Headaches can be debilitating. At the Centeno-Schultz Clinic we experts at evaluating and treating head and neck pain. Muscle dysfunction can be a major source of head pain and requires evaluation. Tight, dysfunctional muscles in the shoulders and cervical spine often give rise to head pain. In a previous blog I discussed referred pain. Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a site away from the site of injury’s origin.
Tight, poorly functional muscles give rise to a pain in common referral patterns. The trapezius and splenius capitus muscle are responsible for referred pain into the head as illustrated below:
Treatment for muscle dysfunction is aimed at restoring normal function through IMS and strengthening through MCU.
PRP has been demonstrated to be effective in the treatment of Achilles tendon injuries. The Achilles tendon, the.thickest and strongest tendon in the body, originate from the calf muscles ( gastrocnemius, soleus and plantaris) and inserts upon heel bone (calcaneus).
Achilles tendonitis, an inflammation of the tendon, is painful and can be difficult to treat. Conservative therapy includes trial of NSAID’s, orthotics and physical therapy.
At the Centeno-Schultz Clinic we evaluate all possible factors which can potentially cause pain and impede healing. RC is a case is point. He is an athletic patient who despite surgery on the left Achilles tendon continued to have pain and limited function Next step was a large orthopedic surgery with grafting of a foot tendon into the Achilles tendon. RC sought a second opinion at the Centeno-Schultz Clinic. Past medical history was significant for the use of simvastatin for elevated cholesterol which has been associated with tendonitis and possible tendon rupture. Physical examination was significant for weakness in the left big toe and abnormal neurologic exam consistent with nerve root irritation of a lumbar nerve root. After being tapering off his cholesterol medication, RC underwent mysofasical deactivation(IMS), x-ray guided injections of platelet derived growth factors into the lumbar spine, ultrasound guided injections of PRP and physical therapy.
Yesterday RC returned to clinic and reported 80% improvement and return to athletic activity. By discontinuing a toxic medication, addressing neurologic and muscular based dysfunction along with PRP injections, RC patient was able to avoid surgery.
Injury or inflammation of the cervical facet can led to neck, shoulder and headache pain.
The cervical facet is a joint in the posterior aspect of the cervical spine. It functions to provide stability and guide motion.
Cervical facet pain is common in patients who have sustained a whiplash injury, trauma to the neck or undergone cervical fusion. Physical examination is typically significant for restriction in range of motion along with pain. Each joint has a distinct referral pattern illustrated below.
The Centeno-Schultz Clinic are experts at diagnosing and treating cervical facet dysfunction. Injury to the joint is not commonly detected by conventional radiographic studies. A thoough understanding of the mechanism of injury is essential.
Successful treatments include intra-articular facet injections, prolotherapy and burning of the nerves which give sensation to the affected cervical facet (radiofrequency ablation).
Pain is a complex phenomenon which can difficult to manage. Identifying where the pain is arising from is essential if treatment is to be successful.
Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a site away from the site of injury’s origin. Sometimes pain felt in one area of the body does not accurately represent where the problem is, because the pain is referred from another area. A common example is the pain associated with a heart attack. While the injury is to the heart muscle, patients often experience pain in their jaw or arm.
At the Centeno-Schultz Clinic we are experts are identifying the source pain. Recent examples include:
1) severe headache pain arising from the cervical facet joint.
2) Shoulder and arm pain arising from muscle dysfunction treated with intramuscular stimulation(IMS).
3) Thoracic pain arising from thoracic facets and instability.
4) Pelvic pain arising from ligament instability of pubis symphysis treated with prolotherapy.
5) Buttock pain arising from SI joint treated with x-ray guided injections.
Headaches and neck pain are very common after motor vehicle accidents (MVA’s). At the Centeno-Schultz Clinic we take post accident complaints of headache and neck pain seriously. We disagree that whiplash is a minor soft tissue injury associated with significant psychosocial factors.
Sources of neck and headache pain and their potential treatment at the Centeno- Schultz Clinic are:
1) Muscle dysfunction and inhibition: intramuscular stimulation (IMS).
2) Loose Ligaments in cervical spine: prolotherapy.
3) Weak cervical muscles: Multi Cervical Unit (MCU) and strengthening of deep neck flexors.
4) Loss for cervical curve: prolotherapy, physical therapy and chiropractic care.
5) Cervical facet dysfunction: x-ray guided intra-articular facet injections, medial branch blocks and radiofrequency neurotomy.
6) Disc Dysfunction: x-ray guided epidurals with lose dose cortisone or platelet derived growth factors.
Appropriate treatment is essential given the fact that whiplash can progress to chronic pain syndromes. Freeman et al demonstrated that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.
There are four principal ligaments in the knee which provide critical stability: anterior cruciate ligament, posterior cruciate ligament, medial and lateral collateral ligaments. Ligament strains or tears can not only be painful but can create instability in the joint which accelerates degenerative changes as discussed in Ortho 2.0. Non-surgical treatment options for knee ligament strains and partial tears at the Centeno-Schultz Clinic include prolotherapy, PRP injections and stem cell therapy utilizing the Regenexx procedure. In a previous blog, I discussed the use of mesenchymal stem cells to treat a partial ACL tear.
EK is a 31 y/o athletic officer at one of the nation’s military academies who sustained a tear in his ACL. He opted for a non-surgical therapy. EK underwent post stem cell therapy MRI of the knee which is presented below. There is significant improvement clinically which corresponds with the improvement seen on MRI. In the pre-injection MRI, the ACL is loosely organized and loose whereas after stem cell therapy utilizing the Regenexx procedure, the ACL is tightly organized and the fibers have a denser appearance. The ACL is identified with dashed red line.
Here are EK’s comments post injection:
“Yes, my knee feels stronger and more stable in day to day, hiking, running, biking and swimming activities. I went hiking last weekend with a light overnight backpack on a steep trail. In loose rock and during slight mis-steps, my knee remained stable. I did do some activity tests at the clinic and the chiropracter noted less sharpness on certain resistance motions with my right leg as compared to my left leg. Considering, I heard a pop and couldn’t walk normally for over two months, I’m happy with the improvements my knee has shown. Stability has improved and mentally I am willing to trust it’s strength. My PT agreed there was no longer any reason for me to pursue surgery any more. ”
At the Centeno-Schultz Clinic different regenerative therapies are available which allow patients non surgical options for common orthopedic injuries. Therapies include prolotherapy, PRP, platelet derived growth factors and expanded mesenchymal stem cells.
Thumb pain can be disabling. A general understanding of the anatomy of the wrist and hand helps one understand possible sources of thumb pain.
There are many bones in the hand but for this discussion we will limit it to two major groups: the carpals and metacarpals.
The carpals are eight small small bones bound in two rows of four bones each.
The metacarpals are five in number and make up our palm region. They lie between the carpals and the fingers (phalanges).
The joint space between the carpal bones and the proximal base of the metacarpals make up the CMC (carpometacarpal) joint.
Thumb pain can occur when there is arthritis in the CMC joint. Other causes of thumb pain include tendonitis, DeQuervan’s tenosynovitis, peripheral neuropathy, peripheral nerve compression, brachial plexus injury, peripheral artery disease.
Treatment options involve splinting, PT, rest and NSAIDs. Surgical options include fusion or prosthetic replacement both of which are major surgeries with moderate to poor outcomes.
At the Centeno-Schultz Clinic other options exist which include prolotherapy, PRP and stem cell therapy.
Pain on the outside of the elbow which is referred to as lateral epicondylitis can be disabling. Typically seen in 30-60 year olds, patients complain of point tenderness over the outside aspect of the elbow ( lateral epicondyle) aggravated by gripping and activities that extend the wrist.
The pain is thought to arise from degenerative changes in the muscles that attach to lateral epicondyle called the extensor muscles. These muscles allow the arm to extend(bent backward) .
The diagnosis is made by clinical signs and symptoms. A common diagnostic test is the Cozen test. Conservative treatment includes PT, NSAIDs, heat, ice and rest. Injection of cortisone has been demonstrated to be no different than placebo. Complications from repeated steroid injections include fat atrophy and potential weaking of the tendon.
Not all lateral elbow pain is lateral epicondylitis.
LF presented with a 5 month history of lateral elbow pain after tripping over her dog and striking her elbow on her granite countertop. Conservative therapy had failed and her physician had referred her for PRP injection. At the Centeno-Schultz Clinic therapeutic injections are performed with either x-ray or ultrasound to confirm accurate placement. LF’s ultrasound exam was significant for tendosis (tendosis) of the extensor muscles which are commonly associated with lateral epicondylitis. More important was the significant tendosis and partial muscle tear of the triceps muscle (not typically seen with lateral epiconduylitis). Identifying this second site of injury was cardinal as it represented another source of pain which needed to be treated for maximal clinical outcome. At the Centeno-Schultz Clinic an accurate diagnosis and appropriate placement of regenerative therapies whether it be stem cell therapy, prolotherapy, APC or PRP injections is our standard.