All posts by DrTucker

Exercises for Foot Pain: A Four-Phase Program

By Jeffrey Tucker, DC, DACRB

We all know if your feet hurt, you probably don’t function well, and we all know many patients complain of foot pain at one time or another. What are the exercise strategies we can use to help improve the function of our patients’ feet? I try to develop an exercise program for the intrinsic muscles, extrinsic muscles, neuromotor control and arthrokinematics. Here’s a four-phase program you can use in your practice.

Changing Foot Biomechanics: Start by Observing the Feet

Changing the foot biomechanics starts with the foot examination, which includes visual analysis, shoes and socks off. I note pronation, supination, calluses, bunions, hammer toes, a deviated great toe (hallux abducted valgus), and scars (especially surgical that the patient forgot to tell me about).

Visual analysis is followed by some functional tests (small knee bends, squats, etc.) and then palpation, feeling for point tenderness in the foot, ankle, calf, knee, etc. Palpation gives me an opportunity to trace the pain. As needed, I perform ortho and neuro tests, etc., and then maybe decide to offer the patient an orthotic. Read More

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Seminars taught by Dr. Jeffrey Tucker

November 9-November 10, 2017 “Xiam, China – Deep Muscle Stimulator”

December 2-December 3, 2017 – St. Louis- Logan University “Performance Health #3” More Information

December 16-December 17, 2017  Minnesota- Northwestern University “Performance Health #1” More information

January 13-January 14, 2018 Minnesota- Northwestern University “Performance Health #2” More Information

January 27-January 28, 2018 Florida- Palmer College-  “Be The Expert” More Information

February 17-February 18, 2018 Minnesota- Northwestern University -“Performance Health #3” More Information

April 6, 2017 – Las Vegas “CLX Training”

 

 

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Is Sockwave therapy and laser therapy the right treatment for damaged discs and bulges?

Both Shockwave and laser help damaged disc and bulges by:

  • Stem cell activation: Stem cells are effective in inhibiting disc degeneration and disc herniation. It’s a pretty complex interplay between the stem cells and the immune system cells but the result can be disc tissue regeneration.
  • Stem cell activation: This will promote regeneration of the outer tissue of the disc and help contain and lessen the bulge (scar tissue formation).
  • Stem cell activation:The increased number of cells to the area brings more oxygen to the damaged disc and accelerates healing by reversing the low-oxygen (degenerative or dying) environment in the spine. Everything heals better and faster with increased oxygen.
  • Stem cell activation reduces and prevents herniation by suppressing the non-healing inflammation.

Office phone 310-444-9393

References: Cunha C, Almeida CR, Almeida MI, Silva AM, Molinos M, Lamas S, Pereira CL, Teixeira GQ, Monteiro AT, Santos SG, Gonçalves RM, Barbosa MA. Systemic Delivery  of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration. Stem Cells Transl Med. 2016 Oct 11. pii: sctm.2016-0033.

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Degenerative Disc Disease (DDD)

One of the therapies I find useful for DDD is shock wave therapy. PiezoWave Pulse Therapy and EnPuls are two of the top brand names in this type of non-invasive treatment. Shock wave therapy changes the degenerative disease environment of the inner spine to a healing environment.

Shock wave therapy stimulates stem cells. When stem cells are stimulated towards the spine or a targeted joint they initially start a line of new communication with the immune system and begin exchanging messages. The stem cells tell the immune cells to call healing factors to the site of damage and to meet them at the points where repair is needed. This is when healing begins.

Using the current research to explain how this change of environment works: When introduced into a diseased joint or spine, stem cells display plasticity and multipotency. This is the ability to change/morph into other cell types and multiply. One of the specific cell types is called Mesenchymal stem cell (MSCs) or connective tissue stem cells. These suppress inflammatory T–cell proliferation and provide an anti-inflammatory effect. The shockwave treatment actually stimulates a ‘controlled irritation’ or ‘controlled injury’ that leads to the beginning of the bodies dampening effect on the chronic inflammation.1

 Shockwave therapy also signals the native stem cells and other growth factors to regroup and begin repairing damaged joints.

 Stem cells and the herniated disc

A bulging disc bulges because the soft jelly like nucleus (inner colloid substance of the disc) are able to push through the weakened, damaged outer wall of the disc.

New research suggests that stem cells, without direct injection to the site of disc lesions in the spine, can repair disc lesions by changing the healing environment of the spine.

1 Davatchi F, et al. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis. 2016 Mar;19(3):219-25

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Knee Osteoarthritis – Brentwood Chiropractor

  • Arthroscopy Journal 2015 – doctors concluded that PRP injections are a viable treatment for knee osteoarthritis and should be considered in patients with knee osteoarthritis.6 Studies like these add to the accumulating evidence that PRP can halt and reverse meniscus degeneration.7,8
  • J Orthop Res. 2016 – doctors confirm that stem cell therapy stimulates the regeneration of meniscal tissue. Specifically with regard to post-meniscectomy meniscus growth (with stem cells).9 This means we can use the PIEZOWAVE and EnPuls to stimulate regeneration even after surgery.
  • Doctors at the University of Iowa found that stem cells and cartilage cells could be influenced to migrate to the site of “white-zone” where the most difficult meniscus tears are. I use Laser therapy, PiezoWave Pulse Therapy and EnPuls shockwave to do just that!
  • I do think stimulating the tissues with PiezoWave and EnPuls shockwave can promote regeneration and is a promising new strategy in meniscus repair.10
  • Stimulating stem cell based strategies for meniscus tissue is a fundamental role in meniscal regeneration.
  1. Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop. 2016 Sep 13:1-7.
  2. Brelin AM, Rue JP. Return to Play Following Meniscus Surgery. Clin Sports Med. 2016 Oct;35(4):669-78. doi: 10.1016/j.csm.2016.05.010. Epub 2016 Jul 9. Review.
  3. Noyes FR, Barber-Westin SD. Long-term Survivorship and Function of Meniscus Transplantation. Am J Sports Med. 2016 Sep;44(9):2330-8.
  4. Niu W, Guo W, Han S, Zhu Y, Liu S, Guo Q. Cell-Based Strategies for Meniscus Tissue Engineering. Stem Cells International. 2016;2016:4717184. doi:10.1155/2016/4717184.
  5. Blanke F, Vavken P, Haenle M, von Wehren L, Pagenstert G, Majewski M. Percutaneous injections of Platelet rich plasma for treatment of intrasubstance meniscal lesions. Muscles Ligaments Tendons J. 2015 Oct 20;5(3):162-166.
  6. Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
  7. Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, Shieh YH, Wu CH, Deng WP. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011 Sep;32(25):5847-54. Epub 2011 May 25.
  8. van Buul GM, et al. Platelet-Rich Plasma Releasate Inhibits Inflammatory Processes in Osteoarthritic Chondrocytes. Am J Sports Med. 2011 Nov;39(11):2362-70. Epub 2011 Aug 19.
  9. Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
  10. McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42.  PUBMED Meniscus Growth With Stem Cells
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Meniscus Tears – Los Angeles Chiropractor

Research suggests the White Zone can heal

Can PIEZOWAVE Pulse Therapy and ENPULS Radial Shockwave Therapy regrow meniscus tissue? What about stem cell therapy and PRP? Is one more successful at treating meniscal damage? All of these treatments are very promising! So far I see stimulation of stem cells (either non-invasive therapy or injections) as promising for meniscus repair and regeneration.

  • Everyone agrees that Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone (the inner portion of the meniscus that lacks a blood supply).
  • I use the non-invasive and less expensive EnPuls and PiezoWave therapy instead of PRP to achieve pain relief and attempt to halt the progression of meniscal damage. More time and research is required to see if this is the way to regenerate tissue.
  • FACT: Regeneration of meniscus and cartilage is difficult to heal especially in the ‘white zone’ where there is a lack of blood vessels and therefore deprives the meniscus of healing nutrients and oxygen.
  • FACT: Stem cell injections and PRP injection treatments are in the infancy stages of research. These treatment options are as controversial as surgery.
    • New York Times, Dr. Gordon H. Guyatt, a professor of medicine at McMaster University in Hamilton, Ontario states: Meniscus surgery is expensive and has potential complications (British Medical Journal even agrees with this).
    • FACT: I want patients to return to sport or leisure activity as fast as possible.
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Shockwave Therapy for Knee Pain

  • Arthroscopy Journal, doctors concluded that PRP injections are a viable treatment for knee osteoarthritis and should be considered in patients with knee osteoarthritis.6 Studies like these add to the accumulating evidence that PRP can halt and reverse meniscus degeneration.7,8
  • J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472 they confirm that stem cell therapy stimulates the regeneration of meniscal tissue. Specifically with regard to post-meniscectomy meniscus growth (with stem cells).9 This means we can use the PIEZOWAVE and EnPuls to stimulate regeneration even after surgery.
  • Doctors at the University of Iowa found that stem cells and cartilage cells could be influenced to migrate to the site of “white-zone” where the most difficult meniscus tears are. I use Laser and PiezoWave and EnPuls to do just that!
  • I do think stimulating the tissues with PiezoWave and EnPuls shockwave can promote regeneration and is a promising new strategy in meniscus repair.10
  • Stimulating stem cell based strategies for meniscus tissue is a fundamental role in meniscal regeneration. 11
  1. Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
  2. Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, Shieh YH, Wu CH, Deng WP. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011 Sep;32(25):5847-54. Epub 2011 May 25.
  3. van Buul GM, et al. Platelet-Rich Plasma Releasate Inhibits Inflammatory Processes in Osteoarthritic Chondrocytes. Am J Sports Med. 2011 Nov;39(11):2362-70. Epub 2011 Aug 19.
  4. Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
  5. McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42.  PUBMED Meniscus Growth With Stem Cells
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Meniscus Tears – Research suggests the ‘White Zone’ can heal (Los Angeles Chiropractor)

 

  • FACT: Regeneration of meniscus and cartilage is difficult to heal especially in the ‘white zone’ where there is a lack of blood vessels and therefore deprives the meniscus of healing nutrients and oxygen.
  • FACT: Stem cell injections and PRP injection treatments are in the infancy stages of research. These treatment options are as controversial as surgery.
    • New York Times, Dr. Gordon H. Guyatt, a professor of medicine at McMaster University in Hamilton, Ontario states: Meniscus surgery is expensive and has potential complications (British Medical Journal even agrees with this).
    • FACT: I want patients to return to sport or leisure activity as fast as possible.
    • Researchers in Denmark have published: “patients undergoing arthroscopic meniscus surgery were too optimistic regarding their recovery time and postoperative participation in leisure activities. This highlights the need for shared decision making which should include giving the patient information on realistic expectations of recovery time and regarding participation in leisure-time activities after meniscal surgery.”1
  • Can PIEZOWAVE Pulse Therapy and ENPULS Radial Shockwave Therapy regrow meniscus tissue? What about stem cell therapy and PRP? Is one more successful at treating meniscal damage? All of these treatments are very promising! I have not seen 80-100% predictable positive clinical outcomes yet with any of these! So far I see stimulation of stem cells (either non-invasive therapy or injections) as promising for meniscus repair and regeneration.4
  • We need more University and Hospital based studies to confirm this trend.
  • Again, everyone agrees that Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone (the inner portion of the meniscus that lacks a blood supply).
  • I use the non-invasive and less expensive EnPuls and PiezoWave therapy instead of PRP to achieve pain relief and attempt to halt the progression of meniscal damage. More time and research is required to see if this is the way to regenerate tissue.5
  1. Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop. 2016 Sep 13:1-7.
  2. Brelin AM, Rue JP. Return to Play Following Meniscus Surgery. Clin Sports Med. 2016 Oct;35(4):669-78. doi: 10.1016/j.csm.2016.05.010. Epub 2016 Jul 9. Review.
  3. Noyes FR, Barber-Westin SD. Long-term Survivorship and Function of Meniscus Transplantation. Am J Sports Med. 2016 Sep;44(9):2330-8.
  4. Niu W, Guo W, Han S, Zhu Y, Liu S, Guo Q. Cell-Based Strategies for Meniscus Tissue Engineering. Stem Cells International. 2016;2016:4717184. doi:10.1155/2016/4717184.
  5. Blanke F, Vavken P, Haenle M, von Wehren L, Pagenstert G, Majewski M. Percutaneous injections of Platelet rich plasma for treatment of intrasubstance meniscal lesions. Muscles Ligaments Tendons J. 2015 Oct 20;5(3):162-166.
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Non-Surgical Options for Meniscus Tears – Los Angeles

You probably have knee pain and then you got an MRI and the doctor said “You have a meniscus tear and you’ll need surgery”.  Do you have other options? YES!

First off, let me tell you that research suggests the meniscus is always trying to heal itself. The length of time it takes to heal can depend on the location of the tear. The “Red Zone” part of the meniscus which is the outer edges, contain areas that have a blood supply and can receive oxygen and nutrients that help heal. This ‘Red Zone’ has a better opportunity than the “White Zone” which is more in the center of the meniscus to heal. The ‘White Zone’ does not have a well-organized blood supply which is required to bring oxygen and nutrients into damaged areas. If you are one of those people with a meniscus tear and your pain and dysfunction is not that great, meaning you can do most of the stuff you want to do, and you can live with the pain, I would recommend a trail of PiezoWave, EnPuls and laser. The research studies comparing people who had surgery and those who did not have surgery show that the outcomes are about the same after two years in those who did not go through a costly and invasive surgery!  Acoustic Pulse Wave (PiezoWave) therapy and radial pulse therapy (EnPuls) is changing the healing pace – results of healing are quicker in the “White Zone” damaged tissue. I suspect it’s increasing the blood flow to these deeper tissues and improving the healing nutrient supply to the damaged ‘White Zone’ tissue and people feel better, faster.

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Dupuytren’s Contracture Alternative Treatment

Restricted fascia may be a cause or a contributing factor to Dupuytren’s Contracture.

I see the tight fascia temporarily respond to EnPuls shock wave therapy or acoustic pulse wave stimulation, but it can require continuous stimulation for several treatments. Over time and repetition of using the EnPuls or PiezoWave pulse therapy and fascial stretching, the tissue does loosen up.

It is well known that altered spindle cell feedback to the brain results in altered stimulation to the muscles and tendons, resulting in altered function which is what we see and feel in Dupuytren’s Contracture. “If I can help one person put there own hand back in there pocket I am thrilled”

Surgeons see Dupuytren’s Contracture as a local problem in the hand and use surgery to try to fix it. I understand their rationale for local treatment but I also treat the whole fascial system up the forearm, arm and neck and sometimes even the jaw area. This type of fascial chain treatment of the mechanoreceptors may literally loosen the hand and not require surgery or repeated surgery.

Local restoration of spindle cell nerves can prevent recidivism and allow long-lasting, normal function for mechanoreceptors along a fascial kinetic chain.

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