Pain Management

The Continuing Relationship Between Physical Therapy and Regenerative Medicine

In regenerative medicine, stem cells are used to treat damaged or destroyed tissues and organs. These stem cells come from the patient themselves and are a “blank state” which can be turned into several different variations of cells including bone, ligament, tendon or muscle.

Given that the main goal of both regenerative medicine and physical therapy is to restore the normal functioning of a diseased or injured tissue it is only appropriate that the two therapies – physical therapy and regenerative medicine – combine forces.Regenerative medicine aims to help the body heal itself more effectively. The study of using a tissue, cellular, organ and medicine substitutes to restore biological function lost as a result of injury, disease, congenital abnormalities or age has brought together a variety of scientists – many with overlapping backgrounds – in the field of regenerative medicine.

Once the regenerative medicine is administered via injection or other procedure, patients are often encouraged to continue physical therapy – as the strength gained from the stem cell therapy enhances their ability to complete physical therapy.

Furthermore, in cases such as artificial organs and medical devices, the relationship between the two fields is also important. A major problem with organ transplant is that there is no way to know if the body will reject the organ or not, and unfortunately, there is no way to prevent it either. However, the great benefit to regenerative medicine, and specifically stem cell therapy and the like, is that the materials used to aid in the healing process are taken directly from the patient – via their blood, bone marrow, or other appropriate sample collected for the needed materials.

However, following the introduction of a new organ or a medical device – even if the organ is one grown from the own patient – physical therapy is still a vital part of the rehabilitation process. Physical therapy has the strong power to enhance the healing potential. As a result of physical therapy, the body can maximize the functional interaction between the host and the donor object – rather it is an organ or a medical device. Following a form of regenerative medicine treatment, physical therapy should be appropriately positioned so that it can optimize the patient’s post-transplant recovery.

Oftentimes, regenerative medicine treatment options are also used for problems such as back pain, knee pain, and other debilitating chronic pain. Typically, the patient was probably receiving physical therapy prior to regenerative medicine treatment options – or had at least tried it as an option. However, to continue to increase the mobility and give the stem cells the best chance at being successful, physical therapy should continue to be an important part of the patient’s regimen.

As the two fields continue to work in close contact with one another, it is also imperative that scientists and rehabilitation specialists continue to work to develop clinically relevant protocols.

When combined, physical therapy and regenerative medicine can continue to optimize the quality of life for those patients suffering from chronic pain or other ailments which have previously inhibited them from doing things.

What You Need to Know About Runner’s Knee (Patellofemoral Pain)

Patellofemoral pain (runner’s knee) is often called chondromalacia patellae. This describes knee joint pain that is at the front aspect of the knee and around the kneecap.

What are the symptoms of runner’s knee?

The symptoms of runner’s knee include:

  • Pain at the front of the knee, under and around the patellacanstockphoto8700031
  • Worsening pain with climbing hills or sitting for long periods of time
  • Tenderness along the inside border of the patella
  • Swelling after exercise
  • Cracking or clicking sound when bending the knee
  • Wasting of the quadriceps muscles

Who gets runner’s knee?

Patellofemoral pain is more common in adolescent females who participate in sports. However, anyone who runs a lot can experience runner’s knee.

What causes runner’s knee?

Because it has no blood vessels or nerves, damage to the knee cartilage cannot cause patellofemoral pain. However, damaged cartilage can lead to synovitis, which involves synovial membrane inflammation. Other causes of runner’s knee include soft tissue injury or irritation and erosion of the bone and/or cartilage. The initial reason for patellofemoral pain is overuse, which leads to increased forces on the joint. The pain related to this condition results from a sudden increase in training, performing at a higher intensity, jumping more, and bending the knee more.

What factors contribute to runner’s knee?

  • Changes in load – This is one of the biggest factors contributing to runner’s knee. You should canstockphoto16354147avoid changing both speed and duration in the same training session. In addition, you need to factor in a lighter training week every four weeks to allow for recovery.
  • The way you move – Biomechanics can affect the relative load passing through the knee joint.
  • Footwear – Inappropriate footwear can contribute to knee pain. When the trainers feel as if the spring has gone, it’s time for a change. Shoes need changed when soles are worn, or when they no longer offer adequate support.
  • Changes in training surface – When you change training surface, the risk increases for runner’s knee. Changing surfaces may increase the demand on your legs, and your body does not have time to adapt. If you must change, do so gradually.

What increases the risk for runner’s knee?

Certain situations and things can increase the risk of developing runner’s knee. Risk factors include:

  • A structural defect
  • Kneecap too high in the joint
  • Weak thigh muscles
  • Tight Achilles tendons
  • Tight hamstrings
  • Poor foot support

How is runner’s knee treated?

Treatment is focuses on reducing pain and preventing further problems. The doctor attempts to identify and modify the causes of runner’s knee. Options for treatment include:

  • Knee bracing – This involves wearing a patella-stabilizing knee brace to prevent further injury RxBracingand provide support for the joint.
  • RICE protocol – This includes resting the knee, use of ice packs, wearing a compression wrap, and elevating the affected leg.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These medicines help decrease swelling and pain. Ibuprofen, ketoprofen, and naproxen are common examples.
  • Physical therapy – The therapist teaches the athlete heel drops and uses sports massage to loosen tight muscles and structures. Gait analysis is done to determine if orthotic inserts are needed for foot biomechanics. In addition, the therapist teaches strengthening and stretching exercises.
  • Surgery – For chronic cases of runner’s knee, surgery is used to release the tight lateral knee structures.

How common is runner’s knee?

In the United States and among physically active people, patellofemoral syndrome is common. The prevalence rate is approximately 20% in student populations, according to a recent study. Runner’s knee is more likely to affect women than men, and it affects the young more than the old.

For the top sports medicine treatment in Gilbert, Chandler, Mesa and Queen Creek, call OSPI today. The practice offers top pain management and orthopedic doctors at the practice, with most insurance being accepted. Call now!

Resources

Kettunen JA, Visuri T, Harilainen A, et al. Primary cartilage lesions and outcome among subjects with patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2005 Mar. 13(2):131-4.

Tennis Elbow (Lateral Epicondylitis) Treatment in the East Valley AZ

Tennis elbow is a painful condition of the elbow that is related to overuse. Also called lateral epicondylitis, tennis elbow involves inflammation of the tendons that joint the forearm muscles on the outer aspect of the elbow.

What sporting activities cause tennis elbow?

As evident by the name, tennis and other racquet sports can cause tennis elbow. However, any sport that involves overuse of the elbow can lead to lateral epicondylitis. Repeating the same motions over and over can lead to pain and tenderness of the elbow.elbow pain

Who gets tennis elbow?

Athletes are not the only individuals who get lateral epicondylitis. Painters, carpenters, auto workers, butchers, cooks, and plumbers are all prone to tennis elbow. Studies show that workers in these professions have lateral epicondylitis more than the general population.

What structures are involved in tennis elbow?

The elbow joint is comprised of three bones: the humerus (upper arm bone), the radius (large lower arm bone), and ulna (smaller lower arm bone). The bony prominences along the bottom portion of the humerus are called the epicondyles, and the one on the lateral side is the lateral epicondyle. Ligaments, tendons, and muscles hold the elbow joint together. The forearm tendons attach the muscles to bone at the area of the lateral epicondyle. The main tendon involved in tennis elbow is the extensor carpi radialis brevis (ECRB).

What causes lateral epicondylitis?

Overuse is the main cause of tennis elbow. The ECRB muscle helps stabilize the wrist when the elbow is in a straight position. When this structure is weakened from overuse, tiny tears form at the area where the tendon attaches to the lateral epicondyle. These tears cause pain and inflammation of the elbow region.

How common is tennis elbow?

Research reports should that the annual incidence of tennis elbow in the U.S. population is 2%. Most people who have this condition are between the ages of 30 and 50 years.

What are the symptoms of tennis elbow?

The symptoms of lateral epicondylitis come on gradually, with pain beginning mild and slowly worsening over the next few weeks. Common symptoms are:

  • Weak grip strength
  • Pain and burning of the outer part of the elbow
  • Worsening discomfort with forearm activity (holding a racquet or shaking hands)

How is tennis elbow diagnosed?

The doctor will ask questions about your activities, inquire about your symptoms, and conduct a physical examination. During the exam, the doctor will have you straighten your wrist, fingers, and elbows to check range of motion, and test your strength. X-rays are used to provide images of bone. The magnetic resonance imaging (MRI) scan is used to assess for soft tissue problems. Finally, an electromyography (EMG) is used to rule out nerve involvement.

What is the treatment for tennis elbow?

Around 88% of patients respond to nonsurgical treatment. This includes:

  • Rest – Resting the arm for several weeks can alleviate the symptoms.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen, ketoprophysical therapy2fen, and naproxen are used to decrease inflammation.
  • Physical therapy – Specific exercises are used for muscle strengthening and stretching. In addition, the therapist uses ultrasound, massage, and electrical stimulation for pain reduction.
  • Counterforce bracing – Use of a brace that is centered over the back of the forearm. This works to rest the tendons and muscles.
  • Corticosteroid injections – The doctor can inject the damaged muscle with a corticosteroid agent to decrease inflammation.
  • PRP Therapy – treatment with platelet rich plasma therapy has been revolutionary for treating tennis elbow. It involves a simple blood draw for patients, and a centrifuge then spins the blood to concentrate platelets and growth factors  for injection.
  • Extracorporeal shock wave therapy – This treatment sends sound waves across the elbow, which creates a form of microtrauma that stimulates the body’s natural healing abilities.

When is surgery indicated for lateral epicondylitis?

If your symptoms persist for more than 6 months, and they do not respond to nonsurgical treatments, the doctor may suggest surgery. Surgery involves removal of diseased muscle and reattaching health tendon and muscle back to the bone. Open surgery is a common approach to elbow repair, which involves making an incision over the elbow. Arthroscopic surgery involves use of a tiny scope and small instruments, which are used to make repairs. These surgeries have a 90% success rate.

What can I expect with rehabilitation?

Following surgery, the arm will be in an immobilization splint for around one week. After removing the splint, sutures are removed, and exercises begin to restore strength and flexibility to the elbow. Total recovery time is 4-6 months.

OSPI offers top treatment for tennis elbow, including comprehensive nonoperative options. Most insurance is accepted for treatment in Gilbert, Chandler, Mesa, Queen Creek and surrounding areas with the best orthopedic doctors. Call OSPI today!

Resources

Herquelot E, Guéguen A, Roquelaure Y, Bodin J, Sérazin C, Ha C, et al. Work-related risk factors for incidence of lateral epicondylitis in a large working population. Scand J Work Environ Health. 2013 Nov. 39(6):578-88.

How Well do Injections Work for Facet Arthritis Pain?

Chronic spine problems can pose not only a diagnostic problem, but also a therapeutic challenge, as the sources of this pain are numerous. There are facet joints at every spinal level on each side. The lack of specific radiolochronic failed back paingical findings, along with overlapping clinical reports, can complicate the challenge. One of the interventional pain relieving tools for spinal pain is the facet joint injection. This can be administered effectively by pain management doctors in Gilbert and Chandler.

This special injection technique can be defined as a way to identify facet joints as a source of the spinal pain, and also provide significant relief. Facet injections might be beneficial for facet syndrome and lower back pain, facet joint tenderness, post-laminectomy problems, and persistent lower back problems.

Inflammation and injury can cause pain during motion. This can initiate a long continuous problem of physical malfunctioning, muscle spasm and the irritation of facet joints. Local anaesthetic and steroids, in the form of image-guided injections around the facet joints, will provide pain relief by breaking this vicious cycle. This outpatient process is reproducible and provides diagnostic accuracy.

Study Shows Facet Joint Injections Work

Few treatments have been rigorously evaluated, which has led to the common cause of chronic lower back pain being unclear. A randomized trial using a placebo was carried out in order to help evaluate the efficacy of corticosteroid injections for Facet Joint Injection Use thisback pain. These are administered into the facet joints for treatment.

In the study, patients were administered injections of local anesthetic between the fourth and fifth lumbar vertebrae. Those who reported immediate relief, were given further methylprednisolone acetate (20mg; n=49) or isotonic saline (in=48) under fluoroscopic guidance into the fifth lumbar and first sacral vertebrae. For six months, 95 patients were followed and their conditions were assessed in regards to back mobility, pain severity and the limitation of function.

After one month, no statistical or clinical difference was noticeable in the outcome of back flexion and functional status from two of the study groups that were evaluated. Of the patients, 42% receiving methylprednisolone, and 33% of those on placebo showed marked or very marked improvement. After three months, similar results were obtained. Eventually at the six month evaluation, the patients who had been treated with methylprednisolone reportedly achieved more improvement. They experienced less pain and less physical disability.

Facet blocks are a common procedure performed for chronic back pain. They may be performed in conjunction with medial branch blocks, and eventually a radiofrequency ablation. The RFA can provide over a year of consistent pain relief.

OSPI offers all types of nonoperative back pain procedures. Call the office today for top pain management in Gilbert, Chandler, Mesa and Queen Creek!

 

 

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