All posts in Sports medicine

OSTEITIS PUBIS | ATHLETIC PUBALGIA

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.

  1. 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.
  2. Beatty T. Groin Pain Osteitis pubis in athletes. Curr Sports Med Rep. 2012 Mar-Apr;11(2):96-8. Groin Pain Osteitis pubis citations
  3. 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
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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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Acoustic Therapy – Knee Pain – Brentwood, CA

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

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Shockwave Therapy for Knee Pain

  • Arthroscopy Journal, doctors concluded that PRP injections are a viable treatment for knee osteoarthritis and should be considered in patients with knee osteoarthritis.6 Studies like these add to the accumulating evidence that PRP can halt and reverse meniscus degeneration.7,8
  • J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472 they confirm that stem cell therapy stimulates the regeneration of meniscal tissue. Specifically with regard to post-meniscectomy meniscus growth (with stem cells).9 This means we can use the PIEZOWAVE and EnPuls to stimulate regeneration even after surgery.
  • Doctors at the University of Iowa found that stem cells and cartilage cells could be influenced to migrate to the site of “white-zone” where the most difficult meniscus tears are. I use Laser and PiezoWave and EnPuls to do just that!
  • I do think stimulating the tissues with PiezoWave and EnPuls shockwave can promote regeneration and is a promising new strategy in meniscus repair.10
  • Stimulating stem cell based strategies for meniscus tissue is a fundamental role in meniscal regeneration. 11
  1. Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. A Systematic Review of Overlapping Meta-analyses. Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
  2. Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, Shieh YH, Wu CH, Deng WP. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011 Sep;32(25):5847-54. Epub 2011 May 25.
  3. van Buul GM, et al. Platelet-Rich Plasma Releasate Inhibits Inflammatory Processes in Osteoarthritic Chondrocytes. Am J Sports Med. 2011 Nov;39(11):2362-70. Epub 2011 Aug 19.
  4. 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. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
  5. McCrum CL, Vangsness CT. Postmeniscectomy Meniscus Growth With Stem Cells: Where Are We Now? Sports Med Arthrosc. 2015 Sep;23(3):139-42.  PUBMED Meniscus Growth With Stem Cells
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Sports Medicine & Cannabis Creams

Dr. Jeffrey Tucker, a sports medicine chiropractor and patent holder on a cannabis cream process says, “Cannabis creams help achy joints and sore muscles be less painful. Getting old doesn’t have to be the end of high quality performances.”

Dr. Tucker says “Continue to train at a level of intensity where you feel pushed every now and then and, stay motivated to be consistent with your workouts. Don’t overdo it each and every workout, we want you to remain injury-free.” Tucker finds that when an older person gets an injury it could take longer to recover and they lose ground in their training. Tucker recommends cannabis creams to his patients for sore joints and muscles.

By the time we are forty Tucker feels we should know our exercise capacity, in other words, the mileage you can walk or run without an injury, or the amount of weight you can lift without needing extra recovery days. Tucker also suggests men get there testosterone checked at age 30 so they have a base line for later in life. We can offer men natural supplements to help boost testosterone if they need it later in life. Estrogen dips dramatically after menopause but estrogen has a number of positive effects on workout performance, including boosting of cardiac output (amount of blood pumped from the heart per minute) and a preservation of bone density. Tucker notes that he has patients that use testosterone and estrogen with cannabis creams. Female athletes who don’t opt for postmenopausal estrogen-replacement therapy might suffer from weaker cardiac action, a higher incidence of stress fractures and greater overall rates of injury, all of which could downgrade performance and aerobic capacity by making consistent training more difficult. Estrogen-replacement therapy should be considered and women can determine how estrogen influences their performances over time.

Tucker encourages exercise intensity and says it is a greater producer of fitness than mileage. Therefore increasing the intensity and recovery and cutting back on the miles is the way to go! It’s easy to do! Here’s an example:

* Running six times a week for a total of 30 miles with 3 miles at a fast pace, can be changed to,
* Running five days a week for 25 miles with 4 miles at a fast pace.

The extra day recovery and less miles will decrease the risk of injury but increasing pace for an extra mile improves V02max, running economy, and competitive performances.

The idea of adding in more recovery seems to fit well with older athletes’ training needs. Tucker is a big advocate of cross training (swimming, walking, running, cycling, step machines, and weight training) and says his favorite exercises these days is isometrics and the Turkish Get Up. Everyone agrees that strength training is important for people over the age of 50 – when atrophy (wasting) of muscle and skeletal tissue begins to become a problem.

Final note: ALWAYS consult your doctor before embarking on a program of cannabis and strenuous exercise.

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Knee Pain

In the Journal of Knee Surgery doctors from the Department of Orthopaedic Surgery, University of Pittsburgh had this to say about regenerative medicine:

  • 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. However, what they don’t say is that these therapies have risks! I encourage patient’s to start with non-invasive, non-operative therapy in the athletic and aging population.

I agree that Platelet-rich plasma (PRP) and stem cells have shown promise in the treatment of various conditions. I see improved outcomes following shockwave therapy and or laser therapy in early osteoarthritis of the knee, as well as in chronic patellar tendinopathy conditions. My feeling is to start with non-invasive regenerative therapies such as laser and shockwave and then go with injections on an as-needed basis.

  • There is evidence that supports PRP in the augmentation of anterior cruciate ligament (ACL) reconstruction. But there is research for shockwave too. Shockwave therapy research exists for collateral ligament and meniscal injuries as well. I’m especially excited about the results we see with knee osteoarthritis using the laser and shockwave devices.
  • …As the volume and quality of evidence continue to grow, biologic agents are poised to become an integral component of comprehensive patient care throughout all orthopedic specialties. (2) I completely agree with this statement.
  • The use of stem cells as a biological approach to treat cartilage lesions and osteoarthritis has widely increased. The same is true for Laser and Shockwave therapy.
  • Different sources have been investigated for clinical application, especially targeting knee or ankle cartilage disease.(3) I continue to be especially excited about the results we are seeing with the shockwave therapy and laser combination treatment.

I think athletes or high activity people with joint pain need to learn about the choices between stem cell injections and non-invasive laser and shockwave treatments to restore damaged cartilage, and also to act as a protector against future deterioration of the knee joint.

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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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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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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