Prolotherapy & Joint Pain

Archives for May 2020

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As evidence of the dangers of chronic use of corticosteroids and NSAIDs mounts, many pain sufferers are looking for other options that can bring permanent relief. Many of these are running across Prolotherapy in their web search, yet much mystery and misunderstanding still surrounds this very effective treatment modality. In this article I’d like to help clarify “how” this procedure works and “why” someone might benefit from it.

First, all pain is nerve pain, that’s how we feel anything. Nerves send signals to the brain that something is wrong in an area and the brain interprets the information, and, viola, we feel pain.  So if you have pain, a nerve is being hyper-stimulated somewhere.  There are nerves everywhere in our bodies like a web of sensors.  If we felt all the sensations our nerves were sending our brain we would go crazy.  And in some rare cases people do go crazy when the brain can’t filter out what’s important from what’s not. Under normal conditions the brain prioritizes what nerve signals to pay attention to and which ones to ignore.  If you’ve ever had a chronic nagging pain that you lived with every day but then you slammed your finger in the kitchen cabinet door or (your painful situation here) then you know that all your attention went to that acute trauma and you forgot about your chronic situation for a while.  This is the brain’s pain prioritization at work. 

Outside of an acute trauma where you cut yourself or fell off a roof, the pain we are discussing here is chronic pain, and most chronic pain is joint pain.  Knee pain, shoulder pain, and back pain are all joint pain.  Since we don’t think of the back as “joint” we might not initially perceive it as such but all those vertebrae interfacing with each other constitute a joint and you can have pain at any of them.  That’s why some people have neck pain and others have low back pain, the nerves associated with the vertebrae at that level are in some way being hyper-stimulated.  The way nerves at joints get hyper-stimulated is typically due to joint misalignment.  Your bones are supposed to fit into the joint in a specific way.  If they aren’t aligned correctly then the sensory nerves inside the joint are going to tell your brain about it.  It is the brain’s job to tell muscles and connective tissue to correct their tension so that the joint goes back to proper anatomical position.  But if that doesn’t work, then the signal gets louder.  That’s why if we ignore small pains they typically don’t go away on their own but get louder.  So the muscles play a roll in proper joint alignment and therefor in chronic joint pain.  This is why massage therapy sometimes can help with chronic pain. 

But muscles are not really designed nor intended to be the primary control over joint alignment.  That role goes to ligaments, a specific type of connective tissue.  The word ligament comes from the Latin word that means “to bind” and that’s what ligaments do, they bind bone to bone.  The primary job of ligaments is to maintain the integrity of a joint and that’s how our entire skeletal system is held together for our entire life. But when the ligaments get weak, a condition medically referred to as “ligament laxity” (think: old rubber band) the joint can’t be held in its proper alignment. Consequently, a nerve signal is sent to the brain making it aware of the condition. This is early stage joint pain that often gets filtered out because we are busy focusing on other things in our day to day life.  But if the joint continues to move around more than intended, the cartilage that lines both faces of the intersecting bones gets damaged, resulting in inflammation which in turn promotes more “help!” signals sent to the brain.  If nothing is done about this alignment situation (NSAIDs aren’t a fix, just a mask), over time it will continue to get worse until you get the dreaded “bone on bone” diagnosis. 

Ligaments can get weak either through acute trauma (e.g. falling off a roof, etc) or through chronic degeneration.  The latter we generally refer to as “aging”.  But a lot of so called normal aging is only “normal” because that’s what we observe all around us and is therefor perceived as the “norm”.  There are things, however, you can do to help prevent or repair ligament weakness.  Exercise is one but it is often more of a preventative medicine because once you are in pain exercise can just cause more.  We’ve already mentioned muscular therapy in the form of massage, and there is also nutritional therapy.  This is the basis of all the ads for supplements to help relieve pain, many of which provide building blocks for joint repair.  Condroitin is a popular one though I find MSM works better for most people and is good for more than just joint pain.  It used to be that humans ate “nose to tail” and in doing so got a lot of collagen in their diet.  Today we tend to get a lot of boneless/skinless nutrition and don’t get the collagen our ancestors got. So is it any mystery why we are a nation where chronic pain management comprises a huge part of our medical system?  I have seen a lot of my patients start taking collagen and eliminate a lot of their pain (as well as have better skin, hair and nails ; ) 

Regarding Chiropractic, to be clear, I am not opposed to chiropractic. After all, skeletal joint manipulation has a thousand year history in Chinese Medicine; it has a place and may be the only thing a pain sufferer needs to do.  However, manual joint realignment can not fix ligament laxity and may even make it worse if the cause of the ligament deterioration is not corrected.  And sometimes even all of the above is not enough to completely relieve joint pain.

Enter Prolotherapy! 

Although this word is now used to cover multiple treatment modalies, all of them are injection based and all have the goal of proliferating the growth of ligaments or tendons (the ends of muscles that bind muscle to bones). So prolo-therapy is a term that can be applied to any approach who’s end goal is to proliferate the growth and repair of tissue.  The injections are given at the site of injury directly into the tendon or ligament attachment.  It promotes tissue growth by creating a slight injury, which acts as an irritant, which sends a lot of nerve signals to your brain telling it to wake up and direct your immune system to massively go to this spot and fix the problem.  This process stimulates the creation of new collagen and elastin fibers in the joint capsule, which then acts like shrink-wrap to pull the joint back into proper alignment, leaving you with a stronger more resilient joint.  This process works well for many people, even “bone on bone” cases where most X-rays show only partial cartilage deterioration. 

In addition to providing this service I have also personally received it for numerous prior injuries and obtained great results.  So for all the rest of you “Boomers” who are getting along in age and want to stay active, I encourage you to explore how this treatment modality might help. I have seen many patients avoid what had been diagnosed as “unavoidable joint surgery”.  Contact us if you’d like to learn more about this effective option for your pain.

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Legend has it that the Chinese sage Shen Nong, who’s name means “Divine Farmer”, discovered tea a few thousand years ago when leaves from a near by shrub blew into his hot water. Enticed by the aroma of the leaves steeping in his water, the Emperor took a taste and voila, tea was born.

This interesting legend may or may not be the whole story but nevertheless the Chinese have been producing and drinking tea for thousands of years. However, contrary to all the attention green tea gets on the internet, Chinese people don’t just drink green tea all day.  In fact, green tea is typically consumed only in the Spring and Summer and during the heat of the day than any other time.  You have to understand that in China tea is considered part of the system of Chinese Herbal Medicine and is thus is a medicinal beverage and different types of teas are prescribed for specific conditions. For instance, according to traditional Chinese medicine green tea is considered a “cooling” beverage (even though it is consumed hot) and thus prescribed for “hot” conditions…….

Confusing?

The concept of foods, herbs, and beverages having a thermal nature is unique to Chinese medicine.  The temperature nature of a substance doesn’t have so much to do with its physical temperature but refers to how it affects the body when consumed.  It could be said that the “temperature” relates more to how the substance regulates the metabolism of a specific organ system.  The ancient Chinese perceived that in order for all of the systems of the body to work in harmony with each other we need an internal balance between warming and cooling.  Traditional Chinese medicine teaches that too much “heat” can lead to symptoms of fever, constipation, dry skin, and acne. The good news is that the cooling effect of green tea can help to negate the heat and restore balance to the system. 

So it might seem like green tea has wonderful curative properties and should be consumed all the time! But, like Goldi Locks, your body is happiest when things are not too hot and not too cold. One of the primary axioms of Chinese medicine is that balance is essential to health. In the case of green tea, its cooling nature reflects its ability to diminish what we might today call “inflammation”. But though getting rid of inflammation is all the rage these days the processes we collectively call “Inflammation” are essential to proper function, regulation and healing of the body. So we don’t want to get rid of it completely, we just want it regulated in the proper amount.   And that’s where the choice of what type of tea to drink comes in…..

You may be surprised to learn that all tea, green, oolong and black come from the same plant, Camelia Sinensis (which is still used as an ornamental shrub all over the Southeast).  Teas get their character from a process that  exposes the leaf to oxygen, which oxidizes chemicals in the leaf, causing it to turn brown, much like a cut apple left on the counter.  In short, the more oxidation, the more warming effect the tea has on human metabolism.  Green tea, on the other hand, has very little oxidation and thus has a greater cooling effect on the body than darker teas. This is an important concept to consider when selecting a tea to drink because too much “cooling” can decrease the metabolism of the body, which is not necessarily a good thing.  For example, if you are overweight, your metabolism is lower than needed to offset the calories you consume.  This is why highly fermented teas, such as Pu Erh tea, are used for weight loss in China; they strongly increase metabolism.

In general, more people in China drink Oolong tea than green tea.  Oolong is a “mid fermentation” tea which is balanced between cooling and warming. This is often an optimum choice for most people since it has metabolism stimulating properties while helping control inflammatory issues.  The partial fermentation also imparts a less grassy, more aromatic taste while not having the stimulation many people feel when drinking black tea.  However, even black tea, while stimulating, also contains phyto-chemicals (L Theanine) which help balance the stronger stimulation with some calming effects on the nervous system.  Thus these darker teas can be used by people who need more metabolic stimulation but for whom regular coffee can overstimulate the adrenals.

Obviously there is more to tea than meets the eye so the current “fad” of only drinking green tea may not be right for you. As you can see the choice to consume green tea versus black or oolong tea should be based on considerations of your existing state of internal balance/imbalance and what your particular body needs.  So how do you know which tea you should drink?  The best guidance comes from someone who can read your body and know what it needs and can make the proper “prescription”.  A doctor of Oriental medicine is trained in such things and the best source to advise and guide you in exploring tea. Call today and make a consultation appointment to start your body on the road to balance.

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It’s almost June! Spring has sprung and Summer is on the way! Meanwhile, how’s that New Year’s resolution going? (Or maybe you just don’t bother anymore? )

The difficulty in changing habits and especially health habits (so common to New Year’s resolutions) is much more than simply lacking the will or “true” desire to change your behavior. Research in the field of Psychology consistently demonstrates that changing a habit is difficult to initiate and much more difficult to maintain long-term. Behaviors that have become automatic or those that require many small changes are much more difficult to change. However, that doesn’t mean they are impossible to change and you are certainly worthy of having a healthier lifestyle.

So how do you avoid the “New Year’s resolution train wreck”, which results from exiting promises of change that inevitably revert back to old habits,  followed by disappointment and self loathing a couple of months later?  (or perhaps you’ve already forgotten about it…)

The first step in success is setting a realistic and attainable behavior change. The S.M.A.R.T. approach to setting a goal is one approach that helps to instill accountability from resolution to behavior change maintenance. The acronym S.M.A.R.T. stands for

“S”pecific

“M”easurable

“A”ttainable

“R”ealistic

“T”ime Bound

  1. Specific – In order to successfully change a behavior, you should first identify what behavior you want to change. Think baby steps, if you want to reduce stress you will likely need to start with one small change. The who, what, when, and where are important to think about. Broadly, you want to reduce stress, maybe you even call it relaxing. Try this as an example: “I will engage in deep breathing for 2 minutes before I go to sleep for 5 days out of the week because this will help me to relax.”
  2. Measurable – Make your goal something that is easy to measure. For example, the above goal can be easily measured each week because our goal is specific. Notice we are not aiming for perfection!
  3. Attainable – Avoid making goals that are out of reach. Expect to put effort into changing but you want to avoid feeling overwhelmed. Think about your week and the small changes that you may have to make to provide room in your life for a new or changed behavior.
  4. Realistic – Be realistic when setting your goals. In fact, be overly realistic…. If your goal is to learn relaxation and you are a stress ball do not expect to be meditating and deep breathing like a champ by the end of a week. Take one step at a time and recognize that you as an individual have limitations but are certainly capable of making realistic steps towards your goal!
  5. Timebound – Your behavior change should be achievable within a specific time period. Maybe you can fully implement the change immediately but most are accomplished in steps. Think about this time period when the behavior change feels automatic or when you feel that you will be able to truly “measure” your progress.

This brings us to an important point. How long does it actually take to make a new habit and for your behavior change to feel automatic?

Patience

Dr. Lally, a well-known psychologist in the field of behavior change, has spent much of her research career working on this question. Her research indicates (what you might already know) that building a new behavior into your life or getting rid of an unwanted behavior takes a lot of effort and time. Dr. Lally has found that on average it takes 66 days or a little more than 2 months for a behavior to become automatic. Importantly, her research demonstrated that missing an opportunity to engage in the new behavior did not adversely affect habit formation. In other words, you can mess up from time to time and still be successful. The key is to not be discouraged by your occasional slip. The path to successful resolutions and a new habit is not black and white!

Allowing this seemingly intimidating timeline to encourage you, not discourage you, is a good first goal. There is no need to get down on yourself for not immediately becoming perfect in your goal of healthier eating. All worthwhile achievements require consistent effort over time. It doesn’t matter if the change takes 1 or 200 days. Wake up each day with a renewed focus on your goal and set small manageable micro goals that you can achieve that day. Doing it all yourself can be a lonely pursuit.  Find someone to be a booster and encourage you in your goals.  Some people find a professional “coach” to be helpful since they are often more consistent than a “well meaning” friend. Watch your thoughts, particularly all those times you tell yourself some version of “I can’t”. Remember, a journey of a thousand miles begins with the first step. So before the busy-ness of Summer overtakes you (and while you have some down time) revisit your goals to become a better you and attain some things that have been “out of reach”.  Make today your fist day and make it a S.M.A.R.T one.

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The Coronavirus pandemic might have heightened your awareness that most of the respiratory virus outbreaks in the last few years have originated in China.  Swine flu, bird flu, SARS, and now Covid19. Interestingly, there are many  herbal formulas in the Chinese medical pharmacopoeia that focus on treating virus induced illnesses.  Some people may be skeptical that Chinese people long ago knew about treating viruses because viruses were only discovered in recent times.  Though it is true we have only had the means to microscopically identify viruses in recent years, their effects on the body, chills, fever, congestion, aches and pains, and malaise, have been around throughout the ages. Adding to the skepticism, Chinese medicine refers to these conditions as an external invasion of “Wind”.  The idea that the “Wind” makes you sick has been ridiculed by modern science as an old superstition.  But, turns out, viruses are largely conveyed and transmitted by the wind, which includes coughing and sneezing. A sneeze propels microbes away from the body at a rate of 65 mph! In in places where contagious viruses abound, like China, Fall fashion includes a face covering for this very reason…to stop the wind!

So we can safely assume ancient Chinese people weren’t actually taking herbal medicine formulas “the Wind” but for viral epidemics.  Further, as the Chinese medical pharmacopoeia lists many different herbal remedies for different symptom patterns and stages of the disease, it’s also fair to presume that establishing this level of sophistication took a long time to figure out.  This means Chinese doctors have been prescribing “plant based medicine” for viruses for millennia. And like all other medicine, that which works sticks and that which doesn’t , falls away.  And even though China’s discovery of how to use plant medicine for respiratory viruses was discovered long ago, that doesn’t diminish their effectiveness against the viruses we are observing today. Who knows, the “novel” viruses like Coronavirus may actually have been around for a long time and have just come out of dormancy and resurfaced, making them appear “new”.  Regardless, mother nature is still a powerful ally in the war on viruses and given that this new Coronavirus may be around for at least a few annual cycles, this treatment approach is well worth your attention. 

Many people are focused on the promise of a vaccine to deal with Covid19 but that might be even a year or two away; some say even longer for a safe vaccine.  It is worth noting that there is still no vaccine for SARS, which Covid 19 shares 80% of its structure and genetics.  Given the effectiveness of the annual flu vaccine….do you really want to solely rely on the sketchy possibility of a “got it right on the first try” vaccine? There is something to say about “tried and true” and that’s where ages old “plant based medicine” comes in.

But, there’s even better news! You don’t have to wait until you are sick and symptomatic to take advantage of this reliable traditional technology.  Many other formulas were created to help build immunity in people who were prone to colds and sniffles and chronic congestion episodes.  Thought these symptoms might seem “minor” and even “normal” (since everyone else has them too) they are really a sub-clinical sign of impaired immune function. We see lots of standard blood labs that indicate compromised immune function, particularly people with all the conditions seen as “risk factors” for Covid19

So if you’re ready to become proactive in treating and preventing respiratory issues, contact us to set up a consultation to discuss a treatment plan customized for your needs. 

(864)761-4141