Spinal Injection Therapy in Calgary: What Works, What Doesn’t, and Why Physiotherapy Has to Come Next

Colin Bouma, PT, FCAMPT
Jun 1
9 min read

Your family doctor mentioned a referral. Maybe you’ve already seen the pain specialist. The plan involves an injection — epidural, facet, maybe radiofrequency ablation — and you’re trying to figure out whether to do it. Reading online has given you conflicting answers, optimistic clinic pages, and a few horror stories. You want a straight read.

Here’s the honest one. Spinal injections are useful tools, but they are not cures. The best evidence shows they create a window of reduced pain that you can use productively — or waste. What you do during that window determines whether the injection bought you a temporary break or actual long-term change. This post walks through what each injection type actually does, what the current evidence says (including the studies the field would prefer you didn’t read), and how to use a pain-relief window for genuine recovery.

At our Calgary physiotherapy clinic on MacLeod Trail, we work closely with the pain specialists and surgeons in the city. Injections have a role. They also have limits — and patients are routinely undersold on both.

What spinal injections actually do (and don’t do)

Spinal injections deliver medication — usually a corticosteroid, sometimes a local anesthetic alone, occasionally biologic preparations like platelet-rich plasma — directly to or near a structure thought to be generating pain. They work locally, which means faster, more targeted effect than oral medication.

What they can do:

· Reduce nerve and tissue inflammation

· Lower pain enough to allow movement

· Confirm or rule out a specific pain source (diagnostic injections)

· Buy you a window of weeks to months in which active rehabilitation works better

What they cannot do:

· Heal a disc herniation

· Strengthen muscles, restore mobility, or change movement patterns

· Resolve central sensitization (chronic pain processing)

· Substitute for the active work that creates durable improvement

Types of spinal injections — and what the evidence actually says

1. Epidural Steroid Injections (ESIs)

Most commonly used for lumbar radiculopathy (sciatica) caused by disc herniation or spinal stenosis. The injection delivers corticosteroid into the epidural space around the irritated nerve root.

The evidence: Multiple systematic reviews consistently show meaningful short-term pain reduction (4–12 weeks), with the AAN systematic review concluding that ESIs are probably effective for short-term reduction in radicular pain and disability, but with limited evidence for long-term benefit beyond 6 months. NICE recommends considering ESIs for severe acute radicular pain — not for non-radicular low back pain.

Practical translation: ESIs work, modestly, for the right patient (severe radicular pain). They do not fix the herniation, and benefit typically wanes after a few months. Many patients require multiple injections — and the long-term evidence on repeated injections is weaker still.

2. Facet Joint Injections

The facet joints are the small paired joints at the back of the spine. They can become painful from arthritis or mechanical irritation. Facet joint injections deliver corticosteroid into or near the joint.

The evidence: facet joint injections have stronger value as a diagnostic tool (confirming the facet joint is a pain generator) than as a therapeutic intervention. When used diagnostically — often as paired medial branch blocks — they can identify candidates for longer-lasting interventions like radiofrequency ablation. Used purely therapeutically, long-term benefit is modest at best.

3. Sacroiliac (SI) Joint Injections

Used when SI joint dysfunction is suspected as a pain source. Similar pattern to facet injections: more reliable diagnostically than therapeutically. Best results when paired with targeted physiotherapy focused on hip, pelvic, and core control — the injection eases pain enough that the active work becomes possible.

4. Radiofrequency Ablation (RFA)

RFA uses heat to ablate the small medial branch nerves that supply pain sensation to the facet joints. The intent is to interrupt pain signalling for 6–12 months while the nerve regenerates. It is widely used for chronic axial low back pain.

The evidence is more contested than many clinic pages let on. The MINT trials (Juch et al., JAMA 2017) were three high-quality randomized controlled trials comparing RFA plus exercise to exercise alone for chronic low back pain, facet joint pain, and sacroiliac joint pain. All three found no significant clinical benefit from adding RFA. That result hit the field hard and provoked years of debate.

The pushback: critics noted that MINT did not use the same rigorous patient-selection criteria (diagnostic medial branch blocks with ≥80% relief) that experienced interventional pain physicians use. Real-world studies (RAPID and others) continue to report meaningful benefit in carefully selected patients. The most accurate summary is: RFA can help carefully selected patients with confirmed facet-mediated pain, but it is not the broadly effective treatment that older marketing suggested.

5. Trigger Point Injections

Injection (usually local anesthetic, sometimes saline) into tight, tender muscle bands. The evidence is weak: trigger point injections tend to produce similar effects regardless of what’s injected, suggesting much of the benefit comes from the needling itself rather than the medication. They can help symptoms transiently but rarely produce lasting change.

6. Platelet-Rich Plasma (PRP) Injections

PRP involves drawing your own blood, concentrating the platelets, and injecting the concentrate into a structure (commonly a disc, facet joint, or SI joint). The theory is that growth factors in the concentrate promote tissue healing.

The evidence: Current systematic reviews describe PRP for low back pain as promising but still low to moderate certainty. PRP for spinal indications is experimental, not standard of care, usually not covered by insurance, and the bar for "effective" has been set low in published studies. If you’re considering PRP for spine pain, do so with realistic expectations — and only after conventional conservative care has been tried.

Why injections don’t fix the underlying problem

Pain is a signal. Spinal injections reduce the signal — sometimes dramatically — but they do not change the underlying tissues, the movement patterns, the nervous system sensitivity, or the deconditioning that contributed to the pain in the first place.

This is why an injection that brings you from 8/10 pain to 3/10 over a weekend often returns to 8/10 three months later if nothing else has changed. The injection wore off — but more importantly, the underlying drivers were untreated. The injection wasn’t a treatment; it was a pause.

A more accurate way to think about a spinal injection is as a window. A few weeks or months of meaningfully lower pain, during which your nervous system, muscles, and movement can be retrained. The window itself doesn’t heal you. What you do in the window does.

When spinal injections actually make sense

Reasonable indications, in our experience and consistent with the evidence:

· Severe radicular pain (sciatica or arm pain) from a confirmed disc herniation, not responding to 4–6 weeks of structured conservative care

· Facet-mediated pain identified through paired diagnostic medial branch blocks, with RFA considered if blocks are positive

· Pain severe enough that it is preventing you from doing the active rehabilitation that will actually change your trajectory

· A patient committed to using the window for structured rehab, not just expecting the injection to fix things

Less reasonable, despite being common:

· Non-specific chronic low back pain without radicular symptoms

· Repeated injections every 3–6 months without active rehab in between

· Injections as a first-line treatment before structured conservative care has been attempted

· Patients who plan to return to the same activity patterns immediately, expecting permanent change

How we use the post-injection window

Phase 1 — Use the window (first 1–3 weeks post-injection)

Pain has dropped. Movements that were too provocative before are now tolerable. We start re-introducing them carefully and progressively. The goal isn’t to return to pre-injection activity overnight — it’s to start the active work that wasn’t possible before.

Phase 2 — Build capacity (weeks 2–8)

Progressive loading — strength, mobility, neuromuscular control — targeted to the specific structures driving your pain. For disc-related radiculopathy, that includes back and hip strength, neural mobility work, and graded re-exposure to bending and lifting. For facet- or SI-related pain, the emphasis is on hip and pelvic control, trunk strength, and movement variability.

Phase 3 — Maintain the gains (weeks 6+)

Self-managed strength and conditioning program built around your goals: work demands, sport, lifestyle. The injection bought you the window; the work in Phases 1–3 is what makes the improvement durable.

Education that changes outcomes

Understanding pain neuroscience, what a flare-up means (and doesn’t), and how to interpret symptoms during exercise consistently changes outcomes. Patients who understand the role of an injection — a tool, not a cure — get more out of it.

Realistic expectations and risks

Most spinal injections are safe when performed by an experienced interventional pain physician under fluoroscopic guidance. Serious adverse events are rare but possible: infection, bleeding, dural puncture, transient nerve symptoms, and very rarely, more serious neurological complications. Cervical injections carry a higher risk profile than lumbar.

Realistic expectations:

· Most injections wear off. Multiple injections are commonly required.

· Benefit tends to diminish with each repeat injection.

· The window is real and useful — but only if you use it.

· An injection that does not produce meaningful relief is a data point, not a failure. It often clarifies what isn’t the dominant pain source.

Frequently asked questions

Do epidural steroid injections cure back pain?

No. ESIs reduce nerve inflammation and can produce meaningful short-term pain relief (typically 4–12 weeks) in patients with radicular pain. They do not heal the disc, change movement patterns, or strengthen muscles. They are best understood as a window — a period of reduced pain that you use for active rehabilitation. The combination is what produces durable change; the injection alone rarely does.

How many injections is too many?

There is no hard limit, but the law of diminishing returns applies. Benefit typically wanes with repeated injections, and most pain physicians limit cumulative corticosteroid exposure for safety reasons (joint, tendon, and bone effects with repeated dosing). If you’re considering a third or fourth injection in a year without the active rehab piece, that’s a signal to step back and ask whether the strategy is working.

Should I try injections before physiotherapy, or after?

Almost always after, unless pain is severe enough that it’s blocking movement entirely. Structured conservative care for 4–8 weeks is the reasonable first step for most chronic spine pain. If symptoms aren’t improving — particularly if there is significant radicular pain or specific structural pain that conservative care isn’t reaching — an injection becomes a reasonable next step.

Are PRP injections worth it for back pain?

Maybe, for some patients, with caveats. The evidence base is encouraging but still low to moderate certainty. PRP for spinal indications is experimental, usually not covered by insurance, and should only be considered after conventional conservative care has been tried. If you’re thinking about it, choose a provider who is honest about the evidence rather than one who promises healing. We can help. guide you in the right direction.

Does radiofrequency ablation actually work?

It can, in carefully selected patients with confirmed facet-mediated pain. The MINT randomized trials (JAMA 2017) found no significant benefit over exercise alone in less selectively chosen patients — which provoked years of debate. The honest answer: RFA can help patients whose facet involvement has been confirmed through diagnostic medial branch blocks, and where active rehab will follow. It is not the broadly effective treatment older marketing suggested.

How long does a steroid injection last?

Typically 4–12 weeks of meaningful relief, with broad individual variation. Some patients get longer; some get less. The relief itself doesn’t "wear off" in the sense that something gets worse — the medication just stops being active and underlying drivers reassert themselves. This is exactly why the post-injection window is the rehabilitation opportunity.

Plan your injection therapy and post-injection physiotherapy in south Calgary

We’re located at 8989 MacLeod Trail SW, serving Haysboro, Kingsland, Acadia, Fairview, and the broader south Calgary community. We work closely with the city’s pain specialists, anaesthetists, and spine surgeons.

Your first visit is 45–60 minutes. We assess what’s actually driving your pain, screen for red flags, and discuss whether an injection is a reasonable next step — including which type, what realistic benefit looks like, and what active rehab plan should follow. If you’ve already had an injection, we build a plan around making the window count.

If you’ve been told an injection is the answer — or that it isn’t — let’s have a more accurate conversation. The truth, as usual, is in the middle.

About the author

Colin Bouma, PT, FCAMPT holds Fellow status with the Canadian Academy of Manipulative Physiotherapy — an advanced post-graduate qualification in orthopaedic manual physiotherapy held by only a small fraction of Canadian physiotherapists. He focuses on spine, disc, and complex pain rehabilitation at our south Calgary clinic on MacLeod Trail.

*This article is for general educational purposes only. It is not medical advice, does not replace individualized assessment by a qualified healthcare professional, and does not create a physiotherapist–patient relationship. Always consult a regulated healthcare provider before starting a new exercise program or making changes to your care.