top of page


What is a High Volume Injection?

A high volume injection (HVI) is a procedure performed to treat tendonitis/tendinopathy. Tendonitis results when a tendon struggles to heal after an acute or chronic overload injury. During healing, small blood vessels and new nerves begin to develop along the tendon. If these nerves and vessels start to over-react and trigger pain, HVI can be used to create space between the tendon and the new nerves to improve the healing process and consequently reduce the pain.

What is involved?

The procedure involves injecting a high amount of normal saline (salt in water) and local anesthetic into the space between the tendon and adjacent fat pad. Depending on the inflammation involved around the tendon, a small dose of cortisone is sometimes added into the solution as well.

What conditions can be treated by High Volume Injections?

HVI can be used effectively for the treatment of Achilles tendon or patellar tendon pain.

How are the injections administered?

All procedures are performed under ultrasound guidance and skin anesthesia is provided before the injection. The solution is given slowly and the spread of solution is seen in real-time by your treating physician through the use of the ultrasound. You will notice swelling due to the high volume of fluid being injected however this resolves within a few days.

Are there any side effects?

  • Bleeding, bruising and infection: Although the injections are done under strict sterile conditions, these are potential risks for any injection therapy.

  • Pain or discomfort: Initially the skin area to be used for HVI is anaesthetised by local anesthetics. The remaining procedure is usually painless. A small proportion (2-10%) of people can experience increased pain which resolves within 2 days.

  • Numbness: Due to local anesthetics used, some numbness around the ankle and foot may occur which resolves the next day. It is advised that you come to your procedure day with driving assistance.

  • Some people may experience a vasovagal episode during or post-injection where they feel lightheaded and sweaty.


Who should avoid HVI?


While very safe, some of these conditions might prevent your Physician from recommending HVI:

  • Pregnancy

  • Cancer

  • Bleeding disorders

  • Local anesthetic or cortisone allergy

  • Certain type of cardiac arrhythmias

  • Skin infection at the injection site


What can I expect after the injection?

Injections are generally well tolerated. Since the procedure involves a high amount of fluid to be injected around the tendon, it is recommended that you walk as little as possible in the first 48 hours and that you do not immerse the area of injection into water (i.e. swimming, bath/spa) during this period. After day 2, you should be able to get back to your daily activities.

We recommend that you speak with your doctor and physiotherapist about how to proceed with your strengthening program after the therapy.

bottom of page