All posts in Shockwave Therapy

Pain Relief in Brentwood

I use two different types of shock wave devices for pain relief in my practice. One is a radial pulse wave (EnPuls) and the other is an acoustic wave (PiezoWave). Both carry energy that can be targeted and focused noninvasively to affect a selected region like the shoulder, hip or foot. When these devices are applied to the soft tissues, the impulses or shock waves interact with the targeted tissues and induce a cascade of biological reactions. This results in the release of growth factors, which in turn triggers new blood vessel formation (neovascularization) of the tissue with subsequent improvement of the blood supply and oxygen to the tissues. This helps healing.
Another effect of shock wave therapy is related to the stimulation of cell proliferation, tissue regeneration, and a process through which new blood vessels form from pre-existing vessels called angiogenesis.

The therapeutic effects of shock wave therapy can be used on patients who need pain relief and reduction of inflammation even in cases with diabetes, nerve pain, soft tissue injury, arthritic joint irritation, and healing of bone (2013, Qiu et al; 2013 Liu; 2013 Siegfried).

My practice is located in Brentwood, CA. I can be reached at 310-444-9393.

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Plantar Fasciitis Chiropractor

The bottom of your foot hurts. Maybe one side, or worse both feet hurt! The cause of the pain is probably something related to a change in your walking or running habits. People say to me “I haven’t changed anything so how does it happen?” There has to be something that you are doing wrong that you don’t even know you are doing wrong. It’s often in your gait or posture causing an excessive strain that is creating repetitive irritation of the arch of the foot.

Plantar fasciitis starts with some inflammation of the fascia on the bottom of the foot and eventual thickening of the plantar fascia. I don’t have to tell you that it can be a severe irritation. In order for me to evaluate and correct plantar fasciitis I examine the whole Superficial Back Line of fascia, which starts at the bottom of the foot and goes all the way up to your head. We might find this fascial band tight anywhere along its entire length. Fascia is the primary force transmission system in your body. If it cannot transmit force efficiently, there is too much strain in certain places: the bottom of the foot is often one of the spots that takes the burden of the excess stress (resulting in too much strain).

The examination includes checking for tightness in the muscles around the calf, especially the soleus and toe flexors. I also check stability and force generation in your glutes, psoas, quads, and abdominals. If they are inhibited or weak the lower leg and foot have to do more work. More work leads to pain and discomfort. A common movement pattern dysfunction of plantar fasciitis is lack of strength and timing of the Gluteus Maximus. Weak glutes contribute to foot dysfunction.

Key non-invasive treatments: 

EnPuls (radial pulse therapy or shock wave therapy) and Piezowave Therapy (Acoustic pulse therapy)

These therapies significantly reduce pain and inflammation while stimulating the formation of new collagen matrix in damaged foot tissues. Properly applied shock wave therapy with optimal dosage is one of the best modalities available for effective treatment of Plantar Fasciitis. Often you will feel significant changes and improvements within several sessions.

 

Kinesiology Taping 

Taping is an effective tool for alleviating symptoms and helping to form new movement habits. Sensory input from the tape on skin ignites the brain maps in discovering new options for movement. Tape adds stability. More stability leads to increased movement variability. Being stability is a good thing.

 

I am the only Chiropractor in Los Angeles with these combinations of modalities to target treatment to the site of pain and I teach patients the use of corrective exercises. This approach leads to more positive outcomes. The body will tell you very quickly what it likes and what it doesn’t like. If you feel better and it lasts you are on the right track. If you don’t, that’s a sign you need to change approaches. I can combine radial pulse waves, acoustic pulse waves, laser therapy, taping, and strength work to help you heal better and faster.

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Sports Injury Chiropractor Brentwood

 

Suffering from Sports Injuries?

For our body to function properly we need energy. The mitochondria are the cells in the body responsible for energy supply to the cells and releasing energy for the body. Oxygen enters the body cells, and the oxygen converts into CO2 and H2O, which takes place in the mitochondria. Food we eat gets turned into nutrients and gets connected to the transference of oxygen. This results in a molecule known as ATP (adenosine triphosphate). This action is essential in virtually any bodily activity, from the motion of our muscles to the transfer of nutrients and waste materials in and from the cells. Furthermore, ATP is essential for the generation of electrical signals in the nervous system.

 

Without oxygen (and adequate nourishment) there simply would be no ATP. Without ATP we simply wouldn’t be able to move, let alone have the capacity to think. If ATP is decreased, muscles start to become sore and ache. Many people are ATP deficient from taking statin drugs, adrenal gland dysfunction, lack of sleep, breathing dysfunctions, poor nutrition, and lack of recovery from sports and work outs.

 

Dr. Jeffrey Tucker uses non-invasive regenerative medicine therapies for sports-related musculoskeletal injuries that are often related to oxygen and mitochondrial dysfunctions. Basic science supports the possibility of enhanced recovery from sports injuries using diet, nutrition and the application of lasers, shockwave machines and breathing strategies.

It’s clear the TheraLase Laser and PiezoWave treatment has an effect. What is not as clear is how it lessens pain but it does decrease pain. It’s possible the PiezoWave impulse is lavaging the area moving along inflammatory substances, or increasing stem cell production that decreases inflammation, or if the shock wave stimulation of stem cells release substances that affect other cells.

Some case studies have shown that the Piezo Wave or Enpuls shock wave treatments can decrease calcifications in tendons and joints, and even regenerate worn-out cartilage.

Dr. Jeffrey Tucker sports injury chiropractor in Brentwood uses non-invasive shock wave therapy and laser as a safe alternative to cortisone or prolotherapy for the treatment of athletic injuries related to poor ATP production.

 

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Chronic Pain Chiropractor

It is well established that regular exercise can help with disorders such as fibromyalgia, chronic low-back pain and arthritic conditions. Most chronic pain and sports medicine practitioners will agree that gentle aerobic conditioning is a good place to start exercising. After an aerobic baseline is achieved, strength training for larger muscle groups becomes appropriate. Core training exercises will most likely be recommended as part of a chronic musculoskeletal condition prescription. It’s not likely that you will be introduced to ‘training to fatigue’ exercise, high-intensity interval training or plyometrics if you have chronic pain. The new model of therapy based on research includes:

  • The use of TheraLase laser and shock wave therapy as a non-invasive approach to treat cartilage lesions and osteoarthritis has widely increased as confirmed by the growing number of clinical trials published on this topic.
  • The use of these procedures in clinical application is gaining in popularity. The cost of these machines has been expensive and kept doctors out of the field.
  • Different sources have been investigated for clinical application, especially targeting knee or ankle cartilage disease.3

Other recommendations for chronic pain patients (even high activity patients) are nutritional supplements to restore damaged cartilage. Some combination of Ginger, Rosemary, Quercetin, Curcumin, Hops, Alpha-Linolenic Acid, omega 3’s and and a ketogenic diet can also act as a protectors against future deterioration of the joints.

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.

  1. Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DNM. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update.Open Access Journal of Sports Medicine. 2016;7:21-32. doi:10.2147/OAJSM.S72332.
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Knee osteoarthritis: Stem cells vs laser/shockwave therapy

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.

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Stem Cell Therapy Without Shots?

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.

 

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Low Back Pain Chiropractor

 

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.

  1. Shaffrey CI, Smith JS. Editorial: Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273.
  2. 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.
  3. 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]
  4. 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]
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Treatment for Tennis Elbow

  • 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.
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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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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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