we always address the underlying cause of the pain so that the pain is unlikely to return after an injection.

At Core Physio most of the injections include an anaesthetic to the skin and the cortisone is mixed with local anaesthetic which can result in an almost pain free injection.

In some parts of the body there are more sensory nerves and some discomfort is inevitable.

If repeatedly injected into the same place there have been reports of degradation of collagen and other soft tissues. The very fact that repeated injections were used in these case studies suggest that the injection was not working, in which case there should not be a need to repeat the injections. At Core Physio we limit the injections to a maximum of three in the same part of the body in a short period of time. Alternatives are PRP and prolotherapy or Shockwave Therapy depending on the diagnosis.

Most pain relief occurs during the first 2-4 weeks and you should contact the clinic for advice to see if you need a second injection for the best outcome after a couple of weeks. Once you are in less pain it is important that you book in to see one of our physios so they can monitor your progress and give you a graduated exercise programme to increase strength and mobility.

PRP – Platelet Rich Plasma Injections

Platelet rich plasma (PRP) is derived from a blood sample from the patient, then spun in a centrifuge to separate the platelets which are drawn off. Platelets are small cells responsible for clotting and healing and are full of ‘growth factors’ and ‘cytokines’ which boost healing. The platelet rich plasma is then injected into the area that is causing your pain.

Conditions treated by PRP – Platelet Rich Plasma Injections

PRP injections are used to treat osteoarthritis especially of the knee and shoulder.  Osteoarthritis can cause pain, swelling and stiffness and is due to the wear and tear of the joints. PRP can be as effective as corticosteroid and a hyaluronic acid injection (a joint lubricant) in improving symptoms and can last longer.  If pain is decreased an exercise programme to strengthen and mobilise will enhance the effect.

Frequently asked questions about Joint Injections

You will have a thorough assessment to see if this treatment is appropriate and the treatment will be explained to you.  You may receive ultrasound equipment for guidance in placing the needle. The consultant will take a small amount of blood from a vein in your arm. The identified area will then be injected once the blood has been spun in the centrifuge to extract the platelet rich plasma.

Anaesthetic is sometimes used so it is not an excessively painful procedure.  The clinician can administer extra pain relief if you do feel pain and will ask you throughout the procedure if you are ok and coping with the treatment.

On average our patients have 3 injections, depending on the severity of your condition

Most pain relief occurs in the first 4-6 weeks.  Do not hesitate to contact our team if you need advice after your procedure or help in rehabilitation programmes.

Hyaluronic Acid Injections

These injections are used to decrease pain and stiffness and improve mobility for people suffering from  osteoarthritis or arthritis (also known as ‘wear and tear’) in the joints.

The solution injected contains sodium hyaluronate and it is injected into the joint space where the synovial fluid is. The fluid acts as a lubricant reducing friction and improving supply of oxygen and nutrients to the worn cartilage.

Conditions treated by Hyaluronic Acid Injections

Hyaluronic acid (HA) Injections are most effective in treatment of osteoarthritis of joints especially the knee joint.  The drug works to restore the balance between the breakdown and production of sodium hyaluronate in the synovial fluid of the joint.  Once pain and stiffness have decreased, a graduated exercise programme supervised by one of our practitioners will result in improvement in mobility and strength.

Frequently asked questions about Hyaluronic Acid Injections

You will have a thorough assessment to see if this treatment is appropriate and the treatment will be explained to you.

Local anaesthetic can be used so it is not an excessively painful procedure.  The clinician can administer extra pain relief if you do feel pain and will ask you throughout the procedure if you are ok and coping with the treatment.

We routinely perform a course of three injections and the benefits of these can last for up to 9 months. You can have as many courses of injections as you require if you find that they alleviate your symptoms for a significant length of time.

You may not notice any benefits immediately after the first injection but you should start to feel less pain and stiffness over the next few weeks. The improvement should last for several months. Once you are in less pain it is important that you book in to see one of our physios so they can monitor your progress and give you a graduated exercise programme to increase strength and mobility.

Epidural Injections

This is an anti -inflammatory cortisone injection into the lower part of the back known as the lumbar spine.

Epidural injections can be between the vertebrae (interlaminar epidural), near the tailbone (caudal epidural) or around the nerves (nerve block, nerve root injection or transforaminal epidural injection).

The purpose of the injection is to carry the steroid mixed with saline or local anaesthetic to the epidural space where the disc or joint is causing pressure or irritation of the nerves.  The drug will work to reduce swelling and pain.

What are Epidural Injections used for?

Epidural injections are for low back pain particularly when the pain is felt in your leg or foot. Research has shown the benefit of epidural steroid injections in reducing pain and swelling around irritated nerves in the back. Once the pain is under control a graduated programme of exercises under the supervision of our practitioners will optimise your long-term recovery.

Frequently asked questions about Epidural Injections

You will have a thorough assessment to see if this treatment is appropriate and the treatment will be explained to you.  You will be taken to clinical area for ultrasound for guidance in placing the needle. You may lie on your front, side or be asked to sit on the side of the couch. You may feel some pressure as the local anaesthetic and steroid is injected. You will need someone to take you home after the procedure as you should not drive for the rest of the day.

In the majority of cases it is not a painful procedure. You may experience some feelings of pressure as the fluid is pushed in. The doctor can administer extra pain relief if you do feel pain and will ask you throughout the procedure if you are ok and coping with the treatment. You will be monitored closely at all times and will rest for at least 20 minutes before going home.

If the pain relief is short lived but significant the epidural may be repeated to give a longer lasting effect so do not be too disappointed if the pain relief is incomplete or eventually returns after the first injection. It can be repeated after three weeks and occasionally after that if necessary.

You may experience pain relief straight away which could last for a few hours. This is due to the anaesthetic. It usually takes the steroid about a week to take effect. The pain relief should allow you to gradually increase your activities and you will need to come for physiotherapy input within two weeks of your injection so your progress can be monitored.

Nerve Root Block Injections

These injections are given to various areas of the spinal nerves at the point at which they leave the spine at their root. You can have lumbar (low back) or cervical (neck) nerve root block injections.

The injection is a mix of anaesthetic and steroid which work together to numb the root for immediate relief and to reduce inflammation over the next few weeks. If the pain reduces during the procedure this helps confirm the accuracy of the diagnosis.

Conditions treated by Nerve Root Block Injections

This type of injection is given to diagnose and treat pain that travels down the leg usually caused by a prolapsed (slipped) disc where the disc bulge presses on the nerve root. Another condition this is used for is spinal stenosis which is when the opening for the root is restricted by bony narrowing due to arthritis and the root becomes irritated. The pressure on the nerve root causes inflammation and swelling which then causes pain to be referred down the leg.

Arm pain from a slipped disc in the neck is also treated by nerve block injections.

Frequently asked questions about Nerve Root Block Injections

You will have a thorough assessment to see if this treatment is appropriate and the treatment will be explained to you.  You will be taken to clinical area for ultrasound for guidance in placing the needle. The clinician will explain what is happening throughout the procedure and you will be closely monitored.  You will have to lie on your front for the procedure and stay lying down for a short while afterwards. Your leg may feel weak and a bit numb for a while and you should not drive for the rest of the day.

Local anaesthetic is used so it is not an excessively painful procedure.  The clinician can administer extra pain relief if you do feel pain and will ask you throughout the procedure if you are ok and coping with the treatment.

You will be booked in for a follow up and progress report and the doctor will decide then on any further treatment if appropriate. It is important to book in with one of our practitioners so they can guide you in a programme of gradual return to full fitness.

You may not feel any benefit for the first day or two and may even feel slightly worse for a couple of days. This does not mean the outcome will be negative and if you have any concerns you can ring Core Physio and you will always have a follow up to discuss your progress and any further treatment with the clinician.

Trigger Point Injections

Steroid injections with a long acting anaesthetic are given to provide pain relief (by blocking pain pathways) and reducing inflammation in soft tissues such as muscles and tendons. Cortisone is used which is a powerful anti-inflammatory medicine that works to break the cycle of pain and swelling in the affected part of the body.

The local anaesthetic can reduce the sensitisation of the nerve pathways which maintain some painful trigger points.  Once the pain is reduced a graduated return to normal exercise can be supervised by one of our physiotherapists.

What is a Trigger Point?

A trigger point is a sensitive area of the body, stimulation or irritation of which causes a specific effect in another part, especially a tender area in a muscle which causes generalized musculoskeletal pain when overstimulated.

Acupuncture and Dry Needling are also useful methods of treating painful trigger points along with manual therapy, stretching and soft tissue massage. If these techniques do not work for you the practitioner will refer you to one of the clinicians for a steroid injection with a long acting local anaesthetic.

Frequently asked questions about Trigger Point Injections

You will have a thorough assessment to see if this treatment is appropriate and the treatment will be explained to you.  You may be taken to clinical room for ultrasound for guidance in placing the needle. The clinician will explain what is happening throughout the procedure.

Local anaesthetic is used so it is not an excessively painful procedure.  The clinician can administer extra pain relief if you do feel pain and will ask you throughout the procedure if you are ok and coping with the treatment.

If the trigger point pain does not improve after the first injection you could have another one but this will be determined at your follow up appointment. Further injections may be needed so long as there is significant but incomplete improvement.

Most pain relief occurs during the first 2-4 weeks and you should contact the clinic for advice to see if you need a second injection for the best outcome after a couple of weeks. Once you are in less pain it is important that you book in to see one of our physios so they can monitor your progress and give you a graduated exercise programme to increase strength and mobility.

Examination

Facet Joint Injection

This is an anti -inflammatory steroid injection into the small facet joints of the neck, mid or lower back.

The purpose of the injection is to carry the steroid mixed with local anaesthetic to the inflamed facet joint which may be irritating the nerves in the back. The drug will work to reduce swelling and pain.

Conditions treated by Facet Joint Injections

Most back ache related to facet joints can be treated successfully with a combination of exercise, manipulation and improved posture. If this does not work and the pain is severe, a facet joint injection might help.  Once the pain is under control a graduated programme of exercises under the supervision of our practitioners will optimise your long-term recovery.

Frequently asked questions about Trigger Point Injections

You will have a thorough assessment to see if this treatment is appropriate and the treatment will be explained to you.  You will be taken to clinical room for use of ultrasound equipment or xray for guidance in placing the needle. You will lie on your front.  Each injection takes less than thirty seconds.

Local anaesthetic is used so it is not an excessively painful procedure. You will not be sedated so you can tell the doctor which joint is tender when the needle comes into contact with it.

Facet joint injections can provide many months of pain relief and the results can be dramatic but this can sometimes wear off and you may need another injection or a different procedure.

You may not feel any benefit for the first day or two and could even feel worse for a few days due to bruising around the injection site. This pain should settle within the first week. As the pain improves you will be able to increase your activities and a graduated exercise programme from our physio team who will optimise your chances of a long term recovery.

For details on any of the procedures and to book a consultation please contact the clinic today on 01698 540380 or alternatively 0141 332 6000

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