INFLAMMATION'S RELATIONSHIP TO CONNECTIVE TISSUES LIGAMENTS, TENDONS, AND FASCIA
In order to understand today's post, you must understand two simple concepts; inflammation and connective tissue. Connective Tissues are just that --- tissues that physically connect various parts of you to other parts of you (FASCIA is a great example of this). Besides fascia, which is the most abundant connective tissue, the others include LIGAMENTS, TENDONS, CARTILAGE, and BONE. And as crazy as it sounds, blood is actually a connective tissue that certain individuals are claiming has a fascial component (HERE). But what about inflammation?
Inflammation is the name given to the group of chemical compounds made by your body for the express purpose of allowing cells and tissues to communicate with each other during the body's response to tissue damage. Thus, while a certain amount of local inflammation is vital for healing injured or damaged tissues (connective tissues included), any amount of inflammation over and above what is necessary is problematic, leading to a myriad of health-related problems (MINIMAL EFFECTIVE DOSE). So, when inflammation becomes "SYSTEMIC," it will adversely affect every cell, tissue, and organ in your body, as well as becoming a frequent contributor to CHRONIC PAIN. If you want to know more about inflammation (scratch that, you need to really understand inflammation), simply CLICK THIS LINK.
If you don't want to read this post in its entirety, all you really need in order to understand that inflammation always leads to fibrosis (thickened tissue that microscopically looks and acts more like a hair tangle than combed hair), and that fibrosis always leads to degeneration, is THIS POST. For the rest of you, allow me to show you some of the finer details of the many ways that inflammation wreaks havoc on your connective tissues, causing mechanical dysfunctions that not only lead to NEUROLOGICAL ISSUES, but are believed by increasing numbers of scientists to be the root of all sickness and disease (HERE).
For years there has been a raging debate over whether run-of-the-mill connective tissue injuries (PARTICULARLY OVERUSE INJURIES) are inflammatory, or purely degenerative. The best example of this phenomenon is found in the Tendinosis / Tendinitis debate. Starting about 35 years ago, researchers began publishing a wave of studies claiming that most tendon problems were not the result of inflammation (itis is the Latin word for inflammation, so Tendinitis would indicate an inflammation of the tendon), but are instead the result of an overuse-induced degeneration known as TENDINOSIS (osis means a derangement of).
This debate came to the forefront in a 2009 issue of Arthritis Research & Therapy (Pathogenesis of Tendinopathies: Inflammation or Degeneration?) in which the authors concluded, "It is conceivable that inflammation and degeneration are not mutually exclusive, but work together in the pathogenesis of tendinopathies." Below are some cherry-picked conclusions that helped solidify what I wrote earlier this year about a 2017 showing that yes, there is indeed an inflammatory component to Tendinosis (HERE).
"Historically, the term tendinitis was used to describe chronic pain referring to a symptomatic tendon, thus implying inflammation as a central pathological process. However, traditional treatment modalities aimed at modulating inflammation have limited success and histological studies of surgical specimens consistently show the presence of degenerative lesions, with either absent or minimal inflammation. Experimental findings suggest that acute inflammation may be involved from the start and that a degenerative process soon supersedes it. Observations in human tendinopathies further support the entangled roles of inflammation and subsequent degeneration within tendons. Inflammation and degeneration are not mutually exclusive, but work together in the pathogenetic cascade of tendinopathy."
We see something similar with fascia. If you are not familiar with FASCIA, just click the link and start reading. As many of you are already aware, fascia is an extremely important tissue, and thanks to increasing amounts of research on the topic, it's no longer the red-headed stepchild of anatomy and physiology, ignored at every turn. And although few seem to be aware of the fact, the very same debate seen with tendonopathies (inflammation -vs- degeneration) is going on with fascia. Nowhere is this seen more clearly than with PLANTAR FASCIITIS. Case in point, an article in Runners Connect by John Davis (Is Reducing Inflammation Really the Best Way to Treat Running Injuries?)
"What is the role of inflammation in running injuries? For a long time, inflammation has been identified as the main culprit for pain resulting from running injuries. But is this inflammatory model valid? By definition, inflammation has features that are observable both on the macroscopic level of sensations in your body (like pain, redness, swelling—things a doctor would call “clinical features”), and on the microscopic level of the inner workings of your cells—this consists mainly of special inflammatory cells which flood an inflamed area and mediate your body’s response to the injury. Using tissue samples taken from patients with chronic tendon or plantar fascia injuries who undergo surgery (and are hence being sliced open anyhow), recent studies have demonstrated a lack of inflammatory markers at the cellular level. Instead, what they observe in injured tissue under a microscope is profound damage and degeneration in the microscopic structure of the tissue."
The Merck Manual is the "Physician's Bible" --- historically the most common reference book used by doctors (I have a copy from my school days). Listen to what Dr. Kendrick Alan Whitney says in an online article for the Merck Manual called Plantar Fasciosis. "Plantar fasciosis is sometimes referred to as plantar fasciitis. However, the term plantar fasciitis is not correct. The term fasciitis means inflammation of the fascia, but plantar fasciosis is a disorder where the fascia is repeatedly stressed rather than inflamed." In a similar article written for the site Evidence for Exercise (Plantar Fasciitis – Inflammatory or Degenerative Condition?), author David Evans quotes peer-review, revealing that, "studies report a predominance of degenerative changes at the plantar fascia. Direct evidence of inflammation has rarely been detected histologically in chronic plantar fasciitis."
What's my opinion? We know that under certain conditions (we'll get to those momentarily) fascia undergoes physical changes consistent with a scar. But does fascia get inflamed or does it not get inflamed? I think that it's hard to argue that it doesn't. Before we discuss the common ways that inflamed fascia causes pain and dysfunction, let me show you the uncommon ways (these are fascia-related inflammatory problems that few of you will ever have to worry about).
For the record, after almost three decades of experience, my opinion is that yes, fascia commonly becomes inflamed for a wide variety of reasons. These reasons include various forms of trauma (WHIPLASH INJURIES are a common one), repetitive injuries which we spoke of earlier, and even POSTURAL DISTORTIONS --- all of which can not only be caused by inflammation, but can actually generate inflammation as well. In this next section I want to show you how inflammation affects fascia, and in the final section show you what you can do about it.
TENDINOSIS OR FASCIAL ADHESIONS?
(DOES IT REALLY MATTER?)
"The concept is that there is a loss of inflammatory response and chronic scar formation with fascia and tendon injuries. The proper terms for such injuries are fasciosis and tendinosis rather than the more commonly used terms of fasciitis and tendonitis. In fasciitis and tendonitis cases, there is good blood supply to the problematic region but there is an inflammatory response that is painful. In fasciosis and tendinosis issues, the fascia and ligament have a decrease in inflammatory response, a reduction in the growth/healing factors and a chronic scar formation that prevents the healing process." Dr. Babak Baravarian from the May 2009 issue of Podiatry Today
If you have read my MAIN PAGE or BLOG POSTS on Tendinosis, you already realize that there are many experts saying that Tendinitis (the word 'itis' means 'Inflammation') does not exist --- or if it does exist --- is extremely rare. What is common, however, is something called Tendinosis. But who really cares whether a person is dealing with an 'osis' or an 'itis'? In other words, isn't it just a word game --- a matter of semantics that doesn't really mean anything? No it's not. Sit up and pay attention as I show you why.
According to an online Medical Dictionary, the suffix "osis" means, "a diseased or abnormal condition; an increase in a pathologic condition; production of an abnormal substance; increased production of a normal substance; a derangement of". When it comes to Tendons or FASCIA (the membranous cover of muscles, organs, and other tissues), even though most of the problems found in these two tissues are believed to be more along the lines of an "osis," they are usually treated as an "itis". In other words, even though the peer-reviewed literature says otherwise, these problems are almost always diagnosed as Inflammatory conditions and subsequently treated as such --- with ANTI-INFLAMMATION MEDS and CORTICOSTEROIDS. But is this the best option? Listen to a bit more of what Dr. Baravarian; a UCLA-affiliated foot doctor, has to say.
"It is ironic that we usually try to treat such issues on the acute (fasciitis/tendonitis) cases with rest while we try to treat the chronic issues (fasciosis/tendinosis) with cortisone injections. This does not make sense as an anti-inflammatory injection such as cortisone has a better chance of working in the acute phase when there is still an inflammatory process that is working. With chronic injuries such as Achilles tendinosis and plantar fasciosis, cortisone injections do not help very much. There is no inflammatory process with these injuries and the injection only works via the trauma caused by the needle, resulting in an inflammatory response in the designated area."
Although Dr. Baravarian is speaking here about the foot, he could be talking about almost any part of the body. What is extremely intriguing is the fact that the Cortisone Injection itself is not only not beneficial, it's actually harmful --- extremely harmful as shown repeatedly in peer-review (HERE). The healing properties of the injection come about not from the medication, but from the INFLAMMATORY PROPERTIES OF THE NEEDLE that induces healing via the creation of an inflammatory response.
There are many different techniques that have the potential to create such an inflammatory response --- a response that is both necessary and vital for healing to take place (remember, it's too much inflammation that causes problems with the healing process). Acupuntcture is thought to do similar, as does the technique known as "Dry Needling" (see previous link). In this case, the physician takes a fairly heavy gauge needle and uses it to repeatedly puncture whatever area he is treating. Prolotherapy works by creating an inflammatory response with sugar water injections (HERE is a possible mechanism for creating such a response). Our SCAR TISSUE REMODELING is designed to work in similar fashion (HERE are some pictures of the local inflammatory response). CHIROPRACTIC ADJUSTMENTS may even do this on a small scale as does STRETCHING & EXERCISE. Among other things, these are all designed to create some degree of FIBROBLASTIC RESPONSE.
You must understand a couple of things here. When I say that Tendinosis is not an "Inflammatory" problem (HERE), what I mean is that it is not creating its own Inflammatory response. I do, however, believe that in many cases, SYSTEMIC INFLAMMATION has the ability to create, cause, or worsen local "non-inflammatory" problems. Let's put this in practical terms as far as helping suffering people is concerned. If we can create a LOCAL Inflammatory response, while inhibiting SYSTEMIC Inflammation, the odds of licking the sorts of problems commonly found in (LIGAMENTS, TENDONS, MUSCLE, and FASCIA) increases dramatically. Beyond our Tissue Remodeling Treatment, HERE are is a post that might be of benefit as well.
Oh, and as to the "does it really matter?" quote from the top of the page; it doesn't. The problem will be dealt with the same, whether it's Fascial or Tendinous.
CRISTIANO HAS TENDINOSIS IN HIS KNEE
A two-day-old article from Yahoo says that, "tendinosis is a non-inflammatory condition involving a previously injured tendon that heals with weak collagenous fibers, low weight-bearing resistance and has a high risk of future injury". BreakingNews.com describes Tendinosis as, "a degeneration of tendon's collagen due to chronic overuse". And in a June 4 article by Andi Thomas (Cristiano Ronaldo has Tendinosis. What the Hell is Tendinosis?) we learn even more. Listen to what Thomas writes...... "According to tendinosis.org, it's a "chronic injury of failed healing". Basically, it's when a lot of tiny tears to the connective tissue around the tendon start to have a cumulative effect on the strength of the tendon. Think pain, think stiffness, think mild swelling around the left knee. It's not to be confused with the more common tendonitis, which involves inflammation of the tendon itself."
TENDINOSIS OR TENDINITIS?
IMPORTANT DIFFERENTIATION, OR MERE SEMANTICS?
It was Doctor Murrell's now famous article in a 2002 issue of the British Journal of Sports Medicine (Understanding Tendinopathies) that said, "Tendinopathy may follow this pathway. An increase in the amount and duration of load that a tendon cell sees may result in activation of intracellular stress activated protein kinases, which when persistently activated cause the tendon cells to undergo apoptosis or programmed cell death. Increased cell death results in a collagenous matrix which is weaker and more prone to tearing. With time, this tendon may rupture." And the crazy thing is, this was not new information when it came out a dozen years ago. Enter Doctor Karim Khan (MD / PhD), currently of the University of British Columbia's School of Kinesiology (human movement).
In the June, 1999 issue of a New Zealand medical journal (Sports Medicine), Dr. Khan published Histopathology of Common Tendinopathies. Update and Implications for Clinical Management. In this article he had some rather interesting things to say concerning this issue of Tendinitis or Tendinosis (these quotes are cherry-picked from the abstract). Tendon disorders are a major problem for participants in competitive and recreational sports. The literature indicates that healthy tendons appear glistening white to the naked eye and microscopy reveals a hierarchical arrangement of tightly packed, parallel bundles of collagen fibres that have a characteristic reflectivity under polarized light. In stark contrast, symptomatic tendons in athletes appear grey and amorphous to the naked eye and microscopy reveals discontinuous and disorganized collagen fibres that lack reflectivity under polarized light. There is more information and pictures of this phenomenon in some of THESE ARTICLES.
After going on to talk about several differences in the cellular matrix of the damaged tendon as compared to the healthy tendon, Dr. Khan states that, "The most significant feature is the absence of inflammatory cells." Why is this a big deal? Why does it really matter in our advanced age of pharmaceutical intervention? Listen to his conclusions.
In the words of the acclaimed St. Louis physician, Dr John G Kellett (who passed away just a few days ago), "Use of these drugs [NSAIDS], if given, should be restricted to a maximum of three days following injury. Any anti-inflammatory action lasting beyond this period would, theoretically, at least be detrimental since the repair mechanism (phase 2 of healing) is itself an inflammatory process. Little data exist to support the routine use of NSAIDs in athletes with acute pain syndromes (despite advertisements extolling their benefits)" ("Acute Soft Tissue Injuries: A Review of the Literature" 1987). To get a better handle on why he says only three days tops for anti-inflammatory drugs, read THIS PAGE.
In light of the way that most of you have been treated by your physicians for your tendon problem, what does all of this tell you? Other than letting you know that EVIDENCE-BASED MEDICINE is a pipe-dear Only that most physicians are decades behind the most current research --- something I have talked about at length in the past (HERE).
SCAR TISSUE REMODELING FOR HORSES?
Scar tissue can restrict movement in adjacent joints, eventually creating injury to the joint itself. This type of restrictive tissue can become stronger and as non-elastic as connective tissue like tendons and cartilage. After an injury, collagen fibers are laid down in a sporadic and unorganized pattern in order to prevent the recurrence of injury...... There is no guarantee that manual therapy can break up the tissue, and you must understand that by mobilizing tissue that has grown over like a scar, you will be required to create a new injury by pulling the adhered tissue from the adjoining tissue. This can be painful, and requires a new healing process attended by more therapy. From an Ezine article by Kathy Duncan called Equine Massage for Releasing Scar Tissue. Although I am not doing massage, the principles are the same.
I had done some SCAR TISSUE REMODELING for injuries Stacy sustained several years ago. He thought, "Hey; if it works on people, why wouldn't it work on a horse?" Not knowing any different, I had to concur.
Although I grew up in the Flint Hills of Kansas and worked for several people who used horses to take care of their cattle (I also used to occasionally wrangle at YMCA CAMP WOOD), I am about the furthest thing from a horse expert there is. Just to see if it's possible, I am using my Scar Tissue Remodeling technique on an area of severe Scar Tissue on Stacy's horse in an attempt to get the horse well enough to compete again.
The problematic area is made up of what I believe to be a combination of TENDINOSIS and FASCIAL ADHESIONS. After taking care of the horse, I finished up by using some COLD LASER on the area. Stacy is STRETCHING the animal as best he can. To get an idea of how effective this sort of work can be when done on humans, take a look at some of our VIDEO TESTIMONIALS (or HERE). Because the Scar Tissue is thicker than anything I have ever seen or dealt with before, I'll see the horse half a dozen times and see what happens.
HERE is a progress report from a few weeks after this post was created.
SIDE VIEW OF HIND LEG
REAR VIEW HIND LEG
BURSITIS -vs- TENDINOSIS
IS YOUR PROBLEM BURSITIS, OR SOMETHING ELSE?
The pain that so many doctors attribute to bursitis usually comes from either TENDINOSIS or FASCIAL ADHESIONS. The bursa (plural is bursae) are tiny fluid-filled sacs that act as cushions to prevent tendons from rubbing on bones or other tissues. When INFLAMMATION gets its claws into the bursae, they can swell, calcify (see picture) and become exquisitely painful. The problem is, most patients who are diagnosed with bursitis have neither the calcification on imaging, nor the swelling seen in the picture below.
IS YOUR TENDINOSIS SYSTEMIC OR LOCAL?
UNDERSTANDING THE DIFFERENCE IS CRITICAL!
Dear Dr. Schierling,
My name is XXX XXXXXX and I'm from Nevada. I found your website on tendinosis and want to know who in my area treats like you do? I am struggling with severe tendinitis (tendinosis) in my shoulders, elbows, wrists, hips, knees, and ankles. This problem is ruining my life. Who could you recommend in my area that does Tissue Remodeling?
Please help me. I am desperate.
Yeah; we help tons of people with local Tendinosis with a very minimal amount of treatment and expense (see HERE, or HERE). But trying to break down tendinous adhesions that are the result of a systemic problem will simply result in more pain and dysfunction. The key to solving Systemic Tendinosis is to figure out what is the underlying cause of the INFLAMMATION that is driving the problem. I get it; Tendinosis is not an "Inflammatory" problem. But if you have Systemic Inflammation coursing through your system, you are much more likely to have a wide variety of health problems, including bilateral, multiple-site Tendinosis.
Some of the things that I recommend for dealing with Systemic Tendinosis (as well as most SYSTEMIC HEALTH PROBLEMS) are simple, common-sense sorts of interventions that will be the foundation for just about any customized treatment protocol. Here is a short list.
- Do a Gluten Free Elimination Diet: The GLUTEN-FREE ELIMINATION DIET is a big deal because GLUTEN and GLUTEN CROSS REACTORS are a huge driver of Systemic, Inflammatory, and Autoimmune processes. There is a reason that you are hearing about Gluten every time you turn on the TV or open a magazine.
- Control your Blood Sugar and Eliminate Potentially Reactive Foods in the Process: One of the biggest reasons that I promote a PALEO DIET for most of my patients has to do with the fact that the diet is extremely non-reactive. The great side effect of this way of eating is that it will totally control your blood sugar levels in the process. UNCONTROLLED BLOOD SUGAR --- even in individuals who have 'normal' blood sugar readings (HERE) ---- is a leading cause of sickness and disease here in America.
- Drink Water and only Water: This goes without saying. I don't mind someone having some green tea, but if you are drinking SODA or other SUGARED drinks and trying to overcome Systemic Tendinosis, you are probably fighting a losing battle. And on top of this, the average American is dehydrated to at least some degree.
- Fix your Gut: GUT HEALTH is a critical part of healing any chronic problem. There is an old axiom in natural medicine that says, "Heal the Gut; Heal the Body". On many different levels and for many different problems, this statement is 100% accurate.
- Cold Laser Therapy: I have a lot of different modalities (ultrasound, Russian stim, electrical stimulators, TENS, etc, etc) that sit in the basement of my office gathering dust. The one and only modality I regularly use these days (for the past several years) is COLD LASER THERAPY.
- Take the Proper Supplements: Although there are several supplements that could go here, I will mention a couple; LIGAPLEX. Ligaplex by Standard Process has been around for a very long time, and actually provides people with the raw materials to heal and regenerate injured Connective Tissues. Despite tendinosis itself not being considered to be "Inflammatory, the body is often in an inflammatory state. Take PFGO. Bear in mind that in the case of Autoimmune-driven Tendinosis, there might be several nutritional supplements to take.
There are certainly other things that could be put on the list, but this will provide people with a starting point. If you have questions or concerns, be sure to read THIS POST.
STATINS ATTACK FASCIA.....
& LIGAMENTS & MUSCLES & TENDONS & BONES &................
"To our knowledge, this is the first study... to show that statin use is associated with an increased likelihood of diagnoses of musculoskeletal conditions, arthropathies [arthritis], and injuries" Dr. Ishak Mansi from this month's issue of JAMA Internal Medicine.
Rhabdo means "with stripes", Myo means "muscle", and Lysis means "rupture". So, in a nutshell, Rhabdomyolysis infers that striped muscle (skeletal muscles --- i.e. biceps, triceps, quadriceps, gluteus, etc, etc) are actually breaking apart at the cellular level and releasing their contents into the extracellular fluid, which eventually make their way to the blood stream. The chief breakdown product of Rhabdomyolysis is something called 'myoglobin'. Myoglobin is an oxygen-carrying protein in the muscle that is analogous to hemoglobin, an oxygen-carrying protein found in the blood.
SYMPTOMS OF RHABDOMYOLYSIS
Rhabdomyolysis can look just like artrhritis, a Rotator Cuff Problem, FIBROMYALGIA, a knee problem, or any number of other painful conditions. This is why I always find out whether or not someone is on Statin Drugs (or for that matter, other drugs) before I do anything else. By the way, certain other things like HYPOTHYROIDISM, DIABETES, AUTOIMMUNE CONDITIONS, CERTAIN ANTIBIOTICS, ANTI-DEPRESSION DRUGS, HARDCORE WORKOUTS, and drug or alcohol abuse can all contribute to the development of this problem as well.
WE ALREADY KNEW ALL OF THIS
WHAT IS THE NEW EVIDENCE FOR STATINS
DESTROYING OTHER TISSUES AS WELL?
The study concluded that, "Musculoskeletal conditions, arthropathies [Arthritis], injuries, and pain are more common among statin users than among similar nonusers." They went even further and clarified the term "muscluloskeletal conditions". They included, "all musculoskeletal diseases, arthropathies [Arthritis] and related diseases, injury-related diseases (dislocation, sprain, strain) and drug-associated musculoskeletal pain". Stop and think about this for a moment. Not only are injuries to the MUSCLES, FASCIA, TENDONS, and LIGAMENTS significantly greater in those taking Statins, but so are the diseases affecting these tissues (not to mention bones), as well as adverse side effects of a wide variety of drugs.
Interestingly enough, the main reason that this study was done in the first place was to "prove" that Statin Drugs had anti-inflammatory powers that could actually help people with arthritis and musculoskeletal pain. Probably why one of the authors disclosed associations with AstraZeneca, Bristol-Myers Squibb, Elan, Forest, Ortho-McNeil Janssen, and PFIZER. It would be safe to say that these companies are now in full "Damage Control Mode". Fortunately for us, it is getting harder for Big Pharma to BURY STUDIES LIKE THIS. To learn more about CHOLESTEROL, just click on the link.
MORE SYSTEMIC TENDINOSIS
Without delving into this issue too deeply, I am going to show you an email exchange that happened over the weekend. The thing I want you to notice is M's answer. Although her doctor is likely unaware of the fact; there is a very specific and logical progression that virtually all health problems go through before differentiating to the point where they can be named as specific disease entities (HERE). If the patient or their treating physician does not realize this (most do not), they will spin their wheels forever trying to deal with symptoms instead of addressing the underlying cause(s) of those symptoms. This concept is the same whether we are dealing with FIBROMYALGIA, AUTOIMMUNITY, CANCER, GUT ISSUES, HORMONAL PROBLEMS, or Systemic Tendinosis. Systemic problems have to be dealt with systemically if you want any hope of a solution.
I came across your website "Destroy Chronic Pain" and had a few questions!! I used to be a long distance runner and stopped 2 years ago because of chronic tendon pain. It is in my hamstrings, knees and feet/ankles. It flares up if i try to use an elliptical or any kind of exercise machine or if I'm on my feet all day. I mostly do light strength training and stretching. I can really only walk for exercise which is a huge let down for me since I used to race and run marathons. What i really am looking for is a honest answer from someone. Do people with these kind of injuries/chronic problems have them for years? Is it possible i could have this for the rest of my life and my running days will never be the same or could be over?? Have you treated other injured runners and have they returned to running again? I am only 26 and this has been heart breaking for me not only because i can't do what i love, but I also struggle with daily activity now too!!!! Any input would be helpful if you find the time!!
Even though I am not a big fan of running, I have successfully treated all sorts of athletes, including runners. Unfortunately, SYSTEMIC TENDINOSIS is not something treatable with the Tissue Remodeling I do. You are going to have to find out what is driving the INFLAMMATION. I would suggest that you go to my blog and read about GLUTEN SENSITIVITY, AUTOIMMUNITY, and LEAKY GUT SYNDROME. My guess is that you are Gluten Sensitive, or have some other underlying issue as well as a Leaky Gut.
You may also want to read my Blog Post on CARDIO TRAINING -vs- STRENGTH TRAINING as well, as this could be causing your problems as well. Please stay in touch and let me know how things go for you after you have done an ELIMINATION DIET / PALEO DIET.
I will check out your blog! It's interesting you think it could be gluten or something else going on because I didn't even tell you about my irritable bowel type symptoms and issues with certain foods!
Thanks again! M
CARPAL TUNNEL OR WRIST TENDINOSIS
PRAYER SIGN: A SIMPLE RANGE OF MOTION TEST
FOR THE FOREARM AND WRIST
(You should be able to keep your hands together, with your arms parallel to the floor)
MEDIAL VIEWS OF THE FOOT (BOTH VIEWS ARE OF THE BIG TOE SIDE)
Turf toe was named as such because the injury frequently occurred when players got their big toe jammed into the old fashioned kind of artificial turf (outdoor carpet over asphalt). The injury itself is a sprain of the First Metatarsal-Phalanges Joint (the large ball at the base of your big toe). This is the joint being used when you get up on the ball of your foot (your tiptoes). If the big toe gets cranked too much in either direction, up or down (flexion or extension), the ligaments will be injured. The result is an athlete who can barely walk, let alone use the big toe to push off or make cuts. Although our TISSUE REMODELING works wonders on turf toe that has had a week or two to heal, rest, ice, controlled motion, and COLD LASER are the best immediate options for the acute injury.
Why did I decide to do a blog on turf toe? It's easy. On the eve before Christmas Eve, Amy was coming down the stairs at my in laws house. The stair treads are very narrow and there were a couple of winter jackets that had somehow been left on the stairs next to the wall. She hit one and it took off like a bobsled. One leg went down stairs, one stayed where it was with the toe folded up underneath. I knew right away she was hurt. My wife has learned far more about turf toe than she ever hoped to.
A RECENT EMAIL CONCERNING
The Flouroquinolone class of ANTIBIOTICS are valued by the medical community because they are considered to be 'broad spectrum' antibiotics. This means that they kill all bacteria --- including the good bacteria that make up 80% of your body's Immune System. Unbeknownst to many, this class of antibiotics is not new, having been around since the early 1980's. Although the first tendon-related side effects of the drug were reported almost immediately after its release in 1983, tendon problems are becoming almost ubiquitous with this class of drug (HERE or HERE). Interestingly enough, all antibiotic use is associated with Tendinopathy, but Cipro and other similar-class antibiotics doubles the risk to approximately 1 in every 250 people taking them --- an ASTOUNDING NUMBER when you consider the number of people regularly taking these drugs here in the US.
The thing that is so sad about all of this is that according to organizations like the Infectious Disease Society of America, the American College of Physicians, and the Center for Disease Control (CDC), the most common use of antibiotics is for illnesses that are almost always viral in nature (HERE). Although information continues to pour forth telling doctors to change their prescription habits (HERE), the most common reasons that doctors prescribe antibiotics continues to be Upper Respiratory Infections (URI's), SINUS INFECTIONS, Sore Throats and Bronchitis ---- health conditions that are caused by viruses approximately 9 times out of 10 (HERE).
The thing about Viral Infections (like the vast majority of bacterial infections) is that they are self-limiting. This means that in 'healthy' people, the body's Immune System takes care of these infections just fine without any outside help (excepting homemade chicken soup). Taking antibiotics for a viral infection will not only not help you get better faster, they will actually weaken (destroy might be a better word) your immune system, leaving you more susceptible to the next infection --- an infection that you will undoubtedly be prescribed antibiotics for. Do you see a viscous cycle beginning to spin? Sickness ----> Antibiotics -----> Weakened Immune System -----> More Sickness ----> More Antibiotics -----> A Further Weakened Immune System -----> Still More Sickness ----> Even More Antibiotics -----> An Incredibly Weak Immune System -----> Repeat Ad Infinitum.
HOW DANGEROUS ARE CIPRO AND OTHER FLOUROQUINOLONE ANTIBIOTICS?
For anyone who has been through a Cipro-induced nightmare, the prognosis is iffy to say the least. A recent study by Drs Khaliq and Zhanel published in the journal Clinical Infectious Disease says that although these tendon weaknesses / injuries occur in an average of 8 days exposure to the antibiotics, they take anywhere from 2 to 20 months to heal. But the truth is, if you rupture an Achilles Tendon (the most common site of antibiotic-induced tendon rupture), it may "heal" but it will never be the same. And as you may have already guessed, the Achilles is not the only place this sort of tendon damage is occurring. Antibiotic-induced tendon damage has also been shown to affect the Rotator Cuff, Hands / Fingers (including the thumb), as well as the Knees.
HOW COMMON IS THIS PROBLEM OF ANTIBIOTIC-INDUCED TENDON DAMAGE?
In doing the research for this Blog Post, I came across a POST by Dr. Matt Mintz. Mintz's column was published in response to him finding out about the "Black Box" warnings that were to required by the FDA for drugs like Cipro. He essentially poo pooed the whole thing, saying that, "these problems are not life threatening" and then referred to the number of people injured as, "a ridiculously low number if one considers the millions and millions of prescriptions that have been written for quinolone antibiotics such as Cipro". The interesting thing about his post, however, was the rabid backlash he received from the general public. As I write this, there are 144 comments at the end of his blog post --- most of them from people who would like to have a firm face-to-face with the good doctor over his idea that tendon-based side effects are neither widespread nor serious.
If your doctor prescribes you Cipro or one of the other similar antibiotics, think twice about having that prescription filled (truthfully, run like the wind). Otherwise you may be sending me a letter similar to Randy's. As you may have noticed from our VIDEO TESTIMONIALS on Tendinosis, I successfully help lots of people with various TENDINOPATHIES. However, I really do not quite know where to start as far as helping people who have been damaged by Cipro. If you have a good solution, post it. For more information on this topic, visit CIPRO IS POISON.
SHOULDER IMPINGEMENT SYNDROME
A VIEW OF BOTH SHOULDERS WITH CERTAIN PARTS REMOVED
THE LIGAMENTS THAT MAKE UP THE JOINT CAPSULE OF THE LEFT SHOULDER. THE ANATOMICAL STRUCTURE ON THE TOP FAR-RIGHT IS THE ACROMION PROCESS. THE AREA JUST BELOW IT IS CALLED THE SUB-ACROMIAL SPACE.
YOU CAN SEE THE BICEPS TENDON
THE TWO HEADS OF THE BICEPS TENDON (LEFT SHOULDER) THE LONG HEAD (LATERAL) & SHORT HEAD (MEDIAL). ALTHOUGH THEY ARE DIFFICULT TO SEE, NOTE THE TWO BURSAE JUST ABOVE AND TO EITHER SIDE OF THE TOP OF THE BICEPS TENDON (LONG HEAD).
THIS PICTURE OF A RIGHT SHOULDER SHOWS THE LONG HEAD OF THE BICEPS TENDON AS WELL AS ONE OF THE MANY BURSAE (BLUE). NOTE THAT THE COLLAR BONE AND ACROMIAN ARE REMOVED IN THIS PICTURE.
IN THIS PICTURE OF A RIGHT SHOULDER, YOU CAN SEE THE SUPRASPINATUS TENDON AND THE LONG, FLAT BURSA IN THE SUB-ACROMIAL SPACE. YOU CAN ALSO SEE THE PROXIMITY OF THE BURSA TO THE TOP OF THE BICEPS TENDON. PAY ATTENTION TO THE AC (ACROMIOCLAVICULAR) JOINT AS WELL.
THE ROTATOR CUFF MUSCLES OF THE BACK SIDE OF THE LEFT ARM (PARTICULARLY THE SUPRASPINATUS MUSCLE AT THE VERY TOP) WITH THE CLAVICLE / ACROMION REMOVED.
Bursa or Bursae (plural) are fluid filled sacs that whose purpose is to reduce friction / wear by providing a barrier cushion between bones and tendons. Healthy bursae create an almost frictionless gliding surface for tendons that makes normal movement painless. Enter BURSITIS. The word "itis" means INFLAMMATION. When inflammation is seen in a bursa, the problem is referred to as "bursitis". With bursitis, movement that occurs on the inflamed bursa becomes difficult and painful. This painful and restricted movement of muscle tendons over the inflamed bursa further aggravates the condition causing even more inflammation. Do you see a vicious cycle starting to spin?
Bursitis is usually caused by repetitive injury. In the case of the subacromial bursa (the bursa below the acromion), this is frequently due to repetitive micro-trauma to the SUPRASPINATUS TENDON. As the bursitis progresses, you see a proliferation of COLLAGEN FORMATION in the area. And unless specific steps are taken, this collagen will be laid down in a tangled, twisted, matted fashion (like a hairball) as opposed to a uniformly smooth fashion (well-combed hair). Furthermore, because Inflammation (a chemical problem) attracts fluid to it, you can often find increased fluid production and swelling inside the bursa, while seeing a decreased fluid production on the outside of the bursa. As you can imagine, this can dry out the joint.
The shoulder bursae allow for smooth motion of the Rotator Cuff underneath the arch made by the Acoromioclavicular (AC) joint (see second picture from the top). Any pressure on the anatomical structures under the arch (in the sub-acromial space) can lead to something called Shoulder Impingement Syndrome. Some of the causes of Shoulder Impingement Syndrome include.......
- Bone Spurs (DEGENERATION):
- Shoulder Instability (Previous Dislocations or Separations):
- Loss of Rotator Cuff Strength:
- RADICULITIS or Nerve Entrapment: (entrapment of the nerve, artery, or vein can also cause something called THORACIC OUTLET SYNDROME)
With both Shoulder Impingement Syndrome and BICEPS TENDINOSIS, the most common symptom is pain along the front of the shoulder. This pain is often associated with muscle weakness as well as lost range of motion in the shoulder. A Subacromial Bursitis causing Shoulder Impingement will often have lateral shoulder pain as well. The classic Orthopedic Test to determine whether or not someone has a subacromial bursitis is the Subacromial Push Button Sign. You simply push the area on the front of the arm / shoulder below the Acromion Process to see if a pain response can be elicited.
As you can imagine, this results of this test are fairly vague and do not provide a lot of valuable information. Neer's Sign (pain in the front of the shoulder when it is raised straight up, directly out in front of you) is not very specific either. These tests tell you something is wrong with the shoulder, they are not very specific as to what that problem really is. Be aware that people with Shoulder Impingement Syndrome will usually have difficulty with overhead activities (throwing, swimming, overhead work, etc) and may find that their problem is actually worse at night.
Make sure you come back tomorrow to learn about the differences between a separated shoulder and a dislocated shoulder ---- two totally different problems (HERE).
TENDINITIS OR TENDINOSIS?
In the nearly two hours I spent figuring out / treating her problems, we talked. One thing that she said sort of perked my ears. She had read my TENDINITIS -vs- TENDINOSIS webpage and was fairly amazed at how much research I quoted saying that it is doubtful that Tendinitis even exists. According to the current science on the subject, virtually all Tendinopathies are Tendinosis --- not Tendinitis. Despite the fact that most of their ICD-9 diagnosis and billing practices have it correct (Tendinosis), I have said for years that not one doctor in a hundred knows the difference between Tendinitis and Tendinosis --- despite the fact that Tendinopathies account for significant numbers of doctor visits.
This woman had recently visited an Orthopedic Specialist's office and did something that I tell my patients suffering with Tendinopathies to do. In one of my Blog Posts I suggested that people ask their doctor the difference between Tendinitis and Tendinosis. She did. Can you possibly guess what she was told? I knew what he would say before she even told me what his answer was. Her orthopedic 'specialist' told her that, "There is no difference between Tendinitis and Tendinosis. They are one and the same ---- two different names for the same problem." She knew then and there that she was in the wrong place. You see; she had been on my TENDINOSIS page, and had one up on her doctor. She had seen the snippets I have posted from numerous scientific studies and position papers on the subject --- all saying the same thing. Tendinitis is an old and outdated diagnosis --- virtually all Tendinopathies are actually Tendinosis.
I realize that if you have never struggled with chronic Tendinosis, you think that this is splitting hairs --- a matter of semantics. 'Au contraire mon frere'. Allow me to explain why by asking a simple question. How do doctors treat 'itis" (INFLAMMATION)? We all know the answer to this. They prescribe anti-inflammatory medications, including CORTICOSTEROIDS. Unfortunately this does not help people with Tendinopathies (Tendinosis) heal their tendon. Why not? Because just like the name implies, these people are struggling with an "osis" (Tissue Derangement) instead of an "itis" (Tissue Inflammation). Not only are the drugs that doctors commonly use to treat what they mistakenly call 'Tendinitis' not effective for this problem, they are downright dangerous and degenerative!
Oh, and by the way. My patient --- the one I was speaking of at the beginning of the post --- was dumbfounded because she could frog leg her hips without pain or restriction when she left my office --- for the first time in 25 years! Her problem was a combination of Tendinosis and FASCIAL ADHESIONS most likely brought on by extremely high arches in her feet. She may have also fallen into THIS category as well.
SCAR TISSUE REMOVAL OR SCAR TISSUE REMODEL?
Interestingly enough, I have had several patients who were frustrated because they Googled "Scar Tissue Removal" and could not find us. This is because I am not in the business of Scar Tissue Removal, I am in the business of Scar Tissue Remodeling. The difference is as significant as the difference between the above pictures.
- SCAR TISSUE REMOVAL: With Scar Tissue Removal, a doctor (M.D. / D.O.) is going to use a knife or Class IV Laser to "remove" (cut out / burn away) Scar Tissue. Most of the time, this sort of Scar Tissue does show up on CT or MRI. You will frequently see it referred to as "adhesions", and is very often post-surgical. The problem with cutting away scar tissue in an attempt to "remove" it, is that it grows back. And guess what it is replaced with? That's right --- more of the same. More Scar Tissue! This is why Scar Tissue Removal is a tricky proposition that so often fails over the long term.
- SCAR TISSUE REMODELING: As opposed to Scar Tissue Removal, Scar Tissue Remodeling is not about actually attempting to get rid of the Scar Tissue. Instead, the scarred area is broken down by me so that it can be remodeled by you. In other words, the scar itself is not "removed" but is instead "remodeled" so that it becomes more functional. If you want to really understand this process, you need to visit our FASCIAL ADHESION PAGE.
Scar Tissue is weaker, less elastic, and up to 1,000 times more pain sensitive than normal tissue. It is a prime culprit in numerous CHRONIC PAIN SYNDROMES as well as DEGENERATIVE ARTHRITIS. Oh, and unlike the gross adhesions seen in Scar Tissue Removal, much of the Scar Tissue Remodeling I do is performed on people who have had one or more MRI's, and not learned a thing from them. In other words, the kind of Scar Tissue that I deal with on a day-to-day basis does not show up on CT or MRI.
If it is Scar Tissue Removal you are after, you need to find a really good surgeon who is up on the very latest technology and techniques (for instance, with Endometriosis, wrapping adhesed areas in disolvable "Proteolytic Enzyme Wraps" is showing some promise). If it is Scar Tissue Remodeling you want, call Cheryl at 417-934-6337 to schedule a consultation today.
Standard Medical Care -vs- Conservative Care
- REST: Undoubtedly, if you develop a tendon problem, you will have to go through a period of rest. The length of time that one should rest a problematic joint, however, is a controversial topic. Everyone has heard the old cliche', "You would have been better off to break a bone than injure a tendon / ligament". Because tendons have a poor blood supply, they heal slowly. However, rest is a double edged sword that can cause its own unique set of problems. Believe it or not, loss of or abnormal joint motion actually causes connective tissues to degenerate in much the same manner than overuse does. This is why there has been so much written about..............
- STRETCHES & EXERCISES: This is a great starting point for minor tendon problems. However, it is certainly not a cure all. Stretching and strengthening exercises can help heal some of the less severe tendinosis, as long as you are careful to take things gradually. Be aware that in certain cases (ususally more severe cases) stretching can actually make you worse (HERE).
- MODALITIES: Therapy modalities include things like ultrasound, TENS, and various forms of electric stimulation (we occasionally use a Mens-O-Matic microcurrent machine). However, the research on these modalities has not really proved that they help Tendinosis heal faster or better than not using them. My belief is that many clinicians still use these outdated modalities because insurance companies still pay for them. Truthfully, there is no real downside to trying some of these things to see if they might help you. Although insurances will not pay for them, there are some cool new modalities on the block that could be highly beneficial for tendon problems. My favorite is COLD LASER THERAPY. OXYGEN is sometimes part of my protocol for TENDINOPATHY / TENDINOSIS as well.
- HEAT / COLD THERAPY: Ice packs are a common treatment for tendinosis. Ice helps to relieve swelling and inflammation. Don't get an area too cold, don't put the cold directly on the skin, don't leave the ice on for more than maybe 10 minutes or so, and don't use ice right before stretching or exercising (HERE).
- MASSAGE: When massage is done properly, it can be a powerful tool in the battle against tendinopathy. The great thing is that with massage, you are actually addressing the degenerated and deranged connective tissue. No downside, but not a solution for many hardcore tendinosis.
- ACUPUNCTURE: This stuff has been around for several thousand years. I used to do lots of acupuncture, but switched to something much more effective about 11 years ago. But the truth remains, acupuncture helps a lot of people. However, those with hardcore scarring of their collagen-based tendon fibers will probably get limited results.
- BRACES: Braces can be a tremendous help in allowing people to function on a somewhat normal basis despite their problem. Be aware, however, that the more one relies on a brace, the weaker the supporting tissues get. Do not use a brace unless you absolutely have to.
- ORTHOTICS: Orthotics can be a Godsend when they are needed and done correctly. I can assure you that most orthotic products on the market are not great. And the so-called "custom" orthotics? 99% are off-the-shelf even though you may have gone through elaborate or computerized casting procedures. After suffering with POSTERIOR TIB TENDINOSIS and a Plantar Fascia problem for a decade, I met Shawn Eno of Xtreme Footwerks on Idaho Springs, CO. He saved my life!
- PROPER ERGONOMICS: In this day and age, this should be a given. Unfortunately, it's not. A while back I was treating a UPS driver for a shoulder problem. He was not improving, even though I could not find any reason he shouldn't be. He had me come out and look at his truck. No lie --- the seat was about 6 inches off-set from the steering wheel. Not good. If your work area is not fit to your body, problems (including tendinosis) can result. Another way to avoid tendinosis is to make sure that if you do a repetitive job at work, get cross-trained and periodically swap jobs.
- PROPER NUTRITION / SUPPLEMENTATION: Although last on the list, proper nutrition is certainly not the least! The very first piece of advice that I can give you for any and every health problem is to eat a healthy diet. Most of us have no idea what this really means, and are totally unaware that synthetic foods (foods not based on WHOLE FOOD NUTRITIONAL PRINCIPLES), are actually horrendously degenerative. The best work on this phenomenon is Dr. Weston Price's classic text, Nutrition & Physical Degeneration --- you can see a review by Steve Solomon online.
WHOLE FOOD VITAMIN C stimulates Type I collagen synthesis. Unfortunately, all the studies that have been done on Vitamin C and tendons have been done with Synthetic Vitamin C (Ascorbic Acid). Remember this because studies have shown that adding Synthetic Vitamin C to injured tendon cells actually causes them produce abnormal collagen, as opposed to normal collagen. Any time you take a single nutritional compound out of its whole food nutritional complex, remove all the co-factors and synergistic nutritional compounds, and then manufacture a high-dose fractionated synthetic in a lab, you are unlikely to get the results you are hoping to get.
Glucosamine Sulfate with Chondroitin is a wonderful supplement. However, because it is more for cartilage issues, it tends to work well for degenerative osteoarthritis. It will probably not help much with tendinosis. And although Tendinosis is not an inflammatory problem, natural anti-inflammatory herbs such as garlic, ginger, tumeric, boswellia, bromelain; and anti-inflammatory fats such as PHARMACEUTICAL GRADE FISH OIL can make a huge difference, as can an ANTI-INFLAMMATORY DIET. Lots of theories on why this is, but I am not sure that anyone knows for sure; other than the fact they have the capability to block pain.
- ANTI-INFLAMMATORY MEDICATIONS: Non-steroidal anti-inflammatories would not be expected to help tendinosis since it is an injury of chronic degeneration ---- not INFLAMMATION. However, these drugs (just like the anti-inflammatory nutritional compounds above) will often relieve pain. Just remember that the pain relief is usually short-lived, and that studies have shown that some NSAIDs actually impede the healing process, which is the last thing needed with tendinosis. For more information, read the article from a 2002 issue of the British Medical Journal called Time to Abandon the “Tendinitis” Myth.
- CORTICOSTEROID INJECTIONS: Cortisone injections have been shown to cause adverse effects on the collagen-based tissues in the area of the injection. Tendinosis is a chronic, degenerative, injury that can't be cured with CORTICO-STEROID INJECTIONS. Corticosteroids actually degenerate connective tissues and slow collagen formation. Corticosteroids are anti-inflammatory medications ---- and tendinosis is not an inflammatory condition! Doctors think cortisone reduces pain by reducing or blocking other irritating biochemical substances that occur as part of the injury process.
- PROLOTHERAPY: This one deserves to be right up there with PRP. I realize that there are people being helped by this treatment, but I have yet to meet them (I have met some people really messed up by prolo). Prolotherapy involves injecting a sugar solution into the injured area. The sugar causes irritation to the tendon which is hoped to promote healing via a local "Inflammatory" response. Although sugar is a fairly benign substance, it can provoke reactions that have the potential to leave people worse instead of better. I have spoken with numerous people who have gone the Prolo route. I have never one time personally met a person that has good things to say about it.
- SURGERY: Surgery is a last resort for tendinosis. There are few studies that show positive results for surgery. If you want to get a more realistic and accurate picture of people's experiences with tendinosis surgery, I would suggest that you check out the online support groups and message boards. You will certainly find some people that surgery has helped. You will also find a slew of people whom surgery has made worse.
WHY SO MANY ITEMS IN BOTH SECTIONS OF THIS LIST TEND TO BE
"The American Academy of Orthopedic Surgeons has provided a new classification of tendon injuries…. In the microtraumatic tendon injury the main histologic features represent a degenerative tendinopathy thought to be due to an hypoxic [diminished oxygen] degenerative process. The similarity to the histology [study of the cells] of an acute wound repair with inflammatory cell infiltration as in macrotrauma seems to be absent. A new classification of tendon injury called “tendinosis” is now accepted. Tendinosis is a term referring to tendinous degeneration due to atrophy (aging, microtrauma, vascular compromise). Histologically there is a non-inflammatory tendinous degeneration due to atrophy (aging, microtrauma, vascular compromise), as well as a non-inflammatory intratendinous collagen degeneration with fiber disorientation, hypocelluarity, scattered vascular ingrowth, and occasional local necrosis or calcification." Dr. Warren Hammer, board certified Chiropractic Orthopedist (in practice since the late 1950′s), from a 1992 column in Dynamic Chiropractic.
WHAT WORKS THE BEST?
- LOW LEVEL / COLD LASER THERAPY: Other than icing at home, this is really the only modality I use in my office. HERE'S WHY.
- VERY SPECIFIC NUTRITIONAL SUPPLEMENTS: When studies show that nutrition does not work well for certain things, they are usually right. However, what these studies almost always do is to take an isolated nutritional compound and then use a synthetic version as their "Nutritional Supplement". There are two problems with this. Firstly, no matter what anyone tries to tell you, Synthetic Nutrition is not the same as WHOLE FOOD NUTRITION. Secondly, you simply do not ever find isolated chemicals in nature. You find entire nutritional complexes being used in synergy with numerous other nutritional complexes. Trying to use a synthesized version of one chemical found naturally as part of a nutritional complex is a recipe for failure. The best supplement for tendons is LIGAPLEX by Standard Process. Ligaplex is made from cold-processed connective tissues of organically raised beef. It gives you the raw material for your body to actually produce the collagen-based tissues it must produce in order to heal injured tendons, ligaments, or FASCIA --- a problem which is frequently seen alongside Tendinosis.
- SCAR TISSUE REMODELING: Because these tendon problems are almost always "Degenerative" and not INFLAMMATORY, simply taking anti-anflammation drugs is not going to help over the long haul. The thing that must be accomplished is to break down these degenerative areas and microscopic adhesions. This is what the better part of this website is all about.
WARNING WARNING WARNING
Try nothing but organic meats and vegetables for a few weeks (no fruits for now) ---- almost like an Atkins Diet Induction Phase or PALEO DIET (heavy on the vegetables). This way you not only cover a likely GLUTEN INTOLERANCE, you cover the potential for CROSS REACTIVITY as well. A great starting point for everyone trying to figure out whether or not they have SYSTEMIC PROBLEMS can be found by following the link.
PLATELET RICH PLASMA THERAPY
MIRACLE OR MASQUERADE?
But this did not seem to bridle his enthusiasm for this admittedly "little studied" therapy when he stated, "it is already being offered to patients in many clinics in the U.S. and abroad." Tiger Woods knee was the first time I had ever heard of it --- and he was treated somewhere overseas a few years ago because the treatment was not yet approved here in the States. Now, it's legal in the United States, and seemingly every professional athlete from A-Rod to Payton Manning is having it done. But what is it? What are platelets, and what can I tell you about the success rate of this relatively new therapy?
Platelets are a component of the blood that is involved in clot formation. Too many platelets and you get blood clots, too few, and you have excessive bleeding. However, the clotting is not what sufferers of TENDINOPATHIES are looking for. The other important thing to remember about platelets is that they contain numerous growth factors, including transforming growth factor-beta vascular endothelial growth factor, and multiple species of platelet-derived growth factors. Essentially, these are substances similar to the insulin-like Growth Factors, that induce healing in connective tissues.
HOW DOES PRP WORK?
Blood is drawn from a patient, and then centrifuged to a platelet-rich broth. The platelets and growth factors are then injected back into the body at the site of injury (knee, ankle, wrist, elbow, shoulder, etc). Like lots of various treatments, the logic behind it makes sense. However, it is expensive, with the cost running anywhere from $1,000 on up. But if it works, who cares how much it costs? The real question we need to answer is how successful it is?
Although I have personally treated several patients who have been through PRP Therapy, I have yet to hear a patient say that it worked for them. This sentiment has been echoed by several recent internet articles, including one from The New York Times saying that the the treatment was over-hyped, and that the results left a lot to be desired (not much better than placebo). One of the more important statements to come out of this article was this, "Although 73 percent of patients given platelet injections improved after a year, compared with 54 percent for steroid injections, Dr. Fu said that was not much success. “Any time you touch a patient, you get 70 percent success,” he said, adding that even placebos give that rate over time." I disagree with his statement about placebos having an average success rate of 70%. If this were true, there would be little need for doctors. However, comparing PRP to CORTICOSTEROIDS is extremely misleading, as these drugs are known to cause,"short term pain relief and long term degeneration."
Our country's oldest scientific journal, Scientific American was pretty much in agreement with the NYT article in an article called, Athletes Such as Tiger Woods and the Pittsburgh Steelers's Hines Ward Have Undergone Platelet-Rich Plasma Therapy, But is There Evidence that the Treatment Really Speeds the Healing of Injuries? So, who are we to believe; professional athletes who will swallow or inject literally anything and everything under the sun if they have heard it will help them perform better (i.e. Deer Antler Velvet or HCG --- a Female Hormone of Pregnancy)? And by the way, the study at the beginning of the post was done by a group of doctors with direct ties to Major League Baseball. Do you think this could have any bearing on the study's results?
In all honesty, for extreme cases, I kind of like the idea of PRP. You are using cells and chemicals that actually came from your own body. It is certainly better than corticosteroids or surgeries that are iffy to say the least. However, the fact remains that I have not personally seen this treatment work on patients. But what does work for TENDINITIS / TENDINOSIS / TENDINOPATHIES and other connective tissue problems such as FASCIAL ADHESIONS? SCAR TISSUE REMODELING is where I would start first. It will either help quickly, or it will not help at all. If it does not work, then move on to other more expensive and invasive therapies such as PRP.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration