Musculoskeletal Injection Therapies.

At Agile we offer multiple evidence-based injection treatments under ultrasound guidance that can be considered to manage acute, chronic and degenerative conditions to get you back on track.  

Sometimes nagging aches and pains last longer than planned or even prevent healing. That’s why we offer injection therapies as an adjunctive treatment in special cases to clients. We offer a wide range of injections tailored to suit your particular needs. If you are an athlete looking for regenerative injections, we offer prolotherapy and platelet rich plasma (PRP) injections. If you suffer from chronic pain or degenerative disease, we have a number of options for you too.

In any case, while some injections can eliminate pain, we believe in a holistic approach to your care. This includes proper strengthening and mobility after your injections. Your care team at Agile will work together to optimize the results from your injection therapy to set you up for peak health and healing.

This service is only available at our Fort Street location.

What can Musculoskeletal Injection Therapies help with?

• Sports injuries including plantar fasciitis and Achilles tendinopathies

• Osteoarthritis, arthritis and other joint conditions

• Pre and post surgical pain management

• Ligament and muscle tears and strains

• Tendon problems

• Chronic pain

• Migraines and headaches

• Frozen shoulder

• Neuralgias including nerve impingement and sciatica

• Low back pain

Types of Injection Therapies Offered at Agile 

• Trigger Point Injections 

• Perineural Injections

• Prolotherapy Injections

• Hydrodissection Injections

• Corticosteroid Injections

• Viscosupplementation Injections

• Platelet Rich Plasma Injections (PRP) (Coming soon!)

What to expect?

An initial injection therapy appointment will consist of a discussion and hands-on orthopaedic testing to identify the root cause of the injuries & pain you are experiencing and whether or not injection therapy is the best from of treatment for your pain & injury. A detailed history and thorough medical check will be taken to assist in identify if injection therapy is appropriate for you.

Your first session will be tailor to not only your history but also based on your goals! Once the correct treatment is selected the injection is performed in-office under ultrasound guidance for accuracy. After the injection at-home care and expectations are clearly communicated and any questions will be answered.

After the injection, a check-in within 24-72 hours after injection will be provided to make sure you are tolerating the injection well and there are no complications. If recommendation, the need for additional injections will be clearly communicated and post-injection care with the Agile Integrated health team to start for strengthening and mobility work.

Clinician Offering Ultrasound-Guided Injection Therapies

Dr. Lorna C. Ciccone, ND. Dr. Lorna is a Naturopathic Doctor with training and certification in advanced injection therapies. Learn more about her here.

Trigger Point Injections

This injection helps with myofascial pain typically due to “knots” in your muscles. Acute trauma or repetitive micro-traumas can cause your muscles to get stuck in contracted state, which feel more sensitive and painful to the touch when pressed. Many times when you press on them, you have referred pain patterns like headaches or pain in other areas of the body. Trigger point injections can be performed with a little anesthetic, another injection medium, or without any injection substance at all (dry needling). It is minimally invasive, affordable, performed with or without pharmaceutical drugs and is administered intramuscularly. Many times, you will feel the muscle twitch during treatment and relief can be felt immediately or within 24-hours after treatment. Repeat treatments are usually not necessary unless your lifestyle continues to cause these knots in your muscles.

Used to treat: acute or traumatic injuries resulting in trigger points, chronic pain points, headaches due to trigger point, myofascial pain syndrome, fibromyalgia trigger points

Sources for Trigger Point: 

1. Hammi C, Schroeder JD, Yeung B. Trigger Point Injection. [Updated 2022 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542196/

Perineural Injection Therapy (PIT)

This minimally invasive, drug-free injection is administered just below the skin and offers an effective pain management option for a wide range of neurological pain. A small isotonic (neutral) amount of dextrose (plant-based sugar) in water is injected around superficial, inflamed nerves, which could be leading to neuralgias or neuropathic pain patterns. It is incredibly safe, even for diabetic patients experiencing diabetic neuropathy symptoms. This differs from prolotherapy, which is delivered much deeper under the skin and with higher amounts of dextrose. You can expect pain-relief to last 4 hours to 4 days initially, occasionally up to 2 weeks. Occasionally it is permanent after one visit though this is not a realistic expectation for most people. Most people need 6-8 visits to be substantially or completely better. Individual results vary and you can discuss these more thoroughly with Dr. Lorna.

Used to treat: frozen shoulder, migraines, sciatica, carpal tunnel, plantar fasciitis, neuralgia, fibromyalgia, nerve impingement, neuropathy, low back pain

Sources for PIT: 

1. Güzel İ, Gül D, Akpancar S, Lyftogt J. Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty. Med Sci Monit. 2021 Feb 6;27:e928759. doi: 10.12659/MSM.928759. PMID: 33547269; PMCID: PMC7874529.

Prolotherapy Injections

Hailing from the word “proliferation,” prolotherapy is all about proliferating new, healthy collagen fibers and is considered a regenerative therapy. This injection targets weak tendons and ligaments by stimulating the body’s innate healing response. This happens when dextrose (plant-based sugar) at a particular concentration is delivered directly to a weak tendon or ligament and causes an inflammatory response. This inflammatory response is what calls the body to action, and jumpstarts the healing process. More nutrients are delivered to the area allowing for new collagen formation and healing. This minimally invasive, drug-free injection is administered via ultrasound guidance by Dr. Lorna to ensure accurate delivery. It’s incredibly safe, well-researched (used since the 1950’s), and affordable. Pain relief with prolotherapy has been shown to last up to a year for musculoskeletal injuries and according to some research is similar to steroids and PRP one month after injection. You can expect to need 2-8 sessions to help you reach maximum relief if this injection is right for you, but is based on your particular injury and needs. 

Used to treat: ligament and tendon injuries, cartilage damage, muscle damage, trauma or overuse injuries

Sources for Prolotherapy:

1. Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med (Seoul). 2021 Jan;16(1):81-95. doi: 10.17085/apm.20078. Epub 2020 Dec 16. PMID: 33348947; PMCID: PMC7861898.

Hydrodissection Injections

This ultrasound-guided injection can be used in peripheral nerve entrapments to help decompress the nerve and to release soft tissue adhesions causing entrapment and subsequently pain. This minimally invasive injection is performed by inserting a needle near the entrapped nerve and a medium is injected such as saline, anesthetic, steroid, or dextrose. Once the injection has been performed, a perineural fluid plane between the nerve and surrounding tissue is created and consequently improves the nerve mobility. Results from this injection are very promising and while duration of benefit is unknown, depending on your condition, this may be a safe and useful injection.

Used to treat: nerve entrapment, carpal tunnel syndrome

Sources for hydrodissection: 

1. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve. 2018 Jan;57(1):25-32. doi: 10.1002/mus.25723. Epub 2017 Jul 6. PMID: 28622409; PMCID: PMC5722677.

2. Lee JY, Park Y, Park KD, Lee JK, Lim OK. Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study. Medicine (Baltimore). 2014 Dec;93(29):e350. doi: 10.1097/MD.0000000000000350. PMID: 25546691; PMCID: PMC4602597.

Corticosteroid Injections

Corticosteroids are delivered to an area of pain and work almost immediately by reducing inflammation. When used carefully, they can serve to provide near immediate pain relief so that appropriate strengthening and mobility can be performed. They can also serve as a quick fix while you determine what other tools you may need to help you treat the root cause of your pain. These injections are used sparingly to reduce the chance of side effects, and pain relief can last for months.

Used to treat:  arthritis, shoulder bursitis, trigger finger, plantar fasciitis

Sources for Corticosteroid: 

1. Jennings JW. The Safety and Potential Harm of Intraarticular Steroid Injections: The Debate Continues. Radiology. 2022 Aug;304(2):370-371. doi: 10.1148/radiol.220700. Epub 2022 May 10. PMID: 35536140.

2. Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis. 2009 Dec;68(12):1843-9. doi: 10.1136/ard.2008.099572. Epub 2008 Dec 3. PMID: 19054817; PMCID: PMC2770107.

Viscosupplementation Injections

Viscosupplementation is the injection of hyaluronic acid into painful joints with osteoarthritis with the intention of restoring the slippery and elastic qualities to the synovial fluid. Synovial fluid is normally found inside the joint space and serves the role of minimizing friction when the bones glide over one another. Hyaluronic acid is a natural component found in synovial fluid and is found to naturally decrease as part of the aging process. When it’s injected into the knee joint, data shows that pain relief can last up to a year with a single injection for some people. Since it is naturally produced by the body, side effects are minimal. Repeat injections are safe and provide longer lasting pain relief than steroids. Find out if this injection is right for you by consulting with Dr. Lorna.

Used to treat: osteoarthritis, knee arthritis, hip arthritis, tennis elbow, non-surgical candidates, people with NSAID allergies 

Sources for VIscosupplementation: 

1. Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, Berger AA, Kassem H, Kaye AD, Sherman WF, Abd-Elsayed A. A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee. Orthop Rev (Pavia). 2021 Jul 10;13(2):25549. doi: 10.52965/001c.25549. PMID: 34745480; PMCID: PMC8567800.

2. Leighton R, Åkermark C, Therrien R, et al. NASHA hyaluronic acid vs. methylprednisolone for knee osteoarthritis: a prospective, multi-center, randomized, non-inferiority trial. Osteoarthritis Cartilage. 2014;22(1):17-25. doi:10.1016/j.joca.2013.10.009.

Platelet Rich Plasma (PRP) Injections

This minimally invasive, regenerative injection consists of using platelets from your own blood and injecting them back into a problem area. At the beginning of the treatment, your blood is drawn and then spun in a machine that separates out the platelets. Platelets can be injected into tendons, ligaments, muscles and joint spaces, which are thought to jumpstart your body’s healing process by releasing growth factors into the area. Some data and people report that after 2-3 injections spaced a month a part, an individual can become pain-free. 

Used to treat: osteoarthritis, tennis elbow, shoulder pain, wrist pain, ankle pain, unstable ACL/PCL, Achilles tendonitis, rotator cuff tears, meniscal tears 

Sources for PRP:

1. Xu J, Du W, Xue X, Chen M, Zhou W, Luo X. Global research trends on platelet-rich plasma for tendon and ligament injuries from the past two decades: A bibliometric and visualized study. Front Surg. 2023 Feb 10;10:1113491. doi: 10.3389/fsurg.2023.1113491. PMID: 36843990; PMCID: PMC9950278.

2. Zhang J, Li F, Augi T, Williamson KM, Onishi K, Hogan MV, Neal MD, Wang JH. Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing. PLoS One. 2021 Sep 16;16(9):e0251166. doi: 10.1371/journal.pone.0251166. PMID: 34529657; PMCID: PMC8445483.

What next?

If you are suffering with pain or injury that’s stopping you do the things you enjoy or need to do, if you have niggles that are annoying you, or if you have some specific sporting/fitness challenges you want to prepare for, then we can help.

If you would like to book an appointment click here, or would like further information, please contact us on (250) 381-2239 or email hello@weareagile.ca