We recently audited the results of 303 consecutive sets of injections. They all had persistent (months or years) of low back pain with or without sciatica and were unable to tolerate exercise-based physiotherapy. If the injection helped, they then embarked on a course of vigorous, core muscle physiotherapy starting two weeks later. The core muscle rehabilitation gradually progressed into more functional activity or sport-specific based exercises. The results were as follows:
Two weeks after the procedure, 58% rated their improvement as substantial and a further 25% reported moderate improvement. 16% were the same and just under 2% were temporarily worse. No permanent complications arose though temporary exacerbations of pain were reported by about 10% of patients. These exacerbations lasted from a few days to 3 weeks.
Two months after the procedure, 56% still noted substantial improvement, 20% reported moderate improvement, 18% reported pain levels at the pre-procedure level and 6% were worse. Patients who had sciatica (leg pain) seemed to get better more often than those that just had back pain.
An independent anonymous post follow-up 18 months after the procedure was responded to by a little over 126 of the patients. Of them, 80% reported improvement in their sciatica and 80% reported improvement in their back pain. The average improvement in pain was 50%. 70% of this group had continued with a maintenance core exercise programme.
When compared with other series and the natural history (what happens if nothing is done), these are impressive results. They also emphasise the importance of combining the injections with rehabilitation exercises and continuing these long term.
Remember, you should view the injections not as the treatment but as a ticket to the treatment. The treatment is exercise.