All posts in Knee pain

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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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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Tailbone Pain

The Zimmer EnPuls and the PiezoWave system is intended to relieve pain, improve circulation and reduce inflammation of myofascial pain. It is especially helpful for coccyx pain, tailbone pain, knee pain, low back pain, hip pain, plantar fasciitis and tendon injuries.

Other indications for the Zimmer EnPuls and PiezoWave include chronic painful muscular hardening, myofascial trigger points in the areas of the: Upper extremities; Cervical spine; Shoulder girdle; Thoracic spine and lumbar spine; Hip area; Lower extremities.
If you have tried other therapies and been disappointed or did not get the results you expected, please call the office at 310-444-9393 to experience the pain relief effects of the Zimmer EnPuls and the PiezoWave technology.
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Deep Muscle Stimulator (DMS) massage is better than a deep tissue massage

Both massage and DMS release muscle tension, body aches, and helps you to relax.

Deep Muscle Stimulator massage is a technique that focuses primarily on the deeper layers of muscle and fascia. The DMS method uses a hand-held vibration percussion device that oscillates to provide soothing pressure that gets difficult muscle ‘knots’ to release. DMS massage is for people who like massage and want a slightly more intense focused approach. DMS therapist are trained to target the taut, tender, and sore spots and hold the device to target the sore muscle and myofascial layer. The DMS massage is not painful yet it reveals the tender and sore spots.

Deep Muscle Stimulator massage eases pain

Deep Muscle Stimulator massage releases pain and increases blood flow. Deep Muscle Stimulator massage has been shown to decrease pain in chronic low back patients, shoulder pain, calf muscle tightness, plantar fasciitis, tennis elbow, tailbone pain, hip pain, and sports injuries.

Deep Muscle Stimulator massage increases range of motion

Most people don’t like stretching but if you have scar tissue from old injuries or prolonged and poor posture (sitting slumped over) you need to make the scar tissue softer and more pliable. And that’s what DMS helps to do. Muscle tissue should resemble raw meat, and not be dried out like beef jerky! The surfaces underneath the skin should slide and glide. If everything is stuck together, and it doesn’t slide and glide, it needs to be changed.

DMS helps to remix the water (circulation) with the taut and tight muscles so they can slide and glide again, releasing tension in the stuck muscles. DMS helps regain softness in the muscles, so they contract and release better to increase your range of motion.

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Chiropractic & Sports Medicine

Chiropractic manipulation does not reposition a vertebra from a misaligned position to an aligned position. Rather, it is likely that manipulation breaks up adhesions present in the joints of the spine, which improves movement asymmetries and/or stimulates mechanoreceptors – thereby reducing spinal muscle excitability, enhancing proprioception and reducing pain.

While manipulation has been proven effective for the management of acute low back pain, a prospective placebo-controlled study by Senna and Machaly demonstrates that long-term chronic low back pain sufferers respond best to maintenance manipulations performed bimonthly for up to nine months. The authors suggest the occasional (Chiropractic) manipulations may allow for the “early treatment of any emerging problem, thus preventing future episodes of low back pain.”

My sports medicine and chronic pain therapy approach of using the DMS (vibration, percussion), EnPuls (radial shockwave), Piezowave (acoustic shockwave) and massage  in conjunction with chiropractic enhances the breaking up of disruptive and painful scar tissue.

  1. Tullberg T, Blomberg S, Branth B, et al. Manipulation does not alter the position of the sacroiliac joint: a roentgenstereophotogrammetric analysis. Spine, 1998;23:1124-1128.
  2. Cramer G, Tuck N, Knudsen J, et al. Effects of side-posture positioning anti-posture adjusting on the lumbar zygopophyseal joints as evaluated by magnetic resonance imaging: a before and after study with randomization. J Manip Phys Ther, 2000;23:380.
  3. Nansel DD, Peneff A, Quitoriano J. Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manip Phys Ther, 1992;15:99-105.
  4. Nansel D, Waldorf T, Cooperstein R. Time course effect of cervical spinal adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes. J Manip Phys Ther, 1993;16:91-95.
  5. Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech, 2001;16:293-9.
  6. Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med, 2004;141:920-928.
  7. Cleland J, Fritz J, Whitman J, et al. The use of a lumbar spinal manipulation technique by physical therapists in patients who satisfy a clinical prediction rule: a case series. J Orthop Sports Phys Ther, 2006;36:209-214.
  8. Senna M, Machaly S. Does maintenance spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcomes? Spine, 2011 Aug 15; 36(18):1427-37.
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ERGONOMICS: #1 Tip to Prevent Knee Pain

Look at what you are doing right now when it comes to your knee. Are you sitting down with your knees bent? Are your feet crossed? Are your feet behind you and under your chair?

All of these positions put greater stress on the knee, leading to irritation of the knee, which leads to knee pain.

The happiest position for your knee is when it is straight. As the knee joint bends, greater stress is put on the joints and ligaments. Basically as you bend your knee, your kneecap presses against your knee, leading to anterior knee pain. If your knee is bent, you increase the tension in the ligaments in the knee, such as the ACL, which can lead to ligamentous knee pain. Lastly if you have internal knee pain, the greater the knee is bent, the more it puts unnecessary stress inside the knee joint.

If you sit in this bent knee position for hours, it will progressively make your knee pain worse.

Quick Fix: While you are sitting at your desk, on the couch, in a meeting, or watching a movie, remember to keep your knees straight when you can to decrease stress on the knee.

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Knee Pain

First, laser the knee area. Laser is a deep heat that does provide pain relief.

Next lets talk about weight loss if needed. Every pound you lose reduces stress across the knee by 3-4 pounds, even higher if you climb stairs or attempt to run. Don’t run, jump, or do anything that involves impact to your knee.

Next lets talk about natural remedies like fish oil and Bosweillia as effective and helpful. Use BioFreeze cream to rub on the knee! Let me put kinesio-tape on your knee.

Next let me teach you the proper exercises. The best long-term method to relieve pain and restore function is consistent low impact exercise. Exercises that stretch and strengthen the muscles around the knee, not only provide support and maintain motion of the joint, but stimulate endorphins and intrinsic growth hormone release — both of which help to relieve the pain of arthritis.

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My approach to chronic pain, muscle pain, joint pain, and  weight loss

Chiropractic. The goal of this treatment is to significantly decrease symptoms such as pain, tightness, stiffness, soreness, aches, and improve athletic performance, mobility, and your ability to perform general activities.

Laser. Evidence for the effectiveness of laser is strong. Patients feel the relief especially for knee pain and TMJ pain

Shockwave therapy. This form of medical treatment is acknowledged as a means for enhancing scar tissue mobility and breaking up muscle tightness and muscle and joint adhesions. It is also helpful for chronic pain reduction and improved mobility. It helps osteoarthritic symptoms with improved functional mobility and quality of life.

Along with laser, Deep Muscle Stimulator (DMS), shockwave therapy is effective for pain control of osteoarthritis of the knee, neck pain, low back pain, and increasing mobility.

Deep Muscle Stimulator Massage. Followed by hands on therapy, DMS is the most commonly utilized treatment in my office. Patients feel better after this type of massage than receiving a regular hand massage. They have significant improvements in pain, stiffness, and physical function.

Dietary supplements. I use a variety of products from Metagenics, Xymogen, Designs for Heath, and Standard Process for joint pain, arthritis, inflammation, and weight loss.

Widening the integrative approach to treatment

There is emerging evidence that integrating multiple conventional and alternative therapies such as chiropractic, exercise, laser, shockwave, DMS, lymph therapy provide the best results for patients.

If you are a person who still has pain and diminished mobility who has already explored other therapies and doctors but have been disappointed, I would like the opportunity for you and I to meet. I continuously evaluate the increasing body of evidence in support of new therapies, and I am confident in offering my patients a wider range of choices than standard chiropractic care.

Call 310-444-9393 for an appointment

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Knee Pain & Osteoarthritis Treatment

I coined the term POLITE Method for how I treat my patients. The ‘P’ is for improving posture and creating a plan of treatment.

The ‘OL’ is optimal loading. This means figuring out self-management activities  for knee pain that are not too easy and not too difficult.

The ‘I’ in instruments that I use in the office for knee pain such as laser, DMS, and shockwave therapy that give effective short- and long-term pain relief benefits.

‘T’ is for taping  the knee and I’ll teach you how to apply simple kinesio-tape to the knee for pain relief.

‘E’ is for education regarding the progressive nature of osteoarthritis (OA) and for pain management education; joint-sparing exercise advice including daily walking, balance tips, and falls prevention; and emotional and cognitive skills to improve quality of life; Eating for weight loss for those who are overweight or obese. Weight loss has been shown to improve mobility and reduce pain. For every one pound of weight lost, there is a 4-pound reduction in the load exerted on the knee for each step taken during daily activities. A weight loss of only 15 pounds can cut knee pain in half for overweight individuals with arthritis.

A low-carbohydrate diet has been shown to reduce weight in obese patients by ?10% and lead to improvements in self-reported scores for overall progress and functional ability.

If you like my POLITE approach call 310-444-9393 for an appointment.

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