All posts in Laser Therapy

ROTATOR CUFF Injuries

What do you do if you have continued pain after ROTATOR CUFF SURGERY

Continued shoulder pain even after a surgery for tears does happen. When complaints persist and have become an unresolved shoulder pain, I am called upon to help patients make decisions what to do next. Helping patients learn about the available treatment options and understand their choices is a discussion that needs to take place. When I discuss Rotator cuff surgery I refer to Lädermann A, et al. from the University Hospitals of Geneva. They state that “Tear recurrence can be related to various factors such as:

(1) Inadequate strength of the initial repair construct

(2) Biological failure to heal despite strong initial fixation (hardware and suture) and

(3) inappropriate postoperative rehabilitation causing structural failure of the repair” (1).

We always hope for good outcomes after a surgery but “The results of (rotator cuff) treatment are not as predictable as the patient (family, trainer, coach and doctor) would like to think” says Nickolas G et al. in the Physical Medicine and Rehabilitation Clinics of North America journal.

I talk to patients about the concept of cellular communication and how there could be a breakdown in the local tissue area and even the brain to stimulate proper healing. We have learned that certain therapies such as stem cell injections, shockwave, and laser can seem to jump start a non-healing area within a damaged shoulder or knee joint. The current thinking is that these therapies change the joint environment from non-healing (diseased) to healing by signaling the local native resident healing cells to get ready to rebuild.

How, can I as a Chiropractor change the joint environment from not healing to healing and working better?

  • By inducing gentle non-painful motion into a poorly functioning joint.
  • By re-awakening stem cells to change (plasticity) and activate (multipotency – the ability to change/morph into other cell types and multiply). I use shockwave to do this.
  • Get the surrounding healthy cells to send signals to suppress inflammatory T–cell proliferation (inflammation) and provide an anti-inflammatory effect. I use laser to do this.

Maybe the above 3 points help activate stem cells to express various growth factors – it takes a lot of reawakening of molecules to stimulate local tissue repair. I like the concept of getting cells to communicate directly cell to cell (even to the resident remaining cartilage cells) in the joint. Seol et al did a study to show that stem cell activation regenerated cartilage in knees, why not the shoulders! (3)

  1. Lädermann A, Denard PJ, Burkhart SS. Management of failed rotator cuff repair: a systematic review. Journal of Isakos. 2016;1(1):32-37. doi:10.1136/jisakos-2015-000027.
  2. Nickolas G. Garbis, Edward G. McFarland. Understanding and Evaluating Shoulder Pain in the Throwing Athlete. Physical Medicine and Rehabilitation Clinics of North America, 2014; 25 (4): 735 DOI:10.1016/j.pmr.2014.06.009
  3. Seol D, Zhou C, et al. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
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Professional Athletes Treatment for Sports Injuries

Serious athletes come in to my office with complaints of back pain and/or hip pain. Their medical doctors have recommended steroids and/or cortisone injections, but these patients want to try something else before risky shots or pills. These patients are savvy, they think long term recovery. They want what the pro-athletes get! They usually already had the MRI, and they have tried to work it through on their own. They want my advice because they heard I take the time to help them figure out the cause of the pain. The question I need to figure out “Is your movement pattern irritating a disc problem, ligaments, or the muscle system?” Then we figure out the best treatment plan together.

Patients are hearing about Platelet-Rich Plasma Therapy (PRP), stem-cell regeneration therapy, shockwave therapy, laser, Deep Muscle Stimulator, and other “locker room” treatments for the pro’s. I organized my office so the average person can get what the pro’s get. I use 3 types of shockwave or pulse therapy, and 2 types of laser that create effective treatments for disc injuries, muscle pain, and spinal ligament instability.

Shockwave therapy, laser therapy and the proper movement therapy stimulates the regeneration of the discs. ligaments and muscles directly. Yes, decreased disc height can be changed and scar tissue can be broken up. As with any treatment, the earlier and sooner the treatment intervention begins the better the outcome.

I constantly look for research that helps recovery in sports injuries and therapies that offer effective therapeutic results.

If you want to try therapies that the top pro athletes are getting to alleviate back pain and hip pain call my office at 310-444-9393.

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Chronic Low Back Pain & Surgery

West Los Angeles Chiropractor

Patients who are thinking about spinal injections or surgery, or have had spinal surgery (fusion, disc procedure, etc.) should see a Chiropractor trained in proper exercise therapy and who uses laser therapy and other new technology such as acoustic wave therapy to improve spinal strength and stability. In addition, scar tissue and muscle atrophy needs to be evaluated and treated. This can help prevent costly and risky injections and surgery.

Why is failed back surgery syndrome so common? Researchers at the Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University in Japan:

Up to 25% of patients report unimproved or worse pain and up to 40% are not happy with the outcome of lumbar fusion.

The possible reasons for poor results include instrumentation failure, inadequate surgical technique, and poor patient selection.

In patients who had continued pain after back surgery, muscle biopsies revealed:

Atrophy of paraspinal muscles

Loss of muscular support leading to disability and increased biomechanical strain and possibly failed back syndrome.1

In another study researchers found that the muscles adjacent to the fusion (the paraspinal muscles of the lumbar spine) play an important role in recovery. The muscles become weak and unstable after a spinal fusion.2 If those muscles remain damaged or weakened, the spine is unstable and pain persists.2

I can’t say enough about this…Doctors at Oslo University Hospital examined patients who had continued pain 7 to 11 years after spinal fusion. They found reduced muscle strength and density of tissue one year after lumbar fusion: 27% reduction in muscle density.3 Again, patients need a skilled practitioner like myself to help them properly build strength and stability…but I recommend doing this before injections or surgery if at all possible.

1 Ohtori S, Orita S, Yamauchi K, et al. Classification of Chronic Back Muscle Degeneration after Spinal Surgery and Its Relationship with Low Back Pain. Asian Spine Journal. 2016;10(3):516-521.

2 Malakoutian M, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T. Role of muscle damage on loading at the level adjacent to a lumbar spine fusion: a biomechanical analysis. Eur Spine J. 2016 Sep;25(9):2929-37.

3 Froholdt A, Holm I, Keller A, Gunderson RB, Reikeraas O, Brox JI. No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises. Spine J. 2011 Aug;11(8):718-25.

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Is Sockwave therapy and laser therapy the right treatment for damaged discs and bulges?

Both Shockwave and laser help damaged disc and bulges by:

  • Stem cell activation: Stem cells are effective in inhibiting disc degeneration and disc herniation. It’s a pretty complex interplay between the stem cells and the immune system cells but the result can be disc tissue regeneration.
  • Stem cell activation: This will promote regeneration of the outer tissue of the disc and help contain and lessen the bulge (scar tissue formation).
  • Stem cell activation:The increased number of cells to the area brings more oxygen to the damaged disc and accelerates healing by reversing the low-oxygen (degenerative or dying) environment in the spine. Everything heals better and faster with increased oxygen.
  • Stem cell activation reduces and prevents herniation by suppressing the non-healing inflammation.

Office phone 310-444-9393

References: 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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Meniscus Tears – Los Angeles Chiropractor

Research suggests the White Zone can heal

Can PIEZOWAVE Pulse Therapy and ENPULS Radial Shockwave Therapy regrow meniscus tissue? What about stem cell therapy and PRP? Is one more successful at treating meniscal damage? All of these treatments are very promising! So far I see stimulation of stem cells (either non-invasive therapy or injections) as promising for meniscus repair and regeneration.

  • Everyone agrees that Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone (the inner portion of the meniscus that lacks a blood supply).
  • I use the non-invasive and less expensive EnPuls and PiezoWave therapy instead of PRP to achieve pain relief and attempt to halt the progression of meniscal damage. More time and research is required to see if this is the way to regenerate tissue.
  • FACT: Regeneration of meniscus and cartilage is difficult to heal especially in the ‘white zone’ where there is a lack of blood vessels and therefore deprives the meniscus of healing nutrients and oxygen.
  • FACT: Stem cell injections and PRP injection treatments are in the infancy stages of research. These treatment options are as controversial as surgery.
    • New York Times, Dr. Gordon H. Guyatt, a professor of medicine at McMaster University in Hamilton, Ontario states: Meniscus surgery is expensive and has potential complications (British Medical Journal even agrees with this).
    • FACT: I want patients to return to sport or leisure activity as fast as possible.
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Meniscus Tears – Research suggests the ‘White Zone’ can heal (Los Angeles Chiropractor)

 

  • FACT: Regeneration of meniscus and cartilage is difficult to heal especially in the ‘white zone’ where there is a lack of blood vessels and therefore deprives the meniscus of healing nutrients and oxygen.
  • FACT: Stem cell injections and PRP injection treatments are in the infancy stages of research. These treatment options are as controversial as surgery.
    • New York Times, Dr. Gordon H. Guyatt, a professor of medicine at McMaster University in Hamilton, Ontario states: Meniscus surgery is expensive and has potential complications (British Medical Journal even agrees with this).
    • FACT: I want patients to return to sport or leisure activity as fast as possible.
    • Researchers in Denmark have published: “patients undergoing arthroscopic meniscus surgery were too optimistic regarding their recovery time and postoperative participation in leisure activities. This highlights the need for shared decision making which should include giving the patient information on realistic expectations of recovery time and regarding participation in leisure-time activities after meniscal surgery.”1
  • Can PIEZOWAVE Pulse Therapy and ENPULS Radial Shockwave Therapy regrow meniscus tissue? What about stem cell therapy and PRP? Is one more successful at treating meniscal damage? All of these treatments are very promising! I have not seen 80-100% predictable positive clinical outcomes yet with any of these! So far I see stimulation of stem cells (either non-invasive therapy or injections) as promising for meniscus repair and regeneration.4
  • We need more University and Hospital based studies to confirm this trend.
  • Again, everyone agrees that Meniscus injuries remain a significant challenge due to the poor healing potential of the inner avascular zone (the inner portion of the meniscus that lacks a blood supply).
  • I use the non-invasive and less expensive EnPuls and PiezoWave therapy instead of PRP to achieve pain relief and attempt to halt the progression of meniscal damage. More time and research is required to see if this is the way to regenerate tissue.5
  1. Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop. 2016 Sep 13:1-7.
  2. Brelin AM, Rue JP. Return to Play Following Meniscus Surgery. Clin Sports Med. 2016 Oct;35(4):669-78. doi: 10.1016/j.csm.2016.05.010. Epub 2016 Jul 9. Review.
  3. Noyes FR, Barber-Westin SD. Long-term Survivorship and Function of Meniscus Transplantation. Am J Sports Med. 2016 Sep;44(9):2330-8.
  4. Niu W, Guo W, Han S, Zhu Y, Liu S, Guo Q. Cell-Based Strategies for Meniscus Tissue Engineering. Stem Cells International. 2016;2016:4717184. doi:10.1155/2016/4717184.
  5. Blanke F, Vavken P, Haenle M, von Wehren L, Pagenstert G, Majewski M. Percutaneous injections of Platelet rich plasma for treatment of intrasubstance meniscal lesions. Muscles Ligaments Tendons J. 2015 Oct 20;5(3):162-166.
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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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Plantar fasciitis treatment

If you have Achilles tendinopathy and/or plantar fasciitis, Theralase laser and PiezoWave acoustic therapy is an effective and safe alternative to injections and cortisone medications. These are cutting edge non-surgical treatments for tendinopathies that are safer and less costly than platelet-rich plasma (PRP) treatments.

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Chondromalacia patella Chiropractor Los Angeles Area

Chondromalacia patella responds very favorably to our TheraLase laser and Piezowave acoustic regenerative techniques. Laser therapy stimulates cell metabolism while the Piezowave decreases pain and inflammation. If you need treatment for patellar tendinopathy or chondromalacia patella you may be thinking about platelet-rich plasma injections (PRP). I find we get better results with these less expensive and non-invasive therapies. Patient’s pain levels decrease and activity level improves.

There is an increasing awareness and popularity of laser and shockwave therapies (PiezoWave, EnPuls) for soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies. We are the only office in the Los Angeles area with two types of laser and two types of impulse devices.

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