Corticosteroid injections are widely used to reduce inflammation and pain, particularly in cases of acute flare-ups or chronic inflammatory conditions.

These injections are commonly known as “steroid injections”. They work by suppressing the body’s inflammatory response, which is often at the root of joint and soft tissue pain.

So, while these injections help with the pain, they do not actually do anything to alter the course of the condition progression, or change the functional environment inside the knee.

Common Conditions Treated:

• Osteoarthritis: Particularly in the knee, shoulder, and hip

• Tendinopathies: Rotator cuff tendinitis, tennis elbow, and golfer’s elbow

• Plantar Fasciitis: Reducing heel pain and inflammation

• Bursitis: Alleviating inflammation in the hip, knee, or shoulder

• Carpal Tunnel Syndrome: Managing inflammation in the wrist

What are the risks with this injection?

These injections are very safe, but in rare cases, a significant adverse effects may occur.

• Risk of joint infection: 1 in 30,000

• Risk of avascular necrosis of the femoral head: 1 in 250,000. It's more commonly associated with long-term, high-dose corticosteroid use, not single injections. 

How corticosteroid injections are performed

• At Reactivate, these injections are performed by our Sports Medicine Physicians

• The area of the skin where the injection is going in will be cleaned with alcohol.

• After this, the needle and syringe containing the steroid will pass through the skin into the joint space. Occasionally the needle encounters bone or cartilage which can be uncomfortable, but the doctor will change the direction of the needle so that the needle is inserted into the joint space and not into any tissues.

• Once the medication is injected, the needle is removed and a bandaid may be placed.

How to take care of yourself after an injection

• Steroid injections can occasionally cause a flare in the pain and symptoms you were experiencing before the injection. This lasts no more than 48h, and can be minimized by not over-exerting yourself or doing more physical loading of the joint than you absolutely have to.

• If you experience any fever, chills, or the joint gets very red and hot, please visit your nearest emergency room as this might indicate an infection.

How Complementary Therapies Enhance the Effects:

• While corticosteroid injections are effective at reducing inflammation, they do not repair damaged tissues or address biomechanical dysfunction. That’s where our complementary therapies come in:

• Exercise-Based Therapy and Mobility Work: Once pain is reduced, we focus on strengthening the affected muscles and improving joint stability. This helps prevent the recurrence of inflammation by addressing muscle imbalances, poor posture, and joint instability.

• Acupuncture: Acupuncture can enhance the pain-relieving effects of corticosteroids by stimulating the nervous system, improving blood flow, and further calming inflammation.

• Chiropractic Adjustments: Misaligned joints can place excess stress on inflamed areas. Gentle adjustments can restore proper joint alignment, improving overall biomechanics and reducing unnecessary strain on the affected tissues.

Viscosupplementation involves injecting hyaluronic acid directly into the joint. Hyaluronic acid is a naturally occurring substance that provides lubrication and cushioning within the joint. By restoring joint fluid viscosity, this treatment can reduce pain, improve mobility, and delay the progression of osteoarthritis.

Common Conditions Treated:

• Osteoarthritis (OA): This is the most common indication for viscosupplementation

  • Contrary to popular belief, it is best to get these injections when your OA is mild to moderate rather than advanced

  • The reason is that the gel-like medication goes into your joint and incorporates it into the cartilage matrix on the bony surfaces of the joint.

  • In early OA, your joint has more “alive” cartilage but it is just stunned (to keep it in lamens terms). So the viscosupplementation goes in and wakes it up to start to make synovial fluid again which is the natural substance that lubricates the joint. In advanced OA, the cartilage cells have been rubbed off or are dead which means that the injection won’t work as well as it will only work on the remaining cells in the joint that are still viable.

    • Studies have shown that 50% of patients with severe OA had satisfactory results, while 90.5% of patients with mild to moderate OA had satisfactory results. 

  • So, while the injections are expensive, they are more effective for pain control and duration of pain control if you get it earlier rather than later.

What joints can be injected?

Any joint can be injected with viscosupplementation. In smaller joints like fingers, we will use a small volume, while larger joints like the knee we will use larger volumes.

What are the risks with this injection?

These injections are very safe, but in rare cases, a significant adverse effects may occur.

• Risk of joint infection: 1 in 30,000

• Risk of avascular necrosis of the femoral head: 1 in 250,000. It's more commonly associated with long-term, high-dose corticosteroid use, not single injections. 

Stacking: Injections of viscosupplementation and corticosteroids at the same time.

Quite often, the physician will also inject a steroid into the joint at the same time. This will help with the period of time that the viscosupplementation is starting to work. It takes viscosupplementation approximately 60 days to reach peak effect, whereas steroid takes only a few days and then it slowly tails off. This “stacking” of medications allows you to have both short term and long term relief.

How is the injection done?

Our Sports Medicine Physician will either do the injection with or without the help of an ultrasound to ensure that the injection is going into the correct space. More challenging joints such as the hip, ankle, or the shoulder will use the ultrasound, whereas joints like the knee or fingers might not use the ultrasound.

The physician will place you in a comfortable position, and then clean the skin with alcohol. They will use lidocaine to freeze the track that the needle will go into the joint, as the needle to inject the medication is larger because the fluid is thick. After the track is frozen, then the doctor will put the needle into the joint and inject the viscosupplementation.

How Complementary Therapies Enhance the Effects:

While viscosupplementation improves joint lubrication and shock absorption, addressing the underlying biomechanics is key to long-term relief. We enhance the effects of this treatment with:

• Exercise-Based Therapy: Strengthening the muscles around the affected joint reduces joint load and improves overall function, complementing the cushioning effect of hyaluronic acid.

• Chiropractic Adjustments: Restoring proper joint alignment helps ensure that the injected hyaluronic acid can be distributed evenly within the joint, enhancing its lubricating effect.

• Massage Therapy and Mobility Work: Soft tissue release techniques can reduce muscle tension and improve joint range of motion, further enhancing the effects of viscosupplementation.

Prolotherapy is a regenerative injection therapy designed to strengthen and stabilize weakened ligaments, tendons, and joints. It works by injecting a dextrose-based solution into the affected area, which triggers a mild inflammatory response. This controlled inflammation stimulates the body’s natural healing processes, promoting the growth of new collagen and connective tissue.

Prolotherapy generally is injected in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.

Prolotherapy is hypothesized to reinitiate the inflammatory process that deposits new additional fibers thereby repairing lax tendons or ligaments and to possibly promote the release of local growth factors. However, the precise mechanism of action remains unknown. Once strengthened, the weak areas would no longer send pain signals.

Most people become pain-free after 6-8 treatments. These can be spaced anything from one week to one month apart.

Common Conditions Treated:

• Patellar tendinopathy

• Rotator cuff tendon tear

• Lateral or medial epicondylitis (golfers or tennis elbow)

• Plantar fasciopathy

• Achilles tendinopathy

How the injection is done

This type of injection needs to be repeated on a weekly basis, but can be done monthly, and usually is done anywhere between 4 and 8 treatments.

The glucose is mixed with lidocaine (freezing) to get the concentration of the glucose correct, and then the space surrounding the affected or injured tissue will be infiltrated with the prolotherapy injection.

What to do and What to expect after you get the injection

After the injection, you can expect some stiffness for a few days, and we ask that during this time you just carry out your normal day to day activities, but you don’t do any more than that. You need to give the injection treatment time to integrate itself in the tissues and start to work.

There is a very small risk of infection (1 in 300,000) mainly because we are putting a needle through your skin to reach the injured area, and this creates a hole. Don’t worry, we thoroughly clean the area with alcohol to keep the area as clean and sterile as possible before we do the injection.

How Complementary Therapies Enhance the Effects:

Since prolotherapy focuses on stimulating tissue repair, it works best when combined with therapies that improve joint stability, strength, and mobility. Our approach includes:

• Shockwave Therapy: By delivering targeted acoustic waves to the affected area, shockwave therapy can enhance tissue regeneration and improve blood flow, supporting the healing triggered by prolotherapy.

• Exercise-Based Therapy: As prolotherapy strengthens ligaments and tendons, we focus on building strength and stability around the joint with targeted exercises, reducing the risk of re-injury.

• Chiropractic Therapy and Mobility Work: Addressing joint alignment and mobility helps ensure that the newly strengthened tissues are functioning optimally within a healthy movement pattern.

SportVis™ is a hyaluronic acid injection designed to aid the healing of tendon and ligament injuries by enhancing the body's natural recovery processes. It contains Soft Tissue Adapted Biocompatible Hyaluronic Acid (STABHA™), which interacts with the fibrin matrix at the injury site to provide support, lubrication, and hydration, thereby facilitating tissue repair and reducing pain. ​

Indications:

• Tennis Elbow (Lateral Epicondylitis): SportVis™ is indicated for chronic cases persisting for more than three months. ​

• Ankle Sprains: Specifically effective for Grade 1 or 2 ankle sprains, with treatment ideally initiated within 48 hours of injury. ​

• Rotator Cuff Tendon injuries: this is an emerging area of treatment where partial tears can be treated with Sportvis to augment the effect of the physiotherapy to rehabilitate and repair the tendon.

How the injection is performed:

The area that is being treated will be identified using a handheld ultrasound machine because the Sportvis needs to be injected adjacent to the injured tissue.

Once the area is identified, a small amount of freezing will be injected after the skin is cleaned and dried.

Then the Sportvis will be injected (1.2mL).

A second injection will need to be done the following week to complete the treatment in the same manner as described above.

Adverse Events:

SportVis™ is generally well-tolerated. Some patients may experience mild erythema (redness) at the injection site, which typically resolves over time. While specific rates of adverse events are not detailed in the available information, serious side effects are rare. Patients should inform their healthcare provider of any known allergies before administration. ​

Complementary Rehabilitation Therapies:

To maximize the benefits of SportVis™, it is recommended to combine the injection with standard rehabilitation protocols

• Shockwave Therapy: designed to break apart disorganized tendon healing that has occurred, as well as stimulate the body to increase blood flow to the treatment area which will bring nutrition and cellular structures necessary for repair

• Physical Therapy: Engaging in guided exercises to restore strength and mobility to the affected area. For example, after completing the SportVis™ treatment for an ankle sprain, patients are advised to perform strengthening exercises, using pain as a guide to avoid overexertion.