By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD
Updated April 2026
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For families across Clear Lake and Bay Area Houston, chronic back pain, neck pain, or radiating nerve pain has a way of taking the joy out of everyday life. The drive on I-45 to Johnson Space Center, a long shift on a Bayport plant unit, an afternoon at South Shore Harbour with the family, even unloading the truck at Big League Dreams — everything gets harder when a herniated disc or pinched nerve is firing every time you move. When physical therapy and oral medication have not been enough, an epidural steroid injection (ESI) is often the next reasonable step.
At the League City office of Performance Pain and Sports Medicine, located on East Main Street just minutes from I-45, Dr. Suzanne Manzi performs epidural steroid injections under fluoroscopic guidance to deliver targeted anti-inflammatory medication directly to the inflamed nerve root. As a quadruple board-certified pain medicine specialist with fellowship training in interventional spine and pain management, Dr. Manzi reviews each patient’s MRI and symptom pattern before recommending whether ESI is the right next step.
The League City office serves the Clear Lake and Bay Area Houston community without the long drive into the Texas Medical Center. If spine pain is keeping you off the boat, off the job, or out of the bleachers at a CCISD game, a consultation in League City is encouraged.
What Is an Epidural Steroid Injection?
An epidural steroid injection (ESI) delivers anti-inflammatory medication directly into the epidural space surrounding your spinal nerves. The epidural space is the area between the protective covering of the spinal cord (the dura) and the vertebrae. When a herniated disc, bone spur, or narrowed spinal canal presses on a nerve root, it creates inflammation that drives pain, numbness, or weakness into your back, neck, arms, or legs.
The injection contains two components: a corticosteroid that reduces inflammation at the nerve root and a local anesthetic that provides immediate but temporary pain relief. Together, these medications calm the irritated nerve and create a window for healing and rehabilitation.
All epidural steroid injections at Performance Pain and Sports Medicine are performed under fluoroscopic guidance, which means real-time X-ray imaging is used to guide the needle to the precise location. This image-guided approach helps ensure the medication reaches the targeted nerve root accurately. According to the American Society of Interventional Pain Physicians (ASIPP), fluoroscopically guided epidural injections carry Level I evidence supporting their long-term effectiveness for conditions like disc herniation (Manchikanti L et al., Pain Physician, 2021).
Three primary approaches to ESI are used, selected based on your specific condition and anatomy:
- Interlaminar: The needle enters between two vertebrae from the back. This is the most common approach and covers a broad area of the epidural space.
- Transforaminal: The needle enters from the side, targeting the specific nerve root where it exits the spine. This delivers a more concentrated dose to the affected nerve.
- Caudal: The needle enters through the sacral opening at the base of the spine. This approach is often used for lower back conditions affecting multiple nerve levels.
The most appropriate approach is recommended after reviewing your imaging and evaluating your symptoms during the consultation.
Conditions Treated with ESI in League City
League City sits between NASA Johnson Space Center, the Houston Ship Channel petrochemical complex, and the Galveston Bay maritime community, and the patients we see at the East Main Street office reflect that geography. Many work as NASA engineers and aerospace contractors at Boeing, Lockheed Martin, Jacobs, or Barrios; others commute to refinery and chemical plants at Bayport, Texas City, or the Ship Channel; we also see UTMB Health and Houston Methodist Clear Lake clinicians, Clear Creek ISD educators, and active retirees who spend their weekends boating Clear Lake. Each of these patient profiles loads the spine in its own way. A 2022 systematic review in Pain Physician confirmed that epidural injections are effective for lumbar radiculopathy (Manchikanti L et al., 2022), and the American Academy of Neurology (2025) found that ESIs probably reduce short-term pain and disability in both cervical and lumbar radiculopathies (Armon C et al., Neurology, 2025).
Conditions commonly treated with epidural steroid injections at the League City office include:
- Herniated or bulging disc. A frequent finding in NASA console operators, refinery shift workers, and active-adult boaters whose lower spine has logged thousands of hours of seated and rotational loading. Targeted injection at the inflamed nerve root often allows return to work and meaningful physical therapy participation.
- Sciatica (lumbar radiculopathy). Shooting pain that runs from the lower back through the buttock and down the leg, common in commuters from Friendswood, Webster, Pearland, and Pasadena who chain hours of seated, vibration-loaded posture together on I-45 every week.
- Spinal stenosis. Narrowing of the spinal canal that compresses nerves and produces leg cramping with walking. ESI extends mobility for older Bay Area patients who want to keep walking the South Shore Harbour boardwalk and the Hometown Heroes Park trail.
- Cervical radiculopathy. Nerve compression in the neck that radiates into the shoulder and arm, frequent in surgical and procedural clinicians at UTMB and Methodist Clear Lake, dental providers, and astronaut training staff who hold sustained forward-head posture.
- Degenerative disc disease. The natural loss of disc height that irritates surrounding nerves over time. Common in long-tenured refinery operators, Ship Channel mariners, and CCISD educators across the Bay Area.
- Failed back surgery syndrome. Persistent nerve irritation after a prior spinal surgery elsewhere. Many of our League City patients arrive with continued symptoms after surgery and benefit from a focused ESI strategy.
- Spondylolisthesis. When a vertebra slips forward over the one below it, producing nerve compression that may respond to epidural steroid treatment.
During your League City consultation, your MRI or other imaging is reviewed to identify which condition is driving your symptoms and whether an ESI is the right next step.
What to Expect During Your ESI in League City
Knowing exactly what happens before, during, and after the procedure helps Bay Area patients arrive prepared and leave with a clear plan. Here is the step-by-step process at the East Main Street office in League City.
Before Your Procedure
Your epidural steroid injection begins with a thorough evaluation in the League City office. Dr. Manzi reviews your MRI or CT imaging, your pain history, prior physical therapy notes, and any earlier injections, then confirms that an ESI is appropriate for your specific condition. You will receive written instructions about which medications to pause beforehand, particularly blood thinners. Plan to have someone available to drive you home; we recommend not driving immediately after the procedure.
During Your Procedure
The injection itself typically takes 15 to 30 minutes and is performed as an outpatient procedure. You lie face down on a procedure table; the injection area is cleansed and numbed with a local anesthetic. Using fluoroscopic real-time X-ray guidance, Dr. Manzi advances the needle precisely into the epidural space at the targeted level of your spine. Once correct needle placement is confirmed on the fluoroscopy monitor, the corticosteroid and anesthetic medication are delivered. Most patients describe the sensation as pressure rather than sharp pain.
After Your Procedure
You rest in the recovery area for 15 to 30 minutes while the care team monitors you. Some Bay Area patients notice immediate relief from the local anesthetic, although that effect is temporary. The corticosteroid typically takes two to seven days to reach its full anti-inflammatory effect. Most patients return to light daily activities the following day; strenuous exercise and heavy lifting are best avoided for 24 to 48 hours. Because Bay Area summers are hot and humid and hurricane season runs from June through November, your team will discuss hydration, indoor air-conditioned recovery, and a contingency plan if a tropical system disrupts a follow-up visit. A follow-up appointment at the League City office is scheduled to assess your response and decide whether additional injections may be beneficial.
Benefits of Epidural Steroid Injections
For Clear Lake and Bay Area patients dealing with chronic back or neck pain from nerve compression, epidural steroid injections offer several meaningful advantages as part of a comprehensive treatment plan:
- Minimally invasive and non-surgical. An ESI requires only a needle insertion. There are no incisions, no general anesthesia, and no hospital stay. You go home the same day.
- Targeted inflammation reduction. Unlike oral medications that circulate through the entire body, an epidural injection delivers the anti-inflammatory medication directly to the inflamed nerve root, which matters for patients in safety-sensitive aerospace, refinery, and offshore roles where DOT and process-safety rules apply.
- May reduce or delay the need for surgery. Research published in The Spine Journal followed patients for five years after lumbar transforaminal ESI and found sustained benefit with reduced progression to surgical intervention (Kennedy DJ et al., 2018).
- Enables full participation in rehabilitation. One of the most important benefits is that ESI pain relief lets you engage fully in physical therapy and exercise, which are essential for return-to-work and return-to-the-water timing.
- Quick procedure with fast recovery. The injection takes 15 to 30 minutes, and most League City patients resume light activities the next day. There is no extended downtime.
- Can be repeated if effective. If the first ESI provides meaningful relief, your physician may recommend a series of up to three injections to extend the benefit. ASIPP guidelines support repeated epidural injections when clinical improvement is documented (Manchikanti L et al., Pain Physician, 2021).
ESIs work best as one component of a broader pain management strategy and are typically combined with physical therapy, activity modification, and other conservative treatments tailored to your specific condition and goals.
If you are considering an epidural steroid injection for back or neck pain, call the League City office at 346-217-1111 to schedule a consultation.
Why Choose Performance Pain in League City for Epidural Steroid Injections
Choosing the right physician for an epidural steroid injection matters. ESI outcomes depend on accurate diagnosis from your imaging, precise needle placement under live fluoroscopy, and disciplined patient selection. These require a physician with deep training in interventional spine procedures and a team that knows the patients of the Clear Lake and Bay Area Houston community, the rhythms of NASA, and the realities of refinery turnarounds, Galveston Bay weather, and Gulf Coast life.
At Performance Pain and Sports Medicine in League City, ESIs are performed by:
- Dr. Suzanne Manzi, MD — Quadruple board-certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine, with residency at Baylor College of Medicine and fellowship training in interventional spine and pain management. Dr. Manzi serves as off-site clinical faculty at UT Health Houston McGovern Medical School and is a founding member of the Society of Women Innovators in Pain Management. She sees patients from Friendswood, Webster, Dickinson, Kemah, Seabrook, Nassau Bay, Texas City, Pearland, Pasadena, and the wider Bay Area at the League City office.
What sets the League City office apart:
- Physician-led care with a board-certified, fellowship-trained interventional pain specialist
- Every epidural injection performed under live fluoroscopic guidance for precision
- TMC-caliber care without the I-45 drive into the Texas Medical Center
- Dedicated one-on-one consultation time, not a five-minute hallway visit
- Convenient League City location on East Main Street, accessible from Friendswood, Webster, Dickinson, Kemah, Seabrook, Nassau Bay, Texas City, Pearland, Pasadena, La Porte, Alvin, and Santa Fe
- Workers’ compensation accepted for NASA contractor, refinery, petrochemical, maritime, and healthcare cases
For League City patients exploring biologic alternatives or adjuncts to ESI, the practice also offers PRP therapy in League City.
Our League City Location
The League City office of Performance Pain and Sports Medicine occupies Suite A at 1216 East Main Street, a short drive from NASA Johnson Space Center, UTMB Health League City Campus, Houston Methodist Clear Lake, South Shore Harbour, and Kemah Boardwalk. East Main Street (FM 518) sits just east of I-45, with quick access from FM 646, NASA Road 1, and the Grand Parkway.
Performance Pain and Sports Medicine — League City
Address: 1216 East Main Street, Suite A, League City, TX 77573
Major Cross Streets: East Main Street (FM 518) at I-45
Nearby Landmarks: South Shore Harbour, UTMB Health League City Campus, Big League Dreams, Kemah Boardwalk
Parking: Free on-site parking
Phone: 346-217-1111
Conveniently located in the heart of Bay Area Houston, the League City office serves patients from Friendswood, Webster, Dickinson, Kemah, Seabrook, Nassau Bay, El Lago, Texas City, La Porte, Pearland, Pasadena, Alvin, Santa Fe, and the wider Clear Lake / Galveston Bay communities, with quick access from I-45, FM 518, FM 646, and NASA Road 1.
Frequently Asked Questions: ESI in League City
Are epidural steroid injections available in League City, TX?
Yes. Epidural steroid injections are performed at the League City office of Performance Pain and Sports Medicine, located at 1216 East Main Street, Suite A. Dr. Suzanne Manzi, MD, performs ESI under live fluoroscopic guidance for patients across the Clear Lake and Bay Area Houston community. Most insurance plans, Medicare, and workers’ compensation cases cover medically necessary ESI. Call 346-217-1111 or request an appointment online.
Do you accept workers' compensation for NASA contractor, refinery, and maritime back injuries?
Yes. The League City office regularly treats workers’ compensation patients from NASA Johnson Space Center contractors (Boeing, Lockheed Martin, Jacobs, Barrios, and others), Houston Ship Channel and Bayport refinery and chemical-plant operators, longshoremen and maritime workers on Galveston Bay, UTMB and Methodist Clear Lake healthcare staff, and Clear Creek ISD educators. We coordinate with case managers and adjusters and document objective findings that support appropriate work status decisions. Call 346-217-1111 to discuss your specific case.
Do you accept referrals from Bay Area primary care, neurosurgeons, and orthopedists?
Yes. Dr. Manzi routinely accepts referrals from UTMB Health, Houston Methodist Clear Lake, HCA Houston Healthcare Clear Lake, NASA contractor health programs, and independent primary care, neurology, neurosurgery, orthopedic, and physical therapy practices throughout the Clear Lake / Bay Area. Most patients are seen within one to two weeks. Records can be sent through your referring practice or directly to the League City office at 346-217-1111.
Will an epidural steroid injection help a herniated disc?
Herniated discs are one of the most common conditions we treat with ESI in League City. Research supports the use of epidural injections for reducing pain and inflammation caused by disc herniation, particularly when the disc is compressing a spinal nerve. Not every herniated disc requires an injection; some respond well to physical therapy alone. Your imaging and exam findings guide that recommendation.
How long does pain relief last after an epidural steroid injection?
Duration of relief varies. Some League City patients experience weeks of relief, while others benefit for several months or longer. A 2025 systematic review published in Neurology found that epidural steroid injections probably reduce short-term pain in cervical and lumbar radiculopathy (Armon C et al., Neurology, 2025). ESIs work best when paired with active rehabilitation.
How many epidural steroid injections can I receive?
There is no single universal limit, but most physicians follow a guideline of no more than three to four ESIs within a six-month period. The decision depends on your response to the first injection and whether the clinical benefit justifies additional treatments. ASIPP guidelines support repeated injections when documented clinical improvement is present.
Does insurance cover epidural steroid injections?
Most insurance plans cover ESI when it is medically necessary and supported by imaging and physical examination. Coverage details vary by plan and may require prior authorization. Call the League City office at 346-217-1111 to verify your benefits before scheduling.
How soon can I return to work after an ESI in League City?
Most patients return to light daily activities the next day. NASA contractors, refinery operators, and offshore workers should discuss return-to-duty timing with their employer’s safety-sensitive policies; strenuous exercise, heavy lifting, and prolonged bending are best avoided for 24 to 48 hours. The injection site may feel sore for a day or two; your physician will provide written aftercare guidance based on the type of injection performed.
Schedule Your League City ESI Consultation
If chronic back pain, neck pain, or radiating nerve pain has limited your work or your weekends, an epidural steroid injection may help you find meaningful relief without surgery. Patients across the Clear Lake and Bay Area Houston community are welcome to schedule a consultation with Dr. Manzi at the League City office.
Performance Pain and Sports Medicine — League City
1216 East Main Street, Suite A, League City, TX 77573
Phone: 346-217-1111
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Performance Pain and Sports Medicine
Medically reviewed by Suzanne Manzi, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. Teaching Faculty, UT Health Houston McGovern Medical School. Last reviewed April 2026.
