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.
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.
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.
- Shaffrey CI, Smith JS. Editorial: Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273.
- 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.
- 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]
- 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]
- The new and exciting non-invasive alternative treatment to risky cortisone injections for elbow pain and instability is PiezoWave acoustic shockwave therapy.
- Tennis Elbow which is also known as lateral epicondylitis is a term for elbow tendonitis, or an inflammation, soreness, or pain on the outside (lateral) part of the upper arm near the elbow. It is usually caused by a partial tear in the tendon fibers, which connect muscle to the bone. Symptoms include elbow pain that gradually worsens and radiates outside of the elbow to the forearm and to the back of the hand. “Tennis Elbow” is more of a term – it does not just happen from playing tennis. This painful condition can result from repetitive use or overuse of the forearm muscles and tendons.
- The ‘usual’ conventional treatment has been rest, ice, compression wraps (braces) and medication for pain relief. When that doesn’t work a cortisone shot or expensive PRP or stem cell injections are recommended.
- Before expensive and risky injections, patients can now try PiezoWave acoustic shockwave therapy. This therapy stimulates blood flow and repair of the injured elbow.
- PiezoWave acoustic therapy offers a new option for the treatment of lateral epicondylitis. In comparison to risky medications, PRP, stem cell, and cortisone injections, PiezoWave treatment is a safe and effective option to reduce elbow pain and repair the elbow tendons.
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.
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.
- 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.
- 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.
- 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.
- 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.
- Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech, 2001;16:293-9.
- 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.
- 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.
- 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.
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
Five of the most powerful tools to target muscle pain and scar tissue adhesions related to sports injury (injuries) are the
Rapid Release device
Deep Muscle Stimulator (DMS)
EnPuls – Radial Shock Wave Therapy
Piezowave – Acoustic Shock Wave Therapy
Between my hands for the Chiropractic evaluation and these tools we can release painful adhesions, tight muscles, stiff joints and help chronic pain.
DMS, Shockwave therapy, Laser therapy has been found in clinical experience to help common repetitive motion injuries (RMI’s) that cause chronic pain.
Musculoskeletal pain and disorders are commonly caused by myofascial shortening. Bilateral myofascial shortening results in compressive forces whereas unilateral myofascial shortening can cause torqueing forces. Either way DMS, shockwave therapy, chiropractic, and laser therapy is very effective in reducing compressive forces and torqueing forces related to pain production. No other office in Los Angeles has three types of laser machines, two shockwave machines and the DMS.