Exercise Prescription and Cellular Orthopedic Intervention

Exercise Prescription and Cellular Orthopedic Intervention

Aging is known to contribute to a multitude of systemic changes including those of the musculoskeletal system leading to decreased health, mobility and function. Most changes in well-being are exacerbated by inactivity. It has been scientifically documented that physical activity and exercise may slow or even reverse these deleterious effects thereby improving health, mobility and function.

In particular, ligaments, tendons and joint capsules become stiffer with age as elastic fibers decrease and cross-links between collagen fibers increase. As connective tissue surrounding the joint changes, so too does the synovial fluid within the joint making movement more difficult. Not only do changes occur within the joint, they also occur in the muscles. The loss of muscle mass and strength also known as sarcopenia, increases with age. Then there is the fatty infiltration of muscle that comes with aging and lack of use.

Recognizing the value of Bone Marrow Concentrate derived Stem Cells, Cytokines and Growth Factors in dealing with his arthritic hip when the alternative was a joint replacement, seven months ago, a 58-year-old man underwent a cellular orthopedic intervention. Over the past many months, the patient committed himself to a minimum of 30 minutes a day, five days a week at moderate intensity aerobic exercise alternating with three days a week at vigorous intensity. In addition, he partook in resistance exercise a minimum of two days a week at a moderate high intensity focusing on 10 exercises at each session targeting most major muscle groups, with 10 to 15 repetitions for each exercise performed thus adding an additional 20 to 30 minutes to the commitment. Then there are the benefits of his additional flexibility and stretching. When this individual came to me at his first visit, his stated goals were to return to a high level of recreational enjoyment with a particular interest in ball room dancing.  As of last week, he had reached those goals but he has no intention of failing to comply with his exercise prescription.

The obvious message of my Blog is to let you know I am unable to reach a desired goal without your commitment. I may introduce Stem Cells, Cytokines and Growth Factors into an arthritic joint but to reach your desired goal or delay or perhaps avoid a joint replacement, those many changes that occur with aging can be slowed and even reversed by a combination of cellular orthopedics and exercise.

If you want to learn about the evidence, schedule an appointment    312 475 1893

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Surgery, Stem cells or Physical therapy for a Meniscal Tear and Osteoarthritis

Surgery, Stem cells or Physical therapy for a Meniscal Tear and Osteoarthritis

“Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and osteoarthritis results in better functional outcomes than physical therapy alone is uncertain.”

The above article appeared in the May, 2013 edition of the New England Journal of Medicine but is still a subject matter of great debate in the orthopedic community. The major reason for the continued debate has to do with arthritis and the nature of the meniscal tear. In the study cited, 351 symptomatic patients 45 years or older with a meniscal tear and evidence of mild to moderate osteoarthritis were followed for up to 12 months using the same outcomes measurement modalities that I use in my Regenerative Medicine practice.  The end result indicated no difference in outcomes for those who underwent arthroscopy and physical therapy as compared to those who underwent physical therapy alone.

In analyzing the study, there is no emphasis placed on the nature of the clinical tear or whether the osteoarthritis affects the entire joint or only a single compartment. What allows me to opine on the subject is my 40-year experience in treating the same type of patients prior to my having graduated to Cellular Orthopedics. During my surgical career, I used arthroscopic surgery when indicated and joint replacement, both total and partial when the latter were deemed appropriate. Now I use stem cells derived from bone marrow in almost every setting as there is evidence that the regenerative potential inherent in bone marrow concentrate will significantly impact the outcomes of patients with a degenerative meniscal tear with associated degenerative arthritis.

Be aware that the vast majority of patients over age 45 will show meniscal changes on an MRI. Also be aware that the vast majority of those meniscal changes will be accompanied by arthritic changes in the articular cartilage of the knee. The only absolute indication for arthroscopic intervention is the mechanical symptom such as “clunking”, locking or giving way. Otherwise, it is the judgement of the orthopedic surgeon that will lead to the definitive recommendation. Therein is the problem as the reconstructive orthopedic surgeon will tend to make one type of recommendation while the sports medicine oriented arthroscopist will tend to be surgically oriented.

If any cohort of patients with osteoarthritis and a degenerative meniscal tear is followed for five to ten years, progressive arthritic changes will be documented via a history and physical as well as via imaging studies. There is only one way to date to potentially alter this natural history and that is by intervening with stem cells and putting their regenerative potential into effect. If not addressed early on, those knee joint changes will result in an eventual grade four osteoarthritic degeneration and an indication for a knee replacement be it partial or total.

To learn more, come in for a consultation   312 475 1893

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“Exercise linked to reduced risk of several cancers”

“Exercise linked to reduced risk of several cancers”

From the AMA Morning Rounds May 16, 2016
Today’s Medical News Prepared Exclusively for You

Leading News
“Exercise linked to reduced risk of several cancers”

ABC World News Tonight (5/16, story 11, 0:25, Muir) reported, “The
National Cancer Institute confirms that moderate exercise, all the way
up to intense exercise, lowers the risk of” cancer “in many forms.”
The Los Angeles Times (5/16, Healy) reports that the research,
published in JAMA Internal Medicine, suggests, “exercise is a powerful
cancer-preventive.” Investigators found that “physical activity worked
to drive down rates of a broad array of cancers even among smokers,
former smokers, and the overweight and obese.”

US News & World Report (5/16, Esposito) reports that
investigators “analyzed data from participants in 12 US and European
study groups who self-reported their physical activity between 1987
and 2004.” The researchers “looked at the incidence of 26 kinds of
cancer occurring in the study follow-up period, which lasted 11 years
on average.” The data indicated that “overall, a higher level of activity
was tied to a 7 percent lower risk of developing any type of cancer.”

TIME (5/16, Park) reports that “the reduced risk was especially
striking for 13 types of cancers.” Individuals “who were more active
had on average a 20% lower risk of cancers of the esophagus, lung,
kidney, stomach, endometrium and others compared with people who
were less active.” Meanwhile, “the reduction was slightly lower for
colon, bladder, and breast cancers.”

Historically, I have directed my Blog to fitness, improved activities of
daily living, and recreational endeavors. The Leading News report
quoted above introduces an additional goal. Considering the significant
progress in research and management of different cancer types, after
mesothelioma explained, I am not going to suggest
that you will prevent cancer by undergoing a cellular orthopedic
intervention to an arthritic hip or knee; but, I am introducing the
concept that by my improving your activity level and functional
potential with a cellular orthopedic intervention for the symptoms of an
arthritic hip or knee, I will improve your exercise capacity and your
exercise tolerance with the inferred inherent health care benefits be it
cancer prevention, heart health, etc.

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Is a lower function score after a Cellular Orthopedic intervention because of your lumbar spine?

Although Orthobiologics and Cellular Orthopedic interventions generally result in excellent pain relief and return to or maintenance of a high degree of function, approximately 20 percent of patients have persistent functional deficits that affect their quality of life as I have learned after review of three and a half  years of Regenexx procedures for the hip and knee.

It looks as if lumbar spine problems are a common cause of functional disability in patients presenting with hip and knee arthritis. While, I didn’t perform a particular study, in reviewing those with less than optimal outcomes from my first three plus years of Regenerative Medical procedures, I observed that patients with a prior history of lumbar spine problems had significantly worse hip and knee functional scores when compared to the majority who did well and had no documentation of a preexisting spinal abnormality.

The results of my observations mirror multiple previous studies that have found poor pre operative and post operative knee and hip function in patients undergoing a joint replacement who had a spinal degenerative co-morbidity. Through the review of our data base, we have identified the problem. Now I must determine the alternatives in dealing with the problem. First of all, from here on out, all new and returning patients will be questioned about their back related symptoms; and when deemed appropriate, images will be requested. If a significant degenerative disc or joint process is identified then the patient will be appropriately advised and referred for timely intervention. As of this writing, the options are either classical pain management or surgical in nature. The good news is that included in classical pain management for the spine is a very successful approach focusing on weight reduction, Pilates core strengthening, and Tai Chi, yoga or stretching. The failure of these non operative approaches is based on the failure of a patient to commit three or four days a week. The next level of pain management is injection based. Historically, an epidural series has been the standard but more recently, Regenexx introduced PRP as a safer and longer lasting approach. As of this writing, Regenexx and others have introduced intradiscal procedures, but I want more outcomes before I recommend such.

As far as what I do for arthritis, there will be more attention to devoted to the patient’s back when we do the intake for an arthritic joint. On the other hand, we do have several improvements and additions in our ever evolving menu of services for the arthritis hip and knee. To learn more, schedule a consultation:

847 390 7666

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Hamstring injuries and Regenerative Medicine

Hamstring muscle injuries — such as a “pulled hamstring” — occur frequently in athletes. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball. A pulled hamstring or strain is an injury to one or more of the muscles at the back of the thigh. Most hamstring injuries respond well to simple, nonsurgical treatments. In this Blog however, I am not focusing on “athletes”, I am raising concern about an epidemic of significant hamstring injuries, as I see it, in middle aged fitness enthusiasts who are seeking consultation in my office.

The hamstring muscles run down the back of the thigh. There are three hamstring muscles:

  • Semitendinosus
  • Semimembranosus
  • Biceps femoris

They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones. The hamstring muscle group helps you extend your leg straight back and bend your knee.

A hamstring strain can be a pull, a partial tear, or a complete tear. Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal. Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers. In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. This is called an avulsion injury.

Muscle overload is the main cause of hamstring muscle strain. This can happen when the muscle is stretched beyond its capacity or challenged with a sudden load. Hamstring muscle strains often occur when the muscle lengthens as it contracts, or shortens. Although it sounds contradictory, this happens when you extend a muscle while it is weighted, or loaded. This is called an “eccentric contraction.”  Restated, several contributory factors have been proposed as being related to injury of the hamstring musculo-tendinous unit. They include: poor flexibility, inadequate muscle strength and/or endurance, dyssynergic muscle contraction during running, insufficient warm-up and stretching prior to exercise, awkward running style, and a return to activity before complete rehabilitation following injury. I am currently investigating Platelet-rich plasma (PRP) for its effectiveness in speeding the healing of hamstring muscle injuries. PRP is a preparation developed from your own blood. It contains a high concentration of proteins called growth factors that are very important in the healing of injuries. For the avulsion, Bone Marrow Concentrate may obviate the need for surgery.  For more information call for a consultation  847 390 7666

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Complications of Arthroscopic Labral Repairs

Complications of Arthroscopic Labral Repairs

In both the shoulder and the hip, there is a structure called the Labrum that since the introduction of the MRI and the arthroscope, has received exponential surgical attention. In the hip, the acetabular labrum is a ring of cartilage that surrounds the socket of the hip joint. Its function is to deepen the acetabulum and make it more difficult for the head of the femur to slip out of place. At the shoulder, the Glenoid Labrum is soft fibrous tissue that surrounds the socket to help stabilize the joint. Injuries to either structure may occur from acute trauma, repetitive impingement or as part of the degenerative osteoarthritic process. Symptoms of a tear in either location include pain, may be mechanical in nature (catching, locking, popping, or grinding), a decreased range of motion and loss of strength.

Herein is the diagnostic and therapeutic dilemma; does the orthopedist address the history and physical examination, the results of imaging, all of the above or some of the above? On the one hand, it has been clearly established both at the shoulder and at the hip, labral injury as demonstrated on the MRI or CT arthrogram may not be the source of the pain. If the problem is pain and there are arthritic changes in the joint, the results of arthroscopic surgery are poor. Even when there are mechanical symptoms such as catching, locking, grinding and popping, arthroscopic clean outs do not succeed in the presence of arthritis. When it comes to the shoulder, the arthroscopic attempt at repair of the labrum as part of the rotator cuff injury has only a 50% success rate. Even when done correctly, poor patient selection and complications can be devastating resulting in injury to cartilage, injury to bone, and chronic irritation of the joint lining.

Assume if you will that a 45 to 55 year old or even older patient presents with pain in the shoulder or hip. The MRI is interpreted as compatible with a labral tear. There is an option which may very well eliminate the pain and affect healing of the torn structure, Bone Marrow Aspirate Concentrate followed by physical therapy. The procedure is done with a needle and not a scalpel; the complication rate in my experience is extremely low and the success rate extremely high. Let me cite an example of a patient who presented at age 67 with bilateral chronic shoulder pain for which he had undergone multiple prior attempts at arthroscopic surgical remedy. Four months after having undergone bilateral Bone Marrow Aspirate Concentrate Stem Cell intervention, he is off his chronic opiate containing pain medication and playing golf while having returned to his unlimited fitness routine. This is only one success story, there are many more. If you want to learn more about the potential options for your painful shoulder or hip, call for a consultation:

847 390 7666

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