Ask a PT: To Inject, or Not to Inject?

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Question: My pain management doctor insists that I need injections to treat my neck pain with symptoms running down my arm and weakness in my hand. On the MRI there is no one area that seems to be the source of this pain. Should I get the injection anyway?

Answer: Injections are one of many treatment options for patients with radicular nerve pain. However, there is a certain order of treatment that makes a lot of sense for the majority of patients, starting with the most conservative intervention (physical therapy, oral medication), then the next step being injections if the symptoms have not improved, and the final step being potential surgery. Many insurance companies will not authorize injections unless physical therapy is tried first. Why? Most patients improve in physical therapy and end up never needing an injection at all. With injection success rates at 50% or less and the pain returning in days or weeks after, it makes sense to try the most conservative and the treatment most likely to succeed prior to trying injections. Also, if there is no specific area on the MRI indicating nerve compression at a specific level of the neck, there is a real chance the problem is not even at the cervical spine, but rather down the brachial plexus bundle of nerves where it passes through a small space between the scalene muscles on the side of the neck, under the posterior first rib, and under the pec minor muscle at the front of the shoulder. None of these areas of potential nerve compression would benefit from an injection at the cervical spine. If your doctor is pushing injections before trying physical therapy, ask to try PT with a manual physical therapist at MotionWorks first- you won’t regret it.