What do you do if you have continued pain after ROTATOR CUFF SURGERY
Continued shoulder pain even after a surgery for tears does happen. When complaints persist and have become an unresolved shoulder pain, I am called upon to help patients make decisions what to do next. Helping patients learn about the available treatment options and understand their choices is a discussion that needs to take place. When I discuss Rotator cuff surgery I refer to Lädermann A, et al. from the University Hospitals of Geneva. They state that “Tear recurrence can be related to various factors such as:
(1) Inadequate strength of the initial repair construct
(2) Biological failure to heal despite strong initial fixation (hardware and suture) and
(3) inappropriate postoperative rehabilitation causing structural failure of the repair” (1).
We always hope for good outcomes after a surgery but “The results of (rotator cuff) treatment are not as predictable as the patient (family, trainer, coach and doctor) would like to think” says Nickolas G et al. in the Physical Medicine and Rehabilitation Clinics of North America journal.
I talk to patients about the concept of cellular communication and how there could be a breakdown in the local tissue area and even the brain to stimulate proper healing. We have learned that certain therapies such as stem cell injections, shockwave, and laser can seem to jump start a non-healing area within a damaged shoulder or knee joint. The current thinking is that these therapies change the joint environment from non-healing (diseased) to healing by signaling the local native resident healing cells to get ready to rebuild.
How, can I as a Chiropractor change the joint environment from not healing to healing and working better?
By inducing gentle non-painful motion into a poorly functioning joint.
By re-awakening stem cells to change (plasticity) and activate (multipotency – the ability to change/morph into other cell types and multiply). I use shockwave to do this.
Get the surrounding healthy cells to send signals to suppress inflammatory T–cell proliferation (inflammation) and provide an anti-inflammatory effect. I use laser to do this.
Maybe the above 3 points help activate stem cells to express various growth factors – it takes a lot of reawakening of molecules to stimulate local tissue repair. I like the concept of getting cells to communicate directly cell to cell (even to the resident remaining cartilage cells) in the joint. Seol et al did a study to show that stem cell activation regenerated cartilage in knees, why not the shoulders! (3)
Lädermann A, Denard PJ, Burkhart SS. Management of failed rotator cuff repair: a systematic review. Journal of Isakos. 2016;1(1):32-37. doi:10.1136/jisakos-2015-000027.
Nickolas G. Garbis, Edward G. McFarland. Understanding and Evaluating Shoulder Pain in the Throwing Athlete. Physical Medicine and Rehabilitation Clinics of North America, 2014; 25 (4): 735 DOI:10.1016/j.pmr.2014.06.009
Seol D, Zhou C, et al. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
Worn discreetly underneath clothing, Unloader Hip gives light compression to the hip and the brace’s rotation control strap rotates the thigh bone to take load off the affected part of the hip joint. With its unique approach, Unloader Hip is an ideal solution for everyday adventures such as shopping, biking and keeping up with the kids.
Before deciding to pick a doctor, I want you to know this about me. My practice is about working together with my patients. I strive to give you what you want: a proper diagnosis that you understand; current and up to date treatment options; appropriate care with recommendations for things you can do at home on your own; make it all convenient and empower you to help you overcome what brings you to see me in the first place. I stay in the forefront of using science and technology.
Dr. Jeffrey Tucker
President of the American Chiropractic Association Rehabilitation Council
Can you stop the pain of diabetic peripheral neuropathy? It is worth doing a trial of laser and vitamin B12. Both are safe and effective treatments.
B12 supplements are known as one of the easiest and safest ways to help relieve this problem – could utilizing laser coupled with supplements increase the results?
Julie Waldfogel, a Johns Hopkins doctor of pharmacy, authored a paper specifically referring to those diabetics who suffer from the excruciating shooting and burning pain of peripheral neuropathy – here’s what we know: The common drugs prescribed for neuropathy come with some serious side effects.
Duloxetene (better known as Cymbalta) also used to treat fibromyalgia, can cause difficulty breathing, swelling of your face, lips, tongue, or throat, anxiety and panic attacks, depression and suicidal thoughts.
Pregabalin, which goes under the brand name Lyrica and is already prescribed for nerve pain from shingles and diabetes, can cause things such as agitation, aggression, and “dangerous impulses.” As if that wasn’t enough, some of the more common side effects are dizziness, blurry vision, weight gain, and swelling of your hands and feet. It has also been linked to the development of blood vessel tumors.
Duloxetene and venlafaxine are said to potentially increase serotonin levels in the blood — something that can be life-threatening.
On the good side, Vitamin B12 is non-toxic, and has been proven to be effective in helping diabetics with this kind of nerve pain. Doctors learn in medical school that a classic symptom of a B12 deficiency is peripheral neuropathy! And guess what has been found to be “unequivocally demonstrated as the prime factor” linked to a B12 deficiency? None other than the popular diabetes medication called metformin.
A study done at Bethesda Diabetes Research Center in the Netherlands, found using metformin could increase the risk of a B12 deficiency by 19 percent. On top of that, around 25 percent of people in the U.S. are deficient in B12, whether they’re diabetic or not.
Another group of drugs draining your B12 are the acid-suppressing meds called proton pump inhibitors (PPI) like Nexium and Prilosec. So, if you have neuropathy please get your B12 levels checked and make sure you don’t have B12 deficiency. If you’ve been on metformin for any length of time, or have been taking one of those PPI drugs, it makes perfect sense to have your B12 levels checked.
And since we know there is plenty of research that laser helps peripheral neuropathy, do a trial of the TheraLase class 3B laser on the feet, legs and lower lumbar spine. It makes sense to take a B12 supplement and try the TheraLase laser!
The combination of laser and shockwave dampens inflammation that causes pain. Dr. Tucker uses current research that confirms the medical merit of these modalities to enhance treatment results, accelerate healing, repair and rebuild tendons, muscles, and ligaments.
Laser activates an anti-inflammatory pathway and shockwave signals cells to promote healing. “We are the only office that has two types of lasers and three different types of shockwave devices – combining these modalities with soft tissue therapy provides the ‘entourage’ effect.” Laser is light therapy and shockwave is stimulating cell therapy. These are efficient treatments to reduce pain, reduce inflammation, and promote healing. We are tapping into neurotransmitters found in nerve fibers, mitochondria, and cell membranes that cover the walls of cells.
These treatments are non-invasive – that means no shots or needles. The combination of laser and shockwave activates anti-inflammatory pathways and provides the signals (messages) that mediate a response transmitted to the damaged area via nerve functions of healing cells. Laser and shockwave can be used with other physical therapy treatments or as a first line of therapy for a vast range of musculoskeletal injuries including, plantar fasciitis, shoulder and hip tendon injuries, scar tissue formation, disc and joint pain. Call 310-444-9393 for an appointment to experience shockwave and laser.
Dr. Tucker is the first Chiropractor to use virtual reality (VR) in a private practice setting. This demonstrates his willingness to embrace new technology and constantly look for new pain relief strategies. VR offers an immersive, realistic, three-dimensional experience that patients describe as pleasant and capable of reducing pain and anxiety. VR is feasible, tolerated, and well-liked by patients, especially for breathing exercises and relaxation.
Dr. Tucker is a Los Angeles based Chiropractor who sees this emerging technology for his patients in acute and chronic pain. Use of VR has been researched in Cedars Sinai Hospital Los Angeles and has been shown to help reduce pain and is a controlled distraction. VR is an effective and safe therapy for pain management. Call 310-444-9393 to make an appointment and find out if VR can help your care.
Dr. Tucker is the first Chiropractor in the Country to use Virtual Reality (VR) as a therapeutic experience for his patients. VR offers relaxation experiences that are effective for reducing pain and anxiety. He incorporates this technology for breathing exercises, muscle tension, and general stress and fatigue. The in office approach provides visual cues that keep patients highly engaged in the virtual world for pain management. VR can be used for acute and chronic pain patients. Come and try the VR experience for managing your pain. Call 310-444-9393 for an appointment.
Serious athletes come in to my office with complaints of back pain and/or hip pain. Their medical doctors have recommended steroids and/or cortisone injections, but these patients want to try something else before risky shots or pills. These patients are savvy, they think long term recovery. They want what the pro-athletes get! They usually already had the MRI, and they have tried to work it through on their own. They want my advice because they heard I take the time to help them figure out the cause of the pain. The question I need to figure out “Is your movement pattern irritating a disc problem, ligaments, or the muscle system?” Then we figure out the best treatment plan together.
Patients are hearing about Platelet-Rich Plasma Therapy (PRP), stem-cell regeneration therapy, shockwave therapy, laser, Deep Muscle Stimulator, and other “locker room” treatments for the pro’s. I organized my office so the average person can get what the pro’s get. I use 3 types of shockwave or pulse therapy, and 2 types of laser that create effective treatments for disc injuries, muscle pain, and spinal ligament instability.
Shockwave therapy, laser therapy and the proper movement therapy stimulates the regeneration of the discs. ligaments and muscles directly. Yes, decreased disc height can be changed and scar tissue can be broken up. As with any treatment, the earlier and sooner the treatment intervention begins the better the outcome.
I constantly look for research that helps recovery in sports injuries and therapies that offer effective therapeutic results.
If you want to try therapies that the top pro athletes are getting to alleviate back pain and hip pain call my office at 310-444-9393.
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.