is paramount. It is always a good sign when the
physical therapist and physician have an open line
of communication, as this will lead to the best decision
making.
Here are some of the currently available injections:
• Corticosteroids
• Platelet Rich Plasma
• Platelet Lysate
• Hyaluronic Acid
• Stem Cell
All the above injections have pros and cons, and none
of them work 100 percent of the time. The following
descriptions are a combination of medical literature-
supported information combined with my professional
experience treating patients of varying athletic
backgrounds, age, and injury types who have received
injections. Hopefully this information can be of use to
you if you are considering an injection.
Cortisone Injections
This is the most common type of injection in the
treatment of orthopedic injuries. It is used for various
injuries, usually aimed at reducing inflammation in
order to decrease pain and improve function. It is
unfortunately not a long-term solution, with patients
often reporting short-term relief (4-6 weeks) before the
pain starts to return. Others often do not experience any
change or improvement in their pain level following a
cortisone injection.
Studies support that the use of cortisone injections
does not provide greater pain relief than conservative
physical therapy and the use of interventions such as
dry needling. In addition, cortisone injections have been
shown to potentially weaken certain tissues in the body
depending on the injection site, which could increase the
risk of future injury. For example, in the case of Achilles
tendinitis, cortisone injections have been linked with
weaker tissue quality and potential long-term increased
risk of Achilles injuries. Also, there is no difference in
the long-term outcome between the use of cortisone
injections and physical therapy.
Platelet Rich Plasma (PRP) Injections
PRP is a form of regenerative medicine using one’s
own plasma (liquid portion of the blood) to harness
the body’s ability to heal and amplify tissue healing by
boosting the body’s growth factor in the injury site. PRP
is obtained from a blood draw, run through a centrifuge,
then re-injected as a concentrate of platelets into the
injury site.
PRP injections have been found to be effective in
problems such as tendinopathies, chronic tennis elbow,
and rotator cuff pathologies. There are no known
significant adverse effects (aside from a potential
inflammatory response), but it is not always effective for
everyone.
Platelet Lysate (PL) Injections
PL injections are a form of PRP injections. However,
in this case, the platelets are concentrated and partially
broken down in order to promote a greater release of
growth hormone and accelerate the patient response
(and possibly the healing time). These injections have
been found to cause less of an inflammatory response
in patients, making them beneficial for treating injuries
with nerve involvement. In addition, they may be used
in more acute conditions when someone has a higher
level of inflammation, to mitigate the response and lead
to accelerated healing by providing a boost of growth
hormone at the injury site.
Hyaluronic Acid (HA) Injections
This type of injection is used mostly for people with
knee osteoarthritis (OA). It has been found that these
injections are most effective for people with mild to
moderate OA, and aim to replace some of the joint
lubricant that is usually lost with OA. In my experience,
these can work temporarily or delay a surgical
intervention, but if the level of OA continues to progress
to the point where pain prevents normal activities, most
people end up having a total knee replacement.
Stem Cell Injections
Stem cells are the newest type of injection available.
There are multiple types of stem cell injections, but
these are often not covered by insurance, and results are
inconsistent at this time. There is no doubt that stem cell
injections will play a huge part in medicine and injury
management, but based on patient experience and
the insufficient medical literature thus far, it is hard to
recommend these injections for now.
If you have any questions, you can contact The
Pickleball Doctor at [email protected]. •
Noe Sariban is a Doctor of Physical Therapy, Certified
Pickleball Teaching Professional through the IPTPA, an
Engage sponsored athlete, and the Team Engage physical
therapist. Please visit www.thepickleballdoctor.com for more
information on injury prevention and rehabilitation tips. Noe
started his website to provide pickleball players around the
world with a reliable and free source of information. Please like
his Facebook page, www.facebook.com/pickleballdoctor, for
updates and new information!
FEBRUARY/MARCH 2020 |
MAGAZINE
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