- Review of radiological studies (x-rays, MRI, etc.)
- Diagnostic (anesthetic only)
- Joint aspiration (draining fluid)
- Viscosupplementation (hyaluronic acid) Gel
- Regenerative Medicine
- Osteopathic Manipulative Medicine (OMM)
- Physical Therapy
- Regenerative Rehabilitation
- Home Exercise Program
- Lifestyle Modifications
- Explore the conditions that led to your symptoms
- Understand the way your symptoms have manifested an individualized change in the quality of life. (movements, activities, hobbies or tasks that have been affected)
- Use advanced technology such as ultrasound to diagnose the region affected
- Formulate an evidence-based customized treatment plan based on available injection therapies with a discussion of risks, benefits, and prognosis for each.
- Perform precision ultrasound-guided injection.
- Provide a comprehensive rehabilitation program that may include physical therapy and/or home exercise program.
- Recommend lifestyle modifications and adjustments and long-term strategies to avoid reinjury and promote tendon health.
Joints are the attachment between bones. While much focus on joint problems is on treating what is visible on x-rays, there is much more to consider when approaching the treatment of joint pain. Degenerative joint disease, commonly known as osteoarthritis, is a complicated disease that the medical community has struggled for decades to get a good handle on the factors that lead to this condition as well as how to effectively treat it. What we do know is that the correlation between visible “arthritis” on imaging and symptoms are poor. In addition, degenerative joint disease, or osteoarthritis, usually develops from more than just “wear and tear”. Joints rely on a concept called stability. The more stable a joint is, the more protected it is from external forces. Not all forces are bad, though. We know that healthy stresses can prevent osteoporosis and promote controlled turnover and homeostasis (balance) in the microenvironment of the joint. However, abnormal forces (excessive or with increased shear forces) can overload a joint. In order for a joint to remain healthy, we must address the following:
- Neuromuscular modulation/Proprioception.
In order for a joint to be stable, it relies on the surrounding tissues to absorb forces and prevent the joint from dislocating or subluxing out of place. There are static (ligaments) and dynamic (muscles, fascia, fibrocartilage) stabilizers of joints.Neuromuscular modulation (“nerve-muscle connection”)
Our nervous system is intimately interconnected with the musculoskeletal system. We know that pinched nerves in the spine can lead to weakness in isolated muscle groups. Think of the muscle as the computer and the nerves as the power cable. The cable plugs into the electrical socket in the wall which represents our brain and spinal cord, also known as our central nervous system. A problem along any of these connections can cause a faulty experience when trying to engage with the computer. When running a diagnostic, we must consider all of the connections to determine the root cause of the problem.
Neuromuscular modulation is the “nerve-muscle connection” that provides several very important functions. Nerves are most well known to provide sensation (feeling) and motor (strength). However, there are specialized nerve fibers whose roles are to manage our keen sense of position, called proprioception. This is a very high tech nuanced system of being able to delineate micro-movements within a joint that helps us walk upright using minimal energy and not fall over when we walk in the dark. However, injuries, surgeries, medications or health conditions such as diabetes or vascular disease can impact these nerves significantly. This is why people who sprain their ankles are at such a high risk of re-spraining them again and again. With low back pain, for example, a buzz word is “core”. Every personal trainer and yoga, pilates, TRX, Tai Chi class instructor raves about the importance of “having a tight core”.
The truth is: core strength is half the battle. Core stability is equally if not of greater importance to protecting the spine and limbs. This is because studies have shown that those with chronic pain often have misfiring of muscles so that certain stabilizing muscles either do not fire at all or are out of sequence. This perpetuates more pain and dysfunction and until the neuromuscular control and body mechanics are fully addressed, we will have a very difficult time affording long-term pain relief for patients.
Our joints, in turn, rely on strong and stable myofascial support. We must address this in order to affect the outcomes we seek to improve pain and restore function to those suffering from joint pain.Flexibility/Mobility/Motion
Many people focus on obtaining a full range of motion as the primary indicator of recovery. However, in certain body regions such as the spine, stiffness is actually preferred for certain conditions to prevent hypermobility or excessive movements which can increase loading forces on the spine. It is also imperative to address the other factors mentioned, rather than solely focusing on the range of motion.Strength
A body region is considered to be strong when it has all of the elements above and there is a lack of pain. Lack of stability, flexibility or presence of pain can all make one feel that strength is lacking. On the other hand, being strong is not sufficient. A pole held by a group of strong people that are not in sync will not remain upright. This is because there needs to be a harmonious synergy of flexibility, strength, stability, and control in order to carry the weight efficiently and effectively.