Steroid injections: Top 10 questions asked by new patients

Steroid injections: Top 10 questions asked by new patients

Many new patients who come to me have already seen a number of doctors for their back and leg pain. Often they have tried medications (pills, lotions, patches), physical therapy, chiropractor visits, or acupuncture. Many have also received injections for pain.

Here are their most common questions:

1. In the past, I had “cortisone shots.” Do I need these again?

It depends. When many people say they have had cortisone, they are referring to epidural steroid injections to the back. However, doctors can put this medication in a number of different areas in the spine (see article types of back pain). Your personal pain story, physical exam, and MRI/CT all help your doctor to figure out which of these locations is the best target to help your symptoms.

2. Will you give me the same injection I had before?

It is always helpful to know what you have tried before. However, we are confident in our ability to find the most effective injections for our patients. This may or may not be the same thing that was done in the past.

3. Will you do the procedure the same way as my other doctors?

There are a number of different “approaches” to injections, and it is our job to determine which has the best chance of success. You may receive an “interlaminar” epidural, a “transforaminal” epidural, or a “caudal” epidural injection, which is tailored to your specific pain.

5. How much will it help my pain?

We are always happy if pain scores drop as low as possible for our patients! In many cases it is just as important if your lifestyle and activities change as well. For example, if you can walk farther without sitting or if you are able to be busier doing what is important to you.

6. How long does it take to work?

Most injections include a steroid to help with inflammation, and a local anesthetic numbing medication. The numbing medication should work quickly, but steroids can take 3-5 days to kick in. For some patients, even a few weeks. This is why we often schedule your follow-up 2 weeks later.

7. How long does the relief last?

All patients are different. In general, we hope they last at least weeks to months. Some people have very few flares, meaning that they may need only one injection over a long period of time.
For many people, the changes in their back are gradually getting worse, meaning that they may need a few injections every year to control their symptoms.

8. What are the risks?

The risks are extremely low. However, anytime a needle is used, there is always a theoretical chance of bleeding, infection, nerve injury, and reaction to the medication. To make the risks as low as possible, it is important that we know your medication list, including blood thinners. We have to make sure you have no infections and take no antibiotics. During the procedure, we have many safety protocols, including use of an x-ray machine (fluoroscopy), contrast medication (to make sure the needle is in a safe position), and sterile preparation.

9. How many injections can I get?

Every patient is different. Generally speaking, patients can have about 3 – 4 injections safely a year. The steroid medications can increase blood sugar so we must be careful in patients with diabetes. They can also temporarily change how your body fights infection, which is another factor. If a patient receives too many steroids, there can be tissue weakening. As a result, we keep track of your procedures and try to give them when your pain is the most bothersome.

10. Will we have to do it again?

We will decide at your follow-up. If you have a partial response, it is possible we would consider a repeat. However, if your pain has changed, we may need to think about other procedures that are more appropriate.

For additional information regarding Gateway Spine and Pain Physicians, please contact us or call (630) 226-1130.

“Fore” ways to Prevent Injury at the Start of the Golf Season

"Fore" Ways To Prevent Injury At The Start Of Golf Season

Posted by By Dr. Andrew Kalin March 28th, 2019

This is the year! Although I can’t promise you that this is the year your golf swing comes together, I can provide you with four tips on how to avoid injury while you try and get back into the “swing of things” at the start of the golf season.

1. Warm up before you play

After a good night’s sleep or after spending many hours seated at work or school, key muscle groups used in the golf swing move less easily. Stretching and use of moderate repetitive motion before play increases muscle range of motion and muscle temperature – both of which prevent muscle injury and increase efficiency. Before your first swing, remember to try and warm up for approximately 10 minutes. Start by stretching your hands, wrists, forearms, elbows, shoulder, back, hips and legs. After you’ve stretched these key areas, swing your golf club a few times, gradually increasing your speed and range of motion. This gradual repetitive motion will help coordinate and further stretch these muscle groups and help prevent injury.

2. Start slowly

If it has been several months since you have last swung a golf club, the first several club swings may not give you your desired result. Although it may be frustrating, remember to limit your initial time of play. It’s tempting to spend hours trying to fix that swing fault, but if your body isn’t conditioned for the strain, injury can easily happen. Remember to start slowly and work up to your desired level of activity.

3. Try to strengthen 2-3 times a week

According to the US Department of Health and Human Services, in order to maintain a healthy lifestyle, Americans should perform 2-5 hrs a week of aerobic exercise and 2 days of strength training. Strength training not only promotes a healthy lifestyle but also helps prevent muscle injury. A great way to help achieve these goals and prevent injury in the golf swing is to focus on strength training golf swing muscles. Fortunately, you don’t need to build large muscles to have an injury free golf season or to have a great golf swing. After all, per PGA statistics, Rory McIIroy is the current FedEx Cup leader; he stands 5’10” tall, weighs 160 lbs and has an average driving distance of 312 yds.

4. Carrying the golf bag properly

Walking the golf course rather than driving a golf cart during play is a great source of aerobic activity that helps improve cardiovascular strength and stamina. However, carrying a golf bag improperly can lead to increased low back strain. Most carry golf bags have 2 straps; make sure that you wear both straps when carrying your bag to evenly distribute the weight of the bag across the back and reduce the chances of developing low back pain from an uneven load.

For additional information regarding Gateway Spine and Pain Physicians, please contact us or call (630) 226-1130.

Minimize Pain & Maximize Life – How Our Company Culture Supports Your Health

Minimize Pain & Maximize Life -- How Our Company Culture Supports Your Health

When it comes to the modern healthcare system, do you feel like you’re really being heard?

Or, do your appointments feel more like a sprint to the finish line where your doctor–who can’t even pry his eyes away from the computer screen–simply prescribes the latest narcotic or suggests a one-size-fits-all treatment?

If you agreed with the latter, then it’s time for a second opinion.

At Gateway Spine & Pain Physicians, we believe it’s not about us or how many patients we can fit in before lunch–it’s about you.

Our company culture revolves around making you feel comfortable, heard, and confident in our custom treatment plans that minimize pain so you can maximize life.

Curious how we make this work?

We Are Dedicated to the Treatment of Pain.

For over a decade, we do one thing and one thing only–treat pain.

Our facilities are dedicated to pain treatment and our physicians have undergone specialized training in the field of Pain Medicine with an additional five years of internship, residency, and accredited fellowship training.

Believe in a Team Approach to Pain.

Successful pain practices understand the complexity of treating pain. Being in chronic pain can negatively impact the health of bones, joints, muscles, ligaments, nerves, and the brain. At Gateway, we have worked hard to create a close network of reputable, ethical, and caring medical specialists. We understand that there is no one treatment that works for everyone. We also understand that we do not always have the tools to treat every situation. Our network of providers allows us to find solutions for the most complex cases of chronic pain.

We Do the Right Thing

Since 2007, we’ve established a reputation for doing what’s right for our patients–not what pays.

We believe that everyone’s problem is unique and deserves a thorough analysis and tailor-made treatment plan. This doesn’t just give our patients more confidence, it also leads to better results.

We Keep Our Finger on the Pulse of Our Industry

Because we are so specialized, we are able to keep up-to-date on the latest cutting edge treatments and technologies for identifying and targeting pain.

Our treatments include minimally invasive procedures, physical therapy, counseling, holistic/integrative medicine, and more advanced surgical techniques. With the opening of our regenerative medicine clinic, Gateway continues to be a leader in using advanced treatments for pain.

With the spreading epidemic of pain medication addiction and abuse, we seek to minimize and even eliminate the use of potentially habit-forming medications wherever possible.

So, are you ready to experience the true meaning of specialized pain treatment?

For additional information regarding Gateway Spine and Pain Physicians, please visit or call (630) 226-1130.

Alleviating Back Pain While Decorating for the Holidays

Alleviating Back Pain While Decorating for the Holidays

The holiday season brings joy, laughter and celebration, but along with it comes tasks that cause additional stress and worsening chronic pain. Holiday decorating, for example, can cause some people to become overwhelmed, which often intensifies their symptoms.

At Gateway Spine and Pain Physicians, our goal is to provide you with simple, helpful tips to get you through the holiday season and allow you to begin the New Year feeling great.

1. Lift Correctly

Holiday decorating usually entails getting boxes from an attic or basement and hauling them to the main level. These boxes can get quite heavy after accumulating decorations year after year, so you need to focus on lifting properly in order to not damager your back or any fragile decorations. When lifting boxes, be sure to keep your back straight, utilize your abdominal muscles, and lift from your legs.

2. Always Use a Ladder

Although you may be able to stand on your toes and reach in order to hang a decoration, it is often safer to utilize a ladder or a stepladder instead of overstretching and risking an injured back or neck.
Another helpful tip: use your ladder safely.  Before climbing up those stairs, ask yourself if your balance is good enough to stand on a ladder. If you decide it is, make sure that the ladder is stable and have someone hold the base to prevent it from tipping over. If changing positions laterally, be sure to move the ladder instead of trying to reach. Not only can reaching out put strain on your muscles, but it can also cause your ladder to tip over.

3. Make accommodations for decorating high and low surfaces.

If you’re decorating a surface lower than you can comfortably reach while standing, sit on a chair or stool if possible so you aren’t bending as often. For higher surfaces, consider placing the box of decorations on a table or chair so you are not constantly bending over to grab items. Again, always be sure to use proper lifting techniques.

4. Make it a family activity.

If the whole family helps out, the projects will get done quicker and you won’t be putting as much stress on yourself. For higher decorations, have one person stand on the ladder while another hands them the decorations. Getting help from the whole family also allows everyone the opportunity to take breaks and to switch activities so no one is stuck sitting or standing the entire time.

For additional information regarding Gateway Spine and Pain Physicians, please visit or call (630) 226-1130.

Holiday Shopping and Alleviating Back Pain

Holiday Shopping and Alleviating Back Pain

Don’t Shop Until You Drop

Some patients have complained that they don’t know what hurts worse, how light their wallet gets during the holidays or the aches and pains associated with shopping. We may not be able to help you with your wallet, however we can give you some tips to avoid pain while shopping.

1. Dress Appropriately

Before you leave your house be sure you are wearing loose, comfortable clothing and supportive shoes. The type of shoe you choose drastically impacts your posture, therefore you should stray away from high heels or flip flops and consider tennis shoes instead. Also, be sure to leave your large bulky purses at home and opt for something smaller like a wristlet or cross-body bag. Heavy purses add extra stress to your muscles and cause you to shift your posture in order to compensate for the extra weight. If you must carry a lot of items, consider utilizing a back pack which will distribute the weight more evenly across your shoulders.

2. Pack Healthy Snacks

While you are at home, pack nutritious snacks that will help you keep energized and allow you to avoid the long lines at the food court. Fast food often leaves people feeling lethargic, so consider avoiding it altogether and opt for healthier options instead. Examples of snacks you could pack are almonds, dried fruit, string cheese, pumpkin seeds or an apple! Also, be sure to take time to drink water throughout the day so you can stay hydrated and feeling great.

3. Rest

Shopping for the holidays can be an all-day affair, so be sure to take breaks to sit down and relax. Consider taking a 10 minute break every couple hours to rest your feet and stretch. This is the perfect time to look over your shopping list and cross off items you already purchased.

4. Consider shopping online

Now that so many stores are offering online shopping, often you can find equal or better prices online than you can in the physical stores. Not only does this allow you to shop from the comfort of your own home, but it also alleviates the stress of going to the mall and carrying around all of your packages. Be sure to sign up for each stores email alerts in order to receive any coupons, free shipping, and discounts they may have.

For additional information regarding Gateway Spine and Pain Physicians, please visit or call (630) 226-1130.

Gateway Spine & Pain Physicians earns AAAASF accreditation for patient safety

Gateway Spine & Pain Physicians earns AAAASF accreditation for patient safety

Bolingbrook, IL — Gateway Spine & Pain Physicians in Bolingbrook, IL has demonstrated its commitment to patient safety by gaining accreditation from the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). AAAASF is celebrating its 35th year of promoting the highest quality patient safety in the ambulatory surgery setting (office-based or outpatient), as well as rehabilitation and outpatient therapy agencies and rural health clinics.

AAAASF requires 100 percent compliance with all accreditation standards and does not offer partial accreditation. If a facility fails to meet any standard, it must correct the deficiency or risk denial or loss of accreditation.

“Thanks to the hard work of our dedicated team, we are very excited to receive AAAASF accreditation for our office based procedure suite. By achieving this benchmark, we ensure the highest level of care and safety within the comfort and convenience of an office setting,” stated founder and President of Gateway Spine & Pain Physicians, Dr. John Hong, M.D.

To earn its accreditation, Gateway Spine and Pain Physicians passed inspection on hundreds of important criteria concerning patient safety. AAAASF facility inspectors are board certified medical specialists trained to perform a thorough and complete facility inspection. AAAASF facility inspectors follow a regimented procedure to inspect an outpatient surgery facility in the following categories:

  •  General Environment
  •  Operating Room Environment, Policy and Procedures
  •  Recovery Room Environment, Policy and Procedures
  •  General Safety in the Facility
  •  Blood and Medications
  •  Medical Records
  •  Quality Assessment and Quality Improvement
  •  Personnel
  •  Anesthesia

“The AAAASF accreditation reflects a level of safety provided by a hospital setting, but at a fraction of the cost and with greater time efficiency.  We hope this adds another level of comfort and reassurance to our patients when choosing us for their care at a time of their greatest discomfort,” stated Dr. Nitin Malhotra, M.D.

Gateway Spine & Pain Physicians is a comprehensive pain management practice serving the greater Chicago region since 2007.  The physicians at Gateway are double board certified, fellowship trained pain specialists that provide individualized, compassionate care.  Their goal is to provide a level of care that exceeds expectations, accurately diagnosing and treating pain quickly and effectively to restore quality of life and functionality.  Gateway Spine & Pain Physicans has offices in Bolingbrook, Hinsdale, and Downers Grove.

For additional information regarding Gateway Spine and Pain Physicians, please visit or call (630) 226-1130.