Injection Service

 

Injection with Corticosteroids and Hyaluronic Acid

 

At Core Body Clinic we are now be providing injections using Corticosteroids and Hyaluronic Acid. 

Please CALL or EMAIL the clinic to speak to a specialist. 

Corticosteroid is a controlled drug and requires prescription which we will be able to provide. Hyaluronic acid is not a controlled drug and requires no prescription - N.B. both have their merits and they are administered based on your injury status.  This means the service is a one-stop service where you can have your diagnosis and treatment at one location.  Because we are one of the few clinics in the area to provide Ultrasound diagnosis we can assess you, perform a point of contact scan to assist in diagnosis and clearly identify your eligibility for an injection. 

You should contact the clinic 1st to check you are eligible for an injection and you would normally undertake an initial physiotherapy with ultrasound assessment prior to having the injection to ensure you are appropriate and to ensure that you will benefit.  All patients are carefully screened by telephone prior to having an injection to ensure also that the prescription is safe for use. 

 

What are the injections? 

Corticosteroids: 

Cortisone is the name of a group of medicines that are very strong anti-inflammatories. Corticosteroids are naturally occurring hormones already present within the human body, they are very different to anabolic steroids as used by some bodybuilders. Cortisone can help reduce the pain of a tendon, joint or nerve that is inflamed.

What us Hyaluronic Acid?

Hyaluronic acid occurs naturally in the body meaning injections are very safe.  These injections can be used for painful joints like arthritis or where you have degenerative changes in the joint and you are not able to perform exercise.  Using these types of injections is sometimes preferrable to cortisone for joints because they are less aggressive.  There are different injections available with hyaluronic acid. It depends if you will benefit from a series of injections vs a single treatment.  Depending on your condition, the treating clinician will assist in helping you find the right solution. 

 

How are injections given?

Cortisone can be taken by mouth but an injection is usually more effective as the medication is placed exactly where it is needed, meaning smaller doses can be used. Typically they are placed around a chronically inflamed tendon or into joint. Both Hyaluronic acid and cortisone are delivered via a needle and syringe.

 

What conditions are treated with cortisone?

Hyaluronic acid is for the treatment of joint conditions that are of a degenerative nature. 

Most painful tendons can be treated effectively with cortisone injections. Inflammatory joint pain from osteoarthritis can be rapidly reduced with cortisone, as can nerve inflammation such as carpal tunnel syndrome.  Some of the common conditions include: 

  • Tendon Pain
  • Frozen Shoulder
  • Joint pain
  • Nerve Pain
  • Carpel Tunnel Syndrome
  • Tennis Elbow

 

Is cortisone a cure or a temporary fix?

  • Cortisone can be a cure for any pain that is entirely due to an inflamed structure such as frozen shoulder and tenosynovitis.
  • Cortisone can also be a temporary fix for any pain that is due to a minor injury, but the patient is unable to take the required time for the injury to heal itself. For example, with Golfer’s elbow in elite sports players who are required to continue with their sports activities.
  • Hyaluronic Acid can last anywhere between 6 and 9 months. 

 

How frequently can cortisone be given?

  • There are no lifetime limits on cortisone injections however expert medical consensus suggests there should be a 3-month gap between the administration of cortisone. Typically, if you do require more than 2 cortisone injections then you may be advised to consider other treatment options.
  • It is important to understand that cortisone is an excellent way to reduce pain quickly to engage in a rehabilitation programme, which will provide the long-term solution to most problems.
  • Hyaluronic acid does not have any side effects and therefore can be administered on multiple occasions provided it is effective. 

Will the injection hurt?

  • Minor discomfort is common however most patients report the injection was far less painful than they thought. There may be the need to use ultrasound to guide injections, where deemed appropriate. 
  •  

Are there any complications?

  • Short term: A small number of people will experience a temporary increase in their pain as the cortisone is working. This is nothing to be concerned about and will pass after 24-48 hours.
  • Long Term: Too many cortisone injections can cause tendon damage or worsening osteoarthritis. If you are concerned about this then your practitioner will be happy to discuss your specific case with you.
  • Many patients are concerned that steroid injections will make them gain weight. This is extremely unlikely after a corticosteroid injection as the doses are very small in comparison to oral steroids.
  • Hyaluronic acid carries very few side effects.  Pain is perhaps the only side effect because of soreness after having the injection.  
  • The rate and risk of infection is very very low.

 

What can I expect from the Injection?

The cortisone can be given with a local anaesthetic so you will usually experience a mild numbness and pain relief for a few hours. When the local anaesthetic wears off many people experience a dull ache or throbbing sensation. A small percentage of people will get a temporary increase in their pain; know as a ‘steroid flare’. This is nothing to be concerned about and painkillers such as paracetamol can be used to help calm symptoms, this will settle quickly.

Hyaluronic acid can also be given with a local anesthetic and again can cause some flair up once the pain killer wears off.  This is because we often feel better and tend to do a little more before we are ready. 

  • It is often best to consider driving arrangements after an injection as the local anaesthetic can cause some localised numbness, therefore driving may be best avoided.
  • If you are having a joint injected then it is advised to avoid strenuous activity for at least 2 days. If an inflamed tendon is to be injected then 10-14 days of relative rest from sport activities is recommended.
  • Cortisone will actively work to reduce your inflammation for 21 days. This means that the benefits of cortisone are seen within 3 weeks. The vast majority of people will start to feel benefits within 7 days after the injection. 

 

Please call or email the clinic to speak to Adrian about Injection therapy and whether this is the right thing for you. 

Read more...

Achilles Tendon Clinic

Achilles Tendon Pain

 

At our tendon clinic we see lots of Achilles Tendinopathies and Achilles Heel pain.  We use our expertise in diagnosis using over 20 years of experience and ultrasound scanning to understand your problem and how best to fix it.  Our unique clinic combines all of our knowledge to understand how your pain started and what we can do to stop your pain coming back. 

There are two types of Achilles tendon pain: Mid portion Tendinopathy and Insertional Tendinopathy.

The mid portion one is the most commonly injured part of the tendon.  People often present with pain after they have been running and start to develop pain in the region or they may feel a sudden onset of pain in the tendon.  They typically find the tendon becomes stiff when first walking in the morning and they may have pain when running or after running.  On occasions, there is severe pain and you are not able to run.  Typical patients at Core Body Clinic are runners who have been training very hard or are attempting to compete.  Our desire gets the better and we run through pain.  Tendons become injured when they are overloaded.  We keep running beyond the capacity of the tendon and therefore we get tendon reaction and eventually the signs of degeneration.  Simply, the tendon can no longer cope and starts to thicken up with inflammatory tissue, scar and excess debris.

TENDON OVERLOAD

Tendons are composed of tenocytes and are therefore structurally different from other tissues in the body.  Initially, there is some inflammation but it appears this is not the main driving force behind the condition.  Because of pain, the calf muscle (in the case of the Achilles) is not able to deliver as much force or contraction. The tendon is loaded to a lesser extent and over time becomes ‘deconditioned’.  The tenocyte matrix is less organised and is again less tolerant to loading. There may be the presence of different cells like proteoglycans which are big sponges and can give the tendon its inflamed appearance.  There is also a suggestion of scar tissue build as the tendon tries to heal itself.

"I wasnt even training hard!"

In any case these tendons are not functioning and your capacity to run and eventually walk pain free becomes limited.  You are able to run a little and then not at all.  It gets better for a few days and then it worse again. Very frustrating.  The key to success is in the understanding of how the pathology and biology of your tendon has changed.  Only then will you become aware of the parameters of training to enable you to appropriately rehabilitate the tendon without over loading it. 

Sometimes, you may not even be aware of over loading the tendon.  You may have enjoyed a problem free year without pain, normal training and excellent times.  You may have been running on the sunny promenade on a day like any other, and then develop a sharp pain.  The key here is that your training may have become attritional and plateaued.  Your tendon starts to go backwards and is no longer functionally capable of loading without injury. This is the danger zone and makes you vulnerable to injury. or stiffness in the tendon.

"Im not very fit" or "Im new to running"

If you are severly out of condition, perhaps you have suffered a long illness or you have taken steroids for a long period of time.  Such persons are more susceptible to Achilles Tendon Pain. 

Snapped tendons or ruptured tendons tend to occur without warning.  It is not common to have a history of tendon pain and then rupture your tendon.  

 

Symptoms:

  1. Pain in the middle of the tendon 
  2. Pain on running
  3. Pain may get better or worse with activity
  4. Pain in the morning for the first 5 or 100 steps
  5. Pain on descending the stairs.
  6. Pain on hopping

 

What you will not have:

With Achilles diagnosis you will not experience burning pain and Pins and needles

You also will not suffer pain shooting up the leg and into the back

 

Assessment:

At Core Body Clinic we have a dedicated Tendon clinic for assessing the Achilles tendon.  We use a combination of history (what happened), examination and also Ultrasound Scanning.  The scan helps us to understand to what extent the tendon is damaged and this provides you with a prognosis.  We will use a battery of tests to diagnose your problem with checks of your balance, knee alignment during function, foot posture and strength.  

 

 

Tendon Scanning 

 

 

 

 

We will also check your hamstring strength and length, hip flexor length and also the ranges of movement in your spine.

We will look at calf strength and ankle flexibility and probably give the tendon a poke and prod.  While this helps to show us where the issue is it does not tell us

 

Treatment:

We know that activity is good for tendons. They love it! But in the early stages gentle massage, rest, ultrasound (big placebo but can be therapeutic), taping, R.I.C.E and Anti-inflammatories (NSAIDS) can all help.  But none of these will sort your tendon out.

Once we have confirmed diagnosis we will set about prescribing a bespoke plan of action to get you back to your normal functional level.

Isometric exercises are thought to be helpful by contracting the calf muscle, like a heel raise and holding the position for 30-60 seconds.  

Graduated exercises are the main stay once pain begins to settle. These are carefully constructed and prescribed in consistency with your pain. Over doing the exercises too quickly will land you back to square one. They need to be gradual and increase in load so that getting you back to climbing the stairs or Everest is a smooth pathway of recovery

Massage and Ultrasound can be helpful to manage pain to allow you to exercixse and load the tendon.

For more difficult tendon pains we can use Shockwave therapy and in very small numbers PRP injections are helpful. 

 

We may also use taping if you are struggling with pain and orthotics if we feel your footwear is a factor in your Achilles Tendon pain. 

Return to Running

At Core Body Clinic the focus of our Sports Physiotherapists is to work with you to get you back running.  We will NEVER say don’t run unless we truly belive it will do you harm.  If you are a keen runner then we will aim to get you running again at the earliest possible convenience.

We can manage your pain and symptoms with effective strategies like appropriate footwear, taping, load management (how much running and how much exercise you should do) and direct therapies (Massage, ultrasound).

Graduated running is KEY.  Start small.  Walk for 5 minutes, run for 5 minutes, walk, run, walk, run – get the picture? The tendon essentially stores kinetic energy and if in a state of reaction it will become more tender and painful over the time of the run.  Key is to stop before it becomes too sensitised.

Avoid hills to begin with (Hard to do in Reading and Tilehurst!) and have no expectations.  You may need a week or two off.  Aqua jogging is a great alternative early on and changing activity to cycling can be a great way to keep your cardio fitness up.

 
 
Read more...
Subscribe to this RSS feed