Injection Techniques

Injection Techniques

Injections techniques including joint injections, trigger point injections, prolotherapy and platelet rich plasma (PRP) are used to reduce pain and correct dysfunction resulting from age-related degeneration, as well as muscle, ligament or nerve injury. Dextrose is often a viable alternative to steroid injections and surgery to promote normal healing.


Prolotherapy is a 60 year old injection technique using dextrose (sugar water) and lidocaine. Prolotherapy targets hypermobile joints and/or pain related to ligament or tendon attachments to bones. A controlled injury is induced in these areas to encourage the ligament or tendon to heal in a shortened position. Prolotherapy has been used to treat chronic back and neck pain for years. It can be used to treat carpal tunnel syndrome, ankle sprains, partial tears of the rotator cuff, TMJ, arthritis pain, scoliosis and a host of other musculoskeletal issues. Carefully conducted research shows evidence of reduced pain in patients with knee osteoarthritis. Research for lateral epicondylitis and Achilles tendonosis is currently underway. Multiple sessions are typically needed to treat each area, with benefit accruing over time.

Prolotherapy can be used to treat carpal tunnel syndrome, ankle sprains, partial tears of the rotator cuff, TMJ, arthritis pain, scoliosis and a host of other musculoskeletal issues.

The concept behind prolotherapy is that musculoskeletal pain can be caused by ligament or tendon injury. Ligaments connect bone to bone. They are both strong and pliable. Ligaments are composed of fibrous bands which are multi directional and interlacing, allowing them to control any motion of the joint. They are important for joint stability. Instability or ligament laxity at the joint can eventually lead to arthritis, an abnormal bio mechanical wear pattern. Although ligaments are able to withstand a lot of force, repetitive injuries can weaken them. If ligaments don’t heal, even small movements of the involved joint can cause pain. Tendons attach muscles to bone. In certain instances, such as Achilles tendonitis, tennis elbow (lateral epicondylitis), or jumpers knee (patellar tendonitis) the attachment is injured. This causes pain whenever the muscle is under a weighted stress. Like ligaments, tendons should heal within six weeks, but if their healing is interrupted, pain, weakness and/or dysfunction occurs.

Both tendons and ligaments attach to bone. The treatment of prolotherapy involves injecting dextrose (sugar water) at the attachment of ligaments or tendons to bones. Lidocaine is used to numb the skin prior to injection. The idea is to create a controlled inflammatory response, promoting the creation of a stronger bond between the ligament/tendon and bone. This “inflammatory cascade” occurs normally during healing but is often interrupted by the use of anti-inflammatory medication (ibuprofen, Aleve, prednisone, etc.) and re-injury, leading to incomplete healing. Two to three months of prolotherapy helps complete the healing process. Postural exercises, arch supports, avoidance of tobacco and anti-inflammatories, correction of hormonal abnormalities, good nutrition and supplements also promote healing.

Most patients report several days of soreness following prolotherapy. Two weeks later, there is a brief flare-up response with some additional soreness. Prolotherapy is typically repeated in 3-4 week intervals for at least three treatments. Timing varies according to individual needs.

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Trigger points

Myofascial trigger points – resulting from muscular injury and/or overuse – can cause extreme pain and/or dysfunction. When a muscle is fatigued and overworked, overloaded, or receives a direct blow, a localized contraction of the smallest muscle unit occurs, interfering with blood supply to the area. This contraction produces a sensitized bump (not visible on the surface of the skin). The muscle tissue on either side of the bump lengthens, causes it to feel like a cord. Irritation to the muscle fiber causes an aching pain that is difficult to localize. Other associated symptoms include sensitivity to touch, numbness, pins and needles, muscle weakness, fatigue, sleep issues, and problems with balance. Compression of the bump or nodule, or stretching of the muscle, reproduces the pain or causes the pain to be felt elsewhere in the body.

Trigger points can be treated in a number of ways including direct compression, massage, spray and stretch techniques, and localized injections.

The goal of treatment is to release the muscle contraction, evidenced by a twitch response.  Trigger points can be treated in a number of ways including direct compression, massage, spray and stretch techniques, and localized injections. Dr. Stebbing uses her hands, acupuncture needles and standard needles to release trigger points.

In addition to injury and overuse, trigger points can be the result of ill-fitting shoes, postural abnormalities and ligamentous instability. Causes of trigger points are explored with each patient. Treatment with arch supports, exercises, or prolotherapy is recommended to avoid re-triggering of the affected muscles.

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Joint Injections

In certain areas such as the shoulder, conditions that cause pain can be treated with steroid injections to reduce inflammation and restore function. Dr. Stebbing’s tendency, however, is to avoid steroids in weight bearing joints.

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Synvisc injections

Synvisc is one of a few lubricating injections used to treat arthritis of the knee. 

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65 year old Henry is an avid golfer. He has knee osteoarthritis that limits his ability to walk long distances. He was told that he would most likely need a knee replacement. He has read the research that indicates that one year after knee replacement, most people’s activity level has not increased, and is wondering if there is another option for treatment. Henry is an ideal candidate for prolotherapy.

Anna, a 58 year old woman, has twisted her right ankle many times. Anna has noticed that she now has some swelling in the area all the time. She is concerned that this may indicate continued injury. After a detailed exam, her hunch is validated. Anna has instability of the ligaments that surround her ankle, and would be a candidate for prolotherapy

45 year old Dave is depressed due to the ongoing pain associated with plantar fasciitis triggered by running barefoot on the beach 3 months ago. His activity has diminished out of necessity. He has already tried exercise, a hard orthotic, new shoes, a night splint, anti-inflammatories and a steriod injection, without any benefit. Dave may benefit from prolotherapy at the attachment of the plantar fascia onto the heel and a custom-made arch support.

Desiree, a 35 year old business woman, was in a car accident many years ago. She continues to have intermittent low back pain that refers down the outside of her left leg. On examination, she has instability of her ligaments in her pelvis.  She would benefit from prolotherapy.