PRP (Platelet Rich Plasma)
PRP is a well studied treatment that utilizes the bodies own healing mechanisms to recover. When the body fails to heal repetitively, we usually end up with arthritis, tendinosis, and chronic pain. This results from inadequate blood flow and trauma that prevents rehabilitation. PRP can stimulate a more localized and powerful healing response to an injury. For this treatment to work, the PRP must be expertly placed at the injured tissue with ultrasound guidance. Afterwards, time must be taken to allow healing, and the bodies healing capacity must be capable of providing the response needed for healing to occur. Treatment of injured joints, tendons, ligaments and nerves all have positive research outcomes showing very low risk of negative side affects. As with surgery and other treatments provided for pain related injuries, there is no guarantee of benefit. Regardless of the hundreds to thousands that have had good results, until you have had the treatment, there is no way to be certain if it will work for you. It is not uncommon for three treatments to be needed, but I have found that one treatment is often enough. PRP is not immediate, I advise patients that the full effect is usually seen 12 weeks post injection. This does make it hard to know if a second treatment will be required. In certain cases, I will recommend that more than one be planned due the amount of injury. Other times, one treatment is likely to work and a simple Prolotherapy follow-up may be all that is necessary for the pain fully resolved.
Great for nerve entrapment usually takes series of 3 to maintain nerve glide. Procedure completed with US visualization of the nerve allowing needle to circumferentially separate the surrounding fascia from the nerve over a distance.
Prolotherapy is the Great Grandfather of all other Regenerative Injection Therapies. It uses a very concentrated sugar called dextrose that is placed into the injured tissue. The dextrose forces the body to dilute the sugar. When the body dilutes the sugar, it causes signals from the local cells to awaken a new healing response. The affect only lasts a week or two, usually prolotherapy will need to be repeated every 2-4 weeks for 3 to 5 treatments total. Many of my patients fully recover using prolotherapy. I recommend 3-5 treatments at the initially. If after 3 sessions the benefit is still not at least 50% better I recommend PRP treatments that are more powerful and work great with the prolotherapy. The Dextrose in prolotherapy also blocks Substance P, an inflammatory signal between nerves. With prolotherapy a lower concentration of dextrose can be used to treat a nerve and a higher concentration can be used to treat a tendon ligament or cartilage. Prior to ultrasound, Physicians had to rely on palpation (touch) to figure out where to put the treatment. At The Road Back to Health, ultrasound is used to specifically place the prolotherapy in the damaged tissue. Ultrasound makes the treatment less aggressive and more precise. Prolotherapy works for many problems and is usually added to other treatments such as PRP or Ozone because it can stimulate healing in a different way.
Bioidenticle Hormone Replacement
Bioidentical Hormone Therapy has been very important to my patients in the past. When certain hormone levels are not optimal, it becomes very difficult to heal injured tissue. Chronic pain is very rarely "in our head". It is often an injury that our body can't recover. There are many reasons for being unable to recover. One of those reasons is subclinical hormone deficiencies. Once Physical Therapy and treatments like PRP and Prolotherapy are used, the damage can finally recover. After the tissue has been healed, some prefer to continue with hormone replacement to maximize weight loss and energy levels. Some prefer to stop the treatments rather than long term medical treatment. Both are acceptable approaches, but if weight management is an issue or return of injury, I encourage supplementation for at least one to two years. The primary hormone that has been found to affect both men and women's tendons is Thyroid. Many people having traditional replacement of thyroid do not have as good of benefit as those treated with Bioidentical. I usually follow patients reports first, then look at lab levels to determine if the treatment is appropriate. Testosterone is also important for healing and weight management for both men and women. Levels are very different in women and men so labs would be required. Unfortunately, labs are not usually covered well by insurance but can be covered for at least the initial testing and one or two follow up evaluations. Other hormones such as DHEA, Progesterone, Estrogen, and Pregnenolone will also be considered during treatments but have been slightly less important for tissue healing.
EPAT shockwave therapy
Many people who are afraid of needles prefer to use EPAT treatments. EPAT has some temporary discomfort during the treatment, which will improve once treatment is complete. Shockwave Therapy (EPAT) is known for its use to treat kidney stones. The EPAT treatment reduces the risk for injury if aimed at the wrong structure. It is capable of stimulating the body to feel better quickly and provides long term healing. EPAT typically takes 3-5 sessions for optimal results, it also works well in combination with PRP or Prolotherapy. EPAT has been used for Plantar fasciitis and tendon injury, joints and muscles. New research data has shown that it is effective at treating pain from bone marrow edema, a very difficult pain to treat, typically treated with joint replacement. EPAT has also been shown to improve cellulitis for cosmetics and insulin lipodystrophy, resulting in a smoother skin.
This is a treatment originally created by, Nikola Tesla. It utilizes a hyperoxygen created by specialty medical equipment using a pure oxygen source. Ozone Therapy improves new inflammation (swelling), systemic inflammation (the whole body being inflamed) which makes the body ache and difficult to exercise and painful bruising. Treatments can be at a localized tissue such as the knee joint or for the whole body using the blood to carry the anti-inflammatory benefits through out the whole body system. This treatment has been used as an adjunct (add on) treatment for many diseases that are poorly treated without it. Research has shown that patients going through chemotherapy experience less nausea and improved quality of life while utilizing Ozone Therapy during their traditional treatments. Patients with Multiple Sclerosis have been shown to have decreased relapsing episodes. Crones disease and Ulcerative colitis have also been shown to have less flare ups while using ozone. I do not encourage patients to use this treatment exclusively, but it can provide extra benefits to issues that are poorly controlled for many people. Ozone Therapy is helpful for those with limited time. An example is someone planning a trip who can not wait 12 weeks for PRP. If an Achilles tendon, knee arthritis, or even shin splints flare up requires quick pain relief, Ozone is one of the best treatments. Cortisone and other other steroids are frequently used to treat the aforementioned problems. Unfortunately, there is greater side effects and risks with this treatment. Steroids can weaken and damage healthy tissue, especially if utilized repeatedly in the same area. They also can decrease the immune systems ability to fight infections. Overall, Ozone is a safer and better treatment.
About Derek Rodeback
Dr. Derek Rodeback currently enjoys teaching at Rocky Vista University as an adjunct physician professor but has been planning this clinic for years and am very excited to open The Road Back to Health in St George Utah. After completing medical school, I knew treating pain was the most fulfilling aspect of medicine for me. During residency, I learned the biomechanics, mechanisms of injury and how the body can heal if given what it needs. Standard medical treatments for muscle and joint problems were inadequate. The treatments did not seem to provide good relief for muscle, joint, nerve and general body pain. Physical therapy, steroid injections, nerve blocks and even manual medicine OMT were mostly temporary pain relief or unable to resolve the issues in many cases. As I searched for ways to help those I treated, I found Regenerative Medicine. Regenerative Medicine made treating patients with pain enjoyable again. Allowing me to finally feel gratified in the care I offered to patients. After years of treating patients with Regenerative Medical treatments, I can confidently say there is no better method to help those who suffer from pain.
Current Adjunct Professor at Rocky Vista University Medical School
Medical School - West Virginia School of Osteopathic Medicine.
Residency in Physical Medicine and Rehabilitation - Loma Linda University.