Jan 11, 2021
Join our free webinar to learn about non-surgical treatments and therapies for rotator cuff tendon injuries. Gain information on cutting edge treatments like platelet-rich plasma (PRP) and other cell-based therapies. Get answers to your questions from experts in the field of Regenerative Medicine.
Dr. Mary Ambach specializes in non-surgical orthopedics, regenerative therapies and interventional pain management. As a key thought leader in the field of Regenerative Medicine, Dr. Ambach conducts research, trains physicians and lectures at international medical conferences.
Dr. Christopher Rogers is one of the world’s leading experts in orthopedic regenerative medicine and a renowned speaker at national medical conferences. He has developed new approaches for the treatment of tendon injuries, osteoarthritis and disc degeneration which provide a safe and viable alternative to surgery.
Register for the Webinar HERE
Dec 30, 2020
ASK THE DOCS
Facebook Live Series
When: Every 1st Wednesday of the month at 12:30 PT
What: Live Question and Answer session with Regenerative Experts
Rotator Cuff Tendon Tear and Tendinopathy
Join us on January 6, 2021 at 12:30pm PT for our Free Facebook Live Series called Ask the Docs. In this session, SDOMG physician experts will answer your questions on this common shoulder problem and non-surgical options to treat it.
Dec 11, 2020
Natural therapies have been a valuable option for patients seeking alternative options to traditional medical treatments. These natural remedies can help relieve pain and stiffness associated with joint arthritis. It can also play an important role in one’s overall wellness.
Natural Ways to Reduce Joint Pain
Massage
Massage therapy has shown many health benefits for thousands of years. It can help improve flexibility, improve circulation, manage chronic pain, and improve rehabilitation. It can also promote overall well-being by reducing anxiety, promoting relaxation and improving sleep.
Acupuncture
Acupuncture is a form of traditional Chinese medicine which involves very thin small needles that are inserted through the skin at specific acupuncture points on the body. It is believed to stimulate the central nervous system, improve blood flow and activate the body’s natural painkillers. A meta-analysis study showed that acupuncture can not only improve chronic knee pain associated with osteoarthritis, it can also improve short and long term physical function.
Yoga
Yoga is an ancient Indian practice that uses deep breathing, meditation and body postures. Several studies have shown significant reduction in pain and function with improved strength, balance and gait, when used as an adjunct in the management of arthritis.1 The psychological benefits of Yoga therapy have been shown in the published literature to help reduce blood pressure, heart rate, anxiety and many other benefits.
Exercise
Exercise keeps your joints flexible and improves the strength of supporting muscles. Low impact exercises such as walking, cycling, and aquatic therapy are great options for patients with joint arthritis. Working with a physical therapist or a personal trainer offers many benefits in addition to getting proper exercise. They can perform manual therapies, counsel on proper positioning and body movement and recommend assistive devices such as braces. Aquatic therapy, also known as pool therapy or water therapy, is an alternative option for those who can not perform land-based therapies with less risk of exacerbating their joint pain. The gravity reduced environment of water can allow for gentle movements to improve strength, flexibility, and endurance that is better tolerated by some.
It is important to maintain a regular home exercise routine to continue the benefits of exercise and maintain overall health.
Weight loss
Being overweight is a major risk factor for the development of osteoarthritis. Losing weight removes extra pounds of pressure on swollen, painful joints. Maintain a healthy weight by combining a balanced diet with regular physical activity.
Heat and Cold
Heat can relieve muscle and joint stiffness while cold can reduce inflammation, swelling and pain. These are easily available modalities that can help manage joint pain and reduce the need for pain medications .
Natural alternative arthritis treatments are generally safe and can be a good adjunct to standard medical treatments. Some do have scientific evidence to support their efficacy, however others need more research to evaluate their benefits. Patients can discuss these treatments with their doctor to determine if these are appropriate for their specific needs.
1 Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: A randomized control study. Int J Yoga. 2012;5(1):28-36. doi:10.4103/0973-6131.91708
Nov 17, 2020
Turmeric, a spice from South Asia derived from the Curcuma longa root, has been used as a medicine for nearly 4000 years. Recent studies have shown that turmeric may help to relieve joint pain caused by arthritis because the active ingredient, curcumin, is now known to have anti-inflammatory properties. Curcumin has been shown to have similar efficacy to diclofenac, a non-steroidal anti-inflammatory drug, with fewer side effects. Similar improvements in pain severity and function were seen with curcumin and diclofenac in a randomized, controlled clinical study of 139 patients with knee osteoarthritis. Nineteen patients in the diclofenac group (and none in the curcumin group) required anti-ulcer medications at 28 day followup [1].
Turmeric for Joint Pain Relief
Curcumin has also been shown to have a strong antioxidant capacity. In a randomized double-blind placebo-controlled trial, patients with mild-to-moderate knee osteoarthritis were given the curcuminoid and were compared to a group that received a placebo for 6 weeks. [2] Researchers measured the levels of enzymes known to influence inflammation (e.g. superoxide dismutase (SOD) and malondialdehyde (MDA)). The treatment group showed significant changes in these enzymes suggesting that short-term supplementation with curcumin decreases oxidative stress.
Another randomized, double-blind, placebo-controlled trial of low or high dose bio-optimized Curcuma longa in 150 patients with knee osteoarthritis measured serum biomarkers of cartilage degradation (sColl2-1). [3] The high dose extract showed a transient but non-significant decrease in the cartilage degradation biomarkers. Moreover, pain improvement in the low- and high-dose extracts was better than in the placebo group after 90 days of treatment.
The effects of topical curcumin 5% ointment on osteoarthritis knee pain in patients older than 70 years was studied in a double-blind, randomized placebo-controlled trial.[4] Subjects applied either the ointment or a placebo (Vaseline) twice a day for 6 weeks. The pain intensity was significantly lower in the group receiving the curcumin ointment than in the placebo group suggesting that this treatment may be considered for older adults with knee osteoarthritis.
[1] Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trial 2019; 20:214.
[2] Panahi Y, Alishiri GH, Parvin S, Sahebkar A. Mitigation of systemic oxidative stress by curcuminoids in osteoarthritis: results of a randomized controlled trial. J Dietary Suppl. 2016;13(2):209–20.
[3] Henrotin Y, Malaise M, Wittoek R, Vlam K, et al. Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multi center randomized placebo controlled three-arm study. Arthritis Research and Therapy 2019; 21, 179.
[4] Jamali N, Adib-Hajbaghery M, Soleimani A. The effect of curcumin ointment on knee pain in older adults with osteoarthritis: a randomized placebo trial. BMC Complementary Medicine and Therapies, 2020, 20:305.
Nov 13, 2020
We all know that sugar is an important ingredient in baking and cooking, but did you know that it also has important medicinal purposes? The simple sugar, dextrose, can be dissolved in solution and given intravenously to treat dehydration or administer medications.
In orthopedics, physicians use dextrose, which is a natural form of glucose, to promote the normal growth of cells and tissues. Proliferative therapy, commonly referred to as Prolotherapy, involves the injection of dextrose and water to the site of an injured tendon, ligament or joint to stimulate healing. It facilitates the restoration of strength and stability in these tissues.
The solution is prepared at varying concentrations of dextrose, combined with a local anesthesia to minimize discomfort. The concentrated dextrose serves as an irritant and triggers mild inflammation to jump start the natural healing process. Prolotherapy, when used in lower concentrations, has been shown to help nerve pain by blocking nerve pain impulses. It can be combined with natural homeopathic solutions to provide immediate relief to joint, nerve and other soft tissues.
Prolotherapy has been used to treat chronic musculoskeletal conditions for more than 80 years. It was developed by Dr. George Hackett in the 1950’s and represented a major step forward in identifying ways in which the body could heal itself naturally.
Conditions Treated with Prolotherapy
Prolotherapy can reduce pain and inflammation and improve healing in patients suffering from a number of orthopedic conditions, including:
- Tendinopathy
- Joint sprains or laxity
- Sacroiliac joint dysfunction
- Ligament sprains
- Osteoarthritis
- Plantar fasciosis
- Sports injuries such as tennis elbow or golf elbow
Prolotherapy is an Out-Patient Procedure
As opposed to oral medications that must work their way through the body’s systems to reach their intended target, prolotherapy is a targeted treatment that involves the injection of the medication directly to the injured body part. This is done using imaging guidance in the form of fluoroscopy (x-ray) or ultrasound. There is no incision, no major recovery time and no need for lengthy rehabilitation. The entire procedure takes less than an hour. There may be mild swelling or bruising for the first few days, however most patients are able to resume their normal activities the next day. To optimize healing and strengthening, patients are prescribed physical therapy and encouraged to maintain a healthy diet to ensure a successful outcome.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with regenerative therapies such as prolotherapy for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same- day treatments with the highest level of safety and efficacy.
https://www.healthline.com/health/dextrose
Nov 6, 2020
The human spine is composed of 24 individual bones called the vertebrae. In between these bones are the intervertebral discs, which are gel filled structures that act as shock absorbers. They consist of a tough outer layer called the annulus fibrosus that protects the disc’s gel-like interior, the nucleus pulposus. In the lower back, the discs are a little more than a third of an inch (10 millimeters) thick and about 1.5 inches (four centimeters) in diameter.[i]
A bulging disc or herniated disc occurs when the outer layer of the disc weakens and tears. This can cause the inner gel to bulge out to the spinal canal and affect the nearby nerves causing back pain, leg pain or muscle spasm. The disc tear can also cause leakage of materials into the spinal canal that can cause inflammation and pain.
Herniated discs most often occur in the lower back but can occur anywhere in the spine, including the neck and the midback. The location of the herniated disc often determines where the patient will feel symptoms of pain, tingling, numbness or weakness. Bulging discs in the lumbar spine can result in pain in the low back, buttocks, thighs, legs and feet. On the other hand, if your herniated disc is in the cervical spine, pain can be felt in the neck, shoulders, arms and hands.
What Causes a Herniated Disc?
Disc herniation can occur due to injury or age-related wear and tear. As people age, the disc nucleus pulposus loses hydration, wears down and leads to degeneration. Other factors may increase the risk of developing a herniated disc. These include:
- Repetitive lifting, pulling, pushing, bending and twisting
- Genetics
- Increased height (tall people)
- Smoking (decreases blood supply to the disk leading to degeneration)
A thorough medical history and physical examination can lead to the diagnoses of disc herniation. An MRI of the spine is an imaging modality that reveals herniated discs and other structural abnormalities of the spine.
Treatment Options
The treatment for most cases of mild to moderate herniated discs involves conservative measures which include the following:
- Activity modification: Avoid repetitive twisting, bending or lifting. Do not sit or stand for extended periods of time.
- Physical therapy to strengthen your trunk, arm and leg muscles that support the spine.
- Medications: Anti-inflammatory medications such as ibuprofen or naproxen, muscle relaxers, or pain killers
- Ice packs or heating pads
- Alternative therapies such as acupuncture, massage or gentle chiropractic manual therapies to manage pain.
Non-Surgical Interventions
When conservative measures fail to provide symptomatic relief, a board-certified spine specialist can offer injection treatments that do not require hospitalization and provide a more rapid recovery than surgery.
Epidural corticosteroid injection is a treatment that delivers steroid, a powerful anti-inflammatory medication, directly to the source of pain. This is performed using fluoroscopic (x-ray) guidance. This treatment can provide immediate relief of pain. The number of treatments is limited as repetitive steroid use could result to tissue damage, hormonal irregularities, osteoporosis and decreased immune response.
Cell-based therapies can treat disc degeneration and tears that are traditionally managed with medications or surgery. These treatments have been shown to increase disc hydration and disc cell proliferation, decrease inflammation, increase disc support tissue and assist in tissue healing. These therapies involve obtaining the patient’s own healthy cells and delivering them to the injured disc where they can jump start the body’s own regenerative healing processes.
- Platelet Rich Plasma uses platelets in the blood that release growth factors and proteins to promote tissue repair, while the plasma carries the hormones, electrolytes and nutrients required to nourish cells during the healing process.
- Cell Based Therapies use cells derived from the patient’s own bone marrow. Bone marrow contain adult stem cells that have the unique ability to develop into the specific kind of cells, including anulus and nucleus pulposus cells. They also contain many other healing cells and molecules that direct other cells in the area to form new blood vessels, awaken stem cells and produce collagen or other proteins essential for creating healthy new tissue.
Patients considering regenerative treatments such as these cell therapies need to know that the U.S. Food and Drug Administration (FDA) does not currently allow the use of stem cells derived from birth tissue products such as amniotic fluid or umbilical cord blood to treat orthopedic conditions. These donor products do not contain live stem cells and have not been tested for safety or efficacy.
Candidates for Cell-Based Therapies for Herniated Discs
The success of cell-based treatments for herniated discs is dependent upon the severity of your condition and your overall health. Cell-based treatments are not suitable for those who have active cancer, infection, history of blood disease, or are pregnant.
Cell-based therapies are giving new hope for long-lasting pain relief to many patients with injured discs. It is important that you take an active role in your healing and recovery with good nutrition and a commitment to overall fitness to achieve the best outcome.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with interventional spine procedures and cell-based treatments for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same- day treatments with the highest level of safety and efficacy.
[i] https://www.kenhub.com/en/library/anatomy/the-intervertebral-discs
https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095
