Following your consultation at LBSM, you may have been referred for an injection treatment.
This guide takes you through the relevant information about what to expect during this process. Please take the time to read it carefully.
Before you have your injection, you will have a further opportunity to ask any further questions at the appointment.
Please feel free to contact us if you have any queries about anything to do with the process of having your injection.
Key summary points about your injection
- Please make sure you read this guide in full, which goes into detail about everything you need to know around your injection
- Injections are used to reduce pain and/or inflammation to aid the recovery process
- They are best used in conjunction as part of a wider rehabiliation plan
- Depending on your condition, different agents and techniques may be used
- The most commonly used agent is corticosteroid, which is an anti-inflammatory drug
- Please make sure you fully understand the risks and benefits of your injection treatment and speak to one of the team if you need further help
- Make sure you familiarise yourself with the steps you need to take after your injections, in particular how and when to return to exercise
- Why do I need an injection?
- What is in an injection?
- What are the main risks of having an injection?
- Are there any conditions that add additional risk to having an injection?
- Will I need a repeat injection?
- Can I take other medicines along with corticosteroid injections?
- Alcohol and Injections
- Fertility, Pregnancy and Breastfeeding and Corticosteroid Injections
- How to prepare for your injection appointment
- What to expect at your injection appointment
- What happens after my injection?
- When can I start exercising after my injection
1. Why do I need an injection?
Injections are often used as treatment adjunct to reduce pain and/or inflammation, and sometimes to promote tissue healing. It can be sometimes difficult to exercise and rehabilitate when in discomfort, so injections can provide a “pain free window” to break the cycle. After the injection, it is important to have a structured exercise programme to help maximise the positive effects and improve your condition. Injections can also be used to promote the healing of an injured or damaged structure.
Other types of specialist injection treatments include;
- Joint injection. These injections are directed into the joints themselves, often to help relieve pain and inflammation.
- Soft tissue injection. These injections are targeted at the soft tissues (ligaments, muscle, tendons) with the objective of relieving pain and inflammation.
- Diagnostic injection. Injections can sometimes be targeted into suspected pain and inflamed areas to see how your symptoms change. This is a method sometimes used to gain further diagnostic clarity around your condition. It may involve examining you pre and post injection.
- Drainage and Injection. Sometimes fluid may accumulate in the body as a response to inflammation, infection or trauma. Your LBSM physician may decide to drain the collection of fluid to aim and speed recovery. It may be that an agent is injected into the drained cavity to try and reduce the changes of the fluid reaccumulating.
- Hydrodilation. In conditions where joint movement is restricted (such as frozen shoulder), larger volumes of fluid (saline or water) can be injected into the troublesome joint at a higher pressure with the aim of distracting “releasing” the joint. This is also often combined with an injection agent such as a corticosteroid to reduce the inflammation.
- High Volume Tendon Stripping. For tendonitis conditions (such as Achilles or Patella tendinitis) high volume stripping involves injecting high volumes of fluid around the tendon structure to enable it to heal properly. Please see the LBSM Tendon Health guide for more information on this.
- Spinal Injection. This procedure involves targeting structures in the spine with a slightly more complex technique and procedure. Please see the LBSM guide on Spinal Injections for more information.
2. What is in an injection?
Injection agents are carefully selected by your LBSM physician to fit the requirements of your injury/illness. It will be made clear to you at your consultation what agents are most suitable for your condition. The most commonly used agents are;
- Local anaesthetic. This provides immediate analgesic effect (pain relief) and it is often mixed in with other agents. Any pain you are experiencing from your injury may temporarily improve due to the anaesthetic. This effect can last several hours or even a few days depending on the type of local anaesthetic used. Local anaesthetic is also sometimes injected under the skin to make the injection procedure itself less painful.
- Corticosteroid. This is a very commonly used anti-inflammatory agent. Injecting a corticosteroid into a painful area (e.g., joint, bursa) is often a good way to reduce the body’s inflammation response.
- Hyaluronic Acid (HA). HA is a naturally occurring sugar molecule that occurs in the body. It binds collagen molecules and acts as a lubricating agent. In Sports Medicine, it is often used to help with conditions such as arthritic and tendonitis. It is a novel treatment that is becoming more recognised and used in healthcare.
- Platelet Rich Plasma (PRP). PRP is a blood product rich in platelets (clotting cells). Platelet cells are rich in growth factors and protein that aim to promote healing of damaged tissues.
For more information on any of the injection agents listed above, please visit the LBSM Injection Therapy page.
3. What are the main risks of having an injection?
Most people have injections without any issues. There are some side effects associated with corticosteroid agents, which are detailed below. It is important you understand these risks before going ahead with your injection. These risks are greater with stronger and longer-acting steroids doses. They include;
If you have had a previous allergic reaction to any of the injection agents mentioned in this article, please discuss this with your LBSM physician. You will be asked specifically about any allergies you may have prior to the injection by the LBSM team. You will also be asked to wait in the hospital for 10-15 minutes after your injection to make sure you are well before you head off.
Numbness and tingling
Local anaesthetic is often used as part of the injection treatment. This may produce numbness and tingling, particularly if the injection is close to a nerve. This is temporary and will go in a few hours. The LBSM injecting physician will counsel you if this is a specific risk for your injection.
Flare up of pain
Occasionally, people may notice a flare up of their pain within the first 24-hours after injection. This usually settles within a couple of days. Simple painkillers, such as paracetamol, ibuprofen and icing regularly may help.
Injections can occasionally cause some thinning and changes in the colour of the skin at the injection site. In rare cases, a steroid injection into muscles or joints can cause an indentation in the skin around the area.
Very rarely, you may get an infection at the injection site. This risk is minimised by vigorous pre-injection preparation and maintaing a sterile environment at the time of injection. If the site where you have had your injection site becomes more painful, hot or swollen, you should seek medical attention immediately as you may require antibiotic treatment.
Corticosteroid injections into specific areas have minimal absorption into the blood stream when compared with steroid tablets. This means the chances of systemic side effects such as weight gain are drastically reduced.
Other possible side effects
Other possible side effects include facial flushing, temporary changes in menstruation and mood fluctuations. Repeated corticosteroid injections may also predispose you to long term infections and low bone density. If you are concerned about any of the above, please contact one of the LBSM team.
4. Are there any conditions that add additional risk to having an injection?
Some conditions add additional risk to having an injection. If any of the following points are relevant to you, please discuss them with the LBSM team.
You may not be able to have a steroid injection if you have an infection, particularly if it is in the same part of the body that is being injected.
If you have diabetes, having a corticosteroid injection can raise your blood sugar levels for a few days after the injection. It is extra important that you monitor your sugar levels closely.
If you have a condition that affects your clotting function (e.g. haemophilia) or are on blood thinner medication (aspirin is usually fine), you could be at an increased risk of bleeding into or around the injection site. Please inform one of the LBSM team if this applies to you.
If you have any other medical condition that you are concerned may interfere with the injection, please contact the LBSM team.
Please see separate LBSM guidance on COVID-19 and corticosteroid injections.
5. Will I need a repeat injection?
Your LBSM physician may decide that an injection needs to be repeated or that you need a course of injections. If this is the case, it will be discussed with you in detail at your consultation. Some injections are safe to have on a regular basis. Repeated corticosteroid injections may cause issues such as tissue damage or buildup of debris in joints, so this will be closely monitored.
6. Can I take other medicines along with corticosteroid injections?
Most medicines are safe to take alongside the injection therapies discussed here, including corticosteroid. If you are taking a drug that thins the blood, known as an anticoagulant (e.g. warfarin), you may need an extra blood test to make sure that your blood is not too thin to have the injection. Please disclose any medication or allergies to your LBSM physician prior to or at the time of the injection.
Corticosteroid injections reduce the effect of your body’s immune system in the short term. This is how they reduce inflammation. Some vaccines work by giving you a very small dose of a particular disease, so that you then become immune to it. You may not be able to have a steroid injection close to the time you have certain vaccinations. Please let the LBSM team know if you are due any vaccinations.
8. Alcohol and Injections
There is no reason to avoid alcohol after corticosteroid injections. Government guidelines recommend that men and women shouldn’t regularly drink more than 14 units of alcohol a week. It’s a good idea to space your units out over the course of a week. Having at least two alcohol-free days a week is good for your health.
9. Fertility, Pregnancy and Breastfeeding and Corticosteroid Injections
Current guidelines state that steroids are not harmful in pregnancy or breastfeeding. Single steroid injections shouldn’t affect fertility, pregnancy or breastfeeding and can be useful treatments in these situations. If, however, you’re pregnant or breastfeeding you should discuss it with your LBSM doctor before having a steroid injection.
10. How to prepare for your injection appointment
Your LBSM doctor will have already counselled you on what is the most appropriate injection treatment for your condition. This will depend on your specific condition and symptoms.
You should feel completely comfortable with the process. If you are not sure or clear about anything, please do not hesitate to ask.
Before your appointment you should;
- Read and make sure you have understood all of the information in this guide
- Make sure you have given all your details to the LBSM team (if you have health insurance, please check that you have the correct authorisation to go ahead with your injection)
- Bring gym/sports clothing with you appropriate to gain adequate exposure for the injection site.
- Think about arranging transport home after the injection, especially if you’re going to have a local anaesthetic as temporary numbness can make it difficult to drive.
11. What to expect at your injection appointment
Your LBSM doctor will run you through the risks and benefits of the injection treatment and give you another opportunity to ask any questions and then ask you to sign a consent form. The procedure will then take place.
Most injections are quick and easy to perform. They will usually be carried out by your LBSM physician but there will also be a nurse in the room to support you.
You may need an ultrasound scan to find where the injured tissue is, so the agent can be injected into a precise location for maximum benefit. An ultrasound scan uses high-frequency sound waves to create an image of part of the inside of a body. Some injections can be given without the need for ultrasound.
Sometimes you’ll be given a local anaesthetic with the agent to reduce the discomfort of the injection. This would mean your pain may be relieved within minutes. This effect can last several hours or even a few days depending on the type of local anaesthetic used. You may have some numbness from the anaesthetic that could last up to 24 hours.
12. What happens after my injection?
It may be necessary to reassess and examine you either before or after the procedure to see how your symptoms change after the injection.
You might be advised to wait for 10 to 15 minutes in the clinic after your steroid injection. If you do have any kind of reaction to the injection, it would be helpful to be around healthcare professionals.
Your LBSM physician will have given you a detailed rehabilitation programme to follow after your injection. This may be in conjunction with your therapist. You will be given a suitable date to have a follow up appointment with your LBSM physician to reassess your injury/illness. If you are not sure on the next steps or have any issues after the injection, please get in touch with the LBSM team.
Please familiarise yourself with the risks of the main risks of having an injection and be vigilant for these over the next few days.
13. When can I start exercising after my injection?
Your LBSM physician will have discussed how to grade back into exercise at your consultation. This depends on your condition and the type of injection who have had. It is important that exercise is reintroduced sensibly and as part of a wider rehabilitation programme to avoid further injury or damage.
Please contact the LBSM team if you are still not sure which activities/exercises are appropriate.