PRACTICING AT
Musculoskeletal injuries can be quite complex - they demand focused treatment placed on the foundation of accurate diagnosis. Fluoroscopy-guided injection therapy removes the guesswork and helps make sure that the medication gets to the right place.
Learn How Fluoroscopy WorksState-of-the-art imaging accuracy, paired with a clinician who understands the complete story of your injury and has been with you since the beginning.
For some procedures, I use live C-arm fluoroscopy. This decreases anatomical guesswork for certain therapeutic injections. Real-time imaging helps navigate the complex anatomy of the spine, joints, and soft tissues - the medication is delivered to the source of the pain. Reviewing the imaging afterwards presents us with an educational opportunity.
For MVA whiplash treatment, this is the most useful option - though it may seem less glamorous at first. Myofascial trigger points (hyper-irritable spots within taut muscle bands) perpetuate pain long after tissue healing. These points create referred pain patterns often mistaken for nerve injury by both patients and clinicians.
Experienced hands find these easily through palpation. The altered sensation patterns you describe guide me directly to the muscle group creating your symptoms.
Like stopping hiccups with a surprise, needling the muscle triggers a reflex response - a twitch or grab that resets how the muscle functions and quells your pain in the process.
Facet and sacroiliac joint pain is very common with MVA injuries. These deep structures can cause real trouble but respond well to fluoroscopically guided treatment.
Often, a single corticosteroid injection calms the inflammation enough for healing to proceed. For cases involving joint instability rather than simple inflammation, PRP or prolotherapy work better. I choose the right medication for your specific problem.
For select patients with ligamentous laxity, tendinopathy, or chronic soft tissue dysfunction, regenerative injection therapy jumpstarts the body's natural healing process.
I use these mainly for true instability or chronic pain that persists after simpler treatments fail. Some patients prefer PRP (derived from your own blood) or prolotherapy (using dextrose) because they feel more natural to them than corticosteroids.
I do these treatments, but I believe they're frequently overused for motor vehicle accidents. The mechanism of MVA injury rarely damages nerves in the well-protected central spine. Epidurals for MVA-related back and neck injuries is almost always the wrong tool for the job.
I've seen this pattern repeatedly over 20 years in my own practice treating MVA injuries: epidurals done early at other clinics provide 2-3 weeks of relief, then fail. I experienced this failure with my own epidurals early in my career and learned (slowly) to change my approach. Patients returned still needing treatment. This short-lived response is specific to epidurals for MVA injuries - the facet and sacroiliac joint pathology isn't what epidurals address. In my opinion, the pain generator in MVAs is almost always the sacroiliac, facet, and myofascial dystonia that results from the repetitive jerking that occurs.
I'm very selective with epidurals. I only consider them when physical exam shows true lumbar or cervical radiculopathy supported by properly performed electrodiagnostic studies. A bulging disc on MRI alone isn't enough - without supporting clinical and EMG evidence, these injections typically fail.
Injection therapy is never first-line treatment - it's targeted intervention built on diagnostic clarity. My approach integrates:
No procedure without comprehensive musculoskeletal and neurological assessment. Provocative maneuvers differentiate radicular pain from myofascial pain from true nerve injury.
When true nerve injury is suspected, electrodiagnostics provides objective data about nerve function, localization, and severity. This determines whether injection therapy should target nerve roots, entrapment sites, or myofascial structures.
I personally review MRI, CT, and X-ray imaging with the patient. Degenerative changes, disc pathology, and structural abnormalities guide target selection and determine when injections are appropriate.
Injections aren't what makes you better - they make your rehab work better. Your body wants to heal and tries hard, but sometimes needs a push in the right direction.
Not all pain requires injections. Many patients respond well to manual therapy, rehabilitation, and addressing psychophysiological factors like sleep disruption, stress, and fear avoidance. In practice, I often put treating psychophysiological factors at the top of the list since these so strongly influence recovery. I use injection therapy selectively - when diagnostic testing supports it, when conservative care has plateaued, and when the risk-benefit ratio favors intervention.
Schedule a consultation to determine if injection therapy is the correct next step in your treatment and recovery goals.