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?
Call 310-444-9393 for an appointment
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.
Call 310-444-9393 for an appointment
Better than Active Release Therapy…For many athletes, their journey continues because of some form of massage such as Active Release Therapy also known as ART. Every athlete has individual needs and goals, so their training, musculoskeletal (strength, muscle and joint flexibility), and recovery programs should be customized for them.
Dr. Jeffrey Tucker evaluates each athlete, taking into consideration age, gender, sport and performance goals to help him or her get faster, stronger and stay injury free. In this day and age, it’s a service that has transitioned from luxury to necessity for many athletes.
Tucker’s sports performance programs and recovery programs include laser therapy, shockwave therapy, deep muscle stimulation, magnet therapy, looking at an individual’s lab results, flexibility, stability, eating habits, body composition and lifestyle habits. This is how we help patients reach their goals – increase speed, power, endurance, overall performance, and of course, achieve their medal dreams.
Call 310-444-9393 for your appointment.
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.
Lymphatic drainage at Dr. Jeffrey Tucker’s office uses the latest technology and takes a whole body approach. The Lymphatic System is one of the most overlooked yet significant systems in the body. The Lymphatic System travels throughout the body to remove waste from every cell while helping to regulate the immune system. It includes a complex network of vessels, ducts, lymph nodes, the spleen, the thymus gland, the adrenal glands, and the tonsils.
The lymphatic vessels act like a giant filter or drainage system for the body that needs to stay moving and clear for it to work properly. Stagnant or sluggish lymph flow leads to waste and toxic build up, weakening immunity and leading to a wide variety of health issues. When your lymph system becomes congested you may notice:
Stiffness, dry skin, water retention, brain fog, stubborn weight gain, chronic sinus congestion, cellulite build up, cold hands and feet.
Dr. Tucker uses the PhysioTouch machine for Lymphatic Drainage. Call 310-444-9393 for more information.
Dr. Jeffrey Tucker. Chiropractor. Posture Expert. Pain Relief Specialist. Educator. Writer. Healthy Aging Advocate.
Born in Los Angeles, Dr. Tucker attended SCHUS. Dr. Tucker provides patients with cutting-edge technology and personalized care. He is Board certified in rehabilitation and a specialist in soft tissue injury therapy. Dr. Tucker helps patients through sports injuries, posture related conditions, trauma related pain and procedures including those helping patients age their very best. Dr. Tucker is an expert in advanced movement assessments, exercise therapy, soft tissue therapy and nutritional weight loss programs.
In West Los Angeles, Dr. Tucker employs a full time master weight loss specialist. His office offers three types of lasers, including TheraLase and Lite-Force devices; he has the only practice that has three types of shockwave machines including Zimmer, Storz, and PiezoWave; the MagnaWave PEMF device for state of the art magnet therapy; Lymphatic therapy, SCENAR; ELDOA exercise programs as treatments and other soft tissue procedures like the Rapid Release and Deep Muscle Stimulator. He recently introduced patients to Virtual Reality for stress reduction.
He dedicates about one to two weekends a month travelling around the Country to teach other practitioners about the POLITE Method. Dr. Tucker is incredibly passionate about helping people solve pain issues and age management practices. With appropriate diagnostic testing, including Functional Movement Screens (FMS), body mass, and comprehensive consultations, he is able to help patients who wish to get healthy and stay healthy by creating an individual precision physical therapy program for each person.
Dr. Tucker feels that each of us are individuals with individual needs. Traditional medicine, in his opinion, is suboptimal, and he will ask you “What matter’s to you?” rather than just “What is the matter with you?”
Call 310-444-9393 if you are ready to maximize the quality of your life for your remaining years.
What’s the first thing I do?
There is a significant association between neck pain and Temporo-mandibular Dysfunction (TMD) symptoms (Ciancaglini ’99). In fact, 50% of cervical spine cases will have TMD, often as the primary problem (Lewitt).
Since many patients present with both neck and jaw pain, I look closely at both areas. However, I check your posture, the skull bones, pelvis, and feet too. It is a very comprehensive examination…I like looking at details! Many muscles of the neck and jaw can be imbalanced , especially the Digastrics, SCM, upper traps and suboccipitals. I teach my patients how to self stretch and balance these muscles.
Depending on the case I might recommend laser therapy, magnet therapy, deep muscle stimulation therapy and ‘hands on’ therapy.
Take home advice includes eat a soft diet; keep your tongue up, gently resting on the palate and teeth apart as the rest position of the jaw; chew on both sides at the same time or alternate sides; avoid clenching and grinding the teeth, tensing, or gum chewing; avoid excessive or prolonged opening of the mouth; avoid sleeping on the stomach; do a trial of laser therapy for pain control; use heat or ice over tender muscles (discuss with Dr. Tucker which is best for your case); I may recommend a topical cream (Hemp based or other cream).
If you need help with your dentist I am happy to work with them.
Dr. Tucker is the first Chiropractor to use virtual reality (VR) in a private practice setting. This demonstrates his willingness to embrace new technology and constantly look for new pain relief strategies. VR offers an immersive, realistic, three-dimensional experience that patients describe as pleasant and capable of reducing pain and anxiety. VR is feasible, tolerated, and well-liked by patients, especially for breathing exercises and relaxation.
Dr. Tucker is a Los Angeles based Chiropractor who sees this emerging technology for his patients in acute and chronic pain. Use of VR has been researched in Cedars Sinai Hospital Los Angeles and has been shown to help reduce pain and is a controlled distraction. VR is an effective and safe therapy for pain management. Call 310-444-9393 to make an appointment and find out if VR can help your care.
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.
Chronic low back pain is the most common and important clinical, social, economic, and public health problem of all chronic disorders. There is a need for improvement to help reduce chronic pain and learn how to manage it. Contemporary pain neuroscience that I use to help persistent chronic low back pain includes
- Identification of central nervous system pain (brain memories of pain) vs actual lower back region pain
- Decreasing chronic inflammation in the body and in the brain itself (Glia cell activation or gliopathy) using laser therapy, extracorporal shockwave therapy and nutrition;
- Improving sleep (poor sleep can increase pain and anxiety);
- Optimize gentle movement therapy to your capacity
My main goals for you include decreasing pain, improvements in coping with pain symptoms, decrease the threatening nature of pain, anxiety, and cognitive speed. I am a specialist in teaching patients how to move again without that “dangerous’ or fear-memory taking over.
If you suffer from chronic low back pain feel free to call for an appointment at 310-444-9393