Physical Therapy

Meet the Non-Surgical Team

Physical Medicine & Rehabilitation

Physical Medicine and Rehabilitation (PM&R) also called physiatry, is a branch of medicine concerned with diagnosing and treating disorders and injuries that involve movement. The physicians are known as physiatrists who are experts in diagnosing and treating pain (acute or chronic). The physiatrists help patients to achieve optimal quality of life and function by reducing pain. This branch of medicine comprises of various treatment options, including interventional pain management such as facet injections, spinal cord stimulation and epidural injections. Interventions in physical therapy may include massage, braces and exercise programs.

Epidural Steroid Injections

Steroids are chemicals that are naturally present in our body. Synthetic steroids are generally used in the treatment of inflammatory conditions such as spinal disc injury and degenerative diseases among others.

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Facet Injections

Facet joint injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. They are given to relieve pain in the back, neck, arm and leg and even headaches caused from inflammation of the facet joints.

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Nerve Block Injections

A selective nerve block is the injection of an anesthetic and steroid medication around the spinal nerve root to diagnose or treat pain. It is indicated to relieve pain, weakness, numbness and tingling sensation in your neck, back.

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Sacroiliac (SI) Joint Injections

The sacroiliac joint connects the lowest part of the spine, the sacrum, to the adjoining bones of the pelvis, the iliac bones that are present on either side of the sacrum. In an adult there is minimal movement at these joints.

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Radiofrequency Ablation

Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique of treating pain. This technique employs radiofrequency waves to produce heat and the heat produced damage the nerves transmitting pain signal to the brain.

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Spinal Cord Stimulation

Spinal cord stimulation (SCS) is used for the management of chronic pain in arms and legs that has not responded to conventional modalities of treatment. Specific segments of the spinal cord are stimulated through electrical signals.

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Spinal Bracing

Spinal braces are external devices that help in the management of spinal disorders. They restrict the movement of the affected region of the spine, as well as support and stabilize it to relieve pain and promote healing.

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Exercise Programs

Exercise is the most significant way to improve the health and decrease pain. Appropriate exercises can increase strength, improve flexibility, and reduce back pain. Most of the doctors accept that exercise plays.

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Physical Therapy

Physical therapy is a health care specialty concerned with diagnosing, evaluating, and treating disorders and injuries of musculoskeletal system. The purpose of physical therapy is to help each patient restore their maximal level.

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Radiofrequency Ablation

Radiofrequency ablation (RFA) also called rhizotomy or neurotomy is a novel non-surgical technique of treating pain. This technique employs radiofrequency waves to produce heat and the heat produced damage the nerves transmitting pain signal to the brain. This procedure is performed to treat painful facet joints in the spine that usually cause chronic low back pain and neck pain.

Radiofrequency ablation treatment is considered only after it is confirmed that the cause of back pain lies in the facet joints and this is confirmed by performing a diagnostic facet joint injection. Facet joint injection relieves pain for a short duration whereas radiofrequency ablation can keep you pain-free for a longer period of time.

Radiofrequency ablation is a minimally invasive technique and therefore administration of general anesthetic is not required. You will be conscious throughout the procedure and lying on your stomach. Only a small area over your back which requires treatment is cleansed and numbed. This procedure is performed under the guidance of fluoroscopy. The fluoroscope is a special kind of X-ray machine that helps doctors to visualize the placement of the needle electrode in invasive procedures.

During the procedure, your doctor will direct a special radiofrequency needle electrode close to the facet joint in such a manner that the needle tip lies almost near to the medial branch nerve. The needle tip is then heated so that the nerve gets cauterized and destroyed thereby reducing the pain. This procedure may last for about an hour or two.

IntraDiscal Electro Thermal Therapy (IDET)

What is an IDET?

An IDET is a minimally invasive outpatient procedure for patients that have painful degenerative disc disease.   Using X-ray guidance, the physician enters the disc with a needle and applies controlled levels of heat to a broad section of the affected disc wall.  This heat contracts the collagen of the disc wall.  The procedure is thought to promote closure of the disc wall fissures and reduce protrusion of disc material.  

 

Why would someone need this procedure?

With age or injury, cracks may develop in the walls of the disc.  These “fissures” are a chronic source of pain for some patients.  The inner disc tissue, the nucleus, frequently bulges (protrudes or herniates) into these fissures in the outer region of the disc, stimulating pain sensors in the disc. 

Who is a candidate for an IDET?

It is important for a physician to diagnose that a disc is the primary source of a patient's back pain. An examination is preformed and testing such as Magnetic Resonance Imaging (MRI), or discogram are done to confirm the diagnosis.The IDET acts on the tissues of the disc itself, and will not relieve symptoms arising from other spinal structures, such as nerve roots or spinal joints. 

What can I expect during the IDET procedure?

The procedure is usually performed on an outpatient basis in an Ambulatory Surgical Center. An IV will be started. Local anesthesia and mild sedation may reduce discomfort during the procedure. The patient is awake and alert during the procedure so that he or she can provide important feedback to the physician. With the guidance of X-ray images, the physician will advance a needle into the disc. A catheter device is then introduced through the needle, which thermally treats the disc tissue. The device is then withdrawn and a small dressing is placed over the incision.

What is the preparation?

DO NOT take any Aspirin, anti-inflammatories, or blood thinners for 5 days prior to the IDET procedure. Notify the doctor if you have any allergies to any medications or an infection in any part of your body.  Also make the doctor aware if you are pregnant or if you have an allergy to shellfish, iodine or IVP dye. A driver must REMAIN at the Surgi-Center until the procedure is completed. You may also be instructed not to eat anything 8 hours prior to your procedure. All patients must arrive 1/2 hour prior to scheduled procedure time with your pre-fitted brace.

What kind of post op care can I expect?

You may be given pain medication for several days post procedure. During the healing process it is important that you treat your back with care. You will also need to wear a brace post IDET procedure. You will be given activity and physical rehabilitation guidelines prior to the procedure.

Spinal Injections

Patient Information Sheet For Spinal Injections

Do you have questions about the surgical procedures, injection treatments or services that we offer? Below is a list of some frequently asked questions, but please feel free to call our office if you need additional information. We are always pleased to assist you.

What can I expect during a spinal injection?

During most procedures, an IV needle will be placed in your arm in case any medication is needed during the procedure. Blood pressure and pulse are monitored. The procedure takes 30-60 minutes. NUMBING MEDICATION IS USED LIBERALLY AND IN MOST CASES THE PROCEDURE IS NOT SIGNIFICANTLY PAINFUL. You should plan on having a ride home.

Why should I have a spinal injection?

The purpose of the injection is to carry medication to the inner part of the spine where the more serious types of strain and injury can affect the disc and spinal joints, causing pressure or irritation of the nerves, or pain arising from the joints. In most cases, the medication that is going to be used is a very potent anti-inflammatory steroid. Many doctors and patients refer to this medication as "cortisone", although hydrocortisone is rarely used anymore. There are better types of medication similar to hydrocortisone. The goal of the injection is to deliver this potent anti-inflammatory steroid as close as possible to the anatomical structure that we believe is causing your pain, thus providing the greatest chance of pain relief.

Are there any long-term complications or side effects from using cortisone?

Much misinformation exist with regards to cortisone-type medications. It is very true that when an anti-inflammatory steroid, such as prednisone, has to be taken daily, it can cause significant side effects. Many patients with conditions such as rheumatoid arthritis, lupus, or patients who have had organ transplants, have to take oral steroids on a daily basis. When this medication is used daily, common adverse side effects include loss of bone density, weight gain, glaucoma, stomach ulceration, and other undesirable problems. IT MUST BE EMPHASIZED THAT THERE IS NO SATISFACTORY EVIDENCE OF ANY LONG TERM COMPLICATION FROM THE USE OF ANTI-INFLAMMATORY STEROIDS INJECTED IN THE EPIDURAL SPACE OR WITHIN A JOINT.

Are there any short term complications from getting a steroid injection?

Minor or temporary reactions may result from the use of the cortisone-type medication and these are rather frequent. The day following the procedure, some patients may develop a facial flush which usually lasts 12 to 24 hours. Occasionally, some women can experience some disruption in their menstrual cycle for 1 or 2 cycles. Extremely rarely, a patient could develop an acute allergic reaction to the anti-inflammatory steroid, and this could be treated promptly with medications during the procedure. Diabetic patients will often experience an increase in their blood sugars which can last for 5 to 7 days.

How many times a year can I have a spinal injection?

Most medical professionals who treat patients by injections of anti-inflammatory steroids feel that it is very safe to inject the same joint or epidural space up to three times per year.

Will I have a lot of pain or discomfort during this procedure?

In the great majority of cases, these injections are not significantly painful procedures. Numbing medication is used which involves a small needle stick and burning sensation, similar to dental work. Once the numbing medication is in, the shot is relatively easy to tolerate, for the most part. Occasionally, a patient can experience a sharp electric-type sensation down the arm or leg for just a split second. This is not alarming and simply means that the needle is being put in an effective place close to the nerve. This does not cause nerve injury. During an epidural injection, you may experience some mild dizziness which may last for a few minutes. This is generally due to a drop in blood pressure and resolves quickly. Intravenous fluids can be administered if the dizziness does not resolve quickly.

How long does it take for the numbing medicine to wear off?

Due to the numbing medicines, some patients experience numbness in the arms or legs after the procedure. The numbing medicine wears off in one to eight hours, causing the numbness or weakness to go away. How long will It take before I see relief from the spinal injection? Increased pain is often experienced the evening after the injection and the following day. Although unusual, this pain may last up to seven days. The benefits from the cortisone-type medication injected generally take 24 to 72 hours to occur. Occasionally, it can take seven days for beneficial affects to occur. The medication usually reaches its peak effect by two weeks.

What if the injection does not work?

1. The medicine was not put in the proper place where the pain is coming from. This means that your doctor should reassess your history and physical examination to re-diagnose the problem. Although disappointing, an injection that does not provide pain relief often helps to correctly diagnose your problem.
2. Another possibility is that the medicine was put in the proper place, but that the problem causing your pain, such as a large slipped disc or severe spinal stenosis, is too great to be overcome by a simple injection. When this is the case, the patient will generally experience some very minor pain relief for several days and then the pain will be as bad as it was previously. When this occurs, it is generally not worthwhile performing any further injections.  

How long will the benefits of the injection last?

Many patients ask how long the injection will last or if the injection "wears off". Simply put, the medication is a potent anti-inflammatory and will cause a reduction in inflammation and pain in the area where it is injected. If the injection relieves 75% to 100% of your pain one to two weeks after the injection, most likely the results will be long lasting. This assumes that the problem that caused the inflammation in the first place is removed. Sometimes the injection will not work at all. This usually means one of two things. (See next question)

What is the protocol for treatment after the first injection?

Patients often achieve pain relief that is lasting. If indicated, we do a second or third injection to further any benefits that are gained from the first injection. Performing up to three injections is considered very safe and is a common protocol for many physicians who do these procedures. Often, the injection is performed just once as this is all that is needed to provide lasting relief.

Are there any complications from having this procedure?

There are extremely rare complications that have been reported from spinal injections. There are case reports, which means very isolated incidents, of patients having significant complications including hip damage with possible need for an artificial hip, nerve damage, infection, bleeding, seizure, and death. These catastrophic events happen so rarely that no quantifiable rate of occurrence has been determined. These are extremely safe procedures when performed competently using good sterile technique to prevent infection. We would like to emphasize, again, that there is no satisfactory evidence of any long term complications from the use of epidural steroids. If the possibility for serious complications does exist, the occurrence rate is so infrequent that an actual rate of occurrence is not available.

We hope this information sheet has been able to answer some common questions regarding spinal injections. Certainly, if there are further questions, we would be happy to discuss them with you.

 

Important notice for patients undergoing spinal injections

If you need to cancel your appointment, please do so within 36 hours. If you fail to show for your scheduled injection, you will be billed a "no-show" fee.

Please note: Any patient who has a bleeding or platelet disorder needs an evaluation by a hematologist prior to any spinal injection. Patients cannot undergo a spinal injection while taking Coumadin.

In preparation for your upcoming spinal injection, there is only one significant preparation that you have to do:

Take no blood thinners, aspirin, plavix, coumadin, anti-inflammatory agents. This family of medications is headed by aspirin, but there are many different nonsteroidal anti-inflammatory agents, with ibuprofen being the most common. All of these medications have the side effect of prolonging bleeding time. If a patient were to be taking these medications prior to an injection, this would set up the possibility prolonged bleeding from tiny veins in the region of the spine which would make a relatively safe procedure somewhat more dangerous.

Thus, it is important that you avoid these medications for at least five (5) to seven (7) full days prior to your shot. If you have been taking any of the above medications within five (5) to seven (7) days of your injection, call us prior to your injection appointment so that we can advise you what to do.

The list of these medications includes (but may not be limited to) the following medications: blood thinners, Aspirin, Plavix, Coumadin, Ibuprofen, Motrin, Advil, Aleve, Nuprin, Naprosyn, Anaprox, Orudis, Lodine, Relafen, Clinoril, Arghrotec, Daypro, Indocin, Indomethacin, Duract, Ticlid, and others.

Sometimes these medications are mixed in with other medications such as: cold remedies, cough medicines, ETC. Read the labels of all the medications that you are taking to insure that none of the above listed medications are included.

Celebrex and Tylenol are safe to take.

If you have any questions regarding medications, please call and we will we let you know if the medications in question are OK to take.

Thank you for following these precautions carefully. This will help us avoid delaying your treatment.

If you are taking these medications under direction of a physician (aspirin, plavix, coumadin), please discuss this with your physician prior to stopping these medications.

Ambulatory Surgery Center

The Christiana Spine Center is proud to announce a new state-of-the-art surgery center that will enable our interventional physicians to perform minimally invasive spinal procedures in the comfort of an out-patient facility. Our main office is on the campus of Christiana Hospital with timely appointments available. Most insurance plans are accepted.

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