All posts in Chronic Pain

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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Low Back Pain Chiropractor

 

Chronic low back pain serves no known helpful purpose. “Back pain is complex to diagnose and expensive to treat. The implications of chronic unremitting low back pain on health quality, worker productivity, and social dynamics are marked. As with any area of medicine, inaccurate diagnosis leading to treatments that do not target the underlying disease exposes patients to risk without benefit (University of Minnesota’s Department of Orthopedic Surgery). It is my opinion that patients should exhaust non-invasive treatments before scheduling back surgery. I am not opposed to surgery but (only) approximately 60% of patients derive clinically important benefits from lumbar surgery.”1 The key to success is patient selection and the proper procedure. Failed back surgery syndrome is self-explanatory and all too common.

 

In the August 3, 2016 edition of the New York Times, an important update on back pain was written by author Gina Kolata. She concluded: Surgery was no better than alternative nonsurgical treatments, like supervised exercise and therapy to help patients deal with their fear of back pain. In both groups, the pain usually diminished or went away.

 

As a sports medicine and chronic pain specialist I treat chronic low back pain with a combination of modalities such as TheraLase laser, Light Force laser, EnPuls shockwave therapy, PiezoWave acoustic wave therapy, SCENAR, Ketogenic diet, supplements, ergonomics, and gentle movement. These treatments are being given the new name of “regenerative chiropractic care”. If you have acute or chronic pain you may require stabilizing the spine, but please, first try by non-surgical repair of muscles, tendons and ligaments.

 

1 Polly DW, Cher D. Ignoring the sacroiliac joint in chronic low back pain is costly. ClinicoEconomics and Outcomes Research: CEOR. 2016;8:23-31. doi:10.2147/CEOR.S97345.

2 Schütz U1, Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg. 2006 Jun;72(3):296-308.

  1. Shaffrey CI, Smith JS. Editorial: Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273.
  2. el Barzouhi A, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-Hague Spine Intervention Prognostic Study Group. Predictive value of MRI in decision making for disc surgery for sciatica. J Neurosurg Spine. 2013 Dec;19(6):678-87. doi: 10.3171/2013.9.SPINE13349. Epub 2013 Oct 18.
  3. Kurosawa D, Murakami E, Ozawa H, Koga H, Isu T, Chiba Y, Abe E, Unoki E, Musha Y, Ito K, Katoh S, Yamaguchi T. A Diagnostic Scoring System for Sacroiliac Joint Pain Originating from the Posterior Ligament.Pain Med. 2016 Jun 10. pii: pnw117. [Epub ahead of print]
  4. Butt AM, Gill C, Demerdash A, Watanabe K, Loukas M, Rozzelle CJ, Tubbs RS. A comprehensive review of the sub-axial ligaments of the vertebral column: part I anatomy and function. Childs Nerv Syst. 2015 May 1. [Epub ahead of print]
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Post Concussion Syndrome Diet

After a concussion injury rest is not enough. It’s important to reduce the inflammation, decrease chemical changes, help heal neuron function and provide neural protection. How do we feed the brain? Start with drinking water – consume 1/2 your body weight in ounces of water. It’s important to limit your calories: try for 250-500 calories less per day than your usual diet. In other words, if you usually consume 3,000 calories a day, strive for a limit of 2500 calories a day. Avoid trans fats, MSG, aspartame, sugars, caffeine, alcohol, artificial colors or flavors. Decrease salt and sodium intake. Add flax seeds or hemp seeds to foods such as shakes or salads; eat avocado and vegetable soups; consume at least 4 cups (2 at lunch and 2 at dinner) of vegetables per day.

Supplements include Boswellia (Standard Process)

NAC

Fish oils

Vitamin D (6,000 IU/day)

Anthocyamides

Most of the above nutients can be taken in a shake by Xymogen called Brain Sustain. Click on the  product vitamin link at the top and go to Xymogen to place your order.

Walking is helpful but don’t walk with music playing in earphones. Make it a meditative type of walk – not to fast and not to slow.

Practice deep breathing – deep inhalations and slow exhalations. Set a timer for 10 minutes twice a day to practice breathing.

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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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Sports Medicine & Knee Pain

Patient with a ‘degenerative knee’ asks “Should I choose to have knee surgery?” The same question is often asked by patients with an ‘arthritic knee’ or a ‘meniscus tear’. These diagnoses along with popping, creaking and painful knees are often seen in my practice. Past research studies, experience, and being informed helps provide answers!

Orthopedic surgeons often recommend arthroscopic or “keyhole” surgery for meniscus tears, degenerative knees or very common arthritic knees.

Knee surgeries are around a $3 billion a year business. When you use laser and other non-invasive procedures that I use in my office, so many patients find that surgery to “fix” degenerative knee problems just isn’t worth the trouble, not to mention the risk, time and money involved.

Even if you have sudden pain, swelling and problems moving your knee, the chances are good that the ortho will recommend the arthroscopic surgery or ‘keyhole surgery’. My first process is to make a proper diagnosis and likely recommend trying laser or PiezoWave instruments to repair the damage. Doesn’t starting with non-invasive procedures sound logical?

I personally had a meniscus tear that the radiologist recommended I have surgery to repair. I was able to fix it with laser therapy and avoid surgery. In 2014 a Finland study used the keyhole surgery on several dozen patients with a torn meniscus, and then took another group and just pretended to do the operation (“sham” surgical procedure). The sham group was more satisfied with the results than the ones who had the actual procedure done. I understand there is a time for surgery, but even the American Academy of Orthopedic Surgeons advises trying other procedures before surgery!

What about knee replacement? I have seen great success with this procedure but up to a third of knee-replacement patients are still in chronic pain after the operation. And for those with milder pain, the procedure is not helpful and unnecessary.

If you are dealing with pain and stiffness in your knees, I will probably recommend a trial of the TheraLase laser therapy, losing weight if you need too, some natural or prescribed by your MD mild painkillers or natural anti-inflammatories.

Why not try this approach first? Call 310-444-9393 for an appointment.

Sources:
“‘Keyhole’ surgery not helpful for knee arthritis, experts say” Dennis Thompson, May 11, 2017, CBS News, cbsnews.com

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Massage – What’s Better?

Laser & DMS Relief from Chronic Pain

When it comes to treating chronic low back pain the traditional treatments have been manipulation, physical therapy, narcotics and surgery. Today the opioid 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 pain? An emerging approach is the Theralase laser and deep muscle stimulator (DMS) system along with a comprehensive, ‘get healthy to improve your overall wellness’ program.

Dr. Jeffrey Tucker, a west Los Angeles Chiropractor aims to change the narrative about chronic pain. Chronic pain alienates people socially. It’s difficult for others to be around people in pain. They don’t want to see you suffering and feel irritable, and get strained by little things in life.

While many Chiropractic and Physical Therapy clinics emphasize manipulation, Tucker incorporates diet and lifestyle modification along with appropriate laser therapy to improve overall health. Dr. Jeffrey Tucker in Los Angeles “We aim to help patients take steps that will keep them active and help prevent future episodes. We help motivate patients to do everything they can do to maintain or improve their health.” Tucker helps identify potential risks such as ergonomics, posture, proper weight, eating, and other risky personal behaviors. When it comes to difficult low back pain patients they shouldn’t give up if the pills don’t work. They need to know that there are effective options offered by TheraLase laser and a deep muscle therapist. These treatments can have a major impact on their quality of life. Tucker will discuss what each individual can do to improve his or her life over the next 10 years to make sure he or she doesn’t develop weak muscles, manage weight properly, and other complications that occur as we age. Chronic pain doesn’t mean having surgery until you have tried TheraLase laser and or DMS.

Call 310-444-9393 for an appointment.

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Chiropractor Sports Medicine

Chronic Pain Patients Offered Help

If you have neck or low back pain for more than 3 months that is considered chronic pain. It will be important for you to find a doctor that combines the most recent and relevant treatments to help you. The assumption is that “Doctors want to help patients” but Doctors and patients alike often prefer subtle changes in practice and patient care. In simple terms, Doctors can be slow to adopt new technology that helps improve outcomes and patient care!

TheraLase laser therapy is a relatively new yet effective treatment that can help reduce chronic pain, however, laser devices have been considered expensive to most doctors. For doctors, purchasing a laser has become as simple as buying an old fashioned ultrasound device. For patients, there’s really only one thing you can do. And that’s to go to your doctor, and ask him or her about laser therapy.

Laser is a solution to help chronic back and neck pain sufferers – it may make the lives of many pain sufferers a lot more enjoyable and a lot less debilitating for a fraction of the cost of surgery and spinal injections.

TheraLase – a Canadian based company introduced a laser that may help prevent nerve (radicular) pain through the interruption of the lack of oxygen and blood flow (the ischemic metabolic pathway) to painful tissues; Theralase may interrupt the generation of inflammation and help decrease inflammatory chemicals that have already occurred and be causing chronic pain; TheraLaser may improve reinnervation in chronic nerve pain (radiculopathy).

What Theralase would do is essentially give doctors and chronic pain patients with mild-to-moderate musculoskeletal pain an option for treatment that is relatively inexpensive compared to drugs and surgery.

Dr. Jeffrey Tucker, a Chiropractor in Los Angeles, California combines TheraLase, hands-on massage therapy, diet and exercise as a perfect fit to help chronic pain patients. Tucker says “Laser therapy combines well with physical therapy, for increasing range of motion to stiff and painful joints and muscles, and increasing muscle strength. Doctors often move too slowly to adopt new technology that can help patient outcomes, then patient’s end up on the wrong side of recovery and health”.

Whether you are an athlete or chronic pain patient, you can never give up finding ways to improve performance and progressive thinking is crucial. The most basic drive for doctors to change is when patients go to their doctor’s office and ask about all of the new possible ways for help. Unfortunately if your doctor doesn’t work that way, you as the patient may have to take a detour from that doctor and find a practitioner using new technology like the TheraLase laser. Call 310-444-9393 if you would like a laser session,

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Chiropractor

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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Chiropractic for Low Back Pain from Car Accidents

A recent paper (April 2017) published in the European Spine Journal on Low Back Injury in a Motor Vehicle Collision ( J David Cassidy) suggests that a history of low back injury in a car accident is a risk factor for developing future troublesome low back pain. The consequences of a low back injury in a car accident can predispose individuals to experience recurrent episodes of low back pain. This is another reason why I recommend patients get checked right away after a car accident. I want to do everything possible to help prevent long term pain and issues related to motor vehicle crashes. Even the American College of Physicians recommends spinal manipulation and other non-invasive, non-drug therapies as the first option for low back pain. My experience suggests that along with chiropractic care, teaching patients certain exercises, gentle yoga stretches, laser therapy, and DMS (massage) are the best methods to relieve acute and chronic low back pain.
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