It is not the first, second, or third time I have had patients say to me, “If I get an injection, isn’t that just a band-aid?” In this scenario, ‘injection’ can mean any type of procedure such as a corticosteroid, viscosupplementation (“gel” shots), or any other type of nerve stimulation/ablation procedure.
And to them, I smile, and reply, “Well, yes, and no”
So let me explain my answer.
Yes, Injections are like “band-aids”
The goal of an injection – particularly a steroid injection – is to decrease enough inflammation around the tissue that is injured, which therefore should decrease the pain one feels from the injury. It is like if you have ever sprained your ankle before. The ankle gets real hot, stiff and swollen. You cannot do much when it feels like that. But unlike the ankle which can be fairly easy to rest, stay off of, and allow it to heal, issues such as neck and low back pain from joint, disc and nerve injury as well as osteoarthritis of any joint in the body, can be a tad more complex and difficult to treat. That is because they are not always acute (recent) injuries; they are chronic with acute episodes. Which means the pathology has been there for a very long time even prior to any pain. It is the proverbial “straw that broke the camel’s back.” The osteoarthritis does not magically disappear and the disc herniation does not reabsorb due to a steroid injection – this is because they are chronic issues.
So, yes. The injection does NOT fix the problem, it just helps control the symptoms that result from the problem. But does that mean we should not use injections for any problem, ever? This will lead me to my next point;
No, Injections are NOT like “band-aids”
When I am explaining the approach I use to help a patient with a musculoskeletal problem, I like to look at the two variables that are impeding this patient from getting better. The first of the two is pain, the second is function.
Unless you have an inflammatory joint condition (think rheumatoid arthritis) or are in the weird 1% that actually has some other abnormal finding, 90% of problems are related to mechanical wear and tear, which results in dysfunction and pain. It looks something like this:
Poor mechanics → Abnormal ‘wear and tear’ on body/tissue/structure → Damage to body/tissue/structure → Inflammation because of damage → Pain
So you can see, pain is the last symptom. But, it is the first reason why people go to the doctor. I have yet to have a person come in saying, “I am here because I notice the shearing forces placed on my spine are abnormal and I would like to correct this prior to having any pain.” Instead, the conversation is, “I cannot sleep, work, or play with my kids because my back keeps flaring up, I didn’t do anything to aggravate it, and it’s really impeding my quality of life.” Sound familiar? Thought so.
When you have someone who is in so much pain, they cannot function within reasonable means, then you should consider pain and inflammation control first. Not only will the patient be happy to have some reduction in symptoms, but when they do start to address the function portion, they will likely have greater leaps and bounds in their progress.
So, to inject or not to inject? Here are my key factors when determining if injections are necessary:
Inject if pain is:
Affecting sleep quality
Affecting ability to work
Normal day-to-day tasks are unbearable
Pain is there most of the time, or if flare ups are frequent and intense
Pain has been there for more than a few weeks, despite attempts to limit or reduce pain in other ways (activity modification, medications, rest, etc.)
Hold on injections if pain is:
Minimal to low grade (more of a nuisance than an impedance)
New within a few days (try some other treatments first)
Has a factor that can be identified that if avoided (aggravating factor) or performed (alleviating factor) has been working to consistently reduce symptoms
If you are in the category of “hold on injection” or you have received an injection that puts you in the “hold on injection” category, then your next focus should be on function. Function identifies the problem from a mechanical movement standpoint which will work on “fixing” the problem.
So yes, injections are band-aids. But when a cut is deep and won’t stop bleeding, the band-aid can provide an essential tool to allow the body an opportunity to take over and heal itself.
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