Injection Therapy

How We Use Injection Therapy

Injection therapy is a treatment option commonly used in conjunction with traditional physiotherapy. To provide relief for a number of conditions, injections are administered to intra- and extra-articular tissues, joint spaces, and painful soft tissue lesions. At Core Physio, our treatments involve the use of steroids or hyaluronic acid injections (i.e: Ostenil), the choice depends on your presenting symptoms and condition. The expert consultants we employ at Core Physio will always advise you accordingly.

This form of therapy can be used as part of a treatment programme for a range of complaints:

  • Inflammatory pain from a range of orthopaedic conditions
  • Achilles Tendonitis
  • Plantar Fasciitis
  • Tennis Elbow
  • Shoulder Tendonitis
  • Joint stiffness and reduced range of movement
  • Carpel tunnel syndrome
  • Bursitis

What Are Cortisone/Steroid Injections?

Cortisone Injections (Corticosteroid Steroid Injections) are commonly used to treat a wide variety of musculoskeletal conditions. They are thought to influence the cells involved in inflammatory responses to disease and injury, which often results in a significant and almost immediate relief of pain and stiffness.

We are very proud to be able to offer cortisone injections as a treatment option at our physiotherapy clinics in Hamilton, Bothwell and Glasgow. The administration of a cortisone injection is an advanced skill that requires extensive post-graduate training and as a result, very few private physiotherapy clinics throughout the UK are able to offer this service.

What conditions can you treat with cortisone/steroid injections?

Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis of the hip, knee, elbow, or shoulder), a tendon (tendinitis such as tennis elbow), and a joint (arthritis). Knee osteoarthritiship bursitis, painful foot conditions such as plantar fasciitisrotator cuff tendinitis, frozen shoulder, and many other conditions may be treated with cortisone injections. Corticosteroid injections given in the shoulder may cure localized soft-tissue inflammation in the shoulder, such as bursitis or tendinitis. Cortisone injections of the shoulder may be used in conjunction with physical therapy to treat rotator cuff syndrome and impingement syndrome.

Injections of cortisone and an anaesthetic such as lidocaine are sometimes used to confirm a diagnosis. For example, if the pain in the buttock and groin improves after a cortisone injection in the hip, the pain is caused by hip arthritis rather than arthritis in the low back.

How long will the cortisone/steroid injection take to work?

The cortisone is combined with local anaesthetic (LA), therefore the patient often experiences immediate relief of symptoms due to the effect of the LA. The LA wears off in a couple of hours and as a result of the patient often experiences a return of the pain or even a slight worsening, known as ‘post-injection flare-up’. An increase in pain can last for a few days and is best treated with icing of the area. The pain relief associated with the cortisone part of the injection can take from a couple of days to a couple of weeks. The timing of the pain relief depends on how long the inflammation takes to settle down following the injection.

How long will the cortisone/steroid injection work for?

The duration of pain relief associated with a cortisone injection is dependent on the condition it is being used to treat. In certain conditions such as an acute tendonitis of the thumb/wrist caused by a single episode of overuse, one cortisone injection can permanently relieve the pain. In other chronic conditions, such as knee arthritis and chronic repetitive strain conditions, the pain relief may be immediate and significant, but the pain is likely to return gradually, due to the underlying wear and tear.

Will I need more than one cortisone/steroid injection?

This is also dependent on the condition being treated. It is common to need repeat injections for chronic conditions such as knee arthritis. For many conditions, one injection will be enough to resolve the problem or reduce the pain to a manageable level, so that the patient is able to perform exercises to further reduce pain and disability.

How many cortisone/steroid injections can I have?

There is no hard and fast rule that says how many cortisone injections can be given over time. However, cortisone injections can have some side effects and repeated use of cortisone injections should be done with caution. Most advanced physiotherapists use the rule of no more than 3 injections in one area within one year. It is common to try a second injection, even if the first provided only partial or short-term relief. If there is only short-term relief following the second injection, a third is unlikely to help and therefore the doctor or physiotherapist would advise against it and would discuss alternative treatment options.

How often can I have a cortisone/steroid injection?

There is no universal agreement regarding the minimum period between injections in the same area, but 6 weeks is used as a general rule of thumb.

Are there any potential side effects of cortisone/steroid injections?

Cortisone injections are widely used in the treatment of joint and soft tissue conditions. They are very safe to perform. Side effects tend to be very rare or very minor. Our physiotherapist will discuss all of the potential side effects with you prior to administering the injection. There are certain conditions that would increase the risk of side effects, so our physiotherapists will discuss your medical history in detail before performing an injection. If it is not appropriate to offer you a cortisone injection, other treatment options will be discussed.

Do you offer spinal joint injections

No, we do not offer spinal joint injections. It is recommended that these are performed by spinal surgeons under x-ray/ultrasound guidance.

Are cortisone/steroid injections the same as anabolic steroids used by bodybuilders?

No. Cortisone is a very powerful anti-inflammatory injection. It helps to settle pain, swelling and inflammation. It does not have the same side-effects as anabolic steroids and does not help to build muscles. Anabolic steroids are synthetic substances related to testosterone. They have a muscle building effect. They have quite marked side effects with repeated use.

Our physiotherapists are happy to discuss any further questions/concerns you have regarding a cortisone injection before you book an appointment. Please call our booking line on 0800 054 6430 and speak to one of the team.

Call us on 08000546430 to book in today. The prices of our services are here

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Injection Therapy

In most cases, injection therapy is not a standalone treatment but can help relieve pain to allow your physiotherapist a ‘window of opportunity’ to treat the underlying problems of a complaint, aiding rehabilitation.

Whilst injection therapy can help to provide pain relief, this is rarely used as a first course of treatment, as the symptoms will likely return without physiotherapy exercises and treatments to help prevent further pain and problems.

Steroid Injections:

Some steroids occur naturally in the body, but man-made steroids reduce inflammation in much the same way. We can inject steroid mixtures into or around the inflamed joints to help reduce pain and ease restricted movement. Some steroids are fast to have an effect, but for a short period of time, whereas others take longer to have an effect, but stay effective for much longer.

Steroid injections are often used for treating rheumatoid arthritis and some cases of severe osteoarthritis, gout and a range of other conditions that affect certain muscles, tendons and soft tissues. Steroid injections help to reduce inflammation within a joint, help to provide pain relief and are often given to people during a strong flare-up of symptoms that can prevent the normal function of the joints.

As steroid injections can help to ease pain and symptoms, they are most commonly used as part of a complete physiotherapy treatment package. Whilst steroids are in effect, it is often easier for your physiotherapist to continue with other manual therapy and exercise treatments to help rehabilitate you and return the affected joint to normal function.

Hyaluronic Acid Injection Therapy:

Hyaluronic acid is a natural component of synovial fluid. Hyaluronic injections are often used as part of a wider treatment package for degenerative joint conditions. Whilst steroid injections are commonly used to help reduce inflammation, hyaluronic injections are best suited to treating joints where the smooth surfaces have worn, but there is no significant inflammation. This form of injection therapy is commonly used as part of a treatment programme for the knees, shoulders, elbows, thumbs or ankles.

WHAT WILL HAPPEN WHEN I HAVE A HYALURONIC ACID INJECTION?

The clinician, performing your injection, will help choose the most appropriate hyaluronic acid for your condition and your symptoms. Usually, they will inject the HA directly into the area of your pain, typically a joint such as your knee. Your treating clinician will explain the procedure in more detail on the day based upon examination findings to help choose the most comfortable and effective treatment. Most HA injections are surprisingly quick and comfortable to perform.

WHAT WILL HAPPEN AFTER THE INJECTION?

You should usually allow a week or two for the effect of the HA to begin.  When having an injection into a joint, we recommend that you might avoid strenuous exercise for three days afterwards due to the possibility of some post-injection discomfort. When having an injection around a tendon, your treating clinician may advise you to avoid heavy impact and loading activities for a few days, again, this is due to potential discomfort following the injection.

To be safe,  we usually recommend that patients remain at the clinic for around twenty minutes following the injection to allow observation for any possible adverse reactions and so that they feel happy to make their journey home.

WILL I NEED FURTHER INJECTIONS?

One of the very positive benefits of hyaluronic acid injections is that they can safely be repeated where patients find them to be helpful. Where other treatments have been unsuitable or may not have helped, HA can provide a viable option or as an adjunct to ongoing treatments such as exercise. There is currently no research evidence to suggest any significant long-term harm from having repeat injections of HA.

POTENTIAL RISKS AND SIDE EFFECTS FROM HA INJECTIONS?

The vast majority of people can have HA injections without any significant side effects. A proportion of people, approximately 1 in 5,  may have some pain for around 48hours after the injections.  This will usually fully resolve quickly and can be managed with relative rest, cold compress and over-the-counter painkillers.

WILL THE INJECTION HURT?

There may be a bit of discomfort at the time of the injection procedure, but many people report that they are not nearly as bad as they had feared. Ultrasound guidance and careful patient positioning mean that injections can be delivered much more comfortably. You can also request local anaesthetic which can also make the injection more comfortable.

WHAT HAPPENS IF I GET AN INFECTION?

Extremely rarely  (around 1:50,000 according to the literature) patient may get an infection to the area shortly after an injection procedure. Your clinician will advise you about this again on the day. Should the joint suddenly become more painful, hot and swollen, in the days following your injection you should seek medical attention immediately, especially if you are feeling generally unwell.

WHAT ARE OTHER POTENTIAL SIDE EFFECTS?

There are very few other side effects that have been linked to the use of hyaluronic acid and they are generally regarded as a very safe procedure.

CAN I SAFELY TAKE OTHER MEDICINES ALONG WITH THE HA INJECTION?

Yes, it is safe for you can take other medications alongside the hyaluronic acid injection. There are currently no known significant drug interactions that occur with hyaluronic acid and other medications.

However, it is important to note that if you are taking a blood-thinning drug,  you may need a blood test (test for INR) to make sure that your blood is not too thin to safely have the injection. The reason for this is due to the risk of bleeding into the joint at the time of the injection which may raise the risk of infection. Therefore you must tell the clinician performing the injection if you are taking an anticoagulant (blood thinning) medication as they may need to discuss this with your GP before proceeding with the treatment.

IS IT SAFE TO HAVE HYALURONIC INJECTIONS WHILST PREGNANCY OR BREASTFEEDING?

Unfortunately, we are not able to offer HA injections to patients who are pregnant. There are currently no known associated risks to having HA injections whilst breastfeeding, although we recommend that patients first discuss with their GP.

BELOW IS A SUMMARY OF THE KNOWN RISKS/SIDE EFFECTS FROM HAVING HYALURONIC ACID INJECTION – Serious side effects are extremely  rare but can include:

  • Joint and soft tissue infections – please see above
  • Anaphylaxis (allergic reaction) – extremely rare

OTHER POTENTIAL SIDE EFFECTS MAY INCLUDE:

• A post-injection flare of pain at injection site – please see above
• Injury or trauma to neurovascular or soft tissue structures during the injection procedure  -your therapist is trained to take all appropriate steps to minimise risks and avoid injecting or traumatising any soft tissue structures, nerves or vessels when performing the injection. However, there will always remain a very small risk that this could occur, particularly with injections at certain locations, this can also be discussed further at your appointment.

You will be asked to remain in the clinic for up to twenty minutes following your injection to allow observation for possible adverse reactions from your injection.

For further information on injection therapy, please call today on 08000546430 or email us at enquiries@core-physio.org

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