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Stem Cell Specialists
Shoulder Problems
Shoulder issues are also a very common presenting problem. The shoulder is a very shallow joint that is totally dependent on its’ ligamentous capsule and the overlying rotator cuff muscles and tendons for stability. As the joint loosens it can start clicking and become painful.
One of the first sign of shoulder problems can be night time pain when people lie on it. As the muscles relax over time, you pull on the capsule- if the capsule is weak, you’ll feel it. MRI gives quite an incomplete picture of exactly what structures are involved. A detailed palpation exam with an experienced regenerative injection specialist is the best way to determine exactly what structures need to be regenerated. (we call it advanced digital guidance systems). As well as injecting in the whole joint we evaluate and commonly inject other shoulder structures including the Anterior Capsule, Coracoid, Infraspinatus, Supraspinatus, Levator Scapulae and Longismus thoracic attachments. In Regenerative Orthopedics it is important to get all the pain generators if you want complete resolution of the pain and dysfunction. Usually three or four PRP sessions (at 2-4 week intervals) over two or three months are sufficient to complete the healing of damaged structures. If the problem persists or if the damage/degeneration is severe than stem cells/PRP may be indicated as a first-line therapy. We can also use stem cells /PRP as first line if the patient desires a faster healing process. Our overall success rate for resolving rotator cuff strains and sprains exceeds 80%.
Hip Pain
After the knee, hip problems are certainly one of the more common problems that patients ask me about. Of course the most common condition is Osteoarthritis or “wear and tear” arthritis.
After I take a history, the first thing I want to do is a careful palpation exam to see if the hip capsule is positive for the “jump test”. I also want to take a careful look at the lumbar spine and particularly at the pelvis. Just because a patient feels pain in the hip doesn’t mean that that is the origin of the pain. We want to find all the pain generators. Also, I like to see a standard weight-bearing hip xray (a-p of the pelvis, single view) to get a direct look at the joint surface. If there is little or no joint space and the patient is close to a “bone-on-bone” situation, we are generally going to lean towards starting the regenerative healing with stem cells and PRP, rather than PRP alone. In other words, because the condition is more severe, we would like to start with a more powerful approach. On the other hand, if joint space is preserved, PRP may be the order of the day and quite proficient at healing joint capsules and pelvic tendon attachments. It usually takes about three PRP treatments given at 2-4 week intervals for complete resolution. As is usual with all regenerative injection protocols, we ask patients to avoid anti-inflammatory medications and I suggest active rehab such as swimming and cycling. I want to move the affected region but not LOAD the muscle attachments too early. I often recommend a foam roller that patients can use on a carpeted surface to “roll out” the kinks.
Wrist & Carpal Tunnel
Our success rate with wrist pain is over 85%. For more severe cases stem cells are indicated but in many cases PRP alone might work quite well. The vast majority of wrsit pain comes from sprained ligaments. To my mind, regenerative injections is the only reasonable way to fix this.
One patient had severe pain for years and had tried splints and been to the best hand surgeons in the country. She was almost at the point of retiring from her Nursing career because she couldn’t function. It took four or five sessions of PRP but she improved dramatically. She is now pain free and able to function normally. Last I heard she had returned to scuba diving and was heading for the Caribbean. As usual the only way to confirm that a patient is a good candidate is with a detailed palpation exam. Arnica gel often helps and can be applied several times per day. Pharmaceutical anti-inflammatories should be avoided, as should steroid injections.
Foot & Ankle Problems
Foot and ankle problems are commonly due to damaged or stretched connective tissue structures.
In Plantar fasciitis the insertions of ligaments under the foot are stretched, irritating the nerve endings at these points and causing pain. I usually recommend soft orthotics (arch supports), massaging the damaged areas with a golf ball on a carpet and Prolo to rebuild the damaged insertions. As is the rule with connective tissue problems cortisone injections are contraindicated as are anti-inflammatories such as Alleve or Ibuprofen. In Achilles tendonitis the Achilles tendon on the heel is stretched. Cortisone injections are dangerous because there is a high incidence of rupture. I usually recommend mild heel lift to take the pressure off plus Prolo to stimulate healing of the damaged insertions. Recurrent ankle weakness and sprains are not uncommon. Prolo can target the affected regions and rebuild the damaged structures. The surgical approach to ankle weakness does not have a very good track record and, in my view, should be kept as a last resort in case Prolo is not successful.
Sports Injuries
Over the years we have treated all sorts of sports-related injuries. The most common sports-related injuries we see include knee problems, rotator cuff and low back issues but we can address almost any region of the body. In general we can successfully resolve about 85% of cases with regenerative injections. The wonderful thing about the regenerative injection approach is there is very little down time with the therapies and usually the athlete can continue their sport while they are being treated. If the patient has the time and doesn’t mind waiting a month or two for resolution, in many cases two or three sessions of PRP by itself may fix the problem. For more serious, long-standing problems and/or if the patient wants to heal and get back to full functioning faster, stem cell with PRP are recommended. With stem cells we can address even more serious injuries and we recommend that athletes would fully explore regenerative approaches before they consider surgical alternatives. In Regenerative Orthopedics our goal is to rebuild the underlying structure that is damaged. Once we are successful at rebuilding that structure the pain problem should be solved and athletes should be able to return to full functioning. Although there is no guarantee that the athlete will not reinjure the same structure, we expect that once healing has occurred, results should be long-lasting.
One of the most useful applications of stem cells and PRP is for all types of sport-induced injuries. The regenerative injection approach excels at fixing the ligament and tendon sprains and strains that can be so problematic for sports people.
Over the years we have treated all sorts of sports-related injuries. The most common sports-related injuries we see include knee problems, rotator cuff and low back issues but we can address almost any region of the body. In general we can successfully resolve about 85% of cases with regenerative injections. The wonderful thing about the regenerative injection approach is there is very little down time with the therapies and usually the athlete can continue their sport while they are being treated. If the patient has the time and doesn’t mind waiting a month or two for resolution, in many cases two or three sessions of PRP by itself may fix the problem. For more serious, long-standing problems and/or if the patient wants to heal and get back to full functioning faster, stem cell with PRP are recommended. With stem cells we can address even more serious injuries and we recommend that athletes would fully explore regenerative approaches before they consider surgical alternatives. In Regenerative Orthopedics our goal is to rebuild the underlying structure that is damaged. Once we are successful at rebuilding that structure the pain problem should be solved and athletes should be able to return to full functioning. Although there is no guarantee that the athlete will not reinjure the same structure, we expect that once healing has occurred, results should be long-lasting.
Over the years we have treated all sorts of sports-related injuries. The most common sports-related injuries we see include knee problems, rotator cuff and low back issues but we can address almost any region of the body. In general we can successfully resolve about 85% of cases with regenerative injections. The wonderful thing about the regenerative injection approach is there is very little down time with the therapies and usually the athlete can continue their sport while they are being treated. If the patient has the time and doesn’t mind waiting a month or two for resolution, in many cases two or three sessions of PRP by itself may fix the problem. For more serious, long-standing problems and/or if the patient wants to heal and get back to full functioning faster, stem cell with PRP are recommended. With stem cells we can address even more serious injuries and we recommend that athletes would fully explore regenerative approaches before they consider surgical alternatives. In Regenerative Orthopedics our goal is to rebuild the underlying structure that is damaged. Once we are successful at rebuilding that structure the pain problem should be solved and athletes should be able to return to full functioning. Although there is no guarantee that the athlete will not reinjure the same structure, we expect that once healing has occurred, results should be long-lasting.
Back problems
Back pain is one of the most common presenting problems that I see. Despite MRI findings and disc abnormalities, in my experience Pelvic strain/sprain is by far the most common root-cause of backpain. The wonderful news is that for a Regenerative Orthopedic specialist, this type of back pain should be quite straight forward to fix.
The large gluteal muscles that stabilize and work the hips are very commonly strained. If a patient presents with backpain the essential part of the exam is a thorough palpation of the whole low back region including the lumbar spine, sacroiliac, gluteal insertions and the hips, as well as the IT bands (down the lateral part of the femur). Quite commonly the gluteal insertions will often light up with the “jump sign” and the patient will report that palpating reproduces their pain. Unfortunately, these stretched insertions don’t show upon MRI’s. These gluteal insertions are one of the simplest and safest areas in the body to inject with either concentrated dextrose or PRP. Our success rate is upwards of 85% for patients who have a positive jump sign. As I have mentioned, it is not uncommon for patients to present with positive MRI findings and show a disc issue. In my view these are imaging abnormalities that are clinically irrelevant. In other words, these discopathies are there but are not the root-cause of the pain. This is, of course, crucial to understand. Otherwise one ends up with the wrong diagnosis and inappropriate treatment (such as epidurals and possibly surgery) that are unlikely to solve the pain problem and may even aggravate the situation. Some of you may be aware that back surgery has a pretty poor track record of improving backpain. The reason for this in not that the surgeon is lacking etc. but that the diagnosis is wrong. Part of the issue is modern medicine is we are overly reliant on MRI to make the diagnosis. When I went to medical school many years ago we were taught that there is no substitute for a good history and physical exam. I think this dictum is still relevant today. A simple yet detailed palpation exam remains a very elegant way to identify the structures that are the root-cause of the pain. We call these palpation exams “advanced digital guidance systems”. When we identify the “jump sign” we have made the diagnosis of where the pain is originating with a high degree of certainty. If one uses PRP injections alone, resolution of back pain usually takes three or four sessions over a two month period. If one elects to use stem cells, results may be considerably faster. We like to recommend an active rehab with swimming and cycling. I also find that using a foam roller on a carpeted floor helps patients roll out the kinks in their pelvis and speeds the healing process. As usual, we ask patients to avoid anti-inflammatory pharmaceuticals for pain. They may use Tylenol or mild painkillers such as codeine or tramadol to make themselves more comfortable while they heal. At our center we have an overall success rate exceeding 85%. Results tend to be long-lasting.
Knee Pain? Facing Knee Surgery?
Knee problems are one of the most common problems I deal with in my practice. The two main types of problems are meniscal tears/ with or without ligament damage and degenerative Osteoarthritis with moderate or severe cartilage loss and joint space narrowing.
Meniscal Tears: For meniscal tears, unless they are very large and cause locking of the joint can generally be handled by stem cells. If they are very large, sometimes patients will require arthroscopic trimming. All patients with meniscal tears should also have their ligaments carefully examined since they are often damaged also and the diagnosis is missed. It is very important that the doctor palpate the medial collateral ligaments and other supporting structures because these can often be the main pain generator. Meniscal tears are often blamed because we see them so well on MRI. The only way to pick up the very common ligament sprains is by a specific palpation exam of the connective tissue structures that looks for the “jump sign”. Osteoarthritis: In the case of degenerative arthritis, patients often arrive saying that their x-rays revealed bone-on-bone and they were given the options of a cortisone shot, anti-inflammatories and, when they couldn’t stand the pain anymore, knee replacement.
Neck Pain
MRI is useful to pick up disc problems but of course misses the stretched tendon and ligament structures which are so commonly the culprits. In the end, unfortunately, the source of the pain is often misdiagnosed leading to inappropriate treatments that are unlikely to solve the problem and may actually aggravate the condition.
Cervical pain of all types whether due to disc or sprain. Neck pain is a common complaint whether due to whiplash, or a degenerative process. It is important to examine the suboccipital region (base of the skull), cervical spine including the facet joints and scapular regions for potential ligament or tendon trigger points.
