As an anesthesiologist and pain management specialist, steroid injections and nerve blocks have been my mainstay of a multidimensional treatment plan for various types of chronic pain. One downside of using steroid injections to alleviate pain is that there is a limit to how frequently they can be done safely. Overuse of steroid injections can cause secondary Adrenal Insufficiency. In other words, your body stops making the steroid cortisol that is needed for normal bodily functions because it thinks it doesn’t need to. The injected steroid is not the same as the cortisol your body makes, but it’s close enough to trick your body into thinking it is. Adrenal insufficiency causes problems regulating blood pressure, decreased immunity, weight loss, fatigue and if it is untreated symptoms can be worse and lead to shock, seizures and coma. Steroid injections are extremely useful for treating acute and chronic pain and can help people resume their normal function. The other caveat is that steroids don’t resolve the original problem or change your physical anatomy for the better.
The most common question that I'm asked about steroid injections is “How long will it last?”. My response is always the same “It’s extremely variable from person to person”. The more accurate answer is, “It depends on how much good muscle mass you have, how strong your body is and what you do after the injection.” Steroid injections work by decreasing inflammation or swelling of tissues that are causing the pain pathways to be triggered. However, if the inflammation returns, the pain will return too. This is also how oral anti-inflammatory medications such as Advil, Aleve or Aspirin work and why they only last for 4-12 hours at a time. The most effective way to keep the inflammation from returning, is to strengthen the tissues around the injured or affected area. Physical therapy and rehabilitation of weak muscles is the long-term solution for treating pain. It requires a dedicated commitment to a process which does not yield fast results, but the benefits are literally transformative.
People either tell me that they have been told, or they ask me, “Is it because I’m old that I’m having this pain?” The answer to this question is a resounding “No!”. I do not subscribe to the popular opinion that as we age, we need to accept a certain amount of pain and disability and that we should to slow down and do less of the activity that would otherwise make us happy and fulfilled. The explanation: however, to the reason that a person is having pain is oftentimes that there is a muscle weakness that has not been addressed. Our muscles protect us from pain and injury but if the muscles are affected and can’t support us the way they should, then the body collapses on itself. Muscular injuries can take time to heal or recover depending on the injury and the health of the muscles at the time of injury. Muscle health depends on activity and nutrition over years but can be negatively affected by only days and weeks of inactivity. Some people have never adopted a lifestyle that involves being physically active and age-related muscle loss only decreases their ability to recover from an injury, pain process or being sedentary. Strength is the most predictive factor of longevity, and it offers a certain degree of protection from injury.
As we age, it becomes even more important to be vigilant about diet and exercise than when we were younger. Malnutrition and inactivity are both very common realities in older adults who tend to eat less and have sedentary lifestyles. Even people who claim to have been athletes or firefighters when they were younger, have very different bodies now. Despite what we would like to believe, we don’t have the same body composition as we did in our 20s, 30s and 40s. Unless we actively work to maintain muscle strength daily, it naturally declines. I talk to my patients endlessly about the importance of nutrition, exercise and core muscle strengthening on pain relief, prevention of falls and longevity.
Sarcopenia is age related muscle loss. Sarcopenia is multifactorial and the severity is also affected by exercise, nutrition and hormones. People naturally lose 3-5% of muscle mass every year after the age of 30 and this increases significantly after the age of 60. The muscle fiber itself changes as we age including muscle fiber disorganization, decreased neuromuscular units and reduced firing rate of muscle units as well a decreased muscle regeneration. Muscle also becomes more infiltrated by fat which further decreases the ability to function normally. If an injury or event, such as surgery, occurs and causes a period of immobility, that muscle undergoes atrophy and older people are much slower to recover because they are doing so with muscle that is already weak and underperforming. People are often dismayed that after having a “curative” surgery, they still have pain and are unable to resume the lifestyle they once had before their pain condition altered their mobility. Surgery is very good at fixing an arthritic joint or a compressed nerve but it can’t fix the residual muscle weakness which causes much of the persistent pain, fatigue and poor balance.
Two non-invasive new treatment modalities that I have added to my practice to reduce pain, decrease reliance on steroid injections and hasten recovery from injury or surgery are Emsculpt Neo and Emsella. These are BTL devices that employ non-invasive High Intensity Focused Electromagnetic wave therapy or HIFEM technology. HIFEM increases muscle bulk, strength and re-education by inducing supranormal muscle contractions in targeted muscles. Emsella is for better pelvic floor strength for increased balance as well as improved urinary incontinence and urinary frequency that are caused by weak muscles. Emsculpt Neo can strengthen most muscle groups of the upper body, abdomen, low back and extremities and the addition of radio frequency to the contractions allows increased blood flow for healing, improved range of motion, lower muscle spasm and fat loss. Both devices are FDA cleared and have 40+ clinical studies and peer reviewed publications.
Emsculpt Neo and Emsella decrease the time it takes to increase muscle strength by stimulating the neuromuscular junction unit directly which bypasses the need for a normal nerve to muscle connection and physical effort that is required by traditional physical therapy and strength training. Electromagnetic waves penetrate tissue more deeply than most electrical devices that purport to do the same thing. One treatment session stimulates 20,000 contractions of muscle tissue. These 28- 30-minute sessions 1x per week x 4 weeks have been proven to increase strength by 29%, muscle size by 25% and fat reduction of 30%, on average.
These devices are particularly helpful for those who have pain during or after their attempts to engage in traditional strength exercise that can then cause a relapse in their attempts to move forward. Emsculpt Neo and Emsella are painless during and after the treatments and not only improve strength but also confidence by helping to restore balance and ease of walking and standing. People can then move forward and maintain a higher level of function with the more traditional modes of exercise once they are cleared from a surgical standpoint or when their baseline function improves to a level to be effective.
What is the key to a healthier and longer life with better quality? Strength building.
Call us for a consultation on how Emsculpt Neo and Emsella can help you get stronger.
