Do All Meniscus Tears Need Surgery?
Research by Horga, et al (1) suggests the answer is no! Using the latest (and most powerful) MRI scanners Horga’s team found abnormalies in 97% of the non-painful knees. Thirty percent (30%) had meniscus tears, cartilage and bone marrow lesions at the knee cap area (patellofemoral). About 1/3 of the knees had severe cartilage lesions. Tendon damage was detected in about 1 in 5 patients.
Remember, these were patients who had NO knee pain. Hence if so many patients have big problems on their knee MRI’s and have no pain, why are we so many people getting knee meniscus surgery for tears?
One answer is that they have not tried alternative therapies like Shockwave Therapy.
Extracorporeal Shock Wave Therapy (ESWT) stimulates newblood vessel growth.
ESWT faster return to competition and athletic activity.
ESWT is a safe and effective non-invasive outpatient procedure.
(1) Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, D’Silva A, Sharma S, Moon JC, Hart AJ. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Feb 14. doi: 10.1007/s00256-020-03394-z.
Bunion’s consist of a thickened callus, an inflamed bursa and excess bone forming at the side of the first metatarsal head (big toe).
Bunions are diagnosed by the following symptoms:
A bulging bump on the outside of the base of the big toe
Swelling, redness or soreness around the big toe joint
Corns or calluses — often where the first and second toes overlap
Persistent or intermittent pain in the area of the big toe
Restricted movement of the big toe if arthritis affects the toe
My treatments and recommendations
Avoid wearing tight shoes especially high heels with pointy toes. Buy footwear that is wide in the toe box area.
Shoe pads are an option especially if they offer relief.
I teach all of my hallux valgus patients awareness exercises: “Always try to straighten the big toe.” I have them press the big toe into the floor and slide the other four toes and foot laterally until the big toe is as straight as possible. This is how I want the patient to stand all the time.
Stretch the feet and calfs. I am yet to meet a patient with bunions that does not have tight calfs. I have my patients stand with the forefoot on a ½ foam roll (3” high) with the heels on the ground for 2 minutes at a time twice a day. After about two weeks they are able to stand up straighter while doing this stretch. Calf tightness can be a cause of low back pain in and of itself so it is important to take this tightness out of the patient’s body.
Strengthening the involved side glutes, getting the hamstrings length and strength proper, and the peroneus longus strength up to normal is important because it allows the first metatarsal to resist the medially directed component of forces associated with hallux plantarflexion.
Use toe spreaders or a bunion splint especially while sleeping.
Massage CBD (Phyto-Zol) serum into the bunion area two to three times a day.
Shock wave therapy aka pulse wave therapy. I do this directly over the bunion area. This is an effective way to reduce bunion discomfort and even reduce the deformity itself.
Other ways to prevent and ease the pressure and pain caused by bunions include:
Watch your weight – remember, the rest of you is pressing down on your feet when you stand, walk or run.
Taping with Kinesio-tape is very helpful. I bring the big toe into a straight position and tape the toe. I teach the patient how to do this at home on their own.
Cover the bunion with a soft, cushioning, protective moleskin or gel-filled pad.
I check for their footwear and offer off-the-shelf shoe inserts or recommend custom made orthotics.
For the acute flare up I try warm foot soaks, ice packs, whirlpool, more CBD serum, etc.
This protocol has helped many patients avoid surgery.
The goal for patients is to increase movement and pain reduction.
Since ‘no one size fits all’ I offer several forms of treatment that may be helpful. Having the ability to use and combine multiple modalities is providing very positive results in terms of increased movement and pain reduction versus single modalities alone.
An advanced modality that is getting a lot of attention is shockwave. This provides peak pressures that are 1000 times greater than a biphasic ultrasound wave. Shockwave increases local blood flow, increases cellular activity, has an analgesic effect on nerves, and can breakdown calcific deposits (primarily, but not exclusively in tendons).
Laser is another treatment device that can target tissues to impact mitochondrial activity. Laser can be used on nerves, tendons, muscles, ligaments, joint capsules, bone, and wounds.
Pulsed Electromagnetic Field Therapy (PEMF) (MagnaWave) has had FDA approval for muscle stimulation since 1998. PEMF is just gaining popularity as ‘nutritional therapy’ to the cells. It increases nitric oxide levels (same thing Viagra does) and has microcirculation enhancement.
Summary: Combining these 3 modalities along with my hands-on therapy is allowing my patients to feel more supple and experience less pain.
Patients often come see me to get second or third opinions about hip pain. They may have been told by another doctor that they need injections or hip replacement surgery. They tell me that there orthopedic surgeon said “it’s the only way” or “I have bone on bone rubbing.” Nobody wants a surgery that they are unsure of having. The risks, the time out of work and play… I get it!
In the Journal of Medical Internet Research they say (1) “Despite the availability of evidence?based guidelines for conservative treatment of osteoarthritis, management of degenerated joints is often confined to the use of painkillers and waiting for eventual total joint replacement.” There are many treatment options available to you before surgery and we should not just wait it out. If injections or surgery is right for you, I am the first person to suggest it. BUT, I still like to offer non-invasive therapies along with education and possible gentle exercise to do (2).
STEM CELL stimulation is OPTION
If you are middle age or older and enjoying good health but diagnosed with osteoarthritis (degenerative hip disease) in your hip(s) using x-rays or MRI and experience pain, discomfort, and/or stiffness, you will want to examine all treatment options.
Pulse Wave Therapy (Storz, MiracleWave, PiezoWave) is effective to stimulate STEM CELLS
Laser Therapy (Class 3B, Class 4) is effective in treating hip osteoarthritis pain
PEMF (MagnaWave) is also helpful in cell regeneration and decreasing pain
The combination of the above is helping many patients take surgery and injections off the table.
To schedule an office visit call 310-444-9393
Biohacks are things we can do that supports optimal inflammatory response, enhanced relaxation, improved sleep quality, improved brain function and improved body structure (fat to lean muscle mass ratios, strength, etc).
Tumeric Forte is a curcumin-rich product where the curcumin is absorbed and utilized up to 45 times greater by your body than standard curcumin products. This is my premier herbal anti-inflammatory, and it helps improve memory, helps regulate glucose metabolism. I think every adult should be using Tumeric Forte. Call the office to have it shipped directly to you.
Laser Therapy. Stem cells are becoming a mainstay treatment for chronic pain and athletic injuries. Laser therapy can be used as a biologic agent to increase stem cells and blood platelets to help manage bony and soft tissue conditions. I especially like laser therapy for those who already have osteoarthritis especially of the knee.
PEMF (Magnet therapy). Clinical evidence lends support for PEMF. The benefits of ‘Magawaving’ include: it stimulates electrical changes — around and within the cell; Activates and promotes cell regeneration; can alleviate the symptoms of arthritis; improves circulation; can help relieve the symptoms of depression and it promotes bone healing.
Shockwave Therapy. Research investigating the role of shockwave therapy for chronic tendon injuries such as Achilles tendon and plantar fasciitis is ongoing and positive. I like seeing the results I get helping break up scar tissue and improve range of motion with my 3 different types of shockwave machines.
SP Detox Balance. This powder makes a delicious shake that helps the organ system detox nice and slow on a daily basis. SP Detox Balance will support and nourish your body so that it does its job properly – helping you increase energy, lose weight, reduce nagging and unpleasant symptoms, improve your mood, and have more vitality. This is part of my biological approach to staying the right weight.
Bio hack number 6 is the Ideal Protein program. This is my weight loss program to help get you at your ideal and proper weight. I use the ketogenic diet which has been confirmed by numerous clinical trials as a major biohack for your weight loss and healthy living program.
Bio hack number 7 is teaching my patients ELDOA exercises. These poses will create space in the spine and help you improve your posture and feel better.
In addition to all of the above, I offer other intensive programs to help my patients achieve good health and well being. Feel free to call and talk to us! 310-444-9393
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.
The goal of epidural injections and surgery is to provide pain relief. The goal of shockwave therapy (Zimmer, Storz, Piezowave), Magnet therapy (Magnawave), and laser therapy (TheraLase, LightForce) is to provide a healing environment inside the body leading to pain relief. Epidural injections do not heal a bad back. Shockwave, laser, magnet therapy, exercise and hands-on therapy will help heal a bad back.
Some patients do get epidural steroid injections and find short-term pain relief. Often times this sense of immediate pain relief prevents people from getting the proper treatment for his/her long term back pain care.
A study from Vanderbilt University discusses the use of epidural injection treatments and spinal surgery:
…surgery is superior to epidural steroid injections for improving quality of life and pain, however after a year neither the surgery or the epidural steroid injections significantly helped improve the patient’s disability.(1)
Johns Hopkins School of Medicine, Walter Reed National Military Medical Center, University of Toronto researchers describe:
Epidural steroid injections provide modest pain relief up to 3 months in patients with lumbosacral radicular pain caused by herniated disks, but they have no impact on physical disability or incidence of surgery.(2)
The Chinese University and Prince of Wales Hospital in Hong Kong: …transforaminal epidural steroid injection cannot alter the need for surgery in the long term.(3)
Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute:
For some patients epidural steroid injections did not work at all. “Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection.” (4)
THE PROBLEM you as a patient face: Epidural steroid injections are still one of the most frequently performed low back pain procedures. BUT, epidural steroid injections really should be questioned for lack of effectiveness, and may be dangerous.
Patients need to know that they have alternatives. Rather than exposing patients to risks from injections and dangerous complications, I start low back treatment with non-invasive shockwave, laser, or magnet therapy, combined with skilled hands-on therapy and ELDOA exercise training. (5) Doesn’t this make sense?
Call 310-444-9393 for an appointment
1 Sivaganesan A, Chotai S, Parker SL, McGirt MJ, Devin CJ. 161?Patient-Reported Outcomes After Epidural Steroid Injections vs Surgery for Degenerative Lumbar Disease: A Prospective, Matched Cohort Study. Neurosurgery. 2016 Aug;63 Suppl 1:164-5. doi: 10.1227/01.neu.0000489730.99853.c3.
2. Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg. 2016 Mar;122(3):857-70. doi: 10.1213/ANE.0000000000001155.
3. Leung SM, et al. Clinical value of transforaminal epidural steroid injection in lumbar radiculopathy. Hong Kong Med J. 2015 Aug 14. doi: 10.12809/hkmj144310. [Epub ahead of print]
4. Radcliff K, Hilibrand A, Lurie JD, Tosteson TD, Delasotta L, Rihn J, Zhao W, Vaccaro A, Albert TJ, Weinstein JN. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation: A Subgroup Analysis of the SPORT Trial J Bone Joint Surg Am. 2012 Jun 27. doi: 10.2106/JBJS.K.00341. [Epub ahead of print]
5. Epstein NE The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature Spine: 2013;3:74-93 6. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am. 2010 Nov;21(4):825-34.
A new study published by Dedes V et al. called Effectiveness and Safety of Shockwave Therapy in Tendinopathies (Mater Sociomed. 2018 Jun;30(2):131-146. doi: 10.5455/msm.2018.30.141-146) concluded:
“Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice (for treating tendinopathies) because of its effectiveness and safety.”
People suffering from tendinopathies exhibit reduced mobility due to the pain caused by the movement of the tendons involved. Shockwave therapy is non-invasive, simple, fast and safe for tendon injuries.
Shockwave therapy is especially helpful in the treatment of elbow tendinopathy, Achilles tendinopathy, plantar fasciitis and rotator cuff tendinopathy.
It can help reduce pain, improve function and quality of life.
Call 310-444-9393 for an appointment
Dr. Jeffrey Tucker is the premier practitioner for the application of shockwave and laser in Los Angeles especially for joint pain. Dr. Tucker is the most extensively trained practitioner, with the most experience, and the only doctor with 3 different shockwave machines and 2 different types of laser available for your specific treatment needs.
If the thought of a potential flare up of chronic pain has you, well, on pins and needles, then shockwave and laser treatments might be able to help.
In addition to the proven benefits of shockwave by itself and laser by itself, Dr. Tucker combines the two modalities for relief from chronic pain, joint pain, osteoarthritis, and tendon pain. Shockwave and laser is a natural remedy that allows the body to heal itself.
Get the skilled care you need by calling 310-444-9393
Shockwave and laser therapy are treatments that come under the term ‘orthopedic regenerative medicine.’
Regenerative medicine uses natural methods to stimulate the body to regenerate its own tissues. Some methods use the patient’s own cells obtained from their own blood using needles and injections. This medical procedure is called platelet-rich plasma (PRP) or stem cell therapy. However, I use safer, no needle, less expensive, easy to administer shockwave and laser modalities rather than injections to stimulate growth factors to help repair the tissues. These modalities have been especially helpful in hip and knee osteoarthritis.
Researchers at the Department of Special Surgical Science, University of Florence found numerous growth factors within blood platelets that have a specific activity on cartilage regeneration. Stimulating growth factors may be what allows the shockwave treatment to be able to significantly reduce pain and improve joint function.1
A typical treatment shockwave and laser is performed once a week for approximately 3-6 weeks.
The treatment goal of using shockwave and laser:
Allow patients to be more active
Decreasing pain often helps improve function
I like to see positive changes within the first 3 to 6 weeks with continued improvement over the next 12 weeks
It makes sense to do a trial of the non-invasive shockwave and laser protocol to improve osteoarthritis of the hip joint prior to injections.
- Civinini R, Nistri L, Martini C, Redl B, Ristori G, Innocenti M. Growth factors in the treatment of early osteoarthritis. Clin Cases Miner Bone Metab. 2013 Jan; 10(1):26-9. doi: 10.11138/ccmbm/2013.10.1.026.
- Sánchez M, Guadilla J, Fiz N, Andia I. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford). 2012 Jan;51(1):144-50. Epub 2011 Nov 10
- Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, Tschon M, Giavaresi G. Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Am J Sports Med. 2016 Jan 21. pii: 0363546515620383.
Extracorporeal Shockwave therapy (ESWT) or Radial shockwave therapy (RSWT) is believed to cause a cellular response leading to tissue regeneration. I use this therapy for plantar fascia, Achilles tendon, Achilles insertion, 1st metatarsal joint pain, and tibia/shin pain. Many of my patients are recreational to elite athletes.
Patients and I co-create the best treatment plan. Most patients need at least 3-6 ESWT treatments with 7-10 days between treatment sessions. The procedure does not hurt, has little to no adverse side effects, and is less expensive and less invasive than risky injections. To enhance our results we can also use magnet therapy and/or laser therapy.
Call 310-444-9393 for an appointment.