By Stewart Kerr, Advanced Practice Physiotherapist
What are high volume injections?
A high volume injection is a procedure performed to treat painful tendons otherwise known as tendinopathy. They are most often used to treat the Achilles tendon (Achilles tendinopathy) and patellar tendon (patellar tendinopathy). In chronic stubborn tendon problems, often tiny blood vessels grow into the tendon bringing with them new nerves as well. These nerves are thought to be related to the sensation of pain in the region.  The procedure involves injecting a high volume of a solution of saltwater (normal saline) and a local anaesthetic into the space between the tendon sheath and tendon. The solution pushes the tendon sheath away from the tendon and strips off the new blood vessels and nerve endings that have grown into the tendon. The aim of high volume injections is to reduce pain and allow individuals to move and exercise the tendon comfortably.
What conditions can be treated by high volume injections?
High volume injections can be used effectively for the treatment of Achilles tendon or patellar tendon pain.
How are high volume injections administered?
Life Fit Wellness offers this procedure via the Ultrasound Scan & Injection Clinic. A diagnostic ultrasound scan will be conducted prior to the procedure, alongside a thorough clinical examination, to ensure that the procedure is appropriated. The procedure is conducted under ultrasound guidance meaning that the needle used is directly visualised throughout to ensure accurate placement. During the procedure, you will feel a prick when the needle is inserted followed by a pressure or stretching sensation when the solution is injected. There may be some discomfort that should last for no more than half a minute. You will also notice swelling due to the high volume of fluid being injected which should resolve within 24 hours. The entire procedure should be completed within 30 minutes.
Are there any side effects?
There may be some complications following the procedure which may include numbness for a day or two, increased pain which occurs in about 2-10% of patients. There may also be a slight risk of bleeding and infection as with any other injection procedure.
What can I expect after the procedure?
You will likely feel immediate improvement after the high volume injection due to the anaesthetic effect, however once this wears off within a few hours you may find the area more uncomfortable. You should allow your tendon opportunity to re-condition to activity following the injection and you should start rehabilitation (physiotherapy) as recommended by your treating clinician. Patients can experience improvement within 4 weeks of the procedure and some studies have shown that these effects can last in the longer term.
