Injection therapy can be a very useful form of treatment to settle acute symptoms to allow you to engage with rehabilitation or to manage long-term chronic conditions.
There are two main types of injection therapy that have proven benefits for a wide range of pain conditions Corticosteroid Injections and Ostenil (Hyaluronic Acid Injections).
Corticosteroid Injections
Cortisone is an anti-inflammatory steroid (vastly different from anabolic steroids used illegally to gain muscle mass!) that occurs naturally in the body. Steroid injections (Corticosteroid injections) are administered by highly trained healthcare professionals (such as Clinical Specialist Physiotherapists) and use a small dose of synthetic cortisone to provide quick and effective relief of pain and stiffness which is caused by inflammation, such as in acute arthritis, bursitis, tendinopathy / tendinitis. frozen shoulder (adhesive capsulitis), trigger finger and carpel tunnel syndrome.
Steroid injections often provide patients significant pain relief allowing them to engage with exercise and the chance to progress their rehabilitation and strengthen the surrounding areas to create longer term gains.
Ostenil Injections
Ostenil is a solution containing hyaluronic acid (HA injections), used specifically to help ease joint pain and stiffness associated with osteoarthritis, by helping to preserve joint health. The Ostenil Standard or Mini is injected into the affected joint once a week for 3 weeks until you have had 3 injections, whereas Ostenil Plus is a single injection that is usually used as top up / follow up injection but can be delivered as in place of the recommended course of 3 Ostenil Standard in certain circumstances.
While injection therapy can provide significant relief for many, it is not always right for everyone. A clinical specialist physiotherapist will complete a full assessment to ensure that an injection is the most appropriate option for you, considering:
- Which joint is affected.
- What your pain is caused by.
- Whether you need fast, short-term relief, or slower, longer-term relief.
- What other medical conditions you have.
- What other treatment you have had so far or are currently undergoing.
- Whether you are aware of the risks and side effects and are still happy to go ahead with the injection.
What happens after the injection?
Injections are performed using safe methods and you will be able to go home straight after the procedure. Your Physiotherapist Laura Cattell and Jolien Borrenberghs will give you guidance on an individualised rehabilitation programme to enable the most effective and longer lasting recovery.
While you may need to rest the joint for a few days following the injection, you will be able to do all normal activities of daily living.
How long do the Effects Last?
With Steroid injections you should notice a benefit a few days after your injection (if not hours!). Some people feel completely pain free, however, unfortunately this benefit often wears off after 4-8 week unless you persist with rehabilitation to address the initial causes of your symptoms. It might also be the case that the short-term benefits will help you live a more mobile pain-free life while you wait for joint surgery or other orthopaedic appointments. You should be aware, however, that while for the majority of people Steroid injections provide fast and significant pain relief, results can vary, and it is not always possible to predict who will respond best.
With an Ostenil injection, you may not notice any improvement after the first injection, however after the 2nd and 3rd injection you should gradually start to notice less pain and stiffness and the benefit from the full course of three injections can last up to 9 months. When the effects do wear off, you can continue to have new courses of injections whenever necessary and top ups may only require a single dose. Typically, you may have an injection every 6-12 months.
Are there any side effects to Injection therapy?
There are rarely any significant side effects from Steroid or Ostenil injections, however, following your injection you should look out for any sign of infection (such as redness, swelling, pain, joint heat and / or a temperature). In this instance you should get medical advice as soon as possible (usually A&E).
There are, however, a few side effects of Steroid injections to be aware of that usually last for up to 7 days:
- Slight discomfort during the injection
- Slight bleeding at the injection site
- Pain or discomfort for a few days – basic over the counter painkillers should help with this
- Temporary bruising or a collection of blood under the skin
- Flushing of the face for a few hours
- Dimples, paleness or thinning of the skin around the site of the injection – this may be permanent
- Headaches, dizziness, or drowsiness
- Nausea
- Itching and skin irritation around the injection site
- If you have diabetes – your blood sugar level may go up for a few days
- If you have high blood pressure, your blood pressure may go up for a few days
There are fewer side effects from Ostenil Injections (HA Injections):
- Slight discomfort during the injection
- Slight bleeding at the injection site
- Pain or discomfort for a few days – basic over the counter painkillers should help with this
- Temporary bruising or a collection of blood under the skin
Is there any reason i may not be able to have an Injection?
There are a number of conditions that may increase the risk to you following a steroid injection, please read this list and make your therapist aware if you:
- Have had a steroid injection in the last 6 weeks
- Have had three steroid injections in the same area over the past 12 months
- Have any severe allergies
- Have an ongoing infection
- Have recently had, or are about to have, any vaccinations
- Are pregnant, breastfeeding or trying for a baby
- Have any other conditions, such as diabetes, epilepsy, high blood pressure, or problems with your liver, heart, or kidneys
- Are taking any other medications, such as blood thinners.
- If you have any laser treatment, chemical peeling, or other dermal procedure due following the injection
- You are planning to have surgery at the injection site in the coming 3-6 months
- If you have excessive scarring (e.g., hypertrophic scarring or keloid formation) or pigmentation disorders
There are very few conditions where Hyaluronic Acid Injections (Ostenil) need considering, including:
- Have any severe allergies
- Have an ongoing infection
- Have recently had, or are about to have, any vaccinations
- Are pregnant, breastfeeding or trying for a baby
- You are planning to have surgery at the injection site in the coming 3-6 months
- Are taking any medications, such as blood thinners
Further information can be found here:
Steroid Injections: https://www.nhs.uk/conditions/steroid-injections/
Ostenil injections (HA Injections): https://www.londonorthopaedic.com/ostenil-plus/
We are all aware of the extreme pressures on the hospital at present, resulting in long waiting times for assessment and treatment.
If you would like to help ease their burden and feel that injection therapy may benefit you, Contact us today to discuss prompt access to treatment options.
