Below was taken from a published piece by Dr Chris Bradshaw:

One of the rules of The House of God, a novel about a young intern and his struggles to get to grips with the demands of life in a large teaching hospital, is: ‘There is no body cavity which cannot be reached with a 14gauge needle and a strong arm’.

Certainly this has been the attitude of many medicos as they ply their trade in different medical fields.

In sports medicine, injection therapy has traditionally been accepted by participants and treating practitioners alike, and even encouraged by coaches and managers. In the not-too-distant past, injection therapy has been used in a ‘whatever the cost’ attempt to keep sportsmen and women on the battlefield, often to the long-term detriment of the participant.

These days we like to think that we are a little more scientific and discerning, and that we don’t put our clients at risk so much. Certainly the incidence of administering local anaesthetic injections to enable sportspeople to take part appears to have dropped dramatically in recent years. Players and participants appear much better educated and informed about such practices and make their decisions accordingly.

Corticosteroid injections are still widely used, although the perspective of a sports physician can be very different from that of a rheumatologist or orthopaedic surgeon. While some sportspeople are definitely after a ‘quick fix’, sports physicians and discerning practitioners recognise a very real diagnostic component to these procedures: if a very well placed injection provides temporary relief, that information can often help with an anatomical diagnosis.

More excitingly, a well deployed corticosteroid injection, by taking away the inhibition of some of the controlling musculature, and by relieving, even temporarily, some of the spasm associated with the initial injury, can provide a real window of opportunity in which the treating practitioner can successfully rehabilitate the patient.
Aside from corticosteroid and local anaesthetic injections, there are a variety of other substances that can be injected to provide a therapeutic effect. Beyond the scope of this current article, these include Synvisc and other synthetic joint fluids, aprotonin, calcium gluconate and the mildly controversial autologous blood injection. The latter has had some media attention lately, particularly in reference to English Premiership soccer players, but it is actually a scientifically proven and very useful method.

I have a few house rules of my own when using the combination therapy of corticosteroid injection and local anaesthesia:

• I am very wary of the effects of repeated corticosteroid injections on large, weight- bearing joints;
• I am cautious not to inject into major tendons because of the reported association with tendon rupture;
• I never inject the same region more than twice in rapid succession;
• I am also aware of the fact that if the first injection has no effect, and you are confident of your anatomy, a second injection into the same spot probably won’t work either.

There are many therapeutic and d iagnostic injections that are regularly used in sports medicine. It is important to remember, though, that injection therapy should never be seen as the be-all and end-all to the treatment of any patient, and nor as a substitute for good clinical practice.