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Non-Surgical Treatments

Cortisone Injections

OrthoClinic – a leading orthopaedic clinic Sydney providing you with the latest non-surgical solutions for arthritis. 

How do cortisone injections work and how often should I have cortisone injections? 

Dr Herald does not perform cortisone injections but can advise whether they are suitable or not for you and refer on. 

Cortisone injections reduce inflammation in a specific area, helping patients return to pain free activities. The injection usually tends to take effect within 3 to 5 days.

Short-term complications of cortisone injections are uncommon and include lightening of the skin, bleeding, soreness and inflammation. In people with diabetes cortisone can elevate the blood sugar level. Cortisone should also be used under careful medical supervision in people with bleeding disorders.

Facial flushing occurs in one in four patients but only lasts briefly, while sweating, dizziness and insomnia are uncommon side effects.

Whilst cortisone injections are generally well tolerated in most patients, due to side effects, most medical guidelines recommend that cortisone injections are used three or four times a year for non-chronic conditions. The recommended maximum number of injections in patients with chronic conditions is generally one injection every six weeks.

Anatomically engineered for every limb, VPULSE devices are “wraps” that deliver compression and cooling in one portable injury healing system.

Peer-reviewed studies now show VPULSE significantly improves healing and hastens recovery in shoulder and knee patients.

Find out more about VPULSE here.



The single injection for arthritis

Synvisc is an injection treatment used in knee patients by Dr Herald and provides up to six months of osteoarthritis knee pain relief with just one injection for many patients.

Before trying this treatment, please tell Dr Herald if you have had an allergic reaction, such as swelling of the face, tongue or throat, respiratory difficulty, rash, itching or hives to Synvisc C.  Also tell Dr Herald if you are allergic to products from birds – such as feathers, eggs or poultry – or if your leg is swollen or infected.

To date, this treatment is recommended for pain relief in knee joints only.

Who is the ideal candidate for this treatment?

Patients with osteoarthritis of the knee who have tried and failed with other non-surgical treatments including over-the-counter pain medication (such as analgesics like Paracetamol)  may benefit. Speak to Dr Herald to see if you are suitable.

How is the treatment administered? 

This injection is a simple procedure that takes only a few minutes. In studies, patients typically found relief about one month after the injection. It is a good idea to avoid any strenuous sporting or lifting activities after your injection for two days.

After that, you should be able to resume normal activities. It is a good idea to have someone else drive you home after your injection and elevate your leg for the rest of the day.

What are the side effects?

Whilst the treatment is generally well tolerated, occasionally patients will have what is called a synovitic reaction, causing pain and swelling in the knees for a few days. Generally, this is treated with anti-inflammatory medication. Alert Dr Herald if you have previously had this condition.

How much does Synvisc cost?

This treatment can be ordered directly from the supplier, Sanofi. Please call 1800 355 939 if you wish to order. The cost will be $476 per treatment through the supplier. If you order before midday, it will be sent to our office by the following day.


Dr Jonathan Herald does not perform PRP in his rooms, however he can assess your suitability for the procedure and refer you on.

Many famous athletes including tennis player Rafael Nadal have used Platelet Rich Plasma (PRP) therapy. This is a non-surgical, non-operative treatment that may relieve pain by naturally promoting long lasting healing.

How does it work? 

Platelets contain proteins called growth factors which are very important in the healing of injuries. PRP is plasma with many more platelets than are typically found in blood. The concentration of these platelets — and thereby growth factors — can be 5 to 10 times richer than usual.

Platelets are involved in the clotting and wound healing process. If there’s  a greater supply of platelets, it will stimulate the inflammatory process, which will in turn encourage the natural healing process.

How is it administered? 

Blood is drawn from a patient. Then platelets are extracted through a centrifuge process. The platelet solution is then injected to the injury site through guided ultrasound. Generally speaking patients will typically experience a reduction in pain a day or two after their first or subsequent injection.

Typically two or more injections are required, separated by a few weeks apart. This may vary depending on which part of your body is injured.

During your injection your previous imaging will be reviewed to ensure the injection is appropriate. Blood will be taken from one of your veins and the spinning process takes about 5 minutes. The whole procedure usually takes about an hour end to end.

How effective is it?

According to the American Academy of Orthopaedic Surgeons, PRP is most effective in treatment of chronic tendon injuries such as tennis elbow.

It has also been used for patellar tendon injuries (runner’s knee)  but it’s efficacy not well proven yet. There is no proven benefit after surgery.

If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including worker compensation plans, provide reimbursement.