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Injection Therapy

injection therapies

Our medical team with guide you step by step through any intervention you may require.

Having an injection can be a daunting process for patients. Furthermore, there are now a lot of different agents to choose from all with different advantages and disadvantages. It is important to remember that injections can also be potentially harmful if performed incorrectly, or the wrong agent used.

Our medical team pride themselves in ensuring that patients fully understand the benefits and risks of any procedure. Using the latest techniques, all injections are performed under ultrasound guidance. This ensures that the correct structures are precisely targeted, improving outcomes. Any intervention we performance is always part of a wider rehabilitation plan.

Our doctors perform a range of ultrasound-guided injections with different agents treating tendon, ligament and joint problems to suit individual patient clinical needs.

Corticosteroids injection

What are steroids?

Some steroids occur naturally in the human body. Man-made steroids act like natural steroids to reduce inflammation. They’re not the same as the steroids used by body builders to increase their muscle size and strength.

They can be taken as tablets or given as injections into the affected area (a ‘local’ injection). Steroid injections are often recommended for people with joint inflammation and if your joints are very painful. The injection should reduce inflammation, which in turn reduces pain and enables healing and rehabilitation.

Corticosteroid injections are commonly used throughout medical practice and in the NHS. Please see the link below to the NHS website to find out more.

Hyaluronic acid

Hyaluronic acid (HA) is a natural component of joint fluid. Hyaluronan injections help to lubricate joints, which reduces inflammation and pain. These injections are sometimes best considered at regular intervals.


Over the past several years, evidence is emerging around a novel preparation, platelet-rich plasma (PRP), and its potential effectiveness in the treatment of injuries.

Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

What Is Platelet-rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets, and thereby, the concentration of growth factors, can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. Then the increased concentration of platelets is combined with the remaining blood.


‘Frozen shoulder’ (also known as ‘adhesive capsulitis’) is a painful condition associated with restriction in the shoulder joint. There are several causes which can include traumatic injury and arthritis.

Our team uses a non-surgical treatment for the treatment of frozen shoulder known as hydrodilatation (or hydrodistention). This involves injecting the shoulder joint with a large volume of fluid to stretch the shoulder capsule and disrupt adhesions (scar tissue), thereby freeing up the joint. Corticosteroid, local anaesthetic and a large volume of sterile saline is included as part of the procedure.

There is good evidence that hydrodistension provides benefits in reducing pain, improving range of movement and function in ‘frozen shoulder’.


Muscle tension and spasticity is a continuous contraction of the muscles, causing stiffness or tightness, which can lead to problems with everyday activities and pain. 

Muscle tension is very common particularly in areas of the body such as the head, neck, upper and lower back. This can be exacerbated by physical inactivity, stress, trauma and poor posture.  

When muscles are extremely tense, they can be labelled as spastic. They can sometimes be very painful and debilitating, e.g., crooked neck and acute back spasm. Spasticity, however, can also be caused by injury to parts of the brain or spinal cord that control movement.  

What is botulinum toxin?  

Botulinum toxin is a naturally occurring chemical produced by bacteria and has been developed into a treatment for spasticity. 

How does it work?  

Botulinum toxin works by stopping the overactive muscles contracting (spasticity). This is done by preventing the release of a chemical between the nerve and the muscle, leading to temporary weakness and relaxation of the affected muscle. 

How is it given?  

The botulinum toxin is given by an injection into a single muscle or a small group of muscles that have been affected. 

How long does it take to work?  

The toxin takes effect gradually over 2 weeks, the maximum effect can be seen after 10 to 14 days. The effects of the toxin are temporary and can last between 3 to 4 months. 

What are the benefits of treatment?  

The main benefits of this treatment are: 

  • the toxin reduces the stiffness in those muscles that have been injected. 
  • to maintain or increase the range of movement. 
  • to reduce pain and discomfort. 
  • to improve posture. 

Botulinum toxin is not suitable for people who:  

  • are allergic to botulinum toxin or human albumin (blood product). 
  • have an infection at the injection site. 
  • have had a botulinum toxin injection within the last 3 months 
  • feel unwell 
  • are pregnant. 

Are there any side effects?  

There can be some common side effects, although not everybody gets them, they can include: 

  • Pain or bruising at the injection site 
  • Flu-like symptoms (fatigue and headache) 
  • Excessive muscle weakness 
  • Skin rash/itchiness 
  • Temporary swallowing problems 
  • An allergic reaction to the Botulinum Toxin. This is rare, however, if this happens  you must  contact the Emergency Department immediately. 

Are there any other treatments?  

Other treatments include oral anti-spasticity medications. These are used to treat generalised spasticity and not specific muscle groups. If you would like further information, please speak to your Consultant. 

What will happen before the injection?  

You will be seen by your Consultant who will again explain the reasons for your injection and the injection itself. When you fully understand the procedure you will be asked to sign a consent form, if you have not already done so.  

You will only be asked to sign the consent form before your first injection. This will cover you for any future injections, if needed. 

What will happen after the injection?  

Following your botulinum toxin injection, you may be given a range of stretches and exercises which you will be expected to carry out at home and/or a specialist splint. 

It is important that you follow the advice given, as this will maximise the effect of the botulinum toxin. 

If you have any questions around your botox injections please do not hesitate to contact one of the team.  

All information of this page is aligned with NHS standards of care

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.