All posts in Arthritis

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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Disc Pain: Non-invasive therapy

Does shockwave therapy such as EnPuls and PiezoWave stimulate stem cells in inhibiting disc degeneration and disc herniation? The research and my clinical experience suggest the answer is ‘Yes’. Stem cells can be injected into the area of local damage but this is invasive and costly. We are using EnPuls and PiezoWave pulse therapy and laser (all non-invasive) to stimulate stem cells to interact with the local stem cells and immune system cells to achieve successful disc pain relief and tissue regeneration.

 

The current theory is that the combination of these non-invasive deep tissue treatments stimulates stem cells that are able to bring more oxygen to the damaged disc and accelerate healing by reversing the low-oxygen (degenerative or dying) environment in the spine. Also inflammation comes in many forms. To keep it simple one type is healing and another type is non-healing inflammation. Research supports stem cells are able to reduce or prevent herniation by suppressing the non-healing inflammation.

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Stem Cell Therapy Alternatives

Here’s what we think is happening when a shock wave and laser treatment is applied to a damaged joint causing you (in your joints):

  • Stem cell stimulation occurs which sends signals to the local stem cells and other growth factors to regroup and begin repairing damaged joints.
  • Mesenchymal stem cell (MSCs – connective tissue stem cells) suppress inflammatory T–cell proliferation and provide anti-inflammatory effects. Applying these (Piezo Wave, EnPuls, TheraLase, Light Force) treatment modalities inhibits damaging chronic inflammation.
  • Mesenchymal stem cells express various growth factors – these are active molecules that stimulate local tissue repair. These growth factors, and the direct cell to cell contact between MSCs and chondrocytes (the present remaining cartilage cells in the joint), have been observed to influence chondrogenic differentiation and cartilage matrix formation – in simple terms – stem cells regenerated cartilage.

Can shock wave repair disc lesions and other degenerated joints? We are seeing clinical outcomes that suggest it does. Do I think you should try this before more expensive and risky injections of stem cells? The answer is Yes!

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Pain Relief in Brentwood

I use two different types of shock wave devices for pain relief in my practice. One is a radial pulse wave (EnPuls) and the other is an acoustic wave (PiezoWave). Both carry energy that can be targeted and focused noninvasively to affect a selected region like the shoulder, hip or foot. When these devices are applied to the soft tissues, the impulses or shock waves interact with the targeted tissues and induce a cascade of biological reactions. This results in the release of growth factors, which in turn triggers new blood vessel formation (neovascularization) of the tissue with subsequent improvement of the blood supply and oxygen to the tissues. This helps healing.
Another effect of shock wave therapy is related to the stimulation of cell proliferation, tissue regeneration, and a process through which new blood vessels form from pre-existing vessels called angiogenesis.

The therapeutic effects of shock wave therapy can be used on patients who need pain relief and reduction of inflammation even in cases with diabetes, nerve pain, soft tissue injury, arthritic joint irritation, and healing of bone (2013, Qiu et al; 2013 Liu; 2013 Siegfried).

My practice is located in Brentwood, CA. I can be reached at 310-444-9393.

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Arthritis Relief Chiropractor

Can fish oils help my arthritis?
Health benefits of using Omega 3 fish oils include lowering your risk of heart disease, blood vessel disease, lowering triglycerides, and “thinning” the blood (reducing the risk of clots). It may improve brain development, concentration, learning ability and behavior in children as well as enhancing brain function in adults (60% of the brain is fat and half of that is DHA). I do find it helpful for my arthritic patients (see dose below). Along with recommending supplements for arthritis I use lasers directly over painful joints. These offer a deep heat sensation and helps relieve pain in arthritic joints.

Do tinned and smoked fish count?
Regarding eating fish, I would say that ALL fish is good for you. It is a very lean source of protein. It’s normally the way that fish is cooked that detracts from its goodness – think battered and fried (Not good). Oily fish such as fresh salmon, herring, mackerel, and sardines contains the ‘healthy’, or polyunsaturated, fats that we are advised to eat more of. These types of fish are high in Omega 3 which is called an essential polyunsaturated fatty acid – it is ‘essential’ because our bodies cannot make it so we need to consume it through our diets.
If a product’s been tinned or smoked it will have fewer micronutrients (vitamins and minerals) than the fresh version, however it will still be a good source of protein, low in fat and contain a certain amount of vitamins and minerals. The fish to really avoid are the ones that have been battered, breaded or already have cheesy or creamy sauces on them. Also, fish to eat the least often are deep sea fish (especially large fish) such as shark, marlin, tuna and swordfish. These may contain particularly high levels of mercury. These fish should be avoided by pregnant women and children under 16 years old. Mercury is potentially harmful for children and it can harm fetuses.

How Much Fish Oil Do I Need?
It is recommended that adults and children over 12 years old eat 2 portions of oily fish per week – a portion is 140g cooked fish and it will contain approximately 450mg of Omega 3’s. I typically recommend that clients take supplements of 3 grams of Omega 3 fish oils each day (order at www.DrJeffreyTucker.meta-ehealth.com)(try EPA-DHA 720 or SPM Active). If a client has acute or chronic pain I may recommend even higher doses.

There are some vegetarian sources of omega-3’s like walnuts, flaxseed (linseed) oil, canola oil, soybean oil, etc., all of these are short chain polyunsaturated acids which must be converted by the body into longer chain PUFAs to be useful. Since fish oil already contains long chain PUFAs, it’s the best dietary source. For vegetarians I recommend Biotics Mixed EFA’s.

When taking fish oil supplements, it is generally a good idea to take vitamin E (3 mg for every 1 gram of fish oil) to protect against oxidation. Omega-3s are polyunsaturated fatty acids and Vitamin E counteracts free-radical formation from unsaturated oils.

 

 

 

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Knee Osteoarthritis Treatment

In the January 2017 edition of the American Journal of Sports Medicine, doctors at the Mayo Clinic have released a new study on the effectiveness of bone marrow derived stem cells for knee osteoarthritis in the active patient. In this prospective, single-blind, placebo-controlled trial, 25 patients with pain in both knees from osteoarthritis were randomized to receive bone marrow derived stem cells into one knee and saline placebo into the other.

In my office we use non-painful laser, EnPuls therapy, and non-invasive PiezoWave therapy instead of painful bone marrow aspiration for knee osteoarthritis. Laser, EnPuls and PiezoWave don’t use injections. Laser feels soothing and provides deep warmth into the tissues.

Laser, EnPuls and PiezoWave are safe to use and reliable alternatives to expensive stem cell injections. If you have arthritic knee pain, don’t ignore the problem or try to fight through the pain. You don’t have to live with ongoing functional limitations and pain.

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Stem Cell Therapy Without Shots?

I have written many articles on laser and shock wave therapy and how these modalities can improve degenerative disease especially of the spine, hips, knees and shoulders.

 

Similar to what stem cell injections are claiming to do in the spine or joints, shock wave therapy and laser therapy also effect cells that turn up communication with the immune system and begin exchanging new cellular messages. The result of a stem cell shot is still expensive and risky whereas a shock wave session or laser session is non-invasive and safe. Both tell the immune cells to mobilize healing factors to the site of damage.

 

Let’s use the research to understand how these therapies work:

When stem cells get injected into a diseased joint (ex. spine, knee) the stem cells have the ability to change/morph into other cell types and multiply. They also signal the native stem cells and other growth factors to regroup and begin repairing damaged joints. Without an injection, I use shock wave therapy and laser to stimulate growth factors and inhibit molecules that have a role in inflammation.

Mesenchymal stem cell MSCs (connective tissue stem cells) suppress inflammatory T–cell proliferation and provide an anti-inflammatory effect. The treatment inhibits damaging chronic inflammation.1

 

If you have a bulging disc in the spine, research in the medical journal Stem cells translational medicine 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. This means we can use stem cell recruitment to inhibit disc degeneration and disc herniation by way of the complex interplay between stem cells and immune system cells in achieving successful disc tissue regeneration.

 

Using non-invasive therapy and exercise the goal is to regenerate the outer tissue of the disc and contain and lessen the inflammation around the bulge. TheraLase will bring more oxygen to the damaged disc and accelerate healing by reversing the low-oxygen (degenerative or dying) environments in the spine. Everything heals with more oxygen.

 

Stem cell activation is able to reduce or prevent herniation by suppressing the non-healing inflammation.2 The take home message is that non-invasive EnPuls radial shock wave therapy, PiezoWave acoustic therapy, and TheraLase laser combined with exercise and diet have unique healing capabilities. Is this treatment right for you? Contact me at my office 310-444-9393.

 

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

2 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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Knee arthritis pain! Massage, Laser, Chondroitin?

Along with the hundreds of thousands in the U.S. who have total knee replacement surgery done every year, many more are held hostage by drugs — from risky OTC meds to terribly dangerous Rx ones — that they have to take daily, just to be able to function.

A study published in the BMJ (May 2017) discusses the benefits of the supplement chondroitin for painful knee joints. Chondroitin is typically derived from animal or fish cartilage and was found to be just as powerful as one of the most widely prescribed Rx drugs for arthritis.

Do you need glucosamine and chondroitin? If you have pain from knee arthritis, chondroitin may be the better choice. The researchers put chondroitin to a head-to-head test with one of the most commonly used Rx meds for the condition, Celebrex which is the only “COX-2 inhibitor” left on the pharmacy shelves (Vioxx and Bextra were taken off the market after untold numbers of patients suffered heart attacks and strokes after taking them).

Chondroitin is extremely safe, and was just as good as Celebrex at stopping pain and improving joint function. The study and experience with patients demonstrates that Celebrex kicks in faster, the improvements from taking 800 mg of chondroitin daily were just as effective after several weeks. And it continued to be as good as Celebrex right through to the end of the entire study.

Chondroitin should be offered to patients with knee arthritis as a first-line treatment.

There are, however, certain circumstances in which chondroitin supplements should be avoided. One is if you have an allergy to shellfish, especially shrimp, as many are derived from fish cartilage. Another is if you have prostate cancer, as some research has found that it may help prostate-cancer cells to spread.

And that’s where glucosamine can be taken instead. Glucosamine, which can also be made from shellfish (so check labels carefully if you’re allergic), has been the subject of numerous studies and found to be extremely effective for the pain and stiffness of arthritis.

While these two are most often found as a team in supplements, since they work even better together, you should still be able to find either glucosamine or chondroitin by themselves.

I use Laser therapy, massage and offer supplements for arthritis pain relief. This is the best non-drug, non-risky combination therapy for knee arthritis available. Call the office at 310-444-9393 to schedule an appointment.

Sources:
“Chondroitin sulfate as good as widely used anti-inflammatory for knee osteoarthritis” BMJ, May 23, 2017.

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Chiropractic & Inflammation

Dr. Tucker uses natural ways to fight back against inflammation without resorting to risky meds.
For example:

  • Research continues to support a Mediterranean-style diet that can help improve the “quality of life” for arthritis patients. That includes cutting down on red meat, eating more servings of fish and veggies, adding a variety of nuts to your diet and using olive oil almost exclusively in your cooking and meals. Dr. Tucker can also recommend specific vitamins for you to take to help decrease inflammation.
  • Laser therapy — Dr. Tucker has two types of laser treatments to offer for pain relief! This method of treatment is safe and especially useful for inflammation in the neck, shoulders, hips and spine.
  • While exercise may be the last thing you probably feel like doing with an ‘inflammation’ condition, being more active, even small increases in movement have been found to help. One study that looked at over 1,600 adults with arthritis found that just 45 minutes of moderate activity a week was enough to significantly improve their ability to function. Swimming is said to be one of the best exercises you can do, even when you’re having an arthritic flare. Call 310-444-9393 to schedule an appointment.
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Massage vs Laser Relief for Low Back Pain

Chronic low back pain is the most common musculoskeletal condition. The traditional treatments for acute or chronic low back pain have been surgery or narcotics, but the opioids epidemic has many doctors nervous about prescribing drugs like hydrocodone or oxycodone. Surgery hasn’t always worked and has its own risks. Are there other strategies for dealing with chronic low back pain? TheraLase laser is an effective non-invasive approach to helping you become pain free.

Have you ever suffered from back pain? It is estimated that 80% of Americans experience low back pain sometime during their life time. It can be triggered by poor posture or lifting something heavy. It can occur when a bulging disc presses on a nerve in the spine. Hopefully the back pain will go away. It’s one thing to have temporary back pain but another to suffer from a back injury that leaves you in chronic pain. Millions of Americans go through unrelenting and debilitating back pain after an accident or injury.

Chronic pain makes people irritable, touchy, tired, and it even alienates people socially. It can make it difficult to be around other people. They don’t want to see you suffering, anxious, and become depressed or feeling hopeless.

I use Theralase laser as a treatment approach offered to chronic low back sufferers who once felt desperate and helpless. Theralase laser helps to achieve beneficial therapeutic outcomes including the alleviation of pain, inflammation, and promotion of tissue regeneration. Chronic back pain doesn’t mean having surgery until you have tried TheraLase.

Call 310-444-9393 for an appointment

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