Are Injections Your Only Solution For Your Arthritis Pain?

From Dr. Negin Jalayer,

Injections are used to therapeutically reduce inflammation and pain throughout our body including our spine and muscles. The benefit of them is that they can deliver the medicine you need directly to the area of pain or injury. However, this one benefit comes with multiple risks that you should be aware of (see risks below).

There are 4 main types of therapeutic injections:

  1. Intramuscular – injected into muscles to reduce chronic spasm, also known as trigger point injections (Botox injections also fall into this category- but they work by paralyzing the muscle they are injected into- which helps against getting wrinkles).
  2. Spinal injections injected into spinal regions to treat nerve impingement, disc herniation, and arthritis. These include nerve blocks and epidurals.
  3. Joint injections – injected into the joints to ease arthritis pain and improve joint lubrication.
  4. Intratendinous injected into the tendons to help with proper tendon healing. These include PRP injections which stand for platelet-rich plasma and involve injecting your own platelets into your tendon to improve how the tendon heals.



So, how do you know if you need injections? 

This is one of the most commonly asked questions that we get. I decided to finally answer this question here. The answer is not a simple yes or no, but more of an algorithm-based approach to help you figure this answer out. This algorithm goes from least invasive (no side-effect or lowest risk of side-effects) to most invasive (highest risk of side-effects and/or complications).

Physical Therapy Techniques We Use

    • Activity Modification-we teach you how to modify your normal activities so that you don’t continue to stress your joint/injured muscle
    • Joint Conservation- we teach you how to best use your body to minimize stress to your joints.
    • Manual Therapy- studies show better patient outcomes and less pain with manual therapy treatments versus exercise alone. The therapist uses their own hands to reduce swelling through massage, stretch muscles, and mobilize stiff joints.
    • Exercise- not solely stretching, but one that includes strengthening. Your muscles act as both the brake and the accelerator to your body. They need to be working well if you want healthy joints.
    • Deep Tissue Laser Therapy- a much newer form of therapeutic laser that speeds up healing and reduces inflammation. It’s technically known as photo-biomodulation, is highly recommended, and has zero side-effects

If you have gone through this algorithm of treatment and have not had success with the lesser invasive treatments, then injections can be a consideration. Please make sure that your doctor has properly diagnosed your problem and that the type of injection he/she recommends matches your exact problem. See my quick reference guide below:

Problem Type of Injection Possibly Needed
Herniated Disc Epidural Injection
Spinal Stenosis Epidural Injection/Facet Block
Osteoarthritis Joint Injection/Viscosupplementation
Trigger Point Intramuscular Injection (Lidocaine/Steroid)
Nerve Impingement Epidural Injection
Tendonitis/Tendinopathy Intratendinous Injection


What Are The Risks and Side-Effects of Injections?

Please note that injections that use steroid medication (cortisone in particular) have bad side-effects that include the listing below. They are not recommended for long term use at all.

  1. Decreased bone density in nearby bone leading to osteopenia and osteoporosis
  2. Cartilage damage
  3. Death of nearby bone
  4. Joint infection
  5. Nerve damage
  6. Temporary facial flushing
  7. The temporary flare of pain and inflammation in the joint
  8. Temporary increase in blood sugar
  9. Tendon weakening or rupture
  10. Thinning of skin and soft tissue around the injection site
  11. Whitening or lightening of the skin around the injection site


For a low-risk alternative, try Physical Therapy

If you’re ready to try a natural, non-invasive solution for your pain, consider physical therapy. Marathon Physical Therapy has 35+ years of dedicated service and has helped over 1,000+ patients on their pain-free journey. Ready to get started? Schedule your free consultation today!

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