The EvergreenHealth Neuroscience, Spine & Orthopedic Institute will create a treatment based on your individual needs and goals.  We offer some of the most advanced pain treatments along with minimally invasive surgical options when necessary.

Active Rest

Physical Therapy


Modalities are a collection of technologies that are utilized by some physical and occupational therapists. While these may help alleviate acute symptoms (e.g. pain, muscle spasm), there may not be a substantial effect on chronic conditions.

Modalities should rarely be the predominate focus in therapy sessions, as these passive treatment programs have been shown to be less effective for promoting functional gains, as opposed to an active treatment program (e.g. therapeutic exercise).

  • Cold packs
  • Heat
  • Ultrasound (non-diagnostic)
  • Deep tissue massage and release techniques(e.g. Astym, Grafston)
  • Manual therapy
  • E-stim



Bracing of a joint, ligament, or tendon may be recommended by your doctor to protect an injured structure until it adequately heals.

In some conditions like osteoarthritis, they can be used long-term for the purpose of joint protection and symptom relief with activities.

Use of bracing in youth athletes to prevent a first or subsequent injury can be controversial, and our doctors can help the child and family with this decision.

Ultrasound-guided Injections

After obtaining an accurate diagnosis with diagnostic ultrasound or other techniques, an injection may be recommended for some conditions involving joints, tendons, ligaments, cysts, or nerves.

Using ultrasound-guidance for a procedure, the physician can be 100% certain that the medication reached and concentrated on the target structure.

This is not the case with “blind” (non-image guided) injections, in which the target is estimated based on feeling the skin anatomy and injection resistance.

For many injections, the needle tip being only 1-2mm away from the target can make a large difference in the degree of procedural comfort and effectiveness of the treatment.

Ultrasound-guided injections are also more safe, since nearby structures can be avoided (e.g. blood vessels, nerves), and the target structure is not damaged (e.g. inadvertent needle puncture of the target or flow of injectate physically damages the structure). Only ultrasound-guidance affords all of these benefits.

Unfortunately, it is not commonplace for medical clinics to have state-of-the-art ultrasound machines, nor physicians trained to perform these advanced procedures.

Thankfully, the physiatry doctors at the EvergreenHealth Neuroscience, Spine & Orthopedic Institute are truly on the leading edge of this technology.


Corticosteroid - also called “cortisone” or “steroid” injections, these involve injecting a high concentration of anti-inflammatory medication into or beside an inflamed structure.

These may be recommended when oral anti-inflammatory medications (e.g. ibuprofen, naproxen) do not provide adequate benefit or are not safe to use.

Corticosteroid medication has been synthesized to simulate the hormone cortisone, which is naturally produced by the adrenal gland when the body is stressed or injured.

Anabolic steroids are different than corticosteroids, as these are illegal substances used for muscle bulking.

Diagnostic / anesthetic blocks - If a diagnosis is unclear, your physician may recommend an anesthetic block (e.g. lidocaine, marcaine, ropivicaine) of a structure that is suspected to be the source of symptoms.

When ultrasound or fluoroscopic guidance is used, there is certainty that the intended structure was completely blocked, as opposed to surrounding tissues.

It is considered a positive block if the pain is relieved, followed by recurrence of the pain after the medication wears off.

It is a negative block if the pain does not change, or changes minimally, and other potential sources then need to be considered.

Your doctor may ask you to complete a pain diary to document your response on an hourly basis after the injection. 

Percutaneous tenotomy - This procedure can be a good treatment option when unhealthy tendon tissue is unable to heal on its own.

After numbing the skin and tendon, a small needle is inserted precisely with ultrasound-guidance into the portion of the tendon that is abnormal and multiple perforations are performed.

This can stimulate a renewed effort of the body to naturally heal the tendon.

Your doctor will let you know of any restrictions or precautions after the procedure.

Calcific tendonitis barbotage - This procedure can be a good treatment option when calcium has deposited in an injured tendon.

It involves numbing the skin and joint before precisely guiding a needle into the calcium deposit and flushing it out with saline solution.

It is an outpatient procedure performed in the clinic using ultrasound-guidance. 

A period of post-procedure rest with restrictions, followed by rehab therapy, will be discussed by your physician.

Nerve hydrodissection - Nerves normally slide between muscles, tendons and ligaments without restriction.

Injuries or repetitive stress can cause restrictive tissue (e.g. adhesions) to form around the nerve.

Ultrasound-guided injections allow a needle to be precisely placed between the nerve and adhesions, and a volume of solution is injected with the purpose of mechanically loosening the restriction.

Hydrodilation - Typically utilized in cases of “frozen shoulder”, this procedure involves placement of the needle in the joint followed by slow injection of a solution to mechanically stretch a tight joint capsule.

Anesthetic is injected to numb the joint to minimize pain during the procedure. Corticosteroids are also often injected to prevent a flare up of the symptoms. 

Platelet rich plasma (PRP) - PRP treatment involves taking a sample of your own blood and spinning the blood to separate out the platelets and healing factors.

The solution is then re-injected into the area of chronic tendon irritation. Some clinical studies have shown benefit but further research is needed to confirm its effect, and until that time this treatment is not covered by insurance policies.

This treatment can be provided by our physicians on a cash pay basis. Contact the clinic for more information. 

Call us: 425.899.4930

Let us connect you with a physician who can help you get back to living with less pain.