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Epidural Injection

Epidural injections are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Most practitioners will agree that, while the effects of the injection tend to be temporary – providing relief from pain for one week up to one year – an epidural can be very beneficial for a patient during an acute episode of back and/or leg pain. Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program.

Lower Back Pain Treatment

Lower Back Pain

How Epidural Injection Work?

An epidural injection delivers medicine directly into the epidural space in the spine. Sometimes additional fluid (local anesthetic and/or a normal saline solution) is used to help ‘flush out’ inflammatory mediators from around the area that may be a source of pain.

The epidural space encircles the dural sac and is filled with fat and small blood vessels. The dural sac surrounds the spinal cord, nerve roots, and cerebrospinal fluid (the fluid that the nerve roots are bathed in).

Several common conditions that cause severe acute or chronic low back pain and/or leg pain (sciatica) from nerve irritation can be treated by injections. These conditions include:

  • A lumbar disc herniation, where the nucleus of the disc pushes through the outer ring (the annulus) and into the spinal canal where it pressures the spinal cord and nerves. Read Lumbar Herniated Disc for more information on diagnosis and treatments.
  • Degenerative disc disease, where the collapse of the disc space may impinge on nerves in the lower back.
  • Lumbar spinal stenosis, a narrowing of the spinal canal that literally chokes off nerves and the spinal cord, causing significant pain.
  • Compression fractures in a vertebra.
  • Cysts which are in the facet joint or the nerve root and can expand to squeeze spine structures.

The epidural injection procedure takes place in a surgery center, hospital, or a physician’s clinic.

Epidural Injection Pain Relief Success Rate

Patients will find that the benefits of an epidural steroid injection include a reduction in pain, primarily in leg pain (also called sciatica or radicular pain). Patients seem to have a better response when the epidural injections are coupled with an organized therapeutic exercise program.

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Platelet Rich Plasma (PRP)

What is Platelet Rich Plasma (PRP)?

PRP refers to a concentrate of platelets in plasma that is higher than that of normal circulating platelets in the body. Beyond this concept, however, there is considerable variation in its definition.

Platelets have a vital role in the healing of injured tissues. The alpha granules of platelets contain growth factors which result in various biological effects. However, variations in individuals and differences in preparation methods can affects the absolute and relative concentrations of these different factors in PRP, which could account for differences in clinical outcome.

The release of these factors can be rapidly triggered by platelet activators thrombin and calcium. This results in the formation of a gel which can be used in open surgery but is impractical for injection. More gradual activation of platelets is also possible through exposure to damaged collagen, which attracts platelets through cytokine for PRP to be administered without pre-activation into damaged tissues.

Experimental and benefit of PRP

The biological effects of PRP and the various platelet-derived factors have been the subject of a considerable amount of laboratory-based research. Studies in animals have shown that for ligament repairs, PRP could result in improved maximal ligament load and linear stiffness. For tendon repairs, the addition of PRP resulted in significantly stronger healing, compared with the control side. Various positive effects on cartilage synthesis have also been seen with PRP and its factors. PRP has also shown potential to modulate inflammation.

Most recent reviews on PRP have concluded that there is a sound scientific basis for its use in soft tissue injuries, but have highlighted the lack of robust clinical data. Truly randomized, placebo-controlled, blinded trials are currently lacking. Clinical reports so far tend to be summations of experiences in groups of patients, or comparative studies against a more established treatment method. It has been reported that muscle tears heal twice as fast with PRP. Other clinical reports in medical press or conference proceedings have reported positive effects of PRP in tennis elbow, Achilles tendonitis, ankle sprains and osteoarthritis. While there appears to be overall support for PRP in soft tissue and wound healing, the benefit of PRP for bone repair and bone graft healing remains controversial.

PRP

Clinical Application in Sports and Musculoskeletal Medicine

A vast majority of sport and exercise related injuries involve soft tissue and are not severe enough to warrant surgery. Such injuries would usually heal on their own over time. A typical muscle strain, for example, would go through phases of homeostasis, inflammation, regeneration (replacement with original tissue) and repair (scar tissue). The management of such injuries typically involves management of inflammation and pain, combined with physiotherapy to address related issues such as spasm, muscle imbalances or joint stiffness which may have predisposed the patient to the injury. Essentially, the injured tissue is left to heal on its own, as determined by the body’s natural pace of healing.

PRP, with its potential to quicken healing, appears to be an attractive option for sportsmen or exercisers wishing to minimize injury downtime from both acute as well as overuse injuries. With an increasing numbers of adults and mid-lifers adopting exercise as a lifelong habit, degenerative and overuse injuries are becoming increasingly commonplace. PRP treatment once again presents itself as being a potential part of the solution for such injuries.

Current uses for PRP in Sports Medicine include:

–         Chronic Insertional or Intrasubstance tendinopathy with or without tear, Eg. Tennis Elbow, Patellar tendinosis, Insertional Achilles Tendinosis, Plantar Faciitis, Rotator Cuff tendinosis.

–         Ligament tears, eg. Medial Collateral Ligament (MCL) of the knee, Ankle ligament sprains

–         Post-surgical augmentation of soft tissue healing, eg. Following surgical tendon repairs in tendo-achilles or rotator cuff, meniscus repair, or cartilage surgery in degenerative joint disease.

–         Cartilage degeneration and early stages of osteoarthritis of the knee, ankle and other joints.

–         Acute muscle tears eg. Myoseptal tears of the calf of hamstring

For enquiry, please call us (+65) 6471 2744, or SMS to (+65) 92357641

Shockwave Therapy (ESWT)

DEVELOPMENT OF THE SHOCKWAVE THERAPY

Shockwave therapy as a medical application was originally developed as a means for pulverizing kidney stones. Since 1989, it has also been employed with considerable success at university clinics to treat non- or poorly healing bone fractures.

Since 1991, Extracorporeal Shockwave Therapy (ESWT) has been employed as an alternative to surgery in treating calcified shoulders and other aches and pains of the bones and tendons.

Shockwave Therapy

The current range of applications for orthopaedic conditions includes:

–         Calcified Shoulder

–         Shoulder joint aches and pains without calcium deposits

–         Tennis elbow or Golfer’s elbow (Lateral & Medial Epicondylitis)

–         Plantar fasciitis and Heel spurs

–         Inflammation of the Achilles or patella tendon

–         Pseudarthrosis

SHOCKWAVE THERAPY WORKS

The therapy equipment generates high-energy shockwaves, which are transmitted to the body through a plastic membrane. The shockwave firstly will pass through the skin and the layers of tissue underneath. They only become effective in the area at which the doctor has set the penetration depth.

The desired effects are:

–         Dispersing of calcium deposits

–         Stimulation of the healing mechanisms of the body (e.g. in the case of tennis elbow)

–         Stimulation of bone growth (in the case of pseudarthrosis)

THE COURSE OF TREATMENT

Shockwave therapy is carried out on an outpatient basis and is mostly administered under local anaesthetic. Using our shockwave equipment, treatment generally involves one or a course of several sessions carried out at intervals of several weeks.

Depending on the condition to be treated, your physician will decide the number and strength of the shockwave to be administered. The duration of the treatment at each session is 10 to 20 minutes or, is the case of pseudarthosis, up to one hour.

RESULT OF THE SHOCKWAVE THERAPY

The therapy described here has been employed successfully in over 80% of cases. Recovery from the aches and pains being treated generally starts to occur immediately or soon after treatment. The therapy sessions may be repeated in individual cases to ensure that the treatment continues to be successful.

To make an Appointment, please call (+65) 6471 2744 or SMS (+65) 9235 7641 24 Hours