The medical field has changed considerably in the past 15 years, and continues to evolve on a daily basis. Certain treatment options that were not available a few decades ago have provided people with opportunities to extend their athletic careers and improve their overall quality of life. In my opinion, conservative management of orthopedic injuries should always be the first course of action. It has been shown and supported that physical therapy is more cost effective than other medical services and very effective in the treatment of various orthopedic conditions such as (not limited to) low back pain, neck pain, knee pain, shoulder pain, and hip pain.

However, there are other measures that can be taken to optimize someone’s recovery. At times, more invasive treatments need to be used in order to solve the problem. Certain types of injections can facilitate the recovery process, and enhance the benefits gained in physical therapy. When conservative treatments in conjunction with injections don’t work, then it may be necessary to consider more invasive methods such as surgeries or other procedures.

But what injections should you receive? How effective will they be? How soon can you be back on the courts playing pickleball?

There is no straightforward answer—it depends. Everyone is different, and every injury will heal differently. Having a good discussion with your physical therapist as well as your orthopedic physician and determining the best course of action for you

is paramount. It is always a good sign when the physical therapist and physician have an open line
of communication, as this will lead to the best decision making.

Here are some of the currently available injections:
• Corticosteroids
• Platelet Rich Plasma
• Platelet Lysate
• Hyaluronic Acid
• Stem Cell

All the above injections have pros and cons, and none of them work 100 percent of the time. The following descriptions are a combination of medical literature- supported information combined with my professional experience treating patients of varying athletic backgrounds, age, and injury types who have received injections. Hopefully this information can be of use to you if you are considering an injection.

Cortisone Injections
This is the most common type of injection in the treatment of orthopedic injuries. It is used for various injuries, usually aimed at reducing inflammation in order to decrease pain and improve function. It is unfortunately not a long-term solution, with patients often reporting short-term relief (4-6 weeks) before the pain starts to return. Others often do not experience any change or improvement in their pain level following a cortisone injection.

Studies support that the use of cortisone injections does not provide greater pain relief than conservative physical therapy and the use of interventions such as dry needling. In addition, cortisone injections have been shown to potentially weaken certain tissues in the body depending on the injection site, which could increase the risk of future injury. For example, in the case of Achilles tendinitis, cortisone injections have been linked with weaker tissue quality and potential long-term increased risk of Achilles injuries. Also, there is no difference in the long-term outcome between the use of cortisone injections and physical therapy.

Platelet Rich Plasma (PRP) Injections
PRP is a form of regenerative medicine using one’s own plasma (liquid portion of the blood) to harness
the body’s ability to heal and amplify tissue healing by boosting the body’s growth factor in the injury site. PRP is obtained from a blood draw, run through a centrifuge, then re-injected as a concentrate of platelets into the injury site.

PRP injections have been found to be effective in problems such as tendinopathies, chronic tennis elbow, and rotator cuff pathologies. There are no known significant adverse effects (aside from a potential inflammatory response), but it is not always effective for everyone.

Platelet Lysate (PL) Injections
PL injections are a form of PRP injections. However, in this case, the platelets are concentrated and partially broken down in order to promote a greater release of growth hormone and accelerate the patient response (and possibly the healing time). These injections have been found to cause less of an inflammatory response in patients, making them beneficial for treating injuries with nerve involvement. In addition, they may be used in more acute conditions when someone has a higher level of inflammation, to mitigate the response and lead to accelerated healing by providing a boost of growth hormone at the injury site.

Hyaluronic Acid (HA) Injections
This type of injection is used mostly for people with knee osteoarthritis (OA). It has been found that these injections are most effective for people with mild to moderate OA, and aim to replace some of the joint lubricant that is usually lost with OA. In my experience, these can work temporarily or delay a surgical intervention, but if the level of OA continues to progress to the point where pain prevents normal activities, most people end up having a total knee replacement.

Stem Cell Injections
Stem cells are the newest type of injection available. There are multiple types of stem cell injections, but these are often not covered by insurance, and results are inconsistent at this time. There is no doubt that stem cell injections will play a huge part in medicine and injury management, but based on patient experience and the insufficient medical literature thus far, it is hard to recommend these injections for now.

If you have any questions, you can contact The Pickleball Doctor at thepickleballdoctor@gmail.com

---
Noe Sariban is a Doctor of Physical Therapy, Certified Pickleball Teaching Professional through the IPTPA, an Engage sponsored athlete, and the Team Engage physical therapist. Please visit www.thepickleballdoctor.com for more information on injury prevention and rehabilitation tips. Noe started his website to provide pickleball players around the world with a reliable and free source of information. Please like his Facebook page, www.facebook.com/pickleballdoctor, for updates and new information!