Author Archive: aenriquez

Do Vestibular Disorders Go Away With Manual Lymphatic Drainage?

The vestibular sensory organs in our inner ear, the cochlea, and the semicircular canals are responsible for our balance and proprioception/position. When these organs are damaged with disease or injury, it can lead to dizziness, vertigo, balance problems, and other symptoms. These can be transient as people are able to recover after a few weeks of normal activity due to vestibular compensation. Conversely, the symptoms can be lasting, affecting a person’s ability to maintain posture and balance.

 

A person with a vestibular disorder may have difficulty in maintaining balance and may adopt an exaggerated hip sway, swivel the entire body while keeping the head still when turning to look at something, or always look down to avoid a confusing swirl of activity. Ironically, these mannerisms can worsen the vestibular symptoms and often cause headaches, muscle tension, and fatigue.
Meniere’s disease is the most common vestibular disorder this procedure is considered for

Endolymphatic sac decompression is a procedure that involves draining of the excessive endolymph from its sac in order to decompress it. It is sometimes indicated for Ménière’s disease or secondary endolymphatic hydrops to relieve endolymphatic pressure in the cochlea and vestibular system. Meniere’s disease is the most common vestibular disorder this procedure is considered for. It is characterized by vertigo, tinnitus, hearing loss, imbalance and a feeling of pressure deep inside the ear. While there are several treatment options for it, including betahistine, cyclizine, steroid injections, and gentamicin injections, but endolymphatic sac decompression is considered for refractory cases.

 

There are multiple ways to perform this procedure. One method involves removing the mastoid bone surrounding the endolymphatic sac and allowing the sac to decompress. Alternatively, a shunt may be placed into the endolymphatic sac so that the excess fluid can drain out into the mastoid cavity.

Endolymphatic sac decompression is performed as an outpatient procedure. During the procedure, an incision is made behind the ear and the mastoid bone is exposed. The bone is fragmented to reveal the endolymphatic sac and a hole is cut into the outer layer of the sac using a laser. A shunt is then inserted into the sac and the incision is closed. The procedure takes approximately 90 minutes and is performed under general anesthesia. If there are no adverse events, the patient is discharged an hour later. Most patients return to work the day after surgery. The patient’s hearing gradually improves in the ensuing few weeks and then returns to normal.

Endolymphatic sac decompression has proven to be an effective treatment for patients with Meniere’s disease with vertigo and light-to-moderate hearing loss. In a recent study published in JAMA, endolymphatic sac surgery provided an improvement in major spells of vertigo in 77% of patients at 24 months after surgery. Furthermore, revision surgery provided an improvement in 65% of cases, especially those with recurrent symptoms more than 24 months after their original procedure.

Grade I Hamstring Strain

Hamstrings are the three muscles at the back of the thigh. They traverse between the hip and the knee and are named semimembranosus, semitendinosus and biceps femoris. They are involved in bending the knee., tipping the pelvis back when you lean backwards, and twisting the knee when the knee is bent.

 

A hamstring injury ranges from a strain to a muscle tear.
There are three grades of hamstring injury:

  • Grade I: a mild muscle strain
  • Grade II: a partial muscle tear.
  • Grade III: a complete muscle tear or tear of an attachment.

 

Grade I injury may take a few days to heal but a grade III injury can take months. We’ll focus on grade I hamstring injury in this article.

The best way to avoid hamstring injury is to spend time working on your hamstring strength

Grade I Hamstring injuries are very common in sports, especially those that involve sprinting, suddenly stopping and changing direction, and jumping. These include football, rugby, baseball and track running. They typically happen at the end of the swing phase of running, just before the outstretched leg touches the ground, as it is at this point that the hamstring muscles have to suddenly contract to bend the knee.

 

There are multiple predisposing factors for hamstring injury, such as:

 

  • Weak hamstrings – if they are not toned up and strong enough to handle the stress, they are more likely to get injured.
  • Lack of warm-up before exertion – Hamstring muscles are less likely to be injured when they are warmed up through brief stretching/contracting exercises. Keeping the legs warm with suitable clothing while warming up also helps a lot.
  • Tiredness – if the muscle is fatigued, it is more likely to get injured. Having good fitness overall helps.
  • Previous hamstring injury – You are much more likely to have a hamstring injury if you have had a previous one.
  • Older age – you are more likely to have a hamstring injury as you get older.

 

Interestingly, being overweight is not thought to be a risk factor for a hamstring injury.

The best way to avoid hamstring injury is to spend time working on your hamstring strength. A highly trained sportsperson will tend to do this as part of their training but anybody looking to do any activities that involve these muscles is probe to grade I hamstring injury and needs to warm up as well.

There are various approaches to hamstring rehabilitation, with varying times of immobilization to the type of exercise. The goal of any hamstring rehabilitation (especially so in cases of sportspersons) is to return to the previous level of performance while attempting to minimize the rate of injury recurrence. It has been shown that Grade I (and even II) hamstring strains can be aggressively treated with brief immobilization followed by early initiation of running and isokinetic exercises. This is likely to lead to early recovery of function and a relatively low reinjury rate.

Microfracture of the Knee – Recovery & Outcomes

Microfracture is a simple but cost-effective procedure performed to treat smaller cartilage injuries. It is not used to address defects with damage to the underlying bone. It also cannot be used to treat widespread arthritis in a joint. But it is an excellent choice as an initial treatment of smaller articular cartilage injuries.

 

Recovery process

After the microfracture repair of the knee, the post-operative recovery period is fairly complication-free. After the procedure has been performed in the patella and the trochlear groove, there will likely be mild transient pain or “gritty” sensation. The pain resolves sooner but the gritty sensation typically resolves with a few weeks. Patients may notice “catching” as the ridge of the patella rides over this area during joint motion. This may be apparent during continuous passive motion machine (CPM). If it is also painful, it is best to limit weight bearing; it should resolve within 3 months. Any residual swelling and joint effusion disappears within 8 weeks after microfracture. Sometimes, there is a recurrent effusion between 6 to 8 weeks after surgery but it is usually painless and typically resolves within several weeks.

 

Rehabilitation

The rehabilitation process is vital to the long-term success and functional outcome of these patients. Postoperative rehabilitation programs for microfracture procedures vary greatly based on lesion size, depth, location, quality of tissue, patient age, BMI, general health, and surgical details. Thus, the appropriate rehabilitation program must be highly individualized to ensure successful outcomes. The goal of rehabilitation is to restore full function in the shortest time possible without overloading the healing articular cartilage. It is imperative to create a healing environment while avoiding deleterious forces that may overload the healing tissue.

The pain resolves sooner but the gritty sensation typically resolves with a few weeks

Paste grafting

In order for microfracture to work consistently, the healing tissue must be stimulated to form cartilage rapidly and durably. The progenitor/stem cells and bone paste can be added to a super microfracture of the lesion in a technique called Paste grafting. The healing process can be augmented by injections of growth factors and hyaluronic acid lubrication injections during the healing period.

 

Outcomes

The studies are showing mid-term and long-term success for microfracture in the knee. Multisite microfracture was seen to have poorer outcomes. This is likely because multiple cartilage injuries are indicative of a more advanced disease process. It has been found that patients younger than 45 years had significantly improved outcomes after microfracture as compared with those older than 45 years. Patient age and BMI have been found to be significant predictors of postoperative improvement after microfracture.

 

Overall, presence of a single cartilage lesion, lower BMI, or being a male has been found to result in greater functional improvement after microfracture. Moreover, larger defects (>3.6 sq.cm) and prior surgery were both independent predictors for future surgery after microfracture.

Stem Cell Therapy for Dementia

Stem cells are undifferentiated cells of a multicellular organism that is capable of giving rise to indefinitely more cells of the same type, and from which certain other kinds of cell arise by differentiation. There are a number of diseases were harvested stem cells can be used therapeutically to repair damaged or lost cells. They have been used for joint repair and wound healing.

 

Signs and symptoms of dementia vary from patient to patient and there is a wide spectrum of clinical severity and associated conditions. Cognitive changes include memory loss, confusion, difficulties with language, communication, finding the right words, reasoning, solving problems, dealing with complicated tasks, organizing, and planning, etc. Furthermore, it can cause depression, personality changes, anxiety, paranoia, hallucinations etc.

Dementia is the next frontier for stem cell therapy. The medical community is now turning to stem cell therapy how it can treat dementia and Alzheimer’s. Dementia may be defined as a loss of cognitive or intellectual function. The most common type of dementia is Alzheimer’s disease. At present, there is no cure for it.

 

In the 90’s, it was discovered that stem cells exist in certain areas of the brain and that they constantly divide, producing new cells. This led to the research that focused on differentiating these from ordinary brain cells and studying how stem cells in the brain are regulated so that they can be stimulated to become the kind of nerve cells needed in the brain.

 

Patients with Alzheimer’s disease lack the stem cells as compared to those with healthy brains, but stem cells nevertheless do exist inside their brains as well. The reduction of stem cells is believed to be due to plaque formation in the brain and the cells.  There are now experimental drugs that stimulate stem cells to produce more nerve cells in animal models with Alzheimer’s. This causes stem cells to create nerve cells when introduced into the diseased brain. This result was shown to cause improvement in behaviors and memory testing in the animals. This is an exciting development as it can translate into successful therapies in humans as well.

 

Majority of so-called “regenerative medicine clinics” in the world aren’t dispensing safe and effective stem cell therapies. It is very important to differentiate between them and state-of-the-art treatment centers that base their therapeutic services on the latest research and use safe means of delivering these treatments. We have the most advanced stem cell procedures available today. We have highly trained and experienced, board-certified doctors and staff who are experienced and professionally trained in performing stem cell procedures. Moreover, we use only the most potent resources of viable stem cells that are harvested on the same day for procedures. We provide excellent post-procedural rehabilitation, diet and supplement protocols to improve the likelihood of success.

Factors and Different Treatments for the Dreaded Scoliosis

Scoliosis is a condition that causes the spine to curve forming a “C” or “S” shape. The curved spine can irritate and stretch nerves, strain joints comprised of two bones, affect the posture, and make muscles fatigued. It causes pressure on the disks between the spinal vertebrae making them inefficient shock absorbers and causes strain with pressure on facet joints of the spine. The cause is unknown and there is no cure. Managing symptoms associated with the condition is the main course of treatment.

 

The single worst symptom is pain. The condition impacts quality of life and is a long-term disability. The curve is not usually painful but when changes cause it to become painful, it is debilitating. For some patients, over-the-counter medication helps them cope with the pain and discomfort, while others require stronger pain relievers that are taken several times a day. Pain is individualized and each person perceives it differently. Pain medications are not a long-term solution because they have no impact on the source of the pain.

 

There are several factors that affect how well the nerves work to decrease pain. These factors are:

  • Genes
  • Environment
  • Medication
  • Personal beliefs or perception

Surgical intervention is generally recommended when the curve is greater than 40-degrees

The most common pain is due to muscle strain as the individual tries to compensate for the curve while completing activities of daily living. (getting dressed, taking a bath, cleaning…)

The basic treatments for muscle strain include over-the-counter pain relievers, hot packs, cold compresses for inflammation, and rest. Often a brace is worn but can be uncomfortable and burdensome. Surgical intervention depends on the progression of the condition.

 

Finding appropriate treatment(s) begin with:

  • Talking to your healthcare provider
  • Participating in alternative therapies
  • Wearing a brace for support, if able to tolerate
  • Possible surgical intervention

 

Physical Therapy can help with pain management by incorporating exercises to improve back strength and flexibility. Stretching often is recommended. If an activity causes increased pain, stop doing it and rest. Other recommended therapies and programs include Pilates and Yoga to promote balance, develop deep and superficial muscles, and relax the mind.

 

Other treatments and therapies that can help alleviate pain and improve coping skills include:

  • Chiropractics
  • Massage Therapy
  • Acupuncture
  • Hydrotherapy
  • Steroid or Anesthetic Injections
  • Counseling
  • Surgical spinal fusion

Counseling can include Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy allows a counselor and patient to identify ways to manage and cope with pain and limitations. It can help the individual to overcome beliefs or behaviors that aggravate or cause more spinal damage and leads to the identifying techniques, like meditation, that help with mental ability to deal with pain (coping skills).

 

Surgical intervention is generally recommended when the curve is greater than 40-degrees. It is done to ensure the curving stops. Without surgery, the spinal curve would continue to increase by 1-2 degrees annually. But surgery has risks, so alternative therapies are recommended first.

The Causes and Treatment of Severe Obesity

Obesity is on the rise in the United States. It is caused by an increase in size and number of fat cells. A scale called Body Mass Index (BMI) is used as a measure to calculate obesity. A normal BMI is 20 or less but a BMI greater than 30 indicates obesity. Obesity is a serious condition with several causes and health complications.

 

Causes of obesity include:

  • lack of sleep
  • unhealthy diet
  • genetics
  • sedentary lifestyle and inactivity
  • age
  • changes in hormones within the body
  • sometimes, hypothyroidism or polycystic ovary syndrome.

 

There are different types of fat in different areas of the body. Three types of fat are brown, white and beige. The body uses these stores of fat to fuel the body, regulate body temperature, and store energy for later use. Fat builds up when there are more calories coming into the body than what is being used for energy. Brown fat builds up in the belly area in and around organs. Belly fat is more dangerous than the other two.  It interferes with the endocrine and immune systems and promotes chronic inflammation and obesity-related complications.

Treatment depends on the cause and severity of the obesity

Risks associated with obesity are as follows:

  • osteoarthritis in hips, back, and knees
  • gallbladder disease due to excess cholesterol
  • sleep apnea, fatigue, and other breathing problems
  • heart disease and stroke
  • elevated cholesterol
  • cancer due to abnormal cell growth
  • elevated blood pressure due to damage to arteries leading to other health problems
  • Diabetes
  • Fatty Liver disease
  • low quality of life
  • mental illness – clinical depression, anxiety and other mental disorders
  • body pain and difficult physical functioning
  • pregnancy problems like gestational diabetes and pre-eclampsia

 

Treatment depends on the cause and severity of the obesity. Communication with your healthcare provider can help with making a weight loss plan. Lifestyle changes are at the top of the list and include :

 

  • eating a heart-healthy diet
  • increasing physical activity as tolerated
  • an FDA approved weight loss medication
  • surgical intervention (gastric bypass or gastric sleeve for example)

 

Healthcare providers have dieticians on staff that can provide guidelines for a low-calorie healthy diet plan. Weight-loss is dependent on setting individual goals and being compliant with the agreed upon plan. Weight loss can decrease the effects of obesity on hips, back, and joints. Exercise programs will improve breathing issues, decrease high blood pressure, decrease diabetes symptoms and in some cases, the need for certain medications.

According to the U.S. Surgeon General, 35 percent of women and 31 percent of men are seriously overweight, and 15 percent of children between the ages of six and nineteen are overweight. Public health officials are warning consumers that inactivity and poor diet are catching up to tobacco as a significant health threat.

Closed Fracture Treatment and Infection Prevention

A closed fracture is a broken bone that does not break through the skin. There are four commonly seen closed fractures. These fractures include wrist fractures, hip fractures, ankle fractures and spinal compression fractures. Hip fractures and spinal compression are often seen in the elderly. Fractures require emergency treatment. If neck, back or hip injury is suspected or if there is exposed bone do not move the person.

 

Diagnosis of fractures can generally be made through physical examination and x-rays. A compression fracture or a wrist fracture may not show on an x-ray. In this case, a CT or MRI can be used to locate the fracture. Often, the fracture will only be immobilized and a repeat x-ray done in 10-14 days when the healing makes the fracture more visible. With a skull fracture, a CT may be done, rather than an x-ray, to determine if there is brain injury secondary to the fracture.

 

Factors that predispose bones to fractures are:

  • Osteoporosis
  • Advanced age
  • Endocrine and GI issues
  • prolonged use of steroids
  • inactivity
  • smoking and alcohol

 

Treatment of these fractures is dependent on the severity and can include the following:

 

  • Reduction
  • Cast, sling or walking boot for immobilization
  • External fixation – intervention used with traumatic soft tissue injury and open fracture
  • Internal fixation – Surgical intervention with placement of pins, screws, plates, or rods.

 

Additional treatment includes medications for pain and to prevent infection.

 

A cast or other form of immobilization is meant to hold the bones in proper alignment and to provide protection from additional injury. Reduction is when the bone is set back in place to heal. Some fractures are realigned and held in place through internal fixation or external fixation. External fixation is a way to hold fragments of fractured bone together using metal pins with a compression device attached on the surface of the skin.

The treatment of closed fractures is highly dependent on age, patient preference and surgeon preference

External fixation is used when:

  • there is an open fracture with soft tissue damage
  • fractures with deficient bone (osteoporosis)
  • Infection

 

Rehabilitation begins right away because long-term immobilization causes muscles to become stiff. It takes 4 to 6 weeks to heal depending on the severity of the fracture and surrounding damage. Physical Therapy begins rehabilitation and has several goals.

 

The goals of Physical Therapy include:

  • promoting circulation
  • preventing clots
  • enhances the healing process
  • Once the cast is removed, exercise in a pool is beneficial and promotes mobility. The water also relaxes muscles making movement easier.

 

Treatment of closed fractures is highly dependent on age, patient preference and surgeon preference.

Causes of Abdominal Pain and How to Avoid Them

Generalized abdominal pain is felt in more than half of the belly between the chest and the groin. There are three types of abdominal pain including:

 

  • Localized pain – which is felt in only one area of the stomach
  • Cramp-like – that results from gas and bloating and usually is not serious
  • Colicky – which comes in waves and begins and ends suddenly. Pain is often severe.

 

Typically, abdominal pain is caused by viruses, indigestion or gas. If the pain is more severe it may be caused by other illnesses. The abdomen is full of organs including the small and large intestines, female organs, spleen, gallbladder, spleen, kidneys, and stomach.

 

Less serious causes may include:

  • Constipation
  • Irritable Bowel Syndrome
  • Allergies or Lactose intolerance
  • food poisoning
  • stomach flu

 

Other, more serious causes include:

  • bowel blockage
  • gallbladder issues
  • kidney stones
  • GERD
  • Pancreatitis
  • Ulcers and Crohn’s Disease

Seek medical attention if the pain is so severe that you cannot sit still

Sometimes pain is due to a problem elsewhere in the abdomen such as, menstrual cramps, endometriosis, urinary infection, and even muscle strain. If the pain lasts more than a week or longer, and does not improve within 24 – 48 hours, medical treatment with your healthcare provider should be sought. When more serious symptoms are present then 911 should be called.

 

Serious symptoms include (but not limited to):

  • constipation and vomiting
  • vomiting blood or having bloody stools
  • chest, neck and shoulder pain
  • tenderness in the abdomen
  • abdomen is rigid and hard to touch
  • recent abdominal injury
  • difficulty breathing
  • severe pain
  • fever
  • yellowish tint to skin
  • weight loss

 

Seek medical attention if the pain is so severe that you cannot sit still, movement increases the pain, and you can’t find a comfortable position to rest. Avoid over – the – counter medicines like Advil because they can cause additional irritation.

 

Diagnosis, whether done by your provider or other emergency personnel, begins with a history and a physical. These are done so the doctor can develop a plan for treatment and determine what the possible cause might be and if the pain is injury related.

 

The doctor will ask about the characteristics of the pain if there were any recent injuries, and when the onset of pain began. Depending on the cause a variety of tests may be used to help diagnose the cause of the abdominal pain.

 

Diagnostic testing may include:

  • An ultrasound to check for fluid and need for a paracentesis
  • stool sample to check for Dif. Or parasitic infection
  • bloodwork like CBC and WBC to determine if there is anemia or an infection
  • CT scan with contrast to see the internal organs
  • Colonoscopy to check for bowel blockage

 

Lifestyle changes and prevention are important to avoid future events of abdominal pain. This includes nutritious meals, plenty of water, and taking medications as prescribed.  Don’t hesitate to seek medical attention. The sooner treatment starts the better the chances of avoiding long-term damage or the need for surgery.

Spinal Manipulation Could Help Headache Sufferers

A headache is something we have all experienced at one point in our lives. But for many these headaches stay for days and days. In many, they are chronic and significantly affect a person’s functioning. This might be at work or at home – either way, it affects who you are as a person and stops you from putting your best foot forward. For those suffering cervicogenic headaches there may be a new treatment on the horizon. For years many of your colleagues or friends may have recommended spinal manipulation – the chiropractic technique – but now research is mounting that spinal manipulation is effective for this condition.

What is a cervicogenic headache?

A detailed run through of cervicogenic headaches can be found at physiopedia but as an overview, a cervicogenic headache is a chronic headache that arises in the neck and at the back of the hand and moves round to the front of the head. Patients experience:

  • A one-sided headache
  • A headache is worsened when they move their neck
  • The top 3 points in the neck are painful to touch
  • There may also be neck pain
  • They have tightness in the upper shoulder muscles or back.

What is spinal manipulation?

Spinal manipulation is one of the man treatments used by chiropractors. There are a number of variants of spinal manipulation but generally, the practitioner will move the spine with his or her hands. They will move the spine in a way that is beyond its usual range of motion – this force can be applied slowly or with great speed.

Spinal manipulation techniques have been gathering evidence for the past 10 years for a whole range of conditions

Does spinal manipulation work for cervicogenic headaches?

Spinal manipulation techniques have been gathering evidence for the past 10 years for a whole range of conditions. However, a recent paper to be published in The Spinal Journal shows that move spinal manipulation therapy sessions is associated with a decreased frequency of having cervicogenic headaches. The trial looked at visits of spinal manipulation therapy versus the number of days with a headache per month. The individuals received 0 6 12 or 18 sessions. There were 256 patients included in the trial. The authors found that:

They found that 6 extraspinal manipulation sessions were equal to a reduction of 1 day with a headache a month

  • In a patient who had 18 sessions of spinal manipulation the average number of headaches per month fell from 16 to 8 days.

The authors end by concluding that

“For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.”

If you or somebody you know suffers with chronic headache – it might cervicogenic in nature. Get in contact with a specialist chiropractic centre today to discuss spinal manipulation therapy further.

Top Athletes Are Turning To PRP Therapy To Heal Injuries

How do top athletes come back so fast from seemingly career-ending injuries? In the NBA, NFL it’s common to hear of athletes coming back from ACL injuries to play their best seasons in just a matter of months. But what is their secret? What technologies and new and innovative therapies are they trying? One of these is known as platelet-rich plasma therapy, and the list of All-American athletes that have used it is grown. It now includes names like Troy Polamalu, Tiger Woods, Kobe Bryant and Danny Salazar.

What is platelet rich plasma therapy?

Platelet-rich plasma therapy is a new and exciting treatment that can be used for a whole host of injuries suffered by sports stars and amateur athletes alike. It works by enhancing the body’s own natural healing mechanisms. The procedure is performed in a number of steps:

  • A sample of the patient or athletes own blood is taken
  • This sample is spun at high speed (centrifuged), which acts to separate out the different components of the blood.
  • The platelets and plasma are removed from the centrifuge, leaving behind the red blood cells
  • The platelets and plasma are injected back into the individual into the area of injury that requires healing.

When these platelets are injected back into the injured site current theories suggest they work to stimulate the bodies healing process and speed up recovery time.

Platelet rich plasma therapy is a new and exciting treatment that can be used for a whole host of injuries

Russell Westbrook Joins growing list of top athletes trialing PRP

In late 2017 Russell Westbrook, star of the Oklahoma City Thunder,  was reported to have a PRP injection in his left patellar tendon. The injection wasn’t for any previously reported injury and Westbrook was it wasn’t for anything serious – he just had a minor injury was needed to get on top of it fast so that it wouldn’t trouble him in the regular season. General Manager Sam Presti said

“I think he really wanted to make sure he took care of that in advance, so it wasn’t something that lingered through the year,” Presti said. “We’ll work him back in, I think, as we get through camp and see how he’s doing.”

Many athletes are following Westbrooks lead, using PRP to get on top of small injuries as well as last ligament tears. PRPs power to improve the body’s own natural healing process is perfect for this.

Another athlete who recently turned to PRP injections to get back to their best was Tampa Bay Buccaneers quarterback Jameis Winston. He received the injection for an AC joint sprain in his throwing shoulder. Jameis ended up being able to finish the NFL season because of conservative treatment like PRP therapy.

If you or somebody you know has suffered a sporting injury and you think you might be benefited by platelet-rich plasma therapy, get in contact with a specialist clinic that specializes in the procedure today.

JOIN OUR E-MAIL LIST!