Treatments

Treatment Programs: Prescribing and supervision of appropriate cardiac and injury specific rehabilitation programs.

Sports Injuries:

Joint pain is often due to overloading of the joints during sport or work related activities or due to osteoarthritis. Local Infiltration with corticosteroid is the traditional method that works but causes temporary weakening and 50% tend to relapse. An alternative to using corticosteroids is the use of a drug called Ostenil. This a solution containing hyaluronic acid. It works by restoring the normal balance between the breakdown and production of hyaluronic acid. This effect of Ostenil means that it can decrease pain and stiffness and improve the other symptoms of osteoarthritis. It contains no animal proteins, which means it is very unlikely to cause an allergic reaction. Ostenil has been given to thousands of patients and has not been found to cause any serious side effects. The exact make-up of hyaluronic acid in Ostenil has been carefully chosen so that it is as effective as possible in treating osteoarthritis.
PDF Ostenil Injections(PDF)
A new approach used in treating tennis elbow, patellar tendon injury and plantar fasciitis.
2-3mls of your own blood is injected under ultrasound guidance into small tears or defects in the tendon. It is thought that introducing one’s own blood into an area of inflammation will initiate the inflammatory cascade and promote healing.
(In lumber and sacroiliac instability, discogenic pain, whiplash injury, and recurrent ankle sprain)
Ligaments help to provide stability in the joints. Sometimes ligaments can be overstretched, or even torn. The ligament may then not control the joint adequately – thus leading to ‘instability’ which may put abnormal stresses on the joints. Sclerosant injections (Prolotherapy) work by stimulating the body to make new fibres which are laid down within the substance of the ligaments, thickening and strengthening them. Each ligament has to be stimulated 3 or 4 times at intervals of a week, in order to produce sound fibrous development. Hence the injections are given as a course of treatment.
PDF Prolotherapy (PDF)
Traumeel is a homeopathic blend of numerous plant and mineral extracts with known healing properties and is a popular treatment for soft tissue injuries including muscle, ligament, and tendon injuries. In professional athletic circles, there is great demand and respect for this therapy. The treatment is appealing because of its immediate effects combined with a low side effect profile compared to steroid injections and anti-inflammatory medications.
In the bodies attempt to repair itself, the inflammation phase can be excessive and prolonged, which delays and disrupts healing. By neutralizing the balance of inflamed cells called “cytokines”, Traumeel restores a balance of inflammation to facilitate healing. Injected into tendons, ligaments, muscle, and joints, under ultrasound guidance to ensure precise placement. The frequency of treatment is dependent on the extent of the patient’s condition, and ranges from 1-2 injection sessions on a weekly to bimonthly basis. Most patients notice an immediate response after the first injection, though sustaining this improvement may require repeated injections.
Nitrate patches containing glyceryl Trinitrate (Minitran 5®,1.25-2.5mg/24hrs) have found its use in tendon injury treatment. The application of the patch over the affected painful tendon increases the level of nitrous oxide (NO donor) found in healing tendons. Tendon healing is reduced when nitrous oxide is blocked. These patches are applied daily for at least 4-6 weeks and are helpful in treating tennis and golfers elbow as well as Achilles tendon pain.
High Volume image guided Injections (HVIGI) for chronic Achilles tendinopathy.
In the case of ongoing Achilles and Patellar tendon pain, ultrasound imaging often highlights abnormal vessels that have grown into the tendon in response to repetitive strain and abnormal healing of tendon injury. The procedure involves injecting a large (40-50mls) volume of solution containing local anaesthetic, normal saline, and a small dose of hydrocortisone (hence the term high volume distension) around the tendon in the area of new vessel development (neovascularisation). These vessels are surrounded by nerves that cause ongoing local pain. Studies have shown that by injecting the high volume solution around the vessels and surrounding nerves, HVIGI significantly reduces pain and improves function in patients with resistant Achilles tendinopathy in the short- and long-term.
AccupunctureA Western scientific approach de-activating painful trigger points in shortened, tense muscles responsible for myofascial pain. It involves the insertion of acupuncture needles into the tight bands and knots of muscle, releasing energy and reducing the local spasm. Beneficial following whiplash injury, back pain, calf pain, and tennis elbow.
Among the many causes of groin pain is the hip joint and all of the conditions that can affect it. Often the clinical presentation in patients with groin pain is mixed. If a patient’s groin pain is entirely relieved by a hip joint injection (diagnostic block), even temporarily, then an anatomical diagnosis is made. The patient will then need further investigation to make an accurate assessment of the hip joint pathology. Hip pain can however also be due to traumatic or degenerative arthritis. Injection into the hip joint under X-ray guidance with a corticosteroid solution or a course of Ostenil can help relieve the pain and improve joint mobility.
Numerous studies on the effect of bisphosphonates for the treatment of isolated bone marrow oedema are very encouraging. Drugs called Bisphosphonates are given with Vitamin D supplements to help with calcium balance and to increase the bone density. Studies have found that treatment with a certain intravenous bisphosphonate (ibandronate, pamidronate) was effective at increasing the density of the bone and significantly and rapidly reducing pain.

Back Pain:

Computer Tomogram (CT) guided contrast enhanced L3nerve block for disc protrusionFluoroscopy is the use of low dose X-ray for targeted injections such as in epidurals, dorsal root ganglion blocks, facet joint injections, and hip joint injections. Procedures which normally would have to take place in hospital can be achieved in a more relaxed setting without the need for general anaesthesia. All of the procedures carried out take no longer than 45 minutes and are with a nurse in attendance. Although complications during the procedure are extremely rare, both your doctor and the nurse are trained in immediate life support should any complications arise.
PDF Spinal Injection Patient Info (PDF)
CT guided C7 transforaminal contrast enhanced nerve block for disc protrusionAlso called Selective Nerve Root Block. If the standard route approach, ie, epidural steroid injection does not provide adequate relief or is inappropriate in sciatic or cervical nerve root entrapment, then a Dorsal Root Ganglion Block can be performed under X-ray control delivering the anti-inflammatory medicine direct to the source of irritation around the spinal nerve providing excellent pain relief.
Epidural injections are beneficial for both sciatica and back pain caused by spinal disc lesions. The solution (a mixture of local anaesthetic or normal saline and corticosteroid) bathes the inflamed spinal cord and nerve structures with anti-inflammatory medicine to reduce swelling and pain. There is no clear evidence of any long term complication from epidural steroids. Your doctor can use two different routes to reach the spinal cord and nerve structures – the caudal or lumbar route.
The facet joints are a common source of pain in the neck and lower back after ‘whiplash’ injury and in the elderly due to arthritis. The pain can often be relieved by a small dose of corticosteroid into the offending joints. Alternatively and in those patients that cannot have a corticosteroid solution injected into them, a course of Ostenil can be used.
AccupunctureA Western scientific approach de-activating painful trigger points in shortened, tense muscles responsible for myofascial pain. It involves the insertion of acupuncture needles into the tight bands and knots of muscle, releasing energy and reducing the local spasm. Beneficial following whiplash injury, back pain, calf pain, and tennis elbow.
(In lumber and sacroiliac instability, discogenic pain, whiplash injury, and recurrent ankle sprain)
Ligaments help to provide stability in the joints. Sometimes ligaments can be overstretched, or even torn. The ligament may then not control the joint adequately – thus leading to ‘instability’ which may put abnormal stresses on the joints. Sclerosant injections (Prolotherapy) work by stimulating the body to make new fibres which are laid down within the substance of the ligaments, thickening and strengthening them. Each ligament has to be stimulated 3 or 4 times at intervals of a week, in order to produce sound fibrous development. Hence the injections are given as a course of treatment.
PDF Prolotherapy (PDF)