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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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Dupuytren’s Contracture

Dupuytren’s contracture is an abnormal thickening and tightening of the normally elastic tissue beneath the skin of the palm and fingers. In Dupuytren’s contracture, the cords tighten, or contract, causing the fingers to curl forward. In severe cases, it can lead to crippling hand deformities. The nodules can occur in the palm of the hand or the foot.

These contractures can affect the old and the young alike. Dr. Tucker consults people with Dupuytren’s and looks for food sensitivities and allergies, sleep disturbances, blood sugar issues, and nutritional deficiencies as a potential cause or contributing factor to Dupuytren’s Contractures. Tucker says “I have seen cases improve with diet, fascial stretching and lifestyle changes. Other recommendations are to stop smoking, lose fat, and decrease alcohol intake.” For some individuals, Dr. Tucker recommends his specialty creams, a fat loss diet, fascial stretches, and even surgery. However, Tucker is in search of identifying the underlying cause instead of just sending patients off to surgery.

Fascial inflammation is an under-looked at diagnosis in the medical profession and needs to be evaluated in these types of chronic conditions. Dr. Jeffrey Tucker works with other practitioners to rule out the potential causes of Dupuytren’s contractures.

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Degenerative Disc Disease – Shockwave Treatments

Shock wave or radial pulse therapy (PiezoWave, EnPuls) is effective in “kick-starting” the healing process to treat degenerative disc disease. Radial (EnPuls) and acoustic (PiezoWave) pulse waves have been used for Achilles tendinopathy, plantar fasciitis, calf strains, and even cellulite. Pulse wave therapy is non-invasive and stronger than percussion treatments such as the Deep Muscle Stimulator (DMS). By stimulating the skin and muscles adjacent to the spine with pulse wave therapy we are doing two things 1) breaking up tight spasm and hard fibrotic tissue, 2) releasing the spasm allows the paraspinal muscles to be less dampened and work more efficiently again. In this way regeneration begins because the discs are indirectly treated and the discs show an increase in disc height.

Exercise is used along with the PiezoWave or EnPuls impulse treatment to address the problems of spinal ligament instability. The sooner you catch the degeneration, the better the results with pulse wave treatment and exercise. Stability exercise training has a protective effect on damaged discs. In the acute phase we may start with the pulse therapy and or laser to decrease the pain and inflammation. Dr. Tucker uses various isometric exercises in his practice. Clinical outcomes and patient satisfaction with these types of treatments is very high. We can use this model of therapy in the early treatment phase and in late stages of the degenerative process. “Earlier intervention in the disease process is more beneficial than later treatment of an already severely degenerated discs”, says Tucker.

“I think most people understand the repair process that the body naturally goes through after an injury but they do not understand how the body can also regenerate a degenerated discs”.  These newer treatments (PiezoWave, EnPuls, and Lasers) are able to recover the mechanical properties of denatured discs, thereby providing a promising effective therapeutic modality.

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Dupuytrens Contracture

Before advising costly and risky surgery, my current non-invasive therapy is to use the laser (Theralase) and acoustic pulse therapy or radial pulse shockwave to increase mobility, joint range of motion and vascular function; I use a specific fat loss and/or deflame diet to reduce underlying inflammation which I see in every case; I teach patients movements of the hand, wrist, elbow and shoulder to improve fascial and muscle movement and gliding; I use a combination of ingredients in a cream form that are recommended for softening the nodules.

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