If you are suffering from a known knee meniscus tear get out your MRI report…
If you have a meniscus tear the radiologist probably used phases or words like located in the “White Zone” and/or “Red Zone” meniscus tears. The “Red Zone” refers to the outer edges of the meniscus and has a fair amount of blood vessel in it. Areas that have a good blood supply typically heal better than those areas without good blood flow. If the radiologist describes your tear as being in the “White Zone” that refers to the center of the meniscus which has a poor network of blood flow. White zone tears are often recommended to have surgery.
The red zone (good blood flow) is known to contain regenerative cells, (cells that stimulate stem cell activity) and those of us using Shockwave Therapies (Zimmer EnPuls, EPAT, Acoustic Wave Therapy, Gaines Wave), hypothesize that shockwave treatments to the knee can help stimulate migration of the regenerative cells in the red zone to the site of meniscal injury in the white zone. Shock wave practitioners know the meniscus is capable of healing tear defects that occur in the white zone (the area without circulation).
Shockwave Therapies (Zimmer EnPuls, EPAT, Storz, Acoustic Wave Therapy, Miracle Wave, Gaines Wave) is a non-invasive alternative to shots and surgical treatment. Shockwave therapy may act as a spark to mobilize the body’s own stem cells to facilitate healing.
Findings in the Journal of Orthopaedic Research demonstrate that articular cartilage and injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential, even into the white zone area (2).
1 Matar HE, Dala-Ali B, Atkinson HD. Meniscal regeneration: a cause of persisting pain following total knee arthroplasty. Case reports in medicine. 2011;2011.
2 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. Journal of Orthopaedic Research. 2016 Nov 1.
Many patients come in to see me for knee pain. These are patients looking for non-surgical options for meniscus injuries, patellofemoral syndrome pain, knee osteoarthritis and ligament injuries. Most people are familiar with arthroscopic surgical procedures and they are hearing about stem cell therapy for joints. But most people have not yet heard about extracorporal pulse attenuating therapy (EPAT), acoustic pulse therapy, radial pulse therapy or shockwave therapy. These are alternative non-invasive regenerative therapies for knee damage.
Most doctors still believe that the inner knee meniscus cannot heal because it has a poor network of blood vessels and blood supply. But newer research is discovering the meniscus is always trying to heal itself.
How does acoustic shockwave therapy help a meniscus regenerate?
1. Re-establish the normal outer soft-tissue textures. If you are swollen shockwave helps get it resolved.
2. It can aid in bone and joint alignment (ankle, femoral, tibial and hips). This may require a skilled Chiropractor.
3. Restore normal range of motion.
4. Shockwave therapies such as the Zimmer EnPuls, PiezoWave Acoustic therapy and the Storz EPAT are used to stimulate the growth of new meniscus tissue and help your own stem cells to do the job of repair. A shockwave sales rep was in my office two weeks ago and commented that I may be the only doctor in the Country who has all 3 top shockwave deices.
Please call 310-444-9393 for an appointment
Hip and groin pain are among the more common problems I see in my practice.
‘Sports hernia’, sacroiliac joint dysfunction, adductor muscle strain, hip osteoarthritis and impingement syndrome are all common diagnosis patients present with. Before presenting to me some patients have tried cortisone shots, platelet-rich plasma (PRP) injections, stem cell injection, physical therapy and exercise.
It is not unusual to find the pain or symptoms in the hip and groin pain being referred pain from the lumbar spine, lower abdomen, and pelvis 1, 2, 3. Figuring this out is all part of making the proper diagnosis.
I will sit and talk to my patients and get a good history, provide a quality physical examination, identify pain causing generators, and come up with a working diagnosis.
Here is what the research tells us:
• The pain at the front of the hip and groin pain is commonly associated with osteoarthritis and hip labral tears.
• Rear hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication.
• Lateral hip pain occurs with greater trochanteric pain syndrome.4
• Patients may also have hip and groin back from a herniated disc without back pain.5
• I often see tight hips that cause low back pain 6
The beneficial effects of Acoustic therapy for the above conditions are often experienced after only 3-6 treatments. Acoustic therapy is safe and non-invasive.
Please call the office at 310-444-9393 for more information.
1 Tan EW, Schon LC. Mesenchymal Stem Cell-Bearing Sutures for Tendon Repair and Healing in the Foot and Ankle. Foot Ankle Clin. 2016 Dec;21(4):885-890. doi: 10.1016/j.fcl.2016.07.015.
1 St-Onge E, MacIntyre IG, Galea AM. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report. The Journal of the Canadian Chiropractic Association. 2015;59(4):390-397.
2. McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012 May;63(2):87-99.
3. Holmich P, Dienst M. Differential diagnosis of hip and groin pain. Symptoms and technique for physical examination. Orthopade. 2006 Jan;35(1):8, 10-5.
4. Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014 Jan 1;89(1):27-34.
5. Oikawa Y et al. Lumbar disc degeneration induces persistent groin pain. Spine (Phila Pa 1976). 2012 Jan 15;37(2):114-8. doi: 10.1097/BRS.0b013e318210e6b5.
6. Suarez JC, Ely EE, Mutnal AB, Figueroa NM, Klika AK, Patel PD, Barsoum WK. Comprehensive approach to the evaluation of groin pain.J Am Acad Orthop Surg. 2013 Sep;21(9):558-70. doi: 10.5435/JAAOS-21-09-558.
Shockwave therapy is a non-invasive treatment. The application is simple and easy. Initiate therapy in 3 steps:
Location of the area to be treated
The area to be treated is located using palpation in order to deliver the therapy precisely.
Sufficient amount of gel is applied to the area located in step 1. Use of gel is necessary to transfer the acoustic waves efficiently and smoothly.
The Shockwave applicator is slightly pushed against the area to be treated and the start button is pressed.
Chronic low back pain is the most common and important clinical, social, economic, and public health problem of all chronic disorders. There is a need for improvement to help reduce chronic pain and learn how to manage it. Contemporary pain neuroscience that I use to help persistent chronic low back pain includes
- Identification of central nervous system pain (brain memories of pain) vs actual lower back region pain
- Decreasing chronic inflammation in the body and in the brain itself (Glia cell activation or gliopathy) using laser therapy, extracorporal shockwave therapy and nutrition;
- Improving sleep (poor sleep can increase pain and anxiety);
- Optimize gentle movement therapy to your capacity
My main goals for you include decreasing pain, improvements in coping with pain symptoms, decrease the threatening nature of pain, anxiety, and cognitive speed. I am a specialist in teaching patients how to move again without that “dangerous’ or fear-memory taking over.
If you suffer from chronic low back pain feel free to call for an appointment at 310-444-9393
Solving the Difficult Forward Head Posture Case (Part 2) By Jeffrey Tucker, DC, DACRB
Continuing our discussion from part 1 of this article [March 2018] on assessing more challenging causes of forward head posture, check the pelvis for asymmetrical quadratus lumborum (QL) and lats. The lats connect to the pelvis and the shoulder. Tight lats can cause forward shoulder syndrome and decrease shoulder motion just to keep the pelvis in check. Breathing by using the accessory muscles can cause the QL and other muscles that depress the rib cage to be overactive Continue reading
“Black box” warnings are issued by the FDA when a drug causes life-threatening complications.
The FDA uses this warning when it’s necessary to “call attention to serious or life-threatening risks.” To a layman, it means these drugs are potentially the most harmful of all drugs issued.
Most drugs are slapped with black box warnings after they are already on the market. There are black box warnings on drugs as common as Xanax and Adderall. These are pills prescribed to millions of Americans every year. And the warnings aren’t innocuous. The black box warning for Adderall, for example, states “increased risk of sudden death and cardiovascular events”.
The risks for black box drugs that aren’t as common can be even more extreme. An anticoagulant drug called Xarelto has been tied to severe internal bleeding incidents, and it doesn’t have an antidote! This means that if an unfortunate patient has an internal bleeding incident while taking the drug (even as prescribed), they will likely bleed to death because there is no counter-drug to reverse the effects.
Whether you’re taking a black box drug or not, you probably want to know the best ways to stay safe from such harmful side effects.
The best way, even though it’s a cliché, is to become your own doctor and advocate. Most doctors in the U.S. have very limited time with each patient, which logically infers that they’re less likely to do extensive research on each individual patient’s needs and issues. You should read through all the documentation that comes with prescriptions you’re written, and come with a list of succinct questions to ask your doctor or pharmacist when you have an appointment. It’s also a good idea to do your own research using free resources like PubMed where you can search clinical trials by condition or by treatment.
If, unfortunately, you do have an adverse reaction from the drug (which is possible even when being fully prepared beforehand), make sure to report it on the FDA Medwatch site. This will help the organization determine whether the drug is still safe for consumers. You also have the option of calling the FDA directly at 1-800-FDA-1088 to report the incident.
There is also the option to stay away entirely from black box drugs as much as possible through diet, exercise and lifestyle changes, and given the risks discussed in this article, that may be the prudent thing to aim for.
The key postural distortions associated with Janda’s upper crossed syndrome (UCS) are forward head and rounded shoulders. If I see this distortion on a static posture analysis, I follow up with ROM and movement assessments. I also perform manual muscle tests, glenohumeral joint stability tests and orthopedic tests for shoulder impingement, and neuro tests for neuropathy and/or radiculopathy. Continue reading
North American marijuana sales grew 30% in 2016 to $6.7 billion as the legal market expands in the United States and Canada. A recent report by A Review Market Research indicates North American sales are projected to top $20.2 billion by 2021!! Like it or not, a growing number of states are becoming more and more accepting of this once illicit practice of growing, selling and consuming. Read more of my article Medical Cannabis Part 1
If you’re suffering from a soft tissue ailment or looking for an alternative, holistic approach to pain reduction, and want overall healthy joint aging, EPAT shockwave and laser may be an effective option. Dr. Jeffrey Tucker says “The results from EPAT (shockwave) and laser are promising for acute pain, chronic pain conditions and regenerative medicine.”
Frequently asked questions about EPAT:
Is deep tissue massage similar to EPAT Shockwave? No, EPAT shockwave penetrates much deeper than hands can get. EPAT goes beyond muscles treating the underside of muscles, bones, and joints to work on a deeper level.
EPAT Shock wave sessions usually last thirty minutes! True, they normally take about 20-30 minutes depending on the number of impulses and the number of areas we are intending to apply to a given area.
Some patients describe the EPAT as a ‘Jack hammer’. Why? The overall feeling is a combination of gliding, kneading, percussion, vibration, deep friction massage, and rolling of the soft tissue and joints.
EPAT is often used in combination with other therapies including laser, deep muscle stimulator (DMS) and cupping.
Like most massage, EPAT is traditionally practiced on exposed skin surfaces. You should wear loose, comfortable clothing to ensure the doctor can have skin exposure and be able to move your joints through the full range of motion. During EPAT therapy, ultrasound gel is used on treatment surfaces.
Dr. Tucker’s philosophy treats patients holistically, focusing on physical, mental, nutritional and healthy aging wellness. “I help achieve joint and muscle balance using a blend of modern technology like the Deep Muscle Stimulator (DMS), Laser, EPAT (shock wave) and therapies that have stood the test of time like cupping and transverse friction massage.
“I have every intention of helping patients detect and correct where they may be blocking recovery by mental and physical tension, bad habits, and the poor health they showed up with if that is the case.”