Injection Therapies

Movies can shape our perception on many life events, be it social situations, relationships and even medical interventions.  Let’s talk about injections, and more importantly super powers. Some famous cases of injectable powers:

  • Neo from the matrix – Injection gave him proficiency in 100s of martial arts
  • Wolverine being injected with adamantium – giving super strength, tissue regeneration and some super sharp claws
  • Captain America – super strength from a military injection/ test
  • Spider Man... we all know that story. 

 

We would all be very interested in miracle injections that could make us sprint like Usain Bolt, play tennis like Roger Federer, have a brilliant mind like Elon Musk or even have a smooth and iconic voice like Morgan Freeman. However in life, there are no short cuts to achieving significant goals, it takes hard work in the right direction, and unfortunately anything else is science fiction.

This blog is about the role of interventional procedures, or injection therapies, in the management of musculoskeletal conditions for our every-day superheroes at Southside Physio.  These therapies can be broadly divided into 2 categories: anti-inflammatory and pro-inflammatory.

A) Anti-Inflammatory
1. Corticosteroid Injections: Cortisone injections are injected into joint spaces for their anti-inflammatory effects to provide quick relief of pain and inflammation.  Some patients experience excellent relief for months after one injection while others experience no relief at all.  There are two common outcomes our clients experience, 1. excellent relief for months or 2. no relief at all.  There are many complex reasons for varied success of Cortisone injections - they greatly depend on: 

  • Accuracy of diangosis and injection 
  • Ability of the tissue to heal 
  • Was the injected site actually a pain generator or simply another sypmtom of a much more complex condition

Remember that the effects of cortisone injections are often short lived and repeated injections (especially into tendons) can have some adverse effects and cause an increase in injury risk to these tissues. Currently, there is no consensus as to “how much is too much.”  Conservative doctors will often try 1 injection first and the patient is then re-assessed within 3 months to determine if the procedure was successful. The decision then on whether to repeat the procedure depends on a risk/benefit decision making process. 

2.  Lidocaine Injections: Lidocaine is short-acting anesthetic injected locally to joints, soft tissues or nerves. It is often used to confirm pain generators and can be quite useful to establish a diagnosis (ie. whether the injected tissue or joint is involved in the patient's symptoms).

B) Pro-Inflammatory injections: This group of injection therapies attempts to restore the normal functioning of tissues. Though commonly administered, how it does so remains poorly understood. The current understanding is that by injecting an irritant into a tissue, this will cause a momentary breakdown in order to trigger the body to respond by initiating a new cycle of healing. It kick-starts a new inflammatory process so that the body can proceed through the stages of tissue healing again, with the hopes that the tissue will rebuild itself to a more natural state. There are 3 types of these injections:
1. Prolotherapy involves the injection of dextrose or P2G (phenol/glycerin/dextrose).

2. Platelet rich plasma (PRP) involves collecting blood from your arm, spinning the blood in a centrifuge, to separate the platelet cells so that it can be re-injected into the joint or soft tissue injury. Although the mechanisms by which the tissue healing occurs is still under study, there is emerging evidence which do show that PRP, like Prolotherapy can be useful adjuncts to treat conditions like joint osteoarthritis, muscle tears and tendinopathies where conservative management has failed.

3. Autologous blood injections: Just like PRP, however, there is no separation via centrifuge. A patient’s blood is withdrawn and then re-injected in its entirety into the joint or soft tissue injury.

Some key messages we would like to highlight: 

  • Your physio is still the expert in managing musculoskeletal complaints and should be a part of your multidisciplinary management
  • An injection alone is unlikely to fix your problem without hard work and correct rehabilitation. 
  • Ie. if weakness in a muscle caused pain, you can't inject a muscle making it strong again. The injection won't make you able to run that 5km pain free. 
  • Your body is most likely to respond to exercise with progressive exposure to activities you are limited in. By going through a gradual increase in tissue loading, your body will learn to take the stresses of your daily activities and can naturally adapt to a pain free state. 
  • If an injection is required, make sure you continue to work with your physio before and after the injection as the injection may only be a small part of your overall rehab and has not been designed as a cure. 
  • Please think twice, ask questions and check in with us - and your spidey senses before you go for an injection. 

Let's get your rehab right, and remove the hollywood effect from injection therapies. 

Adapted with permission from Albert and Karen Chan