Guided Spinal Injections

These procedures involve injection of steroid type chemicals close to spinal nerves (nerve root injections) or the space around the spinal cord (epidurals). The Radiologist positions the needle by viewing on CT scanner into the right spot.

 

I thought I’d share what one of Melbourne’s best spinal surgeons told me about them (as he referred me for one!)

 

He told me in his experience for people he referred to have nerve root injection, approximately 60% described some effect from the injection. More specifically though, roughly 20% of people felt good improvement, 20% fair and 20% slight. 

 

Not great numbers I think you’ll agree, but probably worth a try for unbearable or unchanging leg pain if your doctor thinks so.

 

He also said that he felt epidural injections were a “shot in the dark”.

 

In more general conversation I’m glad he agreed with me that increased back pain first thing in the morning is a key sign for non-invasive treatment. Simply put, more pain in the morning is most likely due to back joints getting stiffer overnight. This is good for someone like me, because stiff joints will usually respond to appropriate manual therapy which I can provide.

 

So even if your CT or MRI is awful, if you are worse in the morning it is worth trying some (manual) Physiotherapy. You should get some improvement.

SHOULDER BURSITIS

By Brendan Dax • October 27, 2025
Bursitis is one of the many causes of impingement pain of the shoulder, giving restriction and pain when lifting the arm. Bursae are small sacks of fluid and when inflamed in the shoulder, take up too much space, getting squashed when raising your arm causing painful pinching. Like all musculoskeletal problems, this is a problem of mechanics. Something doesn’t move properly. From a manual physiotherapy perspective, bursitis, like all shoulder impingement problems usually responds well to joint mobilisation. In all my years of treating shoulder impingement almost all presentations have associated neck/upper back spinal joint stiffness. Manual mobilisation (loosening up) of the neck/back and shoulder joints will always yield improvement, unless there is structural damage. Having seen 100s of acute onset (within the previous two days) shoulder problems in the industrial sector, I can assure you that most of them come in with chronic, stiff upper backs that they’ve had for ages. True bursitis usually responds as well to a guided Cortisone injection. Bear in mind if the neck and shoulder joints are still stiff the jab may not solve the problem. If you have shoulder pain that has not responded to injection and/or seeing a Physio who just uses machines and/or exercises, consider manual physiotherapy from someone like me, before we all retire!

SIDE HIP PAIN

July 1, 2025
Pain on the side of the hip from bursitis or gluteal tendon inflammation is an annoying problem often more so at night because lying on it frequently disturbs people’s sleep. It is a reasonably common problem for me to see. Tendons and bursae degenerate as we age and weakness in hip musculature can be a cause. But it can happen to anyone. Guided steroid injections can help, but most people respond well to soft tissue manipulation. The lower back should definitely be assessed and (usually) treated manually as related spinal joint stiffness frequently contributes to the issue. The hip joint should also be assessed and treated if necessary. Exercises can be helpful but need to match the pathology so an Ultrasound image might be needed give a diagnosis.