Posted by DrTucker in Inflammation, Knee pain, Laser Therapy, Treatment on 09 2nd, 2011 | no responses
2007-2009. For men and women, the prevalence of age-adjusted arthritis increased significantly with increasing BMI (P <.001 for trend). The age-adjusted prevalence of OA among people who were obese (25.2% for men and 33.8% for women) was nearly double that of people who are underweight/normal weight (13.8% for men and 18.9% for women). Source: CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation— United States, 2007-2009. MMWR. 2010;59(39):1261-1265.
Treatment options for OA
In patients with knee OA, my approach tends include shoe inserts. These are good adjuncts to supplements, laser, Deep Muscle Stimulation (DMS), injectables, taping, and exercise therapy. I recommend swimming, recumbent bicycles, rowing machines and elliptical trainers. I teacgh my clients a lot of low load, easy to do stretches and strenghtening exercises. Weight loss is really important here.
On laser therapy for treating patients with knee OA: It depends on the patient and the severity of his or her OA. For example, if the patient is older and has a severely arthritic knee, a total knee replacement will probably be necessary. If a patient has OA and joint effusion, I might recommend laser, aspiration and corticosteroid injection.
If I have a patient with symptoms of OA who may have incurred an injury such as an ACL tear, I will use warm laser and DMS.
If you have undergone an arthroscopic procedure, but not yet fully out of pain, I will use laser.
I often use glucosamine and chondroitin sulfate with high dose omega 3′s.
I like topical menthol products such as BioFreeze. These have evidence of efficacy.
There are dangers of using cortisone, which has been administered for years as an injection in the joints. If any of my patients ask for cortisone because it worked when administered to them 10 years ago, I would educate them on safer long-term options. The most common recommendation I have for most of my patients is to eat less carbs and exercise more. I love the anti-inflammatory diet coupled with UltraInflamX by Metyagenics and high dose omega 3 fish oils. Through weight reduction and a low-impact exercise program, many patients will achieve dramatic improvements in their arthritis pain.
My goal for patients is to decrease pain and inflammation, maintain or improve function and retard disease progression if possible. In this regard, preventing damage to subchondral bone, cartilage, joint space narrowing and osteophyte formation is the goal.
The contraindications for NSAIDs include gastrointestinal (GI) bleeding or adverse effects to the kidneys or liver. Some patients worry about taking a glucosamine product because they have diabetes, but I inform them no data support this concern.
I might recommend UltraInflamX by Metagenics alot. I like garlic, ginseng and gingko — but these affect bleeding time. If used in conjunction with NSAIDs, the risk of GI problems increases.
Often also referred to as anterior knee pain, this condition is an overuse injury which results in non-specific pain at the front of the knee, often aggravated by walking down stairs or hills and getting up after sitting for long periods (movie-goers knee).
It is most common in women, due to a wider pelvis, resulting in an increased angle between the thigh bone and patella tendon (Q angle), at the knee. Other postural factors which can contribute include overpronation at the feet and weakness in the hip abductors which both cause the knee to fall inwards.
I treat patellofemoral knee pain with warm laser, muscle therapy and corrective exercises.
December 21, 2010, 11:42 am
When the Diagnosis Is ‘Dead Butt Syndrome’
By JEN A. MILLER
My butt, unfortunately, is dead.
“Dead butt syndrome,” the sports medicine doctor said to me after making me go through a series of circus-act contortions that involved swiveling my hip in all directions. His voice was very serious, his tone stern. I wondered if I should start making funeral arrangements for my rear, maybe a New Orleans-style blowout parade?
Hold the tuba. My butt’s not really dead. It can’t be revived with defibrillator paddles, but it can be fixed.
The technical name of the condition I have is gluteus medius tendinosis — an inflammation of the tendons in the gluteus medius, one of three large muscles that make up the butt. It’s a very isolated and painful injury that knocked me out of marathon training in January with stabbing pains in my hip. It’s a symptom related to what running experts hammer at: the need for cross-training and strength training. I was running so much that I told myself I didn’t have time for the exercise machines or weights, so I have no one to blame but myself.
I’ve been running for five years, but I’d never heard of the problem. I ran it by a friend, a former track coach at the University of Pennsylvania, and he was baffled too. I haven’t seen any coverage, though the doctor said it’s fairly common with runners who train for half marathons and beyond. It took him five minutes to figure out the problem.
“A new thought in running medicine is that almost all lower extremity injuries, whether they involve your calf, your plantar fascia or your iliotibial band, are linked to the gluteus medius,” said Dr. Darrin Bright, a sports medicine physician with Riverside Methodist Hospital in Columbus, Ohio, and medical director of that city’s marathon. “In the last five to 10 years, we’ve just realized how much of an important role the gluteus medius plays in stabilizing the hips and the pelvis in running.”
If you think of the pelvis as a cup, the muscles that attach to it, including the three gluteal muscles and the lower abdominals, interact in an intricate choreography to keep the cup upright when you run or walk. If these muscles are strong, the cup stays in place with no pain. If one or more of those muscles is weak, the smaller muscles around the hip take on pressure they weren’t designed to bear.
The cup still stays up, but at a price. First come muscle tears and inflammation, followed by scar tissue in the muscle. If left untreated, this process becomes a cycle that keeps feeding into itself.
“For people who have persistent pain, it’s healing gone wrong,” Dr. Bright said. “That gluteus medius isn’t firing the way it’s supposed to. You’re getting an inhibition of the muscle fibers. It’s kind of dead.”
Some of us run through the pain, which is what I did. And many compensate by adjusting their strides in a way that impedes the gait and can lead to problems in the quads, hamstrings, Achilles tendons, heels, knees, calves, ankles, feet or toes.
“Whether they’re recreational weekend runners up to the elite marathoners, the majority of runners I see have weak gluteus medius and gluteus maximus muscles,” said Dr. David Webner, a sports medicine doctor at Crozer-Keystone Health System in Springfield, Pa.
For about 70 percent of his patients, physical therapy that stretches the muscles in the hip and leg and strengthens the gluteus muscles, along with a temporary reduction in the mileage and intensity of running, resolves the problem. Deep tissue massage, which sends more blood to the area to break up scar tissue, along with strength training may also help to break the cycle of inflammation and scarring.
More advanced approaches include ultrasound guided tenotomy, which uses ultrasound to identify the affected muscles and then “poke little holes in the area of the scar tissue,” Dr. Webner said, or platelet-rich plasma therapy, which involves injections of centrifuged blood products and is what Tiger Woods underwent after knee surgery last year.
Fortunately, I didn’t need to take it that far. I’m lucky — the pain has ebbed with physical therapy and changing one of my weekly runs to a cross-training workout.
“Those runners who do multiple types of exercising are less prone to have weakness than runners who do just running,” said Dr. Webner. “Triathletes who come into my office don’t have as much weakness as just solo runners.”
So I’m biking. I row. I sweat through elliptical workouts at the gym.
And I no longer have the feeling that a pin is stabbing my hip every time I drive. I can sit for more than a half hour without pain. And last month I ran the Amish Bird-in-Hand half marathon, and felt no more discomfort than you’d expect to endure running 13.1 miles through the hills of Pennsylvania Dutch country.
To keep my rear alive, I must be vigilant about continuing to strengthen my lower abdominal and gluteal muscles. Last week, I slacked off and the pain came creeping back.
Is it annoying to have to focus so much on these muscles to run? Absolutely. But if it’ll revive my butt, it’s worth every leg lift and crunch.
Jen A. Miller is the author of “The Jersey Shore: Atlantic City to Cape May.”
Posted by DrTucker in Ankle, Arthritis, Hip Pain, Inflammation, Knee pain, Laser Therapy, Low Back Pain, Neck, Shoulder, TMJ (Temporomandibular Joint), Treatment on 11 16th, 2010 | no responses
You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.
Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:
Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.
Treats acute and chronic conditions as well as post surgical pain.
Pain relief is often felt immediately.
Most laser treatments take only 10-20 minutes.
Are you a potential candidate?
- If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
- If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
- If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
- If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
- If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
- Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.
Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442
Patellar tendinitis is the most common knee disorder found among competitive athletes. Known as ‘jumper’s knee’, it is most likely to affect you if you play high impact sports involving bursts of intense or repeated stress, notably basketball and volleyball (these sports demand twisting on the spot, deep knee bends and sprinting).
However, anyone from the casual jogger to contact sport players may develop the condition – all too often with far-reaching consequences. One study has estimated that more than half of athletes diagnosed with patellar tendinitis were forced to retire from their sporting activity.
Classically patellar tendinitis has been explained as chronic inflammation of the tendon connecting the kneecap (patella) to the main shin bone (tibia), at the point of connection to the kneecap. Recent research has, however, revised our understanding of the condition.
Both intrinsic (specific to the individual) and extrinsic (environmental) factors can be contributing factors to patellar tendinitis.
Treatment involves corrective exercise (with proper exercises you can avoid the need for surgery). Partellar tendinosis is also very responsive to warm laser therapy and nutritional recommendations.
Ongoing research at the University of Louisville and Bellarmine University is investigating the effectiveness of Thera-Band® resistance band exercises before surgery for total knee arthroplasty (TKA). “Prehabilitation” consists of pre-operative exercises that are meant to improve strength and functional levels before surgery with the expectation of better rehabilitation and a faster recovery after surgery.
The TKA Prehab Program was featured in an article in the March 2010 edition of Lower Extremity Review. The program utilizes Thera-Band resistance bands, step-up exercises, and stretching exercises. A full-color printable handout of the program is available online.
Reference: Brown K et al. 2010. Preoperative exercise boosts TKA outcomes. Lower Extremity Review: March 2010.
ROME — Contrary to some earlier findings, obese patients with knee osteoarthritis who lost substantial weight showed signs of structural improvement in their damaged joints, according to two studies reported here. In 44 extremely obese patients whose…
Repetitive exercises are another way to help arthritic knees:
•Use a skateboard. Sit down in a chair. Place your foot on the skateboard. Slide your foot back and forth.
•Use a furniture mover. Use these on carpeted surfaces. Do the same thing as with the skateboard.
•Use a rocking chair. Rocking chairs create small, light motions in the hip, knee and spine. They really work.
•Swing your legs in water while sitting on the edge of a pool. For this to work, you have to swing your legs very slowly. Otherwise, you’ll fatigue the muscles too fast.
•People often ask if they can use cycling as a way to improve their joint health and the answer is, it depends! It depends on how much motion you have in your knee, how irritable your knee is, and how easily you can control the resistance on the bike. Cycling can create body weight or higher loads on your knee so it’s usually not my first choice. But, it is an option. And, only on a stationary bike.
•I suggest ten-fifteen minutes per session and aim for three sessions per day. The key is to move slowly and feel very little fatigue in the muscles. The purpose is not to strengthen your muscles; it’s to improve the fluid in your knee.
Regarding Glucosamine, the original Italian studies circa 1988 were using 1200mg GluS04 and 600mg ChonS04 daily for 6 weeks. These studies claimed that people with osteoarthritic knees felt a 50% symptom reduction. Arthroscopy of that group revealed evidence of increased meniscal thickness. Histo revealed increased Chondrocyte size and histo density.
The JOG (Joints on Glucosamine) study used Glucosamine Hydrochloride at 1500 mg/day. Glucosamine hydrochloride has been shown to be ineffective in other studies. Glucosamine sulphate is the active form that is most helpful. My experience is that clients need to be on at least 3-4 grams/day for an initial 3 week dose to be effective. At week 4-6 they can take 2-3 grams daily. A maintaince dose is 1500 mg. I do like to change this supplement out every 10-12 weeks.
Using glucosamine hydrochloride has been a common theme of studies showing lack of benefit.
I’ve been taking glucosamine and chondroitin for a year and I don’t see any changes in my knee, back & hip pain. Do you recommend any other supplements for my joint pain?
If you have been taking at least 1500 mg per day of those supplements, it’s time for a change. I’ve had good results with clients using UltraInflamX Plus 360 by Metagenics. They use 2 scoops twice daily in a shake. I also use EPA-DHA 720 by Metagenics. I dose them high, often at 3-6 grams daily. In addition, I see good results with Kaprex by Metagenics. The dose is usually 2 gel caps in the morning and 2 at night.
Order at www.DrJeffreyTucker.meta-ehealth.com
First off, did you know the FDA annnouced that dicoflenac gel (brand name Voltaren Gel) — often prescribed for arthritis pain –is linked to severe liver damage… and it can happen within the first month of use!
According to the FDA, this topical gel has been reported to cause liver necrosis (death of liver cells), jaundice, and liver failure!
Despite these horrible side effects, dicoflenac gel remains very much on the market.
Don’t risk your life to erase arthritis pain. Natural alternatives I recommend are over-the-counter Capsaicin cream (apply it 4 times a day) or Coolsens from Xymogen. Both are very helpful for arthritis pain relief. Just make sure you use it consistently for 3 weeks to get the best results.
Ideal treatment for joint pain should include Pycnogenol, a pine bark extract with anti- inflammatory effects. Pycnogenol has been shown to help knee osteoarthritis, conditions that need enhanced blood flow, symptoms of menopause, and diabetics manage blood sugar levels.
Dr. Tucker recommends combining Pycnogenol (150 mg of Pycnogenol daily), glucosamine and chondroitin sulphate ( 1500 mg daily), with omega-3s( 2-3 grams daily) to reduce inflammation related to knee OA.