Injection Therapy

Injection therapy has been used extensively in China since the 1940’s. In fact, the term “Dry Needling” was developed by western MD’s to distinguish between the use of a “dry” acupuncture needle from a “wet” fluid filled syringe to treat muscle and joint pain. In China this technique, originally called “water needle therapy” was initially used for the administration of herbal extracts, but eventually other nutrients that proved effective in restoring health were added. Typically the substances were injected at known Acupuncture points, which overlie specific structures under the skin. In the Acupuncture community this technique is often referred to as Acupuncture Injection Therapy (AIT). Today, a number of other substances have been found to be just as effective for a variety of musculo-skeletal conditions. Unfortunately, these different substances have given rise to differently named treatments, all of which have the same end goal. Differing location of treatment has also spawned different treatment names, making it appear as if these treatments are radically different entities. Additionally, along the historical path of discovery, individual researchers working in isolation have independently “discovered” similar techniques yet named them with words unique to their professional discipline, perception or even after themselves. Consequently, a confusing array of treatment names (marketing labels) have been created for the public to ponder, all while essentially referring to a similar process . In the end these procedures are all intended to get faster, more effective results than a “dry”needle, aka “acupuncture”. In the West, many of these techniques are being promoted under the generalized term Regenerative Injection Therapy (RIT). This is probably the best overall descriptor since it clearly states what these injection techniques are aimed at, regenerating unhealthy tissue. Following are some of the regenerative injection approaches we offer in our clinic:

Biopuncture

Originally, the term Biopuncture was coined by German physicians using plant/mineral extracts in homeopathic form to treat pain and inflammation. Over time, as the field has developed other non-drug substances have been incorporated into the initial injection protocols. In current practice the homeopathic preparations are used less frequently due to their relatively high cost and lack of availability. Regardless of the materials used, the term Biopuncture is loosely used to describe a field of practice using low dose, non-drug substances to help treat pain in the muscles, tendons and ligaments through injections into the injured, irritated, or inflamed area. Many clinical studies have confirmed the efficacy, safety, and lack of side effects of of this approach. These treatments are effective for a multitude of acute and chronic pain conditions, including: neck, back and shoulder pain, ankle sprains, tennis and golf elbow, carpal tunnel syndrome, foot pain, and other neuropathies. The determination whether to use the substances described above or something else depends on the patient’s condition and practitioner judgement.

Perineural InjectionTherapy (PIT)

It has become common knowledge that peripheral nerves may be “pinched” by a bulging disc as they exit the spine, resulting in conditions like Sciatica. However, it is less well known that these same nerves can also get compressed as they pass through the various connective tissue planes further down along the nerve pathway. This entrapment limits free movement of the nerve, causing irritation and swelling, which further worsens the entrapment. It is not hard to imagine how this could lead to chronic pain. In Perineural Therapy a simple sugar-water solution is injected around the inflamed nerves, which reduces swelling and restores its freedom of movement. In the right situation, this simple therapy can produce quick pain relief with a minimum of discomfort. This procedure can be so effective it is often the recommended starting point for people who come to our office with long-standing pain that has no known cause. We also often combine this technique with the more robust techniques discussed below to address the problem from multiple perspectives to obtain a better overall outcome.

Trigger Point Injection Therapy (TrPi)

The modern term “Trigger Point” refers to an area of muscle where the fibers have been damaged and are now non-functional. In these areas a small lump or knot has formed and is tender or downright painful when palpated. In China they used to call these points “That’s it!” points because that’s what the patient would blurt out when the doctor pushed on it. This tissue damage could occur from trauma or even from something as simple as sleeping in the wrong position. Ever heard the term “I slept on it wrong”? Minor trigger points often heal themselves just by stretching, moving around or rubbing on the area; this is a primary purpose of massage. However, in cases where the muscle tissue has been stressed beyond a certain point these areas become persistent and non-healing. Left untreated they tend to cause adjacent fibers to become easily damaged and painful. “One trigger point begets another”. Damaged muscle fibers can not relax and contract, causing limited range of motion and pain when the impaired muscle is used. The development of Acupuncture/Dry Needling likely stemmed from the need for a tool to help reach and break up persistent trigger points when finger pressure was not adequate. With the advent of the hypodermic needle it was found that the needle effect combined with the hydraulic, fiber loosening action of a nutritive, pain relieving fluid substantially reduced the healing time and prevented deeper injury. This approach is widely used among professional athletes to recover faster and get back in the game quicker.

Prolotherapy Injection

The word Prolo-therapy literally means ‘proliferative therapy’ since its focus is on proliferating or accelerating the growth of new tissue. Most joint pain arises because of instability of the joint. Joints are designed to be tightly held together such that the bones comprising the joint are held in a strict anatomical relationship to each other. A joint that loses this integrity allows for hyper-mobility and subsequent damage to the components of the joint. The primary structures holding a joint together are the ligaments that bind bone to bone and maintain proper anatomical structure. If the ligaments get weak due to traumatic or chronic injury, or weaken due to “age” (or likely a combination of all the above), then the joint is at risk of getting damaged. Since all pain is nerve pain, joint pain indicates an injury and misalignment of the joint. The pain is a signal from your brain to stop doing what you’re doing and seek help to fix the problem (not mask it with pain killers like NSAIDs). Traumatic injury or long-standing trigger points can put a compromising strain on the attachments of tendons and ligaments that surround joints. This level of stress can cause the tissue to tear or pull away from its connection to bone. The resulting tissue damage causes micro-bleeding, and generalized inflammation, which create swelling and pain. Further, the normal re-growth rate of tendons and ligaments is painfully slow so even normal movement while tissues are healing may cause a re-injury of these fragile tissues. This can create a situation of seemingly never-ending chronic pain and re-injury. Conventional treatment uses anti-inflammatory or pain medications to reduce the discomfort. Unfortunately, studies show these treatments can adversely affect the ability of the tissue to heal. A more effective option is to inject substances that promote healing and reduce pain directly into the affected area, ie, the ligaments and tendons. The general objective is to speed up the healing of the tissues faster than you can re-injure it while performing normal activities of daily living. These injections typically consist of nutrients, vitamins, and plant extracts proven to relieve inflammatory pain and are typically given at a 3 week interval.

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