Hypermobile Ehlers-Danlos syndrome (EDS) and hypermobility spectrum disorders are the most common symptomatic joint hypermobility conditions seen in clinical practice. One of the more serious long-lasting affects of joint laxity is chronic joint degeneration. The increased mechanical stress caused by ligament laxity leads to chronic joint instability, making them more susceptible to soft tissue injuries. Continual instability and injury leads to an earlier onset of degenerative joint disease in hypermobile and other patients with ligament injuries than in the normal population. #prolotherapy #PRP #hypermobilityjointpain #jointpain #painmanagement #chronicpain #kneepain #backpain #SIjointpain #anklepain #EDS #EhlersDanlos #hypermobility #arthritispain
Prolotherapy's mechanism of action is to create microinflammation, stimulating regeneration of new cells. The end result is new tendinous and ligamentous tissue indistinguishable from native tissue. Scar tissue is not created, but rather, tissue that acts as the original structure that had been injured or torn. #prolotherapy #PRP #pain management #tendinopathy #chronic pain #sports medicine #regenerative joint therapy.
Low back pain can often be caused by ligament injury, leading to instability of the lower lumbar spine and sacroiliac joint [SIJ]. Using hypertonic dextrose-based prolotherapy and/or platelet-rich plasma [PRP], these structures can be repaired, restoring stability to the lower back. This can be a very effective non-surgical approach to SIJ dysfunction in combination with PT, without the need for steroids or surgery. #prolotherapy #SIJ dysfunction #back pain #PRP #pain management #low back pain.
Chronic shoulder pain is a common problem seen in primary care and sports medicine. Shoulder pain is second only to low back pain in patients seeking care for musculoskeletal ailments in the primary care setting.
Effective therapy depends on an accurate diagnosis of the more common etiologies: rotator cuff disorders, adhesive capsulitis, acromioclavicular joint osteoarthritis, glenohumeral osteoarthritis, impingement syndrome and ligament instability. Activity modification and analgesics are the initial treatments in most cases. If this does not lead to improvement, or if the initial presentation is of sufficient severity, a trial of physical therapy that focuses on the specific diagnosis is most often the next step. Combined steroid and local anesthetic injections can be used alone or as an adjuvant to the physical therapy, but recent studies have shown these do not always prove to be a long-term solution to the problem, especially if ligament laxity, partial rotator cuff tears or pain at the attachments of ligament to bone [humerus] persists.
The site of the injection (subacromial, acromioclavicular joint, or intra-articular) depends on the diagnosis. Injections into the glenohumeral joint can be more precise with ultrasound guidance. Symptoms that persist may be candidates for prolotherapy and/or platelet rich plasma [PRP] injections.
#shoulderpain #PRP #prolotherapy #MSKUSshoulder #familymedicineshoulderpain #rotatorcufftear #sportsmedicine #shoulderbursitis #shoulderimpingement
One year ago in 2020, I would have been in Tempe, AZ, teaching the second module in the year-long 300-hour course provided by Helms Medical Institute. In reviewing pictures from that time, it is hard to believe a year has gone by.
Thankfully owing to the magic of technology, the HMI course was able to begin this past weekend with a 3 day introduction to medical acupuncture, including didactic sessions, lectures and videos, small group breakout sessions, as well as Zoom supported group meetings with students starting their education in the art of medical acupuncture.
Thanks to an amazing support staff with HMI, known for its solid reputation and experience in education, the program was a rousing success. Despite a few glitches with technology owing to power outages around parts of the country because of winter weather, the course exceeded expectations. We look forward to our next installment later this Spring by continuing to provide educational platforms for residents, nurse practitioners, and physicians in training.
It is a blessing to be part of this wonderful program and it is with great gratitude that I remain active in a role of a senior Faculty Preceptor for HMI. #helmsmedicalinstitute #HMI #ACUS # Acusfoundation #acupuncture #medicalacupunctureeducation #HMIGrads #painmanagement #alternativepainmanagement
Concerns Over Long-term Steroids and NSAID’s for Joint Pain: Why Prolotherapy and PRP may be better long-term options.
During the recent December 2020 annual American Academy of Orthopedic Medicine [AAOM] conference, concerns were voiced over the use of corticosteroids. For many years, steroids and NSAIDs have been a mainstay in pain management. They remain the “community standard of care”. But for those of us in regenerative joint management, there has been increasing awareness that steroids and long-term NSAID’s [Motrin, Naprosyn, e.g.] can have potentially damaging effects on native tissues.
If you’ve ever been advised against multiple steroid injections/year, you will appreciate the following information. Multiple injections of corticosteroid can actually damage the very cells that provide support to the joint and joint surfaces. Studies have shown damaging effects that these medicines can have on cells that produce cartilage, as well as cells that repair tendon and ligament structures.
Intra-articular (IA) corticosteroid therapy has been used for the treatment of inflammation and pain in the knee, for example, since the 1950’s. Corticosteroid therapy has been shown to be effective at temporarily alleviating joint symptoms associated with osteoarthritis and other inflammatory disorders. However, the long-term negative effects of these medications on articular cartilage remains a concern. The deleterious effects of the reviewed corticosteroids on articular cartilage are extensively supported by the basic science literature. The beneficial effects of corticosteroids occurred at low doses and short durations (usually <2-3 mg/dose or 8-12 mg/cumulative total dose in vivo), at which increased cell growth and recovery from damage was observed. However, at higher doses and longer durations (>3 mg/dose or 18-24 mg/cumulative total dose in vivo), corticosteroids were associated with gross cartilage damage and chondrotoxicity. The literature demonstrates the complex effect methylpredisolone, dexamethasone, betamethasone, and hydrocortisone have on cartilage proteins through the processes of protein production and breakdown. Methylprednisolone, dexamethasone, and hydrocortisone have demonstrated simultaneous mediation of both beneficial and detrimental upstream regulators of cartilage protein synthesis and breakdown.
Many in the field of regenerative joint therapy [prolotherapy] as a result, have promoted injection solutions designed to heal native tissues, regenerating the very structures injured from trauma or as a result of joint instability.
For more on this topic, I invite you to watch a recent interview with Dr. Ross Hauser, MD at Caring Medical in Ft. Meyers, Florida, who expands on this topic.
As of 12-31-2020, we have seen the introduction of a nationwide vaccination program utilizing mRNA vaccines to begin the process of creating 'herd immunity.' What are the challenges posed, the factors being taken into consideration by the Oregon Health Authority? How are vaccines being supplied and distributed? And when can I expect to be able to be vaccinated? Also included is a brief description of dis-information, conspiracy theories, that have since been 'debunked' by those in the fields of immunology and vaccine development. #Covid-19 #Covid-19vaccine #pandemic2020 #vaccine #health #preventioninhealthcare #aafp #americanacademyfamilyphysicians #OregonAcademyofFamilyPhysicians #OregonHealthAlliance #familymedicine #familypractice #oregonacademyoffamilyphysicians #herdimmunity #moderna #pfizer #mRnavaccines #marchforscience.
Grief expert David Kessler recently weighed in on our collective grieving during Coronavirus in the Harvard Business Review. He argued that we are experiencing a variety of different types of grief at once; including a general loss of a sense of safety. Grief manifests itself in a variety of emotions.
Lower emotions, such as sadness, boredom, or general fatigue, are ones many people experience day to day. When we experience lower emotions, they take a small presence in our lives, but we have more capability to function while feeling sad or angry. Higher emotions, like rage, anxiety and PTSD can completely saturate our minds and bodies and leave us feeling incapable of getting rid of the looming fear. It’s easy to become overwhelmed with all of these emotions, and we want you to know that there are strategies you can use to cope, no matter the level of feelings you’re having. #stress #PTSD #mental health
If you are experiencing lower emotions, like sadness or grief, here are some ideas for you.
Contribute to your community. Reach out to those you haven’t spoken to in a while. Offer support by simply having a (virtual) conversation with your loved ones. Order takeout, if you are able to, from a local restaurant you enjoy. If your neighbors are at risk, offer to pick up a few items for them the next time you go grocery shopping, and make sure to wipe the groceries with disinfectant and leave them on their doorstep.
Soothe the senses and take a moment to relax. Make your favorite meal and enjoy the way it smells and tastes. Look at your favorite photographs. Put on a comfortable sweater and enjoy the way it feels. Listen to soothing music or the songs that bring you happiness. Take a warm shower and refresh your mind and senses, taking a moment to relax.
Exercise mindfully. While a high intensity workout is beneficial to our health, you don’t need to do one every moment you feel stressed. A simple 30 minutes of yoga or dancing can lift your spirits and elevate your heart rate. Many local yoga studios are offering free classes during this time.
Take time to laugh. Maybe this comes from your favorite comedian, or that raunchy movie that always makes you giggle. Whatever it is, laughter can bring us back to a positive state of emotion and alleviate our stress levels.
Higher emotions can sometimes be more difficult to grasp. If you are experiencing higher emotions, here are some strategies for mindfulness.
Paced breathing exercises reduce stress levels. Breathe in for 5 seconds, out for 7. Do this for 5-10 minutes. While it may feel uncomfortable at first, we urge you to push past this and allow your body to get used to this technique. Pacing your breathing can help boost your immune system as well, because it lowers stress. Your body will regulate and you will feel the calmness wash over you.
Get out of bed in the morning. It’s easy to lie down and overthink our stressors, but this does more harm than good. Distract yourself by getting up and getting fully ready for the day. Make yourself a nutritious meal. Give your best friend a call and reminisce on fun memories.
Intense exercise. Go for a run at a comfortable pace to get warmed up. Do movements like burpees and jumping jacks to increase the intensity. Exercising releases endorphins and can relieve feelings of anxiety.
Change your body temperature. Using cold water, change your temperature slightly to refresh. Dip your face in water for 10 seconds, take a moment to breathe, and dip again. Do this for a minute. Make sure you’re using cold water, or else it will be difficult to successfully complete this exercise.
There are many more ways to cope with emotions that may be exhausting you. At-home activities are a fun way to take up free time and be creative. If you’re interested in learning about fascinating topics, watching educational documentaries can be both entertaining and informational.
We hope that these ideas give you inspiration to fill your time and help you through both high and low emotions. Below is a helpful document containing the above strategies, and more, assembled by experts. This time is difficult, but our community is strong and we will get through it together (even while separate).
Excerpt from a recent article in The Washington Post: "In the past several months, a bevy of studies have added to a growing literature on the mental and physical benefits of spending time outdoors. That includes recent research showing that short micro-breaks spent looking at a nature scene have a rejuvenating effect on the brain — boosting levels of attention — and also that kids who attend schools featuring more greenery fare better on cognitive tests."
For the entire article click on this link:
I offer this article in response to a question asking about scientific proof that acupuncture works, despite a wealth of evidence based studies showing clear benefit.
Tom Etges, MD
Read here for news and helpful tips from the office of Dr. Tom Etges.