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?
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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.
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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.
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Osteitis pubis is a painful overuse injury of the pubic symphysis and the surrounding bone area. This is typically found in athletes whose sports involve kicking, rapid accelerations, decelerations, and abrupt directional changes. This is often seen in soccer, rugby, football players, and distance runners with complaints of groin pain.1
Specific complaints include anterior and/or medial groin pain. Some patients also point to the lower abdominal area, adductor muscles, inguinal region, perineal area, and/or scrotal area and describe “pain”. Symptoms can be severe and can limit participation in sports until proper treatment is instituted.
TREATMENT FOR GROIN, HIP, AND PELVIC PAIN
Get a good evaluation by a doctor who understands sports injuries. I treat a lot of persistent groin pain due to chronic repetitive trauma and overuse stress. If it involves the pelvic joints, the muscles, and/or tendons a Chiropractor is a good first choice.
I usually find insertional tendinopathy accompanied with pubic symphysis irritation, so Shockwave is a good first line of therapy. I am the only practitioner we know of who has 3 different types of shockwave machines.
Prolotherapy and Platelet Rich Plasma Therapy may be a useful treatment for this diagnosis as well.2,3 In some cases of advanced deterioration I am hearing players using Stem Cells. We have many patients combining treatments like laser, shockwave, and injections to accelerate healing.
- Scholten PM, Massimi S, Dahmen N, Diamond J, Wyss J. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R. 2015 Jan;7(1):79-83. doi: 10.1016/j.pmrj.2014.08.943. Epub 2014 Aug 16.
- Beatty T. Groin Pain Osteitis pubis in athletes. Curr Sports Med Rep. 2012 Mar-Apr;11(2):96-8. Groin Pain Osteitis pubis citations
- Topol GA, Reeves KD: Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series. Am J Phys Med Rehabil 2008;87
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)
- 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.
- 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
- 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.
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.
If you are suffering from a known knee meniscus tear get out your MRI report…
If you have a meniscus tear the radiologist probably used phases or words like located in the “White Zone” and/or “Red Zone” meniscus tears. The “Red Zone” refers to the outer edges of the meniscus and has a fair amount of blood vessel in it. Areas that have a good blood supply typically heal better than those areas without good blood flow. If the radiologist describes your tear as being in the “White Zone” that refers to the center of the meniscus which has a poor network of blood flow. White zone tears are often recommended to have surgery.
The red zone (good blood flow) is known to contain regenerative cells, (cells that stimulate stem cell activity) and those of us using Shockwave Therapies (Zimmer EnPuls, EPAT, Acoustic Wave Therapy, Gaines Wave), hypothesize that shockwave treatments to the knee can help stimulate migration of the regenerative cells in the red zone to the site of meniscal injury in the white zone. Shock wave practitioners know the meniscus is capable of healing tear defects that occur in the white zone (the area without circulation).
Shockwave Therapies (Zimmer EnPuls, EPAT, Storz, Acoustic Wave Therapy, Miracle Wave, Gaines Wave) is a non-invasive alternative to shots and surgical treatment. Shockwave therapy may act as a spark to mobilize the body’s own stem cells to facilitate healing.
Findings in the Journal of Orthopaedic Research demonstrate that articular cartilage and injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential, even into the white zone area (2).
1 Matar HE, Dala-Ali B, Atkinson HD. Meniscal regeneration: a cause of persisting pain following total knee arthroplasty. Case reports in medicine. 2011;2011.
2 Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. Journal of Orthopaedic Research. 2016 Nov 1.
Many patients come in to see me for knee pain. These are patients looking for non-surgical options for meniscus injuries, patellofemoral syndrome pain, knee osteoarthritis and ligament injuries. Most people are familiar with arthroscopic surgical procedures and they are hearing about stem cell therapy for joints. But most people have not yet heard about extracorporal pulse attenuating therapy (EPAT), acoustic pulse therapy, radial pulse therapy or shockwave therapy. These are alternative non-invasive regenerative therapies for knee damage.
Most doctors still believe that the inner knee meniscus cannot heal because it has a poor network of blood vessels and blood supply. But newer research is discovering the meniscus is always trying to heal itself.
How does acoustic shockwave therapy help a meniscus regenerate?
1. Re-establish the normal outer soft-tissue textures. If you are swollen shockwave helps get it resolved.
2. It can aid in bone and joint alignment (ankle, femoral, tibial and hips). This may require a skilled Chiropractor.
3. Restore normal range of motion.
4. Shockwave therapies such as the Zimmer EnPuls, PiezoWave Acoustic therapy and the Storz EPAT are used to stimulate the growth of new meniscus tissue and help your own stem cells to do the job of repair. A shockwave sales rep was in my office two weeks ago and commented that I may be the only doctor in the Country who has all 3 top shockwave deices.
Please call 310-444-9393 for an appointment