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  • Cervical epidural steroid injection BEFORE physical therapy even starts?

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    Old 07-30-2005, 03:44 PM   #1
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    Cervical epidural steroid injection BEFORE physical therapy even starts?

    New to this board and need some info!

    Over past 3 years I've been huddling over a computer for hours on end.
    Bad posture!

    Over time, developed mild stiff neck and mild neck pain (emphasis on MILD), when turning head, frequent but mild headaches "fixed" with Excedrin... but nothing incapacitating. I have no spontaneous neck pain at all.

    Two weeks ago, I had a couple of brief "episodes" of left shoulder and arm tingling. ( small area at upper shoulder, at the crook in the elbow and at inside of wrist.)
    It does not radiate into hand, nor does it happen anywhere else. The paresthesias were transient and only seem to occur when I lean on arm (not elbow).
    This sent up a red flag though, since I know just enough that this could be nerve impingement coming from my neck.

    I saw an orthopedist yesterday who tooks xrays and examined me. The xrays showed a couple of osteophytes. (Okay okay, so I'm over 21!) His initial clinical exam and diagnosis indicates mild degenerative disc disease- cervical spine.
    Possibly early foraminal stenosis involving C-5 C-6.
    Also (no surprise) shoulder and neck muscle spasm.

    I'm having an MRI today which will give us more info.

    If the MRI bares out his tentative diagnosis, he is suggesting I have physical therapy but here's my MAIN question:
    He suggested an epidural steroid injection (2 levels, one sitting) BEFORE I start therapy, his feeling being that PT might make me worse without an injection first. Feels that an injection prior to any manipulation etc will make it easier for me to get the full benefits from the therapy.

    This makes sense but I've been reading about the injections and aren't they usually reserved for people who do NOT get much relief from PT first? And who are severe pain? I feel pain free and totally comfortable most of the time.

    While examining me, I hardly had much pain and he couldn't find any provocative position that produced any tingling at all!

    Is he putting the cart before the horse here? Aren't the injections a bit of overkill given that this is very recent and I'm pretty comfortable?

    The injection scares the [blank] out of me and I sure don't want it if I don't need it. PT I definitely want. Need postural re-training that's for sure, plus strengthening exercises etc.

    What do you guys think? Shots first? or straight to PT?

    zuzu xxx

    Last edited by zuzu8; 07-30-2005 at 04:24 PM.

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    Old 07-30-2005, 04:16 PM   #2
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    Re: Cervical epidural steroid injection BEFORE physical therapy even starts?

    There is not fast rule about when to start PT or have epidural injections, everyone is individual and the order your doctor decides to do things is related to your symptoms (or lack of ) and their cause.

    I had an epidural injection shortly after my neck problems started, it significantly improved my symptoms and spasm by reducing the swelling. In many cases things then continue to improve on their own or with PT. The injection itself wasn't bad but a word of caution - some surgeons are still requesting 'transforaminal epidural injections' - this approach has been recently questioned as being dangerous and having a high incidence of complications. From what I understand, the more usual cervical epidural is pretty safe - both are done with xray guidance.

    PT is more a long term process to help healing, prevent you from doing more harm (such as sitting in a safer position while on the computer) and strengthen muscle groups so as not to harm yourself more.
    Good luck,

    Old 07-30-2005, 05:48 PM   #3
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    Re: Cervical epidural steroid injection BEFORE physical therapy even starts?

    Do the PT first, what's the worst that can happen? More pain? You're physical therapist will stop if it gets too painful. There are machines that specifically address the muscles that stabalized the spine medX. Physcians love to bill, and shots are big money. I had the Epidural, they inject at T2 and it works it's way up the spinal canal to reduce swelling. The downside is they are steroids and steriods DO NOT strengthen anything, in fact they can cause your ligaments to become weaker. So why try the drug before the PT? Bad Posture is DEADLY I have been suffering almost a whole year now after years of 10 hour days in front of the PC. I know work in a recliner with a swingarm LCD and my neck is ALWAYS supported. The injection isn't going to make anything better. The purpose of BEFORE is simply to lower swelling so PT is more tolerable. The thing about drugs is they are always there, why not see if you can fix yourself without them first?

    Old 07-30-2005, 05:53 PM   #4
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    Re: Cervical epidural steroid injection BEFORE physical therapy even starts?

    I left out the most important part. Make sure your PT does a complete evaluation for MUSCLE IMBALANCE. Poor posture means some of your muscles have chronically contracted muscle tissue. Basically the muscles in your upper back become strong and contracted and your middle back weakens. Essentially the WRONG muscles are over compensating for tasks other postural muscles should be completing. Releasing these muscles is a HUGE help. I am working with a massage therapist to break up these trigger points. You really have no idea you have them until they (massage therapist) gets you all relaxed then starts moving them. This will absolutely help your muscle spasms. Plus you get a much better understanding of what is wrong and how to correct it.

    Old 08-01-2005, 07:43 PM   #5
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    Re: Cervical epidural steroid injection BEFORE physical therapy even starts?

    Hi Zuzu8,

    I have a different opinion re your question. First of all I get epidurals, in a variety of spinal locations. I had one a week ago Tuesday in fact. There is really nothing to be scared of. You have a C5/6 problem and it isn't going to go away. No matter what the PT does, if your muscles are "locked" up tight and you are full of inflamation which is creating ever more muscle rigidity.

    In my experience (over the past 25 years) the PT will be a waste of time until you get the other issues under control. The PT will not have a lasting effect until you get the electrical problems fixed. Your scapular region will continue to get worse, the arm might get worse. In my experience you cant retrain a muscle that is being cramped etc by inflamation and irritated nerves. The epidural may well settle things down. Then the PT can do some good.

    I wish you well and hope that what ever decision you make, it works for you.

    Old 08-04-2005, 10:34 AM   #6
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    Re: Cervical epidural steroid injection BEFORE physical therapy even starts?

    Hey, thank you all so much for your input and expertise.

    The MRI showed less pathology than my ortho suspected at first, although, yes, there is some foraminal stenosis on a couple of levels.

    He suggested, instead of the epidurals, a 6 day course of MEDROL [4mg dosepak] and then wrote me a script for physical therapy. It's day 3 of the pills and already my neck stiffness, spasm and pain has subsided,(for the time being of course).. also no arm tingling since 2nd day... so it'll be PT starting next week 3 times a week for a month for starters. Fortunately I have a health plan that miraculously doesnt put a cap on the amount of PT sessions allowed per year -as long as it's "medically necessary" (so we all know that they'll probably cap me at 12 anyway!) I know this facility and also this particular phys. therapist (who got me out of major frozen shoulder problems 4 years ago...she's amazing), so I know I'll be in good hands.

    Big lifestyle changes in store for zuzu that's for sure!

    MAJOR postural re-training, strengthening muscle groups that are all out of whack, getting my body back into balance with a proper regular exercise routine etc and of course maintaining this on my own once I "feel better."

    Once again, you've been terrific. Thanks!

    zuzu xxx

    Old 08-05-2005, 10:53 PM   #7
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    Re: Cervical epidural steroid injection BEFORE physical therapy even starts?

    I have found, if you have a disc problem, nothing PT can do will really make it better. You can strengthen the spine but the neck is a special thing b/c of the ROM and the fact it holds up the head and is the one part of the spine with the most movement (was that redundant? ) Anyway, I have done ESI prior to PT and after. My story:
    I am 27, 26 at the time. I went into work July 14 with shoulder pain, then that was my last day worked. Over time I had xrays and mris. DX: Never mind the lumbar, had a two level fusion in December and am doing well, on to the neck...
    Herniation C5-6
    loss of lordosis C5-6
    and from EMG: Pinched nerve
    I had ESI (transverse-one on each side of neck, got better then worse after my lumbar surgery), had PT, did NO GOOD. Then, another ESI, this one got rid of the pinched nerve (oh, had traction done too after the first ESI). My pain is now MUSCLE spasms like you'd NeVER believe in my neck, traps, shoulders, upper back. I have a tens unit that doesn't do much. Heat helps, percs help a little, zanaflex helps a little.
    Anyway, got off track. I hurt right now and need to sleep. LIfe goes on for me and I am dealing with this. I have to get through eleven months of school and if this gets worse, then I will get a second opinion from a neuro, to heck with my orthos. Lucky for me, my arm pain did get better, infact, much of it has been better. BUT, I do have good and bad days. I keep thinking, just eleven months to go......
    I wish you all the best and after I rest, I'll try and help better

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