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Sports Medicine
Injections in Sports Medicine: Your Questions Answered
October 26, 2018 | by By Dr. Najam Mian, Fortius Physiatrist

Maybe you’ve heard about injections in sports medicine, or maybe it’s something you are already discussing with your physician.

Either way, for most, we know the thought of injections can be a bit unsettling.

To help ease some of your concerns, we’ve compiled a list of four commonly asked questions and answers related to injections in sports medicine.

1. Which injection is right for me?

Table of needles and injectable substances

Prior to the procedure, you and your physician will discuss advantages and disadvantages of various types of injectable substances. Some of these are artificially synthesized and some are harvested from your own body. These may include:

Corticosteroid:
This is an anti-inflammatory substance that can help reduce local inflammation within a joint (synovitis) or tendon sheath (tenosynovitis). This is the most common injectate used in sports and musculoskeletal medicine.

Hyaluronic Acid:
This is a synthetic compound that mimics the fluid inside a healthy joint. This very viscous substance can be injected into joints that have developed arthritis, in an attempt to reduce pain and inflammation.

Platelet-Rich Plasma:
This treatment involves drawing your own blood and spinning it in a centrifuge to remove unhelpful cells, leaving behind a layer with growth factors that can be injected. Over the last few years there has been increasing medical literature supporting its use in sports medicine conditions.

Mesenchymal Stem Cells:
These cells are most commonly obtained from either the bone marrow or from fat. The scientific evidence supporting use of MSC’s is limited at this time.

No injectate:
Some procedures (e.g., ultrasound-guided tenotomy) do not require the use of any injectate, and instead utilize the mechanical properties of the needle tip to disrupt target tissue and ‘reset’ the healing process.

Some patients will benefit from one injectate but have no benefit when a different injectate is used, even for the same condition.

2. How are injections administered?

Injections can be performed with ultrasound guidance, fluoroscopy guidance, or landmark technique.

Image-guidance can help your doctor guide a needle point to its intended target. The American Medical Society for Sports Medicine (AMSSM) extensively reviewed common types of joint and soft tissue injections performed under ultrasound guidance, compared to landmark-based techniques (no image-guidance used). They found strong evidence that ultrasound-guided injections are more accurate, moderate evidence that they work better (efficacy), and preliminary evidence that they are more cost-effective.1

Ultrasound has better visualization of soft tissue structures and fluoroscopy has better visualization of bony and spinal structures.

3. At what point in my rehab should I try AN injection?

Client in a lunge with physiotherapist holding the knee to explain the exercise

The goal of any injection is to reduce your pain and to improve your ability to perform household or recreational activities. Injections will be only be recommended if you have already tried a suitable, movement-based rehab program such as sports physiotherapy or chiropractic therapy.

If you are having difficulty performing your exercises because of pain, or if you are no longer making gains with your therapist, then an injection may be a suitable way to reduce your pain so you can more effectively engage in your rehab program.

4. What are the risks?

Sports Medicine Clinic Room with bed, TV and computer for charting

No injection is without risk. Every time a needle enters the body, there is a risk of complications such as infection, bleeding, injury to nerves and blood vessels, post-injection flare, lightheadedness, systemic toxicity, and skin thinning/discoloration.

You and your physician will discuss whether the potential benefits of an injection outweigh the potential risks before proceeding. Complications from sports medicine injections are rare. The use of image guidance (x-ray, ultrasound) during injections reduces the risk of complications.

Our Sport Medicine team at Fortius performs a variety of injections to help athletes and active individuals of all levels get back to activity and sport. Visit our website to learn more about our services!

NOTE: All appointments with our primary care sports medicine physicians and specialists require a referral from a family physician.

References: 

  1. Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, Smith J;
    American Medical Society for Sports Medicine. American Medical Society for Sports Medicine position statement: interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med. 2015 Jan;25(1):6-22