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Are epidural steroid injections safe?

Recent studies have called into question use of epidural steroid injections (ESI) for patients with spinal stenosis. Some patients, whether they required surgery or responded to non-surgical care (i.e. chiropractic, physical therapy, acupuncture, etc.) have seen better long-term outcomes without ESI. (Spine. February 15, 2013, volume 38-Issue 4, pp. 279-291).
Two key findings:

  • For all patients in the study, ESI resulted in “less improvement” at four year follow-up compared to those who never received injections
  • In cases of surgery the patients with ESI had more complications after surgery (ie longer hospital stays, etc)

Suspected contributors to worse outcomes:

  • Damage to nerves and intervertebral disc cells may mask pain stimuli, risking further injury
  • Increased volume in spine may cause a “crowding” of tissues, increasing pain response

Similar poorer outcomes with the use of steroid injections have been seen in patients with lateral epidcondylitis, also known as “tennis elbow.”
Further studies are necessary to determine effectiveness and safety of ESI use.
Please consult with your physician about the risks and benefits of any treatment.  When considering treatment for myself or my patients, I always ask, ”What is the risk of waiting and allowing time to heal?”.  If you are unsure about what type of treatment to pursue there are plenty of physical therapists and physicians to provide initial consultations  or second opinions  in the greater Paramus, Ridgewood and Bergen County area.

 Apex Orthopedic Rehabilitation located in the Gabriel Realty Building at One East Ridgewood Avenue in Paramus, NJ provides orthopedic and sports physical therapy services for the greater Ridgewood, Paramus, Oradell, River Edge, Westwood, Ho-ho-kus and Bergen County region.  This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your physician or healthcare practitioner before engaging in a orthopedic, cardiovascular or sports physical therapy rehabilitation program.
 
 
 

Tom Willemann

Tom Willemann

Tom Willemann is a premier physical therapist based out of Bergen County, New Jersey. He holds an MS in physical therapy from the University of Miami, is credentialed in the world-renowned McKenzie Method of Mechanical Diagnosis and Therapy (MDT), and holds an OCS (Orthopedic Clinical Specialist) certification. As of 2018, there are approximately 14,000 ABPTS certified specialists in the nation and less than 400 of them are located in the state of New Jersey. Tom is the owner and director of Apex Orthopedic Rehabilitation in Paramus. He opened the clinic, which specializes in spine and sports injury prevention, in 2004 after many years of experience in the field. Tom’s caring interest in others and his strong belief in continuity of care, combined with his clinic’s ability to find solutions for the most difficult orthopedic problems, have earned Apex Orthopedic Rehabilitation its excellent reputation with patients and medical professionals in northeastern New Jersey and beyond. A true “family man,” Tom takes pride in his clinic’s warm and welcoming environment.
Tom Willemann

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