Whether from an acute injury or long term degeneration, the joints in the body,
including their surrounding capsules, ligaments, and muscles become inflamed.
While initially inflammation in our body serves a positive purpose, however it
also damages normal tissue.
The debris from the inflammatory process coagulates and forms hard masses
of scar tissues that form in the muscles or joints, preventing normal function
from returning. An injection of corticosteroids can help reduce the inflammation,
preventing tissue damage and scarring, as well as decreasing pain and
As a multi-specialty clinic we understand what it takes to help patients who are suffering from severe pain and discomfort. Performance Care offers a unique combination approach that is needed when treating chronic pain.
The pain injection procedures that are offered at Performance Care are performed by Board Certified Physical Medicine & Rehabilitation Physicians. We believe in caring for each patient individually and walking step by step through the healing process. Depending on the type of injection, most injections are performed right here in our office with patient feeling immediate relief.
Trigger Point Injections
Performance Care providers educate patients that there are many causes of back and neck pain. They include bulging and herniated discs, spinal stenosis, and sacroiliac joint disease and muscular or myofascial pain.
That being said, myofascial pain is a common painful muscle disorder caused by muscular trigger points and it’s important to understand the nature of trigger points to better address the symptoms. Trigger points are discreet, focal, hyper-irritable spots located in a taut band of skeletal muscle. The spots are painful on compression and can produce referred pain, tenderness, muscle weakness and autonomic dysfunction. Many patients refer to a trigger point as a “knot” in their muscles. Trigger points can be located almost anywhere in the body and can cause a variety of painful symptoms and can be described as active or latent.
What causes Trigger Points to Develop?
There are several possible causes of trigger points. Repetitive trauma or injury to an area may cause trigger points. Lack of exercise, poor posture, vitamin deficiencies and joint problems may also cause or contribute to the problem. Occupational or recreational activities that produce repetitive stress on a specific muscle or group of muscles may cause trigger points to develop.
How is a Trigger Point Treated with an Injection?
Trigger Point Injections (TPI) involved administering medications into the specific area or areas of the trigger point in the muscle. Our providers may use non-steroidal, anti-inflammatory medications, cortisone and muscle relaxants depending on the nature of the trigger point. If a patient has been in an auto accident, this treatment can be very effective in calming the trauma and spasm. Once a patient has received trigger point injections, modalities including myofascial release, deep tissue massage, and physical therapy and stretching are encouraged for optimal results and pain relief.
Why Physical Rehabilitation & Chiropractic Care before and after Injections?
As a multi-specialty team, we realize how important conservative treatments like physical rehab, physical therapy, chiropractic care, myofascial release (ART) and massage are in aiding the healing process. We also understand what a patient needs that is not reaching certain benchmarks in their recovery process. Advanced pain treatment procedures may be the next step in the recovery process.
Interventional Pain Management treatments (spine injections), are designed to flush out inflammation and reduce the chemical irritation to nerves, muscles, and joints. In our experience, placing medication solution directly at the site of inflammation can put out the “fire” that is causing your pain. This creates a gap for effective conservative care treatments.
What Should You Expect?
At Performance Care we believe that reducing the chemical cause of pain is not enough. We address your pain on two fronts, chemical (inflammation) and structural (muscle spasm and imbalance). Our highly trained physicians have created rehabilitation programs that will address the structural problems that develop from prolonged chemical irritation, pain, and imbalance.
Once we are able to decrease your pain and you can tolerate therapies, we can then begin a rehab program that will not only get you feeling better but teach you how to deal with minor flare-ups of pain in the future. We utilize a wide range of manual techniques and rehabilitative exercises to get you back enjoying your life.
There is no magic wand when it comes to relieving the body of pain, but we believe proper exercise and restoring normal range of motion to the body is crucial to healing.
What is Cortisone?
Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting.
Injectable cortisone is synthetically produced and has many different trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body’s own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes).
How does the cortisone injection help?
Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving medication, it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.
Intra-Articular Joint Injections
Intra-articular joint injection is a common therapeutic procedure, which aims to reduce pain and inflammation in a joint. Joint inflammation can be caused by a variety of conditions, such as osteoarthritis. The procedure is most commonly performed in the knee, hip, and shoulder, but can be done in the costo-chondral joints (between ribs and breastbone), facets joints (between vertebrae in the spine) and joints in the hands and feet.
Joint inflammation is usually associated with a proliferation of white blood cells and reduction of blood flow. This results in a painful, swollen joint. This procedure involves the injection of corticosteroids into the affected joint. This can provide quick and long-lasting pain relief with very little risk of damaging the tendons, ligaments or nerves.
Intra-articular joint injections are fairly safe and can provide long-term benefits. Normally, the pain relief lasts about 3-4 months. After that time, the procedure may be repeated if necessary.
Some injections do not require the use of a corticosteroid. An all-natural injectable anti-inflammatory compound such as “Traumeel” can also be used to provide relief without using corticosteroids.
Whether into a joint, muscle, or around a nerve, injecting an anesthetic medication could provide relief in addition to diagnostic information, helping to identify the source of someone’s pain. Trigger point injections with the use of non-steroidal medication can be very helpful for muscle spasms and chronic trigger points.
In our experience as multi-specialty pain specialists, many patients are under conservative care with their Chiropractor or physical therapist. Non-steroidal injections, in conjunction with their current conservative treatment plan, can help support the healing process.
Sacroiliac Joint Injections
At the lower end of the spine lies the Sacrum. The Sacrum is a triangular shaped bone formed by the fusion of several smaller bones. The Sacroiliac (SI) joint sits between the Sacrum and the Ilium. The Sacroiliac joint has an irregular surface and has very little motion. The older one gets, the less motion occurs in the joint. This can create a significant amount of pain and loss of mobility.
How do I know if the Sacroiliac Joint is the cause of my pain?
Sacroiliac joint problems are one of many causes of low back pain. Sacroiliac joint dysfunction may be difficult to diagnose. X-rays, CAT scans and MRIs may be normal and several other problems can mimic the pain of SI joint dysfunction. One maneuver called the FABER test can provoke pain caused by SI joint problems. With this maneuver, the patient is lying down and our physician flexes, abducts and externally rotates the hip. If this maneuver reproduces the pain, then the sacroiliac joint may be the problem. If the diagnosis is still unclear, an injection into the joint may give the answer.
How is Sacroiliac Joint pain treated?
Initially, conservative treatment is prescribed. This consists of rest, anti-inflammatory medications and physical therapy. If this is not successful, an injection into the joint may help. As pain specialists, we perform this procedure using X-Ray guidance.
Our pain providers will discuss in detail what to expect and the treatment plan regarding SI joint injections and pain.
Already a patient? Contact us or call us today at (818) 766-4307 to schedule an appointment.