Dr Emmanuel
Dr Emmanuel
Orthopaedic Surgeon

Pain Management Program

Please select a question of your interest or click tab to read the whole section.

Lumbar Epidural Steroid Injections

What is an Epidural Steroid Injection?

Answer:Epidural Steroid Injections (ESIs) are the most common treatment options to relieve low back pain and leg pain. Epidural Steroid Injections are have been proven to be effective non-surgical treatment method to alleviate low back pain and radicular pain which is more commonly known as sciatica

What are the Benefits of an Epidural Steroid Injection?

Answer:One of the benefits of an Epidural Steroid Injection (ESI) is that it can provide relief from back pain and sciatica from one week up to one year. ESI’s are beneficial if the patient has had an acute episode of back or leg pain, and the injection can provide substantial relief of the patient’s symptoms. If the injection is effective, the patient may have up to 3 injections in a one-year period.

Another benefit of an Epidural Steroid Injection is that it delivers the medication (corticosteroid) directly to the source of pain. ESI’s also reduce local inflammation in that area which may be causing the pain.

Are Epidurals only used to relieve low back pain?

Answer:While Epidural Steroid Injections are commonly used to treat low back pain, they have also been very effective in relieving pain experienced in the neck (cervical) region and in the mid spine (thoracic) region.

How effective is an Epidural?

Answer:Studies show that more than 80% of patients who have had Epidural Steroid Injections state that they have experienced noticeable relief of the back pain symptoms.

How do Epidural Steroid Injections Reduce Inflammation ?

Answer:Epidural Injections are most commonly used to treat radicular pain, better known as sciatica, which is pain that radiates from the back and “shoots” down the leg. Inflammatory chemicals and immunologic mediators in the body can cause pain. The steroids used in the Epidural Injection block the inflammatory response and therefore, relieve the patient from pain.

Who is a good candidate for an Epidural Steroid Injection?

Answer:Patients who are symptomatic and have been diagnosed with the following conditions are good candidates for Epidural Injections:

  • Lumbar Disc Hernation
  • Degenerative Disc Disease
  • Lumbar Spinal Stenosis
  • Compression Fracture in the vertebra
  • Cysts in the facet joint or the nerve root
  • Annular tear

If you are a patient that has been experiencing low back pain or shooting leg pain call for a consultation with Dr. Emmanuel. Following a thorough evaluation, Dr. Emmanuel will discuss your treatment options and let you know if you are a candidate for an Epidural Steroid Injection.Contact Us to schedule your appointment. You don’t have to suffer with back pain any longer!

Nerve Root Blocks

What is a Nerve Root Block ?

Answer: A nerve root block is an injection into the area surrounding a nerve root in the spine to alleviate your pain as well as to identify the nerve that is causing the pain. The injection uses a combination of two medications (a steroid and a numbing agent) to reduce the pain and inflammation in the area.

What should I expect from this procedure?

Answer: Nerve Root Block is a fairly simple outpatient procedure and the patient will go home or even back to work the same day. You may experience some numbness from your symptoms for about six hours after the procedure. The follow 2-3 days you may experience pain again, but by the 5th day, the benefits of the steroid in the injection will kick in and your pain will be alleviated.

If the first injection provided relief of your symptoms, it may be recommended to do a second injection. It is important as the patient that you keep track of how long you feel relief from the injections and report it to your physician. This will determine the treatment plan for your current condition.

Sacro-Iliac (SI) Joint Injection

What is a Sacro-Iliac Joint ?

Answer: The sacro-iliac joint is the large joint between the sacrum (at the base of the spine) and the ilium of the pelvis (hip), which are joined by ligaments. The body has two sacroiliac joints, a left and a right joint. When the SI joint becomes painful, it causes pain in the low back region (pain in the groin, abdomen, hip, buttock or leg).

The SI joints’ function includes shock absorption for the spine.

Signs and Symtpoms of Sacro-Iliac (SI) Joint Problems:

  • A dull ache in the lower back
  • Pain may become worse and sharp while doing activities such as standing up from a seated position, or lifting the knee up to the chest during stair climbing
  • Usually pain is felt on one side or the other (unilateral pain) but can also be on both sides too
  • Patient notices frequent changes in body posture to avoid prolonged stress on the SI Joint and ligaments
  • When SI Joint dysfunction is severe, pain is experienced into the hip, groin, sometimes down the leg
  • Low back pain and stiffness usually on one side that increases with prolonged sitting or walking

What is a Sacro-Iliac (SI) Joint Injection?

  • Sacro-Iliac Joint Injection is an injection of a long-lasting steroid (cortisone) in the sacro-iliac joints, which are located in the low back area. The purpose of this injection is to numb the painful (SI) joint, which will give the patient immediate pain relief. It is also a diagnostic tool to confirm that the pain is originating from the SI Joint if the patient experiences immediate relief from the injection (block). Therefore, if the patient obtains complete relief from pain while the joint is numb, it means that the SI joint is most likely causing the pain in the patient’s lower back. Lastly, the cortisone in the injection will reduce any inflammation in the area, which will provide long-term pain relief.
  • Sacro-Iliac (SI) Joint blocks are injections that are primarily used for diagnosing and treating low back pain associated with sacroiliac joint dysfunction. The SI joint lies next to the spine and connects the sacrum with the pelvis (hip).

What should I expect after the SI Joint Block procedure?

Answer: An SI Joint Injection is a relatively easy procedure that is performed under local anesthesia. The patient will go home shortly after the procedure and rest at home for the remainder of the day and will be able to resume normal activities the next day. Many patients can go to work the next day.

Immediately after the injection, the patient may feel that the pain is gone or considerably less. This is because of the local anesthetic (lidocaine) injected which lasts for a few hours. The patient may have a “sore back” for 1-2 days but will notice pain relief by the 5th day.

It is common that the patient will receive another injection about two weeks later after the first one. Most physicians limit the patient to three injections in a 6-month period.

Selective Nerve Root Block (SNRB)

Selective Nerve Root Block (SNRB) for Back Pain Mangement

Answer: Selective Nerve Root Block (SNRB) injections are used to diagnose the specific source of

nerve root pain. They are also used to relieve low back pain and/or leg pain.

When a nerve root is compressed or inflamed, it can cause back and leg pain. An SNRB injection is often performed to isolate the source of pain and locate the nerve causing the pain. While an SNRB injection is used as a diagnostic tool, it is also a type of injection used for pain management and can be used as a treatment for lateral disc hernation.

In an SNRB injection, two types of medications are used. A steroid (anti-inflammatory medication such as Kenalog) and Lidocaine (a numbing agent) are used in combination for this procedure. Typically, a fluoroscopy (live x-ray) is used to ensure that the medication is being delivered to the exact location. If the patient’s pain goes away after the injection this indicates that the specific nerve that was injected was causing the back pain. The steroid component in the injection will help to reduce inflammation around the nerve root.

How many times can I get an SNRB injection?

Answer: Most physicians limit SNRBs to three times per year.

What should I expect after an SNRB injection?

Answer: Experienced physicians should perform SNRB and epidural injections. Since the injection is outside the spine, there is NO risk of a wet tap (fluid leakage). This is an outpatient procedure and patients go home after 1-2 hours of recovery.

Steroid Injections

What is a Steroid Injections?

Answer: Steroid Injections are the most common non-surgical approaches to treat many spinal conditions. When oral medications and physical therapy fail to improve the patient’s symptoms and the patient is complaining of severe pain, spinal injections are very effective in alleviating the pain.

Depending on what kind of spinal condition the patient has, a small amount of steroid in combination with a numbing agent (lidocaine) can be injected into the area of the back in question. This procedure often immediately alleviates the pain and inflammation.

While there are many different types of spinal injection, the Epidural Steroid Injection (ESI) is the most common one recommended by physicians.

Types of Steroid Injections of the spine


  • Epidural Steroid Injection (ESI)
  • Facet Joint Injection
  • Nerve Root Block (NRB)
  • Sacroiliac (SI) Joint Injection
  • Coccyx Injection

Who is a good candidate for a steroid injection?


  • Patients with disc injury
  • Patient with spinal arthritis where the nerve is irritated and causing pain
  • Patients with severe facet joint arthritis
  • Patients with nerve inflammation
  • Patients with sacroilitis or coccydynia

At the Orthopedic Institute of Los Angeles, our pain management specialists are known for their precision and expertise in the field. More than 80% of the patients experience marked improvement and relief from pain after a steroid injection. If you tried pain medications and physical therapy and are still living with back pain, it is time to consider another option. Contact our office to schedule an appointment with Dr Emmanuel regarding your back condition. You don’t have to live with pain!

Trigger Point Injection (TPI)

What is a Trigger Point Injection (TPI)?

Answer: Physicians often recommend trigger point injections (TPI) in alleviating pain in areas of the muscle that contain trigger points. They are also useful in areas where knots form in muscles when muscles don’t relax. Patient often say “I feel a knot under the skin” referring to a tight muscle. Trigger point cause pain by irritating the nerves around them.

What Happens During Trigger Point Injection?

Answer: A Trigger Point Injection is when a small needle containing a local anesthetic (lidocaine) and a steroid are injected into the trigger point area. This injection causes the patient’s trigger point to become inactive and therefore, it alleviates the pain.

This simple procedure is performed in the physician’s office and usually takes a few minutes. Your doctor may inject several sites in the same visit if the patient is complaining of a lot of pain.

Who should get a Trigger Point Injection?

Answer: Trigger Point Injections are used to treat muscles in the neck, lower back, arms and legs. It is commonly used to treat fibromyalgia, tension headaches, and myofascial pain syndrome.

  • North American Spine Society
  • California Medical Association
  • Spine Arthroplasty Society
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