Piriformis Syndrome: Ultrasound Therapy is Superior

The piriformis is a small but important muscle in the gluteal (buttock) area.

It originates from sacrum(base of lumbar spine), exits the pelvis through the sciatic foramen and inserts on the greater trochanter of the femur(hip bone).

The piriformis muscle functions to  laterally rotate the hip.

Piriformis syndrome is a condition in which the piriformis muscle irritates the traversing sciatic nerve causing pain, tingling and numbness in the buttock and leg.

Common causes of pirifromis syndrome include weak abductors combined with tight adductors, SI joint dysfunction and overpronation of the foot.  Runners, bicyclist and other athletes engaged in forward moving activities are particularly susceptible.

Comon referral pain pattern is:

Treatment involves  stretching exercises and massage, and avoidance of contributory activities,

When conservative treatments fail,  injection of local anesthetics and low dose steroids are a viable option.

Are all injections the same?  NO

At the Centeno-Schultz Clinic we have both x-ray and ultrasound within our clinic.  Our practice is to use ultrasound as it has been demonstrated to be superior to x-ray in placing the medication directly into the piriformis muscle.  Finnoff found that most of the fluoroscopically attempted piriformis injections were placed superficially within the gluteus maximus and therefore did not reach the targeted piriformis.

Stem Cell Therapy for Meniscus Injuries: A Comprehensive Approach

Steep and deep skiing is fantastic but can result in debilitating injuries.

CP is a 60y/o avid extreme snow and water skier who sustained a right knee injury in the back-country.  He had undergone three previous knee surgeries with limited success.

Conservative treatment included active release PT, chiropractic care, acupuncture and trial of NSAID’s without significant benefit.

CP was familiar with the studies which demonstrated progression of degenerative changes after meniscectomies and therefore declined.  He opted to use his own stem cells via the Regenexx procedure.

At the Centeno-Schultz Clinic CP  was noted to have a 15 year history of low back pain, instability of ACL and extreme pain on the medial aspect of the knee.  Physical examination was signficant for laxity of ACL and decreased strength and sensation in his left foot.  X-ray of lumbar spine demonstrated significant lumbar degenerative disc disease most advanced at the L5/S1 level.

Joint stability and maximizing neural function is critical as discussed in Ortho 2.0.

MSK ultrasound allows for a dynamic, real-time examination which in CP demonstrated multiple tears in medial meniscus, partial extrusion of medial meniscus and thickening of MCL.

At the Centeno-Schultz Clinic CP underwent x-ray guided injections of Regenexx PL, prolotherapy of ACL and MCl and Regenexx SD into his medial meniscus via ultrasound guidance.

3 weeks post injection I received this e-mail:

“Overall the joint feels much more stable than before. I am now able to walk down stairs in a normal fashion instead of 1 step at a time. Epidural injections have really diminished lumbar and scapular pain. Down to a bearable 2-3  where before it was 5-7 all of the time. Very noticeable improvement when I bike ride. I felt things tighten up (unprovoked ) in the lumbar region, the the scaps a couple of days ago, still tight but not super painful. Right leg seems to function normally on the mtn bike. I’ve been doing the Sprint 8 routine every 3rd day on reasonably flat trail. Hitting 22mph on the sprints, heart rate of 165, peaking to 170 as come off the sprint for 90 sec recovery which leads me to believe I’m hitting a solid anaerobic level and creating an 02 debt. Still an imbalance from left to right in pedal power. Walking has gotten much easier with the resolution of both the back and knee pain.”

In 2012 CP expects to exceed his previous seasons which is shared with us (he’s the one with the moustache): View CP’s Video

Nutrition and Stem Cell Therapy

Is there a correlation between nutrition and osteoarthritis?

Yes!

At the Centeno-Schultz Clinic and Regenexx we acknowledge the critical role between the two.

1 in 5 patients have metabolic syndrome characterized by central obesity, hypertension and elevated lipids and serum glucose. This syndrome results in the release of detrimental chemicals into the joints which can lead to the breakdown of cartilage matrix.

These same patients do poorly with knee and hip replacements due principally to the systemic proinflammatory state.

Obesity and hyperglycemia are associated with increased infection rates after knee replacements.

Diets rich in carbohydrates, refined sugar and processed food can promote a pre-diabetic state.   SIRT-1 gene expression plays an important role in circulating blood sugars levels and joint health.   Activation of SIRT-1 gene by dietary restriction and Resveratrol is associated with healthy cartilage.  Inactivation of SIRT-1 gene, commonly seen with aging and diets high in refined sugar and carbohydrates results in increased body fat, decreased energy and cartilage cells becoming less stable.  This can become the perfect storm for the onset of osteoarthritis.

In counseling deconditioned and overweight patients with osteoarthritic and musculoskeletal injuries, the Centeno-Schultz Clinic recommends at a minimum diet modification and increased activity levels.  These efforts are taken in an effort to optimize clinical outcomes from Regenexx SD, Regenexx AD and Regenexx SCP therapies.

Centeno-Schultz Clinic Reviews: Successful Knee Stem Cell Therapy Returns Skier to Slopes

Aggressive skiing particularly in the moguls can take it’s toll on one’s knees and back. PM is 55y/o Canadian physician who was passionate about skiing and moguls.  Unfortunately he had significant bilateral knee and lower back pain. As a physician and a an avid skier he recognized that knee replacement and lumbar fusion would most likely prematurely end his life-long passion.  Accordingly he rejected the surgical recommendations and sought to use his own stem cells for knee stem cell therapy with the Regenexx procedure.

At the Centeno-Schultz Clinic he underwent x-ray guided bilateral SI joint prolotherapy, Regenexx C when it was still being performed, bilateral L5/S1, S1 epidural injection with Regenexx PL, Regenexx SD.  PM had both his back and knees treated acknowledging the importance of treating all areas of pain.  The lumbar spine and knee and ankle function are intimately connected as discussed in Orthopedics 2.0.

PM’s recent e-mail:

“I am enjoying an excellent result from the stem cell knee injections. I can kneel and stand up without any knee pain. I no longer look for an escalator and can run up stairs. My knee caps no longer feel loose while walking down the street. At 56 yr.’s old I can now ski for 4 hrs. nonstop with a much younger crowd without any knee swelling or pain. I can hit icy mogul lines without discomfort. The knees feel strong and bulletproof. The single stem cell injection to my large toe joint substantially reduced the pain and increased the ROM by 80%. I can now stand on my tippy toes. I have not taken any NSAID’s or pain medications since attending your clinic. My reflexes during skiing are now much sharper. I avoided medications, knee replacements and a fused toe joint. I only missed a day off work during the whole recovery. Thank you Regenexx and the CentenoSchultz Clinic.”

Successful Stem Cell Treatment of Meniscus tear

Tears in the knee meniscus can cause pain and limit activity.   Menisectomy is a surgical procedure in which a portion of the injured meniscus is removed.    Knee meniscectomies  are not without risk: they can advance the degenerative process, create  instability in the knee,  result in infection and exacerbate pain.

DG is an athletic 41 y/o patient who sustained a complex tear of the knee meniscus while roller blading.  Conservative therapies in the form of PT, massage and chiropractic care failed to reduce his pain which he rated as 4/10 in severity.  He declined surgical options and opted to use his own mesenchymal stem cells through the Regenexx procedure.

On physical examination  DG had  tenderness along the medial aspect of knee along with a loose ACL.  The ACL is a critical ligament in the knee as it prevent forward motion of the shin bone in relation to the thigh bone.  Creating stability in the joint is paramount for optimal clinical success.

DG underwent therapy at the Centeno-Schultz Clinic which included prolotheraopy of the ACL under x-ray along with Regenexx C therapy in the posterior horn of the medial meniscus.

Follow-up MRI was significant for ” improved appearance of the known complex tear of the posterior horn medial meniscus”.  This corresponds will his clinical response.  DG notes an 85% improvement in pain and 80% improvement in stability. He recently completed three days of snowboarding and is transitioning from his beach cruiser to a mountain bike.

Below are MRI images of the meniscus tear prior to and following Regenexx C therapy. The picture on the left was taken 9 months before the stem cell injection into the knee meniscus. Note the light areas in the triangle shaped meniscus  represent weak areas and tears. On the left the red arrows identify the complex meniscus tear.  The right picture was taken 22 months after the stem cell injection-note the darker appearance of the meniscus with less of the light areas representing weakness and tears.  The yellow arrows on the right identify the areas of healing with the meniscus.

Stem Cell Therapy Passed Steep and Deep Test: Aguille du Midi

The Aguille du Midi in Chamonix, France is the starting point for the longest lift-serviced ski and snowboarding run in the world: the 13-mile-long Vallée Blanche. It’s often called the greatest ski run on the planet.  The terrain is steep and dangerous with no exit other than helicopter.

CM is a 56 y/o patient who sustained a right knee meniscus tear while running to catch a plane.  The  knee pain was severe in nature, progressive in nature and  interrupted his sleep.  The pain made walking difficult and resulted in a significant limp. He declined athroscopic meniscectomy involving the surgical removal the damaged meniscus.  Surgical procedures have been demonstrated to accelerate osteoarthritis in the knee.

 CM underwent Regenexx C whereby autologous mesenchymal stem cells were injected into the damaged meniscus.  He has no down time and left the Centeno-Schultz Clinic with a knee brace which he wore for several weeks. 

16 months post stem cell injection CM reports no pain or limp.  He has returned to his active lifestyle and recently successfully finished the Aguille du Midi.

Bravo!

Steroids and Cell Death: Apoptosis

 

Apoptosis is the process of programmed cell death.  The process is controlled by a variety of factors both within and outside of  cells.  High dose steroids have been demonstrated to create cell death in muscles, bones, cartilage and ligaments.  High dose steroids are commonly used to treat a variety of painful conditions which include rotator cuff tears, lateral epicondylitis, patellar and Achilles tendonitis, pes anersine bursitis,  lumbar facet dysfunction and sciatica.

At the Centeno-Schultz Clinic we acknowledge the negative effect of  high dose steroids.  Our aim is to identify the source of a patient’s pain and provide a therapy which will attempt to repair the damaged tissue.  Our treatments are not aimed at advancing the degenerative process or triggering apoptosis.  Accordingly we use only very small doses of steroids when necesary and have a large number of regenerative therapies which promote healing: prolotherapy, platelet rich plasma (PRP), Regenexx SCP, Regenexx AD and Regenexx SD.