Injection Therapy in Brighton
For the most part, soft tissue injuries usually respond to initial rest and ice, followed by various conservative therapies, including stretching and then gradual exercise. Sometimes medications are needed to control inflammation and manage pain. Allied Health therapies can assist, including manual therapy, dry needling and specific strengthening. Where pains are not settling by about 6 to 8 weeks, it is probably time to consider whether some form of injection therapy might help. Some injections, such as cortisone, aim to reduce swelling and inflammation, while other regenerative injections may be used to encourage and promote natural healing. Injections by themselves are rarely an instant cure, but they can assist in recovery, usually in conjunction with specific exercise programs. here is a brief overview of some of the more common types of injection therapies available at Brighton Spine and Sports Clinic, with links to more detailed information.
CORTISONE INJECTIONS
Cortisone is a synthetically manufactured drug which mimics certain functions of the natural hormones that appear in the body. These natural hormones include glucocorticoids which regulate sugar metabolism within the body, adrenal corticoids which regulate fluid balance within the body, and androgenic hormones which are one class of sex hormones within the body, but its main effect is as a powerful regulator of the immune system, reducing inflammation. Cortisone injections are used to provide a localised concentration of the drug into areas of excessive inflammation. They are typically used to settle nerve pain and swelling in the spine in cases of disc prolapse. They are also useful in settling joint inflammation in the short term – to provide a “window” where other treatments can be introduced. Recent research suggested cortisone is not helpful long term for tendon or ligament sprains as they settle the inflammation but don’t encourage strengthening and healing of weakened tissues.
DEXTROSE PROLOTHERAPY
Sclerosing, or prolotherapy injections, were first proposed by Hackett, an orthopaedic surgeon, in the 1950s. Early injections included various solutions of local anaesthetic, dextrose (sugar), phenol and glycerol. The solution was designed to create an inflammatory reaction initiating the proliferation of scar tissue (collagen) in the tissues injected. The idea was to cause thickening, tightening and strengthening of the tissues through scarring. Studies confirmed that injections into damaged tissues lead to about a 40% increase in collagen fibre strength and cross sectional area of tendons and ligaments. More recent trends have led to the use of less irritant solutions of 5% to 25% dextrose mixed with local anaesthetics – a very tolerable and safe injection.
There are 2 main variations of dextrose prolotherapy:
- Sclerosing Prolotherapy – utilising the stronger 25% concentration of dextrose mixed with local anaesthetic designed to stimulate a fresh healing / strengthening response.
- Neural Prolotherapy – utilising 5% dextrose, a much gentler injection thought to calm nerve inflammation in the soft tissues.
Dr Wilk has over 30 years of experience utilising prolotherapy injections in the rooms at Brighton, as well as under fluoroscopy amd CT guidance. more details can be found by clicking on this link to the Dextrose Prolotherapy page.
PLATELET RICH PLASMA ( PRP)
Platelet Rich Plasma, commonly known as PRP, is a product extracted from your own whole blood, containing concentrated growth factors and proteins which enhance soft tissue healing. The number of basic science, animal and human investigations of PRP for tendon and muscle injuries worldwide has risen sharply in recent years. These studies are helping clinicians better understand the mechanisms of PRP and are guiding novel treatment protocols. Recent studies are highlighting the need to precisely separate the various components of blood to optomise the positive health powers.
Currently at our clinic in Bayside Melbourne, PRP is being used clinically in the following areas:
- enhancing tendon repair in tennis elbow, golfers elbow, shoulder rotator cuff tears, and jumpers knee
- Sacro-illiac pain, reducing instability in post-pregnancy pelvic pain.
- Osteoarthritis if the ankles, knees, hips, shoulders and the smaller joints.
- Chronic neck and back pain.
Dr Victor Wilk at Brighton Spine and Sports Clinic has been utilising PRP injections for over 20 years. We have recently updated our extraction methods, incorporating the Alocuro system of PRP preparation, maximising platelet numbers while at the same time minimising red blood cells. For further information, see our dedicated PRP info page.
PENTOSAN POLYSULPHATE SODIUM ( PPS )
PPS therapy has been in the news in recent years showing impressive improvements in footballers with crippling knee osteoarthritis. It is still an experimental drug and only available from Paradigm Biopharma – an Australian listed pharmaceutical company as part of the clinical trials program they are running. Dr Victor Wilk of this clinic was involved in the running of some of these trials that consisted of twice weekly subcutaneous injections of PPS for a period of 6 weeks. The results were variable with about 2/3 of patients reporting about 50% improvement for a few months, but with any improvements wearing off by 6 months.
Paradigm Biopharma are continuing to run trials for knee arthritis but Dr Wilk is no longer involved in these. The drug is available for private patients – but at a cost of over $4000 for a 6 week treatment course. If still interested you can make an initial appointment with Dr Wilk. For further information go to the Paradigm website: https://www.paradigmbiopharma.com
STEM CELL THERAPIES
Stem cell therapies are available for knee osteoarthritis – but at present do not show any superior benefit over PRP injections and are still classed as an experimental therapy. The cost of such injections at present is prohibitive and thus not recommended for routine treatment.
TRIGGER POINT INJECTIONS
The majority of patients complaining of chronic pain will have areas of muscle tightness throughout their body. In some cases these areas of muscle tightness are the primary cause of pain. In other cases the muscles tighten up in reaction to an underlying joint or nerve system problem. Where the muscle is the primary source and cause of the pain, a simple injection into a tender spot in the muscle can relax a tight band in the muscle, (otherwise known as a trigger point) resulting in relief of pain.
A trigger point can be described as a taut band within the muscle, which when stimulated, causes pain locally and also may cause pain to spread to nearby areas. Examples of trigger points which may cause headaches include tender spots within the trapezius muscle at the base of the neck, sending pain up the back of the neck to the base of the skull. The strap muscles at the front of the neck (sternomastoid) can cause pain that spreads up to the side of the face, the temple region and around the eye.
