All posts in Sports medicine

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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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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Post Concussion Syndrome Diet

After a concussion injury rest is not enough. It’s important to reduce the inflammation, decrease chemical changes, help heal neuron function and provide neural protection. How do we feed the brain? Start with drinking water – consume 1/2 your body weight in ounces of water. It’s important to limit your calories: try for 250-500 calories less per day than your usual diet. In other words, if you usually consume 3,000 calories a day, strive for a limit of 2500 calories a day. Avoid trans fats, MSG, aspartame, sugars, caffeine, alcohol, artificial colors or flavors. Decrease salt and sodium intake. Add flax seeds or hemp seeds to foods such as shakes or salads; eat avocado and vegetable soups; consume at least 4 cups (2 at lunch and 2 at dinner) of vegetables per day.

Supplements include Boswellia (Standard Process)

NAC

Fish oils

Vitamin D (6,000 IU/day)

Anthocyamides

Most of the above nutients can be taken in a shake by Xymogen called Brain Sustain. Click on the  product vitamin link at the top and go to Xymogen to place your order.

Walking is helpful but don’t walk with music playing in earphones. Make it a meditative type of walk – not to fast and not to slow.

Practice deep breathing – deep inhalations and slow exhalations. Set a timer for 10 minutes twice a day to practice breathing.

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Chiropractor Sports Medicine

Chronic Pain Patients Offered Help

If you have neck or low back pain for more than 3 months that is considered chronic pain. It will be important for you to find a doctor that combines the most recent and relevant treatments to help you. The assumption is that “Doctors want to help patients” but Doctors and patients alike often prefer subtle changes in practice and patient care. In simple terms, Doctors can be slow to adopt new technology that helps improve outcomes and patient care!

TheraLase laser therapy is a relatively new yet effective treatment that can help reduce chronic pain, however, laser devices have been considered expensive to most doctors. For doctors, purchasing a laser has become as simple as buying an old fashioned ultrasound device. For patients, there’s really only one thing you can do. And that’s to go to your doctor, and ask him or her about laser therapy.

Laser is a solution to help chronic back and neck pain sufferers – it may make the lives of many pain sufferers a lot more enjoyable and a lot less debilitating for a fraction of the cost of surgery and spinal injections.

TheraLase – a Canadian based company introduced a laser that may help prevent nerve (radicular) pain through the interruption of the lack of oxygen and blood flow (the ischemic metabolic pathway) to painful tissues; Theralase may interrupt the generation of inflammation and help decrease inflammatory chemicals that have already occurred and be causing chronic pain; TheraLaser may improve reinnervation in chronic nerve pain (radiculopathy).

What Theralase would do is essentially give doctors and chronic pain patients with mild-to-moderate musculoskeletal pain an option for treatment that is relatively inexpensive compared to drugs and surgery.

Dr. Jeffrey Tucker, a Chiropractor in Los Angeles, California combines TheraLase, hands-on massage therapy, diet and exercise as a perfect fit to help chronic pain patients. Tucker says “Laser therapy combines well with physical therapy, for increasing range of motion to stiff and painful joints and muscles, and increasing muscle strength. Doctors often move too slowly to adopt new technology that can help patient outcomes, then patient’s end up on the wrong side of recovery and health”.

Whether you are an athlete or chronic pain patient, you can never give up finding ways to improve performance and progressive thinking is crucial. The most basic drive for doctors to change is when patients go to their doctor’s office and ask about all of the new possible ways for help. Unfortunately if your doctor doesn’t work that way, you as the patient may have to take a detour from that doctor and find a practitioner using new technology like the TheraLase laser. Call 310-444-9393 if you would like a laser session,

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