All posts in Chronic Pain

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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Shock wave

Is Shock Wave Therapy Right For You?

My treatment goal is to help you relieve pain as fast as possible. My bigger goal is to help you slow the aging process of muscles, tendons and joints and change the internal environment of the joints from a degenerative condition to a healing condition.

When EnPuls (radial shockwave) therapy or PiezoWave (acoustic waves) is applied to the spine or joints it interacts with the skin, the fascia, the muscles, the blood vessels, nerves, and lymph to cause a mild controlled trauma that will restart the inflammatory and healing cycle. Part of that cycle is stem cell stimulation – the immune cells become ‘re-stimulated’ or ‘re-awakened’ to the site of damage. This will begin or restart the repair process needed.

These newer technologies called ‘shock wave’ are helping the body to re-start the healing cycle, especially if you have had a poor quality of healing take place. Poor quality of healing is probably felt as pain or stiffness in the area of a trauma or where there has been repetitive trauma even after a sufficient amount of time has passed by.

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Post-surgical pain

A large part of my practice is made up of post-surgical pain patients. Chronic low grade pain seems to be common in about 1/3 of joint replacement patients and also in patients with scar tissue formation from surgical incisions. Scar tissue or fibrosis is an often overlooked cause of chronic pain and receives little attention from medical institutes.

Chiropractic and physical therapy modalities like cross-friction soft tissue release, laser treatments, and shockwave therapy are the safest interventions to change the chronic pain cycle. The goal is to restore normal motion and decrease pain with movement.

Unfortunately most doctors do not know how to address post-surgical pain without using drug therapy. Doctors lack the knowledge, hands on skills, and time to provide this intervention. If you have post-surgical pain or pain related to an epidural injection, I would like to hear your story and figure out a safe and non-invasive way out of the pain.

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Cartilage Pain Treatment

Cartilage is the soft padding that keeps your bones from grinding against each other.

When you’re young, the cartilage between your bones is moist and thick…but as you get older, that soft padding can start to get dry, wear thin or tear. Knee cartilage is meant to be smooth so you can walk, run, and even jump. If you have muscle imbalances this can cause excessive and uneven wear and tear in the joint cartilage.

Over time, friction may develop in the joint and you feel inflammation, burning, discomfort, and pain.

Cartilage pain relief – Patients ask me “Can I regrow and rebuild my joints?” The answer is yes!

I see this happen in patients who get laser and shock wave or pulse wave therapy. You can also make your joints fluid and flexible by decreasing inflammation by losing extra fat if you are overweight. I also recommend water-based “lubrication” supplements that help keep your joints soft and moist. If you need certain exercises I will teach you those.

These new technologies (laser and shock wave) are non-invasive without the pain and risk of costly surgeries or addictive drugs.

Some patients start to feel relief within the first 12-24 hours.

I used this very same procedure of laser and shockwave to help rebuild my knee when I had a meniscus tear years ago. I remember when the radiologist said “You need to go see an orthopedic surgeon”. After seeing the ortho surgeon I decided to use my own machines and it helped me avoid surgery and years of endless pain… and I think it could help you, too.

Laser and Shockwave is the Missing Technology that
Lets Your Body Build MORE Cartilage and Repair Tendons

Call 410-444-9393 for an appointment

We are the only office in West Los Angeles with two types of laser and two types of shock wave devices

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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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Tendinopathy Pain Treatment

Chiropractic care or medication/shots?

Bone marrow stem cell injections vs non-surgical, non-invasive therapy?

DC’s, PT’s and MD’s know that chronic tendon pain is a challenge to treat. Chiropractors and Physical therapists use non-invasive procedures while medical doctors use cortisone shots and now some are using stem cell therapy injections. Research by doctors at the National University of Singapore suggest that bone-marrow derived stem cells accelerate tendon healing.1 Resolving ongoing inflammation is the key to management of these cases.

This is why the great excitement in stem cell therapy, it has the potential to reduce inflammation. BUT, so does TheraLase laser therapy and the use of PiezoWave and EnPuls. These are non-invasive therapies that the general public are not aware of yet.
Even the Center of Translational Regenerative Medicine researchers, in Torino, Italy say: “Tendon injuries represent even today a challenge as repair may be exceedingly slow and incomplete. Regenerative medicine (Tucker’s note – meaning laser and shockwave like the EnPuls & PiezoWave) and stem cell technology have shown to be of great promise.”2

I would much rather have patients try these non-invasive and less expensive therapies before getting a cortisone shot or going through expensive stem cell therapy first.

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Plantar Fasciitis Chiropractor

The bottom of your foot hurts. Maybe one side, or worse both feet hurt! The cause of the pain is probably something related to a change in your walking or running habits. People say to me “I haven’t changed anything so how does it happen?” There has to be something that you are doing wrong that you don’t even know you are doing wrong. It’s often in your gait or posture causing an excessive strain that is creating repetitive irritation of the arch of the foot.

Plantar fasciitis starts with some inflammation of the fascia on the bottom of the foot and eventual thickening of the plantar fascia. I don’t have to tell you that it can be a severe irritation. In order for me to evaluate and correct plantar fasciitis I examine the whole Superficial Back Line of fascia, which starts at the bottom of the foot and goes all the way up to your head. We might find this fascial band tight anywhere along its entire length. Fascia is the primary force transmission system in your body. If it cannot transmit force efficiently, there is too much strain in certain places: the bottom of the foot is often one of the spots that takes the burden of the excess stress (resulting in too much strain).

The examination includes checking for tightness in the muscles around the calf, especially the soleus and toe flexors. I also check stability and force generation in your glutes, psoas, quads, and abdominals. If they are inhibited or weak the lower leg and foot have to do more work. More work leads to pain and discomfort. A common movement pattern dysfunction of plantar fasciitis is lack of strength and timing of the Gluteus Maximus. Weak glutes contribute to foot dysfunction.

Key non-invasive treatments: 

EnPuls (radial pulse therapy or shock wave therapy) and Piezowave Therapy (Acoustic pulse therapy)

These therapies significantly reduce pain and inflammation while stimulating the formation of new collagen matrix in damaged foot tissues. Properly applied shock wave therapy with optimal dosage is one of the best modalities available for effective treatment of Plantar Fasciitis. Often you will feel significant changes and improvements within several sessions.

 

Kinesiology Taping 

Taping is an effective tool for alleviating symptoms and helping to form new movement habits. Sensory input from the tape on skin ignites the brain maps in discovering new options for movement. Tape adds stability. More stability leads to increased movement variability. Being stability is a good thing.

 

I am the only Chiropractor in Los Angeles with these combinations of modalities to target treatment to the site of pain and I teach patients the use of corrective exercises. This approach leads to more positive outcomes. The body will tell you very quickly what it likes and what it doesn’t like. If you feel better and it lasts you are on the right track. If you don’t, that’s a sign you need to change approaches. I can combine radial pulse waves, acoustic pulse waves, laser therapy, taping, and strength work to help you heal better and faster.

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Chronic Pain Chiropractor

It is well established that regular exercise can help with disorders such as fibromyalgia, chronic low-back pain and arthritic conditions. Most chronic pain and sports medicine practitioners will agree that gentle aerobic conditioning is a good place to start exercising. After an aerobic baseline is achieved, strength training for larger muscle groups becomes appropriate. Core training exercises will most likely be recommended as part of a chronic musculoskeletal condition prescription. It’s not likely that you will be introduced to ‘training to fatigue’ exercise, high-intensity interval training or plyometrics if you have chronic pain. The new model of therapy based on research includes:

  • The use of TheraLase laser and shock wave therapy as a non-invasive approach to treat cartilage lesions and osteoarthritis has widely increased as confirmed by the growing number of clinical trials published on this topic.
  • The use of these procedures in clinical application is gaining in popularity. The cost of these machines has been expensive and kept doctors out of the field.
  • Different sources have been investigated for clinical application, especially targeting knee or ankle cartilage disease.3

Other recommendations for chronic pain patients (even high activity patients) are nutritional supplements to restore damaged cartilage. Some combination of Ginger, Rosemary, Quercetin, Curcumin, Hops, Alpha-Linolenic Acid, omega 3’s and and a ketogenic diet can also act as a protectors against future deterioration of the joints.

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.

  1. 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.
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Knee osteoarthritis: Stem cells vs laser/shockwave therapy

New research continues to establish stem cell therapy as a first line of treatment for athletic joint injuries.

In the Journal of Knee Surgery doctors from the Department of Orthopaedic Surgery, University of Pittsburgh:

  • Biologic agents (stem cells and blood platelets or PRP therapy) are gaining popularity in the management of bony and soft tissue conditions about the knee. They are becoming the mainstay of nonoperative therapy in the high-demand athletic population.

In my office I use non-invasive laser and shock wave therapy as the first line of treatment of various joint conditions. We are demonstrating improved outcomes following laser and shock wave therapy treatment compared to standard physical therapy modalities such as ultrasound and electrical stimulation. To my knowledge, I am not aware of studies that compare TheraLase laser and Enpuls shockwave or PiezoWave acoustic wave therapy to injection. We are the most experienced Los Angeles chiropractic office for providing non-invasive treatment for early osteoarthritis of the knee, chronic patellar tendinopathy and plantar fasciitis.

  • Early clinical evidence also lends support for PRP in the augmentation of anterior cruciate ligament (ACL) reconstruction. Research investigating the role of biologic agents in collateral ligament and meniscal injuries is ongoing. Studies assessing the utility of stem cells have shown encouraging results in the setting of osteoarthritis.

Again, I prefer to have patients start with a trial of TheraLase and shock wave therapy especially for knee osteoarthritis instead of spending a lot of money and risk with shots/injections. 

  • I believe the shift is occurring where the volume and quality of evidence continues to grow for biologic agents, and laser/shock wave therapy are poised to become an integral component of comprehensive patient care throughout all orthopedic specialties.2

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.

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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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