Advanced Injection Therapies
Evidence supports the use of various injectable techniques to manage stubborn chronic and acute pain, as well as degenerative conditions.
What is injection therapy?
Injection therapy is the term used for the diagnosis, prescription, and administration of medicine via injection by a medical professional such as a Naturopathic Doctor (ND).
Dr. Kelly Robertson offers advanced injections under ultrasound guidance to ensure the injection is accurately injected into the intended site.
What to expect
During an initial appointment, your Naturopathic Doctor will:
- Take a detailed history
- Perform a physical examination
- Determine what injectable therapy would be most beneficial
- Outline the plan and cost of treatment
Note - injections are not usually commenced at the initial appointment
Types of injectable therapy
Your Naturopathic Doctor has the advanced training to provide injection therapies which include:
Prolotherapy
Prolotherapy is a relatively inexpensive regenerative injection therapy. It provides an alternative, non-surgical solution to those experiencing chronic pain or musculoskeletal complaints.
Prolotherapy consists of injecting a dextrose solution into the damaged tissues which stimulates an immune response allowing for new tissue growth and strengthening. Prolotherapy can help repair tissue, such as ligaments, tendons, cartilage, or muscle, that have been weakened by trauma or overuse, and decrease pain.
Prolotherapy has also shown to be beneficial in the treatment of chronic pain.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) is a regenerative therapy that is used to treat chronic and acute musculoskeletal injuries.
PRP injections are derived from the body’s platelets, growth factors, and stem cells and stimulate the body’s innate ability to heal itself. Injections can allow for pain relief and reduced joint destruction when used appropriately. Robust evidence indicates that PRP can be beneficial for chronic conditions, such as arthritis or more acute conditions such as injured cartilage/tendon/ligament/joints.
Pinpoint Physiotherapy and Health is one of the only clinics currently offering the Arthrex Angel PRP system. This system allows for highly concentrated PRP.
Hyaluronic Acid (HA) Injection Therapies
Hyaluronic acid (HA) is a natural substance that has been utilized to treat painful arthritis, as well as tendon and ligament injuries.
Hyaluronic acid provides lubrication and shock absorption for arthritic joints, minimizing the experience of pain. HA may also be used to improve the integrity and strength of tendon and ligament structures.
Hyaluronic acid injections have proven effective at reducing knee and hip arthritis, as well as helping people recover from acute ankle sprains and chronic lateral epicondylitis (aka "tennis elbow"). There is also evidence supporting the potential role Hyaluronic acid may play in improving rotator cuff tendinopathies.
Perineural Injections
Perineural injection therapy is a safe and effective modality for chronic pain management.
This therapy consists of a subcutaneous injection of a substance to reduce the experience of neurological pain. The injection of a dilute sugar solution into the subcutaneous tissue layers allows for treatment of neuroinflammation, and a reduction in the sensation of pain.
This treatment may be beneficial for neuralgia, fibromyalgia, headaches, migraines, nerve impingement, neuropathy, as well as low back pain.
Corticosteroid Injections (Cortisone)
Cortisone injection treatments provide a potent anti-inflammatory effect and reduce the experience of musculoskeletal pain, providing a quick resolution while considering adjunct treatment options to address the direct cause of the pain.
This injection therapy can assist in the treatment of joints, tendons, muscles, and fascia. Commonly treated conditions include: Arthritis, Synovitis, Bursitis, Tendonitis, and Fasciitis.
Trigger Point Injections
Trigger point injections treat dysfunctional and tight muscles which cause pain – more commonly known as “knots”.
A trigger point injection consists of locating and isolating the dysfunctional portion of the muscle and injecting a solution, allowing for release, relaxation, and reduction of inflammation.
Trigger point injections can address chronic pain, headaches, fibromyalgia, myofascial pain syndrome, minor injuries, or acute traumatic injuries resulting in trigger points.
Get Started with Advanced Injection Therapies
Have questions about Advanced Injection Therapies or any other treatments? Visit the FAQs page or get in touch for help.
Supporting evidence for injection therapies
Prolotherapy
- “Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction.” (Hauser, Et al., 2016)
- “Prolotherapy is an easily applicable and satisfying auxiliary method in the treatment of chronic rotatory cuff lesions” (Seven, Et al., 2017)
- “Dextrose prolotherapy is more effective in the treatment of chronic pain compared to saline injection or exercise.” (Bae, Et al., 2021)
Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938120/
- https://pubmed.ncbi.nlm.nih.gov/28215611/
- https://pubmed.ncbi.nlm.nih.gov/33348947/
Platelet Rich Plasma (PRP)
- “provides significant potential chondro-protection and alleviates symptoms compared to control in knee OA.” (Bansal, Et al., 2021)
- “In patients with mild/moderate hip osteoarthritis, PRP may provide pain relief and functional improvement for up to six months.” (Singh, Et al., 2019)
- “Percutaneous injections of PRP have the ability to achieve pain relief and halt of progression on MRI over 6 months in patients with grade 2 meniscal lesions.” (Blanke, Et al., 2015)
- “Ultrasound-guided injection of platelet-rich plasma holds promise as an emerging, minimally invasive technique toward symptom relief, reducing pain, and improving function in patients with hip labral tears.” (De Luigi, 2019)
Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889864/
- https://pubmed.ncbi.nlm.nih.gov/30958873/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617215/
- https://pubmed.ncbi.nlm.nih.gov/31162277/
Hyaluronic Acid (HA)
- “Treatment with NASHA is an effective and safe single-injection procedure, which can be beneficial in the clinical management of knee OA.” (Leighton, Et Al., 2018)
- “A single injection of HA (NASHA) in the setting of hip joint OA was both safe and efficacious in this 87 patient cohort. Improvement in pain and function as measured with mHHS was statistically significant and reached the MCID of 10.” (Long, Et Al., 2021)
- “Peri-articular HA treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing. Further, HA treatment was highly satisfactory by patients and physicians and resulted in better return to pain free sport compared to control.” (Petrella, Et Al., 2010)
- “Peri-articular HA treatment for acute ankle sprain was highly satisfactory in the short and long term versus PL. This was associated with reduced pain, more rapid return to sport, fewer recurrent ankle sprains, fewer missed days from sport with few associated adverse events.” (Petrella, Et Al., 2007)
- “Subacromial HA injections could be an effective and safe alternative treatment for patients suffering from RC tendinopathy” (Merolla, Et Al., 2013)
Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967379/
- https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04672-0
- https://www.sportvis.eu/Clinical-Studies-18
- https://www.sportvis.eu/Clinical-Studies
Perineural Injections
- “Perineural Injection Therapy is an effective new modality in management of pain, physical function, psychological status and disability in mechanical low back pain.” (Abu-Zaid, et al., 2019)
- “Perineural injection therapy with D5W is a novel and effective approach for CTS based on the current series of high-quality clinical studies.” (Wu, Et al., 2021)
- “High glucose levels can mitigate TNF-α-induced NF-κB activation, the upregulation of proinflammatory cytokines, and metabolic dysfunction in neural cells.” (Wu, Et al., 2022)
Sources:
- https://ard.bmj.com/content/78/Suppl_2/534.1
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621462/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225069/
Corticosteroid Injections
- “effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA” (Davis, Et al., 2018)
Sources:
- https://pubmed.ncbi.nlm.nih.gov/29095245/
Trigger Point Injections
- “Trigger point needling or injection can be effective in inactivating Trigger points” (Gerwin, 2016)
Sources:
- https://pubmed.ncbi.nlm.nih.gov/27704503/