General Guideline Principles for Injections:

Therapeutic for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Injections: Therapeutic.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Injections: Therapeutic

Therapeutic Spinal Injections

After attempting early conservative therapies including physiotherapy, occupational therapy, medicine, exercise, manual therapy, or acupuncture, therapeutic spinal injections may be performed.

  • Only once pathology has been proven by imaging examinations and diagnostic injections may therapeutic injections be administered.


  • Clinical manifestation and counterstatement should be strictly followed while administering injections since they are intrusive procedures that can result in fatal outcomes


  • The goal of spinal injections allowed active treatment by offering momentary pain and inflammation alleviation.


  • All victims and patients should continue with functionally focused therapy while engaging in appropriate exercise.


  • It is usually necessary to repeat the sessions that were originally scheduled for active therapy, which patients should have had before receiving injections.The use of injections by itself is unlikely to bring about long-term relief. Instead, active rehabilitation with reduced work improves the active range of stability, strength, motion to to promote long-term relief.


  • If an injection doesn’t work the first time, don’t get another one.


    • enhancement of performance


    • Pain alleviation that is both temporary and long-lasting as determined by recognized pain measures, such as a fifty percent pain reduction on the visual analog scale decrease in the dosage of prescription analgesics.


    • Based on the patient’s assessment and reaction, medical care should either be maintained or changed.

Special Considerations:

  • Multi-planar fluoroscopy is necessary during operations for all injections (apart from activating poi nerve blocks) to toe cord technique and needle placement.


  • All injections (apart from activating point) must be administered by a doctor with training in the technique. A doctor or a nurse practitioner/doctor assistant skilled in the process can provide trigger point injections.


  • To record the positioning of the needle, permanent pictures are necessary.


  • Physicians that provide injections may have a variety of specialist backgrounds, including but not restricted to anesthesiology, radiography, surgery, or physiatry.


  • The practitioner should have undergone fellowship training with interventional training in a relevant medical specialty (e.g., neurosurgery, orthopedic surgery, physiatry, pain, management, etc.). For investigations done with fluoroscopy, the practitioner must also be educated in radiation safety.


General complications of spinal injections may include:

The general risks associated with spinal injections include

  • momentary neurapraxia


  • regional pain


  • Nerve damage


  • Infection


  • Headache


  • Vasovagal reactions


  • There might potentially be a spinal meningeal abscess, epidural hematoma, long-term neurologic harm, dural perforation and CSF leaking, and/or other complications.


  • Although they are uncommon, more severe side effects might cause mortality, quadriplegia, spinal cord injury, and persistent ataxia.


  • A dose-dependent suppression of the hypothalamic-pituitary-adrenal axis caused by steroid injections may continue for one to three months. 
  • Particularly in diabetics, steroid injections may cause a brief increase in glucose levels.


Absolute prohibitions on therapeutic injections include the following:

  • systemic or localized bacterial infection, bleeding diatheses,


  • hematological disorders, and the possibility of pregnancy

Associated indications why diagnostic injections should not be used include:

  • poorly managed Diabetes Mellitus,


  • a contrast allergy,


  • hypertension

Aspirin, NSAIDs, anti-platelets, and anticoagulants—drugs that alter coagulation—are frequently prohibited.

Considering the patient’s unique underlying medical condition, decisions on anticoagulation should be determined in consultation with the injector, the prescribing doctor, and any other necessary experts

Cervical Epidural / Interlaminar Steroid Injections (ESI)

Corticosteroid injections into the epidural space are known as cervical ESI.

By reducing pain and inflammation and improving range of motion, ESI helps patients advance in more active regimens.

As with other therapies, it’s crucial to make sure patients have reasonable expectations for how the process will turn out.
Patients with diabetes who are candidates for ESI should be advised that while a post-intervention blood glucose spike may be noticeable, the increase is often temporary.

Cervical ESIs must consist of all outlines fluoroscopically replacement of the needle.

Needle position to record the positioning of the needle, permanent pictures are necessary.

Contrast epidurograms make it possible to confirm the medication’s passage into the epidural space. As clinically indicated, one epidurogram is advised for each round of ESI injections.

  1. Cervical Epidural / Interlaminar Steroid Injections (ESI)

    Cervical Epidural / Interlaminar Steroid Injections (ESI) is recommended in those who have cervical radicular pain syndrome symptoms

    Cervical Epidural / Interlaminar Steroid Injections (ESI)

    Cervical Epidural / Interlaminar Steroid Injections (ESI) is not recommended for non-radicular pain syndromes or cervical axial discomfort.

    Note: Anesthesia is often not advised for cervical ESI.



    • Depending on the patient’s reaction (increased function and pain reduction), three injections (per spinal area) may be given within 12 months. Per therapy sessions, sessions than one level may be used.


    • It is advised to schedule each injection individually and


    • Instead of planning a “Series of Three,” the effects of each injection should be assessed based on the patient’s reaction (increased function and pain reduction).


    • Repeat injections are not advised if the initial injection does not result in a response with temporary and persistent pain alleviation (for at least two weeks), supported by recognized pain scales (i.e., a 50% reduction in pain as assessed by instruments like the VAS), and improvement in function.


    • A successful outcome (functional improvement) should involve a return to baseline functionality or job responsibilities as well as a discernible enhancement in physical activity goals.


    • After each injection, patients should be evaluated again for:


      • enhancement of performance


      • Pain alleviation that is both temporary and long-lasting as evaluated by recognized pain scales, such as a 50% reduction in pain on the VAS decrease in the dosage of prescribed analgesics.


      • Depending on the evaluation and reaction of the patient, medical care should be continued or modified.


      • The disappearance of symptoms, their reduction to a manageable level, or their absence.


      • In the absence of substantial radicular symptoms, epidural glucocorticosteroid injections are harmful and not ad sed for acute or non-acute neck discomfort.


      • Any non-acute axial neck discomfort without a radicular component is not advised to be treated with them.


  2. Cervical Transforaminal

    Cervical Transforaminal Injections is not recommended


  3. Cervical Diagnostic and Therapeutic Medial Nerve Branch Blocks / Facet (Zygapophyseal) Joint Injections

    Facet joint (medial branch block or injections into the intra-articular facet joint area that blocks the main middle nerve innervation of the facet joint)


    • Cervical Diagnostic and Therapeutic Medial Nerve Branch Blocks / Facet (Zygapophyseal) Joint Injections

      Cervical Diagnostic and Therapeutic Medial Nerve Branch Blocks / Facet (Zygapophyseal) Joint Injections are recommended Cervical Diagnostic and Therapeutic Medial Nerve Branch Blocks / Facet (Zygapophyseal) Joint Injections are recommended for acute neck pain that has not improved with conservative care when there is axial neck discomfort that persists after an accident (for instance, status after whiplash injury).

      These injections include an anesthetic and a steroid to treat acute pain.

      Frequency: As clinically needed, at least three injections for acute pain may be given overall every 12 months.


    •  Cervical Diagnostic and Therapeutic Medial Nerve Branch Blocks / Facet (Zygapophyseal) Joint Injections are not Recommended.

      For severe neck discomfort, only anesthetic-only diagnostic injections into the medial branch block or facet joints are recommended.

      Cervical Diagnostic and Therapeutic Medial Nerve Branch Blocks / Facet (Zygapophyseal) Joint Injections are recommended Select patients with non-acute neck discomfort may receive medial branch block injections to see if procedures targeting the facet joint (by obstructing main middle nerve innervation to the side joint) should be carried out


  4. Repeat Medial Branch Block Injections

    Repeat Medial Branch Block Injections is recommended Whether steroids are utilised, if a patient responds well to a diagnostic medial branch block injection, the second injection of medial branch block should be given to solidify the diagnosis. To validate the degree of participation, this second injection of coa narrative medial branch block should be carried out on a different day.

    The patient should be assessed to see whether they require more definitive therapy, such as radiofrequency ablation, or if there is a good response to the second diagnostic medial branch block injection.

    To allow for the possibility of prolonged pain alleviation, the anesthetic drug and steroid should be combined while providing a diagnostic injection.

    The diagnosis should be reevaluated if there is no positive good response to the initial diagnostic injection.

    Doctors have not advised to repeat diagnostic injection if the initial injection does not result in a favorable reaction. Optimal Therapeutic Effect (either the injection of Medial Branch Block or Facet Joint Injection)

    To extend the benefits, steroids may be given therapeutically. The extended therapeutic benefit’s objective is to reduce pain and improve function so that the patient can engage in an active rehabilitation program (in which the patient was incapable to inject the injection before the time).

    To extend the benefits, steroids may be given therapeutically. The extended therapeutic benefit’s objective is to reduce pain and improve function so that the patient can engage in an active rehabilitation program (in which the patient was incapable to inject the injection before the time).

    Patients should undergo reevaluation following each therapeutic injection for a confirmed 50% reduction in pain, as determined by recognized pain measures, and for improved functional outcomes.

    Measurable progress in physical activity objectives, including a return to previous levels of work activities, should be part of a favorable outcome (functional improvement).

    Before to the operation, shortly after the procedure, and at certain intervals following the procedure, pain should be assessed using recognized pain measures.

    The requirement for radiofrequency ablation does not necessarily follow from a positive reaction to a therapeutic injection

    Repeat steroid injections are not advised if the first healing injection does not result in improved function for at least four to six weeks and persistent pain alleviation supported by recognized pain scales (i.e., 50% verified pain reduction as evaluated by recognized pain instruments).

    Frequency: Depending on the patient’s documented reaction (i.e., better functional gain and pain reduction), up to three injections for each suitable joint may be given for 12 months, but not more than three joint levels (four medial branch nerves) each session. 3 sessions maximum a year.

    Note: Based on patient-specific clinical factors, the time frames mentioned above for considering different injections may change.


  5. Intradiscal Steroid Therapy are not recommended.


    • Occipital Nerve Block

      Occipital Nerve Block is recommended There may be peripheral greater occipital nerve block suited as the first line of defense against occipital neuralgia.

      Frequency/ Duration – Depending on the reaction, there may be one to three injections. If progressive clinical and functional improvement is shown, up to three injections may be given.infection, neurological damage, and bleeding. Ataxia following a procedure is frequent and often lasts for 30 minutes.

      Inadvertent blood vessel injection is a concern of this treatment and might result in systemic toxicity and/or convulsions since the occipital artery and occipital nerve are connected.


    • Trigger Point Injections and Dry Needling Treatment

      Localized hyperirritable, palpable nodules called myofascial trigger tips are found in extraordinarily sensitive bands of tense skeletal muscle fibers. These nodules cause both local discomfort and pain that is referred to distant regions when compressed.


      • Situation point injection is not the same as acupuncture; the only methods of treating trigger points are dry needling or local anesthetic injections into myofascial trigger points. Please see the Medical Treatment Guideline’s section on acupuncture for further information.


      • No proof administering drugs intravenously enhances the outcomes of trigger point injections. A portion of the healing response might be attributed to needles alone


      • As with other therapies, it’s crucial to make sure that patients have reasonable expectations for how their care will turn out.=


    • Trigger Point Injections and Dry Needling Treatment

      Trigger Point Injections and Dry Needling Treatment is recommended For non-acute pain that is not going away after six weeks of trying more conventional treatments (such as NSAIDs, progressive aerobic activity, or other activities), trigger point injections may be a viable secondary or tertiary choice.

      Trigger Point Injections and Dry Needling Treatment

      Trigger Point Injections and Dry Needling Treatment are not recommended injections into trigger points to alleviate severe neck discomfort.



      • The main goal of trigger point injections is to promote functional improvement.


      • Trigger point injections can help with active treatment and stretching of the troubled regions while easing myofascial pain.


      • It is not advised to utilize therapeutic injections when not enrolled in an active therapy program or when trying to keep a job.


      • Two weeks following each injection, patients should be reevaluated for:

        Enhanced functionality


      • A fifty percent pain reduction on the Visual Analog Scale, which is one of the acknowledged pain measures used to quantify temporary and long-term pain alleviation.


      • A decrease in the dosage of any prescription analgesics


      • Depending on the evaluation and reaction of the patient, medical care should be continued and/or modified.A three-month period should pass after functional improvement.


      • A successful outcome (functional improvement) should involve a return to baseline functionality or job responsibilities as well as a discernible betterment I physical activity objectives.


      • It is not advised to employ ultrasound or other scanning and imaging tests for trigger point injections.



      • The second round of injections may be justified if there is a partly demonstrable improvement following the first set, but at least four injections each session or more than four sessions 12 months.


      • It is advised to space these injections out by not more than three to four weeks.


      • Further injections are not advised if there is no subjective or objective betterment at that time.


      • Subjective and objective improvements should be connected to repeated injections.


      • The second series of injections is appropriate if the first batch’s outcomes are unsatisfactory. Furthermore, ore injections are not advised if there are not at that point any subjective or objective improvements.


      • Reasons to stop treatment include improvement, intolerance, or finishing two rounds of injections without a significant impact on the disease.


  6. Prolotherapy (Sclerotherapy)

    Prolotherapy (Sclerotherapy) is not recommended.


  7. Platelet Rich Plasma (PRP)

    Platelet Rich Plasma (PRP) is not recommended.


  8. Epiduroscopy and Epidural Lysis of Adhesions

    Epiduroscopy and Epidural Lysis of Adhesions are not recommended due to the risk of spinal cord damage, hemorrhage, and dural puncture in the cervical spine.

What our office can do if you have workers compensation Injections: Therapeutic

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Call Us Now!

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Thomas Slavin
15:02 02 Mar 23
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Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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