If you suffer from the pain and stiffness of hip arthritis, a steroid shot may seem like a miracle. After all, anything that can give you complete relief from that pain (even if just for a short time) is amazing. However, a new study has found that these injections can cause a domino effect that results in even more serious hip problems. And that can happen very quickly.
Before turning to steroids that can damage bones, let’s give this a second thought. Especially since there are some proven safe and effective treatments for hip pain that won’t prove to be bone damaging!
Dr. Connie Chang, a radiologist at Massachusetts General Hospital, examined patients X-rays after hip steroid injection. She kept finding “rapidly” developing changes, namely bone “death and collapse” occurring several months after such injections.
Dr. Chang arranged a study of close to 250 patients with hip arthritis, some of whom received a steroid shot in their hip and some who didn’t. And as soon as three months later, she was finding “new” occurrences of bone death, eventually affecting up to a quarter of the volunteers who had been given a shot.
Along with that, around 17 percent of those who got a steroid shot suffered from bone collapse in the “head” of their femur bone.
Dr. Chang said that joint and bone changes in those with arthritis usually develop “slowly over time.” That’s been my clinical experience over the years. This is why I talk about your age and current pain levels before getting a cortisone shot. If you are young there is a lot of risk. If you are old but plan on living a long time, let’s talk about this.
The fact is that steroids can cause damage to your bones.
The Mayo Clinic warns that steroids are the most “common cause” of “avascular necrosis” (which is basically the death of bone tissue caused by a lack of blood supply, eventually leading to collapse of the bone) that isn’t caused by bone trauma.
The University of Michigan Medical School and the VA Center in Ann Arbor, Michigan, found that you don’t have to be taking steroids for a long time to suffer some serious side effects.
Even a low dose, such as 20 mg a day or less, can trigger sepsis… triple your risk of a blood clot… and double the chance of breaking a bone.
While steroids can be lifesavers, say, during a bad asthma attack, the truth is that, given the risks they come along with, they’re given out way too haphazardly.
Before you resort to a shot in the hip, why not first give these alternative treatments a try?
• Laser: This treatment uses light therapy and has been proven to reduce inflammation and decrease pain in numerous conditions, including arthritis.
• Shockwave therapy: This has been a remarkable therapy for my patients. It penetrates deep into the tissues to increase circulation and stimulate the breakup of scar tissue and other pain producing substances.
• Exercises: Having a skilled doctor that can guide you through stretches and exercises can help keep your hips moving smoother.
• Natural anti-inflammatories: Taking a daily supplement of omega fatty acids that contain DHA and EPA made by Metagenics (offered to our patients) is well known to reduce swelling, pain, and inflammation.
“Steroid injections for arthritic hips: More trouble than they’re worth?” Robert Preidt, November 29, 2017, U.S. News & World Report, usnews.com
What I do as a practitioner is provide the kind of care I want for myself and my family. My practice style is interactive, meaning we make decisions together, co-decide treatment options for pain relief, and I will help you achieve new range of motion. If you need weight loss I have very successful practical plans, and if you want to improve your fitness I can help guide you along. I’m formally trained in pain reduction strategies, flexibility and mobility training, weight loss, strength training, cardio and all its many forms, nutritional supplements, diets, and stress reduction. I have studied all of these concepts for 35 years. The things I continue to do and use are methods I know have worked for other people. I have stayed at the top of my game by staying in active practice, I’ve continued learning, I am an instructor to other Doctors around the world, I enjoy writing, sharing, and I continue to learn my craft.
I have been challenged by difficult patients with chronic pain, over-achievers with lots of stress, and patients with crazy character. I’ve learned and tried many different techniques, studied with masters and put together my own processes based on what works. For example if you ask me “What’s a good exercise?” I will say ‘One the patient does’ – I teach the ones I know patients do because I live it every day. As I have gotten older I have become more direct, a no nonsense style, and I have applied ‘healthy aging’ knowledge to myself and my patients. I am more serious about helping people regain lost range of motion in the neck, shoulders and back and then it is up to you to never lose it. That is my ‘healthy aging’ program for patients.
A session with me starts with getting to know you. Then we make a plan or program. Maybe you will need to schedule twice a week, once a week, once every two weeks. I don’t know that answer until we meet. I will teach you what you can do at home on your own. The truth is that what we do in the office is 10-20% of your change, the other 80-90% is what you do at home. Please call my West Los Angeles office 310-444-9393 for an appointment.
Stem cell therapy for osteoarthritis is gaining in popularity by practitioners but are the patients who get these injections seeing the results? My answer based on my patient population is about 50-50. Meaning about 50% of those getting injections note some improvement and the others don’t notice any change in pain relief from the injections. Stem cell injections are expensive and risky. However, I have recommended several patients try stem cell injections, but honestly I am still on the fence regarding these injections. I am ‘all-in’ on the concepts of regenerative medicine and I definitely see this as the future for osteoarthritis.
For years my ‘non-invasive’ approach to the treatment of osteoarthritis is using laser (TheraLase, LightForce), PiezoWave (Acoustic waves therapy), EnPuls (shock wave therapy), LymphaTouch lymphatic therapy, SCENAR (Russian therapy), localized vibration and percussion devices (Deep Muscle Stimulator, Rapid Release Therapy), nutrition, supplements, diet and gentle movement exercise for achieving similar results to the stem cell regenerative medicine concepts.
- Certain supplements, shockwave therapy and exercise have a high chondrogenic capability (the ability to make cartilage) without the risks of injections.
- The non-invasive approach is a safe treatment strategy.
- Laser for treatment of osteoarthritis patients has no side effects.
- Laser by itself, EnPuls by itself, help the cells undergo high rates of proliferation.
- PiezoWave by itself decreases pain and increases circulation.
- LymphaTouch has immunosuppressive actions because it stimulates the lymphatic system.
- All of the above (laser, shockwave, supplements and exercise) modalities can produce anti-inflammatory effects, and pro-regenerative properties.
My take home message to you is that it’s important to pick the right therapy for you and we can discuss the benefits of stem cell injections versus the natural anti-inflammatory and pro-regenerative devices at the same time.
1 Kopka M, Bradley JP. The Use of Biologic Agents in Athletes with Knee Injuries. J Knee Surg. 2016 May 20. [Epub ahead of print]
2 Filardo G, Perdisa F, Roffi A, Marcacci M, Kon E. Stem cells in articular cartilage regeneration. Journal of Orthopaedic Surgery and Research. 2016;11:42. doi:10.1186/s13018-016-0378-x.
3 Yang X, Zhu TY, Wen LC, Cao YP1, Liu C, Cui YP, Meng ZC, Liu H. Intraarticular Injection of Allogenic Mesenchymal Stem Cells has a Protective Role for the Osteoarthritis. Chin Med J (Engl). 2015 20th Sep;128(18):2516-2523. doi: 10.4103/0366-6999.164981.
- Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update.Open Access Journal of Sports Medicine. 2016;7:21-32. doi:10.2147/OAJSM.S72332.
5 Shapiro SA, Kazmerchak SE, Heckman MG, Zubair AC, O’Connor MI, A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis. Am J Sports Med. 2017 Jan;45(1):82-90. doi: 10.1177/0363546516662455. Epub 2016 Sep 30.
6 Burke J, Hunter M, Kolhe R, Isales C, Hamrick M, Fulzele S. Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis. Clinical and Translational Medicine. 2016;5:27. doi:10.1186/s40169-016-0112-7. 2
The answer is pretty simple: oxidize fat. That means lose fat via some combination of an effective diet and exercise. Stay low carb, be consistent and be disciplined. Everyone is talking about the ketogenic diet. Ketones are a byproduct of fat oxidation. Ketones are an effect, NOT a cause. My office uses a protocol, it’s a rational way to eat that’s the ultimate cause of your fat loss. Ketones are an effect of this fat loss—they are merely the evidence along the way that you’re indeed losing body fat. Technically, any diet that produces significant and sustained fat loss is a ketogenic diet.
Our fat lose program is very hands-on, we provide weekly coaching, weight and body composition analysis, advice, products to produce ketones from dietary fat and supplements. This is the most sensible diet approach I have seen for fat loss.
By the way, when people put in the effort required to actually oxidize body fat by means of a sensible diet that accounts for energy in and out, it works! They lose fat.
Warm ups are used prior to training and competition by athletes from all sports. But, can a warm up actually improve performance?
Dr. Jeffrey Tucker, a sports medicine chiropractor in Brentwood, CA teaches his patients that a proper dynamic warm up can increase endurance performance. In one study that pertains to cyclist performances, eight well trained road cyclists were used and they performed time trials after the following warm ups. These warm ups were performed in a random order.
* No warm up (control)
* Easy warm up – This involved a 15 minute warm up, made up of three 5 minute segments at power outputs of 70, 80 and 90% of ventilatory threshold followed by 2 minutes rest.
(Ventilatory threshold is the point during incremental exercise where lactate begins to build up in the bloodstream marked by a rapid increase in breathing rate).
* Hard warm-up – This involved the same three 5 minute segments, plus 3 minutes at the respiratory threshold followed by 6 minutes rest.
(Respiratory threshold is a higher intensity of exercise marked by the onset of hyperventilation).
Oxygen uptake, power output and the contributions of the aerobic and anaerobic energy systems to the 3k time trial effort were measured throughout each test. Key results were as follows:
* 3k time trial performance was improved after both easy (266.8 seconds) and hard (267.3 seconds) warm ups, compared with 274.4 seconds after no warm up.
* The gain in performance after both active warm up conditions was mostly during the first 1,000m, reflecting higher early power outputs than after no warm up.
* Oxygen uptake was significantly greater after the active warm ups than after no warm up;
* There were no differences in anaerobic power output during the trials, but aerobic power output during the first 1,000m was larger after the active warm ups than after no warm up.
The authors concluded that the pre exercise warm up led to a significant performance enhancement of about 2-3%, which seems to be associated with boosted aerobic efficiency especially in the early stages of a race.
Med Sci Sports Exerc 2005; vol 37, no 9, 1608-1614
These are the types of studies we use to help patients make decisions about training and workouts.
Both Active Release Technique and Deep Muscle Stimulator (DMS) are a deep tissue therapeutic technique used to reduce adhesions in soft tissue, thereby reducing pain, increasing range of motion, and significantly decreasing recovery time from athletic injuries. Both have been taught to thousands of providers worldwide, including medical doctors, chiropractors, athletic trainers, and physical therapists. Both are utilized by athletes at the highest level of competition, from the NFL to the NBA and even to the US Olympic Committee. Dr. Tucker prefers DMS treatments for his patients because “We can provide similar results with the DMS at half the cost of an ART session”. Compare them both and then decide for yourself.
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.
- The new and exciting non-invasive alternative treatment to risky cortisone injections for elbow pain and instability is PiezoWave acoustic shockwave therapy.
- Tennis Elbow which is also known as lateral epicondylitis is a term for elbow tendonitis, or an inflammation, soreness, or pain on the outside (lateral) part of the upper arm near the elbow. It is usually caused by a partial tear in the tendon fibers, which connect muscle to the bone. Symptoms include elbow pain that gradually worsens and radiates outside of the elbow to the forearm and to the back of the hand. “Tennis Elbow” is more of a term – it does not just happen from playing tennis. This painful condition can result from repetitive use or overuse of the forearm muscles and tendons.
- The ‘usual’ conventional treatment has been rest, ice, compression wraps (braces) and medication for pain relief. When that doesn’t work a cortisone shot or expensive PRP or stem cell injections are recommended.
- Before expensive and risky injections, patients can now try PiezoWave acoustic shockwave therapy. This therapy stimulates blood flow and repair of the injured elbow.
- PiezoWave acoustic therapy offers a new option for the treatment of lateral epicondylitis. In comparison to risky medications, PRP, stem cell, and cortisone injections, PiezoWave treatment is a safe and effective option to reduce elbow pain and repair the elbow tendons.
In the May 9, 2017 issue of the Journal of the AMA – an article titled “Introducing Genomics and Percision Health” was published. In this editorial, author W. Gregory Feero states: “To leverage advances in precision health, nongeneticist physicians must gain an adequate understanding of emerging technologies.” Why? Because of the shift in medicine “from an endeavor in which care for individual patients is driven by trial and error informed by studies designed to measure population outcomes to one in which care is selected based on a deep understanding of health and disease attributes unique to each individual.”
This sentence summarizes how I feel. “In the not-too-distant future, the coupling of sound science with an in-depth understanding of an individual’s characteristics, environmental exposures, and behaviors to achieve good health will probably simply be called quality care.”
This is what is happening – the convergence of genomics, social media, big data, biometrics, and systems biology with Functional Medicine and P4 Medicine (Predictive, Preventive, Personalized, and Participatory, as defined by Dr. Lee Hood).
Dr. Jeffrey Tucker, a Los Angeles Chiropractor “I have been a part of the new, health-focused medicine and chiropractic care for many years. My goal is to deliver precision, personalized lifestyle health care”.
With healthy circulation, oxygen and nutrient-rich blood gets to the cells that have been damaged from a sports injury, car accident, or repetitive strain in the gym. The new TheraLase Laser provides treatment to increase Nitric Oxide which acts as a signaling molecule that sends an alert to your blood vessels to open up and get your blood moving. This allows for more blood to run through the arteries and nourish damaged cells. If there is a deficiency in Nitric Oxide, the signal to your arteries decreases and they tend to become less flexible, narrow, and even clog. Nitric Oxide is also shown to help reduce plaque and platelets from sticking to the inside of your blood vessels, so that blood flow doesn’t get blocked. This is very important in the process of healing tissue to help relieve pain. When Nitric Oxide is abundantly produced, your circulation improves. This allows for more oxygen and nutrients to get to the tissues and cells that need repair.
As we age Nitric Oxide production declines. This helps explain why it takes older individuals to sometimes take longer to heal. TheraLase Laser therapy helps boost Nitric Oxide. TheraLase laser treatment enhances the release of Nitric Oxide from the lining of arteries, causing them to dilate (relaxes blood vessels) and helps to make sure blood gets where it needs to support the repair process. As a result, TheraLase laser helps to promote the healing of damaged arteries, veins, nerves and increase ATP energy levels.
If you want pain relief from a chronic or acute musculoskeletal condition, I can use TheraLase Laser to improve the circulation in and out of the damaged tissue. TheraLase Laser therapy is cutting edge technology that addresses Nitric Oxide deficiency, and relaxes the muscles of the blood vessels to help injured cells and promote tissue healing. As a doctor, I can tell you that anything that helps improve circulation is going to benefit the healing process.
Nitric Oxide: A Physiologic Messenger, Charles J. Lowenstein, MD. Basic Science Review, 1994 American College of Physicians p 229
Nitric Oxide and geriatrics: implications in diagnostics and treatment of the elderly, Ashley Torregossa. Journal of Geriatric Cardiology (2011) 8 230-242