In a physical medicine practice such as physical therapy and/or a chiropractic practice, patients arrive having had a variety of injections, or they are contemplating a variety of injections, in an attempt to remedy their particular ailment. In physical therapy practice, we often see a mismatch of the type of injection with the actual goal of the injection. In order to get the best response and outcome, it is necessary to match the type of injection with its anticipated effect and the condition or process it is being used to treat. The types of injections most often seen in physical therapy practice are cortisone, platelet-rich plasma, stem cell, prolotherapy and lidocaine injections. Each one is used for a different reason, based on what you are trying to achieve from having the injection.
Cortisone injections are probably the most common injection given and receive a great deal of attention, both good and bad. They are used to treat inflammation of localized areas of the body that exhibit signs of inflammation due to trauma, overuse conditions or chronic processes. They are referred to as anti-inflammatory injections. They can be injected into a specific joint or tendon. They do work better when injected into a joint that can hold the cortisone for a period of time. When injected into a tendon, the cortisone disperses rather rapidly and the effect becomes analgesia (pain relief) versus anti-inflammatory. Cortisone injections can cause tendon weakening and rupture, so exercise after an injection should be supervised and guided by a licensed health care professional to minimize the likelihood of tendon injury. Patients with diabetes should monitor their insulin and blood sugar levels, as spikes can occur after an injection.
Platelet-rich plasma, or PRP, is a nonoperative treatment for conditions such as arthritis, degenerative tendon disease and ligament/tendon sprains and tears. It utilizes the body’s natural healing process. PRP is a concentration of platelets that are injected into the damaged ligaments, tendons and joints to promote tissue repair and accelerate healing through hyper-oxygenation. It is therefore referred to as a healing agent. Platelets are rich in growth and healing factors, which means, on average, a patient's recovery from an injury can be accelerated with a PRP injection. There is still no consensus about what to do after the injection. The rest period post-injection varies from one to six weeks depending on how your doctor was trained.
Stem cell therapy, also known as regenerative medicine, is the newest of the injections referred to as "ortho-biologics." The idea is to promote the reparative response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. Stem cell injections are therefore classified as a healing agent used to heal and repair tissues. Researchers grow stem cells in a lab. These stem cells are manipulated to specialize into specific types of cells, such as cartilage, bone, etc. For knee injections, doctors often take stem cells from the patient's bone marrow, fat tissue or blood. Doctors who do the treatments cite anecdotal evidence as validation that the treatments work. But the big research universities, such as Duke University, Johns Hopkins and Cleveland Clinic, are producing research that is promising beyond anecdotal.
Prolotherapy involves injecting irritants into an injured or inflamed joint to stimulate healing. It has also been referred to as a sclerosing agent. The irritant kick-starts the body's healing response and is therefore used in an attempt to stabilize an unstable joint. Joints can become unstable through overuse, stress, degenerative joint disease and/or trauma. Prolotherapy is not a surgical treatment. Because of this, it is also known as a regenerative joint injection, or non-surgical ligament and tendon reconstruction. Some sources state that once activated, the body will start to strengthen and repair the damaged ligaments in the joint. The strengthening of the ligaments, over time, helps to stabilize the joint, thus reducing the instability. Once the joint stabilizes, the patient’s pain begins to resolve. Prolotherapy may require several injections into the injured area or unstable tissue to achieve its full effectiveness. Patients should expect anywhere from four to 15 shots per session, and for several sessions to occur over the course of three to six months.
Lidocaine is a local anesthetic (numbing medication). It works by blocking nerve signals in your body. Lidocaine injections are used to numb an area of your body to help reduce pain or discomfort caused by invasive medical procedures. Lidocaine is classified as a pain-relieving agent. It can also be used for trigger point injections to help with muscle pain and headaches. Trigger points are focal areas of shortened muscle fibers and inflammation in skeletal muscle. The rhomboid and trapezius back muscles, located in the upper back and behind the shoulder areas, are a common site of trigger points and TPIs.
Regardless of the injection, the key to success is matching the type of injection with the intended goal of the injection. If an injection is recommended, ask the provider what the intended goal is and if the particular injection will meet that goal and how.
Dr. Dale Buchberger is a licensed chiropractor, physical therapist, certified strength and conditioning specialist, and a diplomate of the American Chiropractic Board of Sports Physicians, with 30 years of clinical sports injury experience. He can be contacted at (315) 515-3117 or activeptsolutions.com or shouldermadesimple.com.