Another Meniscectomy/Arthritis Patient

Discussion in 'Health & Fitness' started by PigPen, Apr 28, 2013.

  1. Chas Tennis

    Chas Tennis Hall of Fame

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    Last edited: May 10, 2013
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  2. PigPen

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    Thanks again Charlie. Great info!
     
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  3. PigPen

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    Posture,

    How successful has the Egoscue method been with knee osteoarthritis in your experience especially when it comes to pain when playing sports? How often should the exercises be performed?

    Thanks again
     
    #53
  4. RogueFLIP

    RogueFLIP Semi-Pro

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    All those exercises can be very helpful, but I'd still suggest you work on increasing your flexibility and decreasing that tightness and soft tissue restrictions.

    The connective tissue in your body goes all the way down to the cellular level. Any kind of restriction may impede proper nutrient flow in and also, proper waste removal of the cells out.

    So you may be eating right, supplement this and that, but it's like pouring water over a stone, mate.

    So in your case, 20 years of gluco/condro and you still have developed OA. Is the supplement not working or has it not been able to penetrate where it needs to go because you have developed all these soft tissue restrictions? Esp to the point where exercise will not be able to break them up?

    Just a different perspective on things....
     
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  5. Posture Guy

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    I just don't get why these forums sometimes email me new post alerts and sometimes they don't. Weird.

    First, to RogueFLIP's last point, he is absolutely right. If the connective tissue has lost pliability, it's ability to participate in the distribution and flow of water and nutrients, and the expulsion of wastes, is limited. And there is zero question in my mind that can have a profoundly negative effect on body function. Getting connective tissue work can be hugely beneficial, and the Barnes approach is one of the best, in my opinion.

    I would suggest that when RF asks if the supplement wasn't working or if it simply couldn't penetrate, that there's another option. Both of what he suggests are possibilities. From our perspective, another option is the supplement is working but if your body is trying to lay down new protective material but the joint is mispositioned, it's 2 steps forward and 3 steps back. You'll "wipe away" any new material as fast as you can create it. The supplement could be working beautifully, but the position of the joint is immediately erasing any benefits.

    For such a supplement to have a benefit, I think you need to have all 3 things in place: a supplement constructed such that it CAN make a positive difference, a body that can absorb, distribute and utilize those nutrients, and a joint position that doesn't make it all for naught.

    To answer PP's question, how good "good" can be depends in large part on how much bony deterioration has occurred within the joint. In most cases, clients do very well if they follow the protocol and perform their corrective exercises daily, get periodic re-evaluations and updates, and take care of their metabolic health (which includes things like what RF is speaking of, having sound nutrition, etc...). If the bony surfaces are now riddled with bone spurs, if the femoral condyles have become misshapen because of prolonged abnormal wear, then that will create an upper limit as to how good things can be. But I've yet to see a case other than the most severe cases (which you aren't) where things couldn't significantly improve.

    But it does take consistent effort, diligence and patience.
     
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  6. Posture Guy

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    You'll notice that my last paragraph there doesn't even mention the state of the cartilage. Obviously, the more you have, the better. But what I've found is that even when a client has a significant loss of cartilage, if the knee is soundly positioned, pain dramatically decreases and function increases.

    I'm an example. When I was about 20 I was working at the Grand Canyon one summer, at the El Tovar Lodge. We'd get off work around midnight and have the rim to ourselves all night. One night a friend of mine and a couple of girls decided to go party out on one of those floating rock spires you see in pictures. Stupid, but hey, alcohol and pretty girls were involved, what can I say. We had to climb down a 15' tree to get to this natural terrace just below the main level of the rim in order to get to the rock formation we wanted to sit on. Climbing down the tree I fell and landed squarely on my right knee, right on a rock. Came about 5' away from rolling off a 500 foot cliff, and fractured my knee cap. Apparently, I also dislodged a good sized piece of cartilage in the joint. Before Egoscue I had constant issues with that knee, and at one point was told that I would absolutely need a knee replacement, but to just go as long as I could stand it to allow the technology to get better. Now, as long as I keep my knee in a good position (along with the rest of my body), the knee gives me virtually no issue. I played almost 3 hours of singles the other night, zero pain. And I'll be 52 in a couple of weeks.

    Restore positional/postural integrity, get the connective tissue restored to be able to do the job it's designed to do, take care of yourself metabolically, and good things can happen.
     
    #56
  7. PigPen

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    RF,

    I agree that I need to increase my flexibility and appreciate your perspective. I am taking Yoga classes 3x per week. I noticed that I have tight hips (piriformis stretches are very aggravating), fairly tight hamstrings (probably the least of my problems) and a very tight area a few inches above my kneecap (rectus femoris?). This area above my kneecap impedes me from reaching my foot in a quad stretch or sitting on my heels in Yoga. In your experience, what are the best exercises for getting flexibility in these area?

    Thanks again.
     
    #57
  8. PigPen

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    I received the "Pain Free" book on yesterday and did the knee stretches from the book last night. After reading the knee section, I noticed that my knee does point out externally. I also typically stand with my foot pointed externally as well. This probably explains my my surgeries were on the medial meniscus, but have most pain on the outside of the knee. Perhaps my misalignment puts too much stress on that area during overcompensation. What do you think?

    Interesting to note that Egoscue is against wearing braces. My doctor at HSS said the same thing during my last visit.
     
    #58
  9. J011yroger

    J011yroger G.O.A.T.

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    ^^ Are you friendly with Carl at Glen Head?

    The trainer there is supposedly a miracle worker. After Carl tore his ankle and tried everything the guy said "When you are ready to scrap the brace, and let me work on you, we will talk." Within 4-6 weeks he was almost 100% better after 6 months of nothing else helping.

    Remind me next time we play, or shoot me an e-mail.

    J
     
    #59
  10. Chas Tennis

    Chas Tennis Hall of Fame

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    Some of your issues sound like mine.

    I'm not young and play doubles 4 or 5 times a week, my main exercise. The rest of the time I'm not active enough. I stretch problem areas when required but should do more preventive stretching.

    I've had the tendency to have tight rectus femorus muscles and the special corrective quad stretches help a lot. My knees feel better under the knee cap area and above. I've posted many times the link.

    There is a book Stretching Scientifically, Kurz. Very good book with some insights. He says that if you can't squat because of balance issues - that's me - it could mean that your Soleus is tight/short. My ankles seem to go so far and I would like to bend the shins farther but there is a tightness. That makes sense as the Soleus limits the range of motion of the ankle joint. [The Gastroc is slackened when the knee is bent but not the Soleus.]

    I don't like the Piriformis 'Figure 4' reclined stretch, but it works if I do it. You can also do it from a seated position but the 'Figure 4' is more often recommended (better for back?).

    If uninjured good exercise and stretches are:

    1) Piriformis stretches

    2) Clamshell exercises with resistance bands for the gluteus medius. "Firehydrants" with bands.

    3) Rectus Femorus special stretches. The regular standing quad stretch might also work well if you can hold your pelvis in the recommended position. (The regular quad stretch usually gives me instant cramps behind my knee. I do other stretches.)
     
    Last edited: May 13, 2013
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  11. Posture Guy

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    PP....yes, the position of your knees is beating the crap out of them, and then your body is having to compensate to move, which creates another host of issues.

    And yes, braces are not constructive. They will weaken the joint in question, which is not positive, and cause other compensations.
     
    #61
  12. RogueFLIP

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    I like yoga for more "global" stretching, whole body stuff. Then nothing wrong with targeting specific muscles if you feel that's what you need. But if you need to break up even more specific muscle knots/spasms/restrictions, that's where I recommended earlier you use a foam roller, or a tennis ball.

    Biggest rule of thumb is not to force anything. As long as you don't try to force anything, you won't injure yourself.

    Also, make sure when you're going on AND off a roller or ball, you do it SLOWLY. Don't just pop on or off.

    Just slowly roll a tennis ball on your leg while you're on the floor up, down, side to side. Any spots that are tender, painful or just plain hard, that's where you'd hold and soften into the area. Breathe into it. Hold there for 5 minutes to get a good release. Might be a little tender at first, but if you can soften into it, the initial tenderness/pain should start to subside.

    Little common sense: if an area is very painful or the pain increases even if you're trying to soften into it, come off of it slowly. You don't always have to go where X marks the spot, you can go to the periphery of it.

    Don't be afraid to play around with different angles and positions, you don't have to use said items straight down, you can angle your leg and body differently if you feel like it. You might find that those different angle is what you need.

    If you are as tight as you say, you might not be able to tolerate holding areas for 5 minutes, that's ok. You can work your way up to that.

    I tend to use the foam roller for more "global" releases, then I have a variety of shapes and density of small balls for more specific spots and small nooks and crannies.
     
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  13. PigPen

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    Thanks Chas. I periodically get cramps in the hamstring when doing quad stretches.
     
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  14. PigPen

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    Been doing the 4 "Pain Free" knee exercises for the last two nights. Will continue for the foreseeable future and report on any progress. I'm also trying to stand with my foot pointing straight ahead. Will see how this works as well.
     
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  15. PigPen

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    Thanks for the tips RF. I have tries the roller and will go back to it. Will try the tennis ball as well on that tight area above the knee.
     
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  16. Chas Tennis

    Chas Tennis Hall of Fame

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    Rectus Femorus Stretch for Knee Pain

    Here's the rectus femorus stretch in case you have not seen it.

    From an earlier thread - http://tt.tennis-warehouse.com/showthread.php?t=462700&highlight=rectus+femorus+chas+tennis
    ---------------------------------------------------------------------------------------
    Is you pain under the knee cap? I have the very common cartilage issues there that, in my case, I believe are related to a tight rectus femorus - the only quad that originates above the hip joint. It can also be a more complicated issue where imbalances between the quads cause the patella to mis align in its cartilage track.

    Patellar-femoral joint pain
    http://www.aafp.org/afp/2007/0115/p194.html

    Quote:
    Originally Posted by Chas Tennis View Post
    The knee has two joints - the one between the femur and tibia with the meniscus, etc., and the one under the knee cap, the patellar-femoral joint.

    In my opinion, pain under the knee cap is often caused by posture issues, quad strength & tightness, as discussed in the above replies.

    When I had an MRI for a torn meniscus, the MRI report included serious damage to the patellar-femoral joint. (Get the written MRI report from the imaging specialist, read it and research all issues even those not being treated or showing symptoms.)

    One particular issue, that of a short/tight rectus femorus, is described in this link

    http://www.mrtherapy.com/articles/article3.html

    BE AWARE THAT STRETCHING THE RECTUS FEMORUS MIGHT PUT STRESS ON THE LOWER BACK.

    The rectus femorus is special because it is the only quad that attaches above the hip joint, the other three quads attach to the femur.

    I believe that this is a good description, believe that I have a short rectus femorus, and that the stretch is very effective in correcting it. It may be my over-simplified picture, but I believe that a tight rectus femorus simply causes the patella to ride too high in the joint. This damages the cartilage separating the patella from the femur. Some of the other better known patella tracking problems involve lateral tracking issues, the patella being pulled to the side or 'tilted' relative to the joint track.

    Search: rectus femorus quadriceps anterior pelvic tilt
    Last edited by Chas Tennis : 05-05-2013 at 11:00 PM.
     
    Last edited: May 14, 2013
    #66
  17. Posture Guy

    Posture Guy Professional

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    RF....great post on how to do self-myofascial work. In fact, just printed it out and handed it to a client. I'm saving it for just that purpose. Saves me from having to explain it.

    Question: do you ever have folks use lacrosse balls instead of tennis balls? For things like specific spots in the IT band, I think tennis balls are great. But for shoulder girdle stuff, I find sometimes we just need the density of a lacrosse ball.
     
    Last edited: May 13, 2013
    #67
  18. RogueFLIP

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    LOL, that's pretty much my speech when giving out home exercises to patients; more or less.

    The hardest ball that we give out is tennis balls, but that's not to say patients can't use something harder if they feel like it's necessary. Golf balls, hockey balls, lacrosse balls, as long as the patient doesn't force anything, they can use whatever they want.

    But usually, I tell people to do lower intensity with a longer duration versus a high intensity with short duration.
     
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  19. Posture Guy

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    good advice, thanks.
     
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  20. PigPen

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    Very helpful Chas. Much appreciated.
     
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  21. RogueFLIP

    RogueFLIP Semi-Pro

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    The "workhorse" ball is our most universal tool for self MFR. 4 inch ball like such:

    http://www.amazon.com/dp/B0042SSUN0...e=asn&creative=395093&creativeASIN=B0042SSUN0

    But a tool I use very often, but don't offer too many patients is the Nola Rola:

    http://www.nolarola.com/index.php

    I use the end grooves to get the outer edges of my distal quadraceps near my patella, and in a controlled lunge position I've been able to use the kneading edges to get into the patella tendon. Very painful on me! But a "good" kind of hurt.

    But the nola rola can be used almost anywhere as seen on their website.

    When I first used it on my back (paraspinals), I couldn't tolerate 30 seconds of trying to soften into it, I was very tight and it was too painful in a bad way. But after months of daily use and other things, I can easily sink into my paraspinals without too much pain, haha. Also give you a good idea of how stuck you are rotation wise. When you use it on your paraspinals while lying on your back with your feet on the floor, you can rotate your legs right and left; you'll notice some levels you can go further in one direction than the other. And well at least for me, there were some dramatic ROM differences even just one level up!

    But there are many similar tools available and many can accomplish the same goal.

    Oh, and for sure your check in luggage will be opened if you bring this bad boy with you on vacation because under the Xray it looks like an artillery round. :)
     
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  22. RogueFLIP

    RogueFLIP Semi-Pro

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    #72
  23. drak

    drak Professional

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    Yep. so far very good results for me after 2 1/2 months, wife who just found out (arthroscopy last Thursday) has articular cartilahe holes on lateral femur and tibia will be getting stemcell/PRP on Monday. She will be more of an "acid test" then me. Cost has dropped to $1150

    Drak
     
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  24. Posture Guy

    Posture Guy Professional

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    I've tried using tennis balls to do MFR on my post-surgical right shoulder (had a hemi cap procedure done in December after an accident). The tennis ball just never feels like it gets into the affected tissue, feels like it skates over it, even when I linger.

    just takes a much firmer ball to dig into my stuff. Though, a tennis ball is perfect for my IT band.

    I like "The Grid" as a roller, and also the Rumble Roller. Use both in different ways.
     
    #74
  25. PigPen

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    Thanks Drak. May have to inquire about this.
     
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  26. PigPen

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    I've been doing the knee Egoscue exercises and mfr for the past week and I must say that they have helped. I also have been. Interesting that during Yoga, I feel a cramping in the outside hip a few inches below the waist during some poses.
     
    #76
  27. adventure

    adventure Banned

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    I'm going to have do some research on that. Mainstream doctors and pharmaceuticals are making money hand over fist with treatments that don't work, so they probably want to maintain the status quo. Meaning, I doubt any favorable publicity will come to light regarding stem cell treatments unless the existing status quo can control and profit from it.
     
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  28. Posture Guy

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    I'm really glad Regenexx was brought up. I have zero direct interaction with them, but they opened a clinic very close to our one in Orange County and their facility has been referring to our folks there, and vice versa, and our clinic director in Orange County said he is seeing AMAZING results in joint replacement candidates. For example, he had a client with a severely degenerative hip, guy had a lot of pain just walking short distances on level ground. Had started with Egoscue and was doing well, but then added in Regenexx and within a few months, he was hiking with virtually no pain. And they've seen that result repeated.

    Obviously those are not clinical results, just anecdotal, but the early results have been very impressive. It ain't cheap, though.
     
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  29. PigPen

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    As an update, I played today on clay and haven't felt this good in a few years. No pain while running all out for an hour and no swelling afterward. I am truly convinced Egoscue and MFR are what has helped.

    Thanks Posture and RF for your help!
     
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  30. PigPen

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    Don't know Carl (or the trainer) but I would certainly like to speak with them. Thanks!
     
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  31. Posture Guy

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    PigPen....i'm very happy to hear how well you did today. Great job! Your thanks are appreciated, but if you really want to thank the right person, look in the mirror. You are the one who took action. Well done!
     
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  32. drak

    drak Professional

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    I read a lot of the Regennexx info and as they were an early pioneer it's one of the reasons I gave stem cell a try with the only person in my area who does it and it was a lot less expensive. It was not the exact same treatment as there is a debate as to whether adipose or bone marrow sten cells are better. That will work itself out in the years ahead.

    Drak
     
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  33. adventure

    adventure Banned

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    That is FANTASTIC news! Keep us posted, mate. :)

     
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  34. Posture Guy

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    Hey RogueFlip, would you please email me when you have a moment? I have a question on behalf of a client of mine.

    rickATegoscueDOTcom.

    Thanks!
     
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  35. Posture Guy

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    I was asking RogueFlip if he could recommend any good self-myofascial release resources. I have some clients where we recommend work on a specific area, and though MFR is outside my core competency, I know just enough to be of assistance in recommending targeted work on limited areas. But I've got a few clients who really need to work on their bodies in a comprehensive fashion and that's just not what I do.

    He was kind enough to email me and recommend a book by one of his colleagues, and it looks so good that thought I'd pass the link along here:

    http://www.mfrselftreat.com/book-information-buy-now/

    I'll provide more detailed comment on it after I get it (just ordered a copy), but there is no active tennis player who would not benefit from this kind of work. This looks like a terrific resource.
     
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  36. PigPen

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    Thanks Posture. I will be getting this book as well.
     
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  37. Raul_SJ

    Raul_SJ Professional

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    Thanks for the update.

    It sounds like the PRP/MSC (Mesenchymal stem cells) injections are becoming a bit more affordable.

    $1150 per injection... and how many injections are planned?

    Is the goal of the PRP/MSC treatment to regenerate the damaged cartilage in the tibia and femur?

    Is it basically the same treatment described in the following "Regenexx" site?

    http://www.regenexx.com/whats-the-difference-between-prp-and-stem-cell-therapy/

    MSC therapy would be more appropriate for degenerative diseases where there is lost tissue (like chronic arthritis, a partial tendon or ligament tear, a low back disc where there are torn fibers allowing the disc to bulge).

    In addition, the lab prep for MSC therapy is much more complex than PRP. While PRP can be made in a simple bedside centrifuge,

    MSC’s are isolated and grown in a sophisticated cell culture lab by cell biologists usually over a over two week period.

    The upshot, PRP is great to kick start a healing process that may be stuck, MSC’s and other stem cell approaches will likely rule the day in regenerative medicine.
     
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  38. Posture Guy

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    Drak....yes, I'd like more details on what you did and are doing, as well. How many injections did you have, and what were your physical limitations during that time? I'd imagine you're not supposed to play tennis after getting one, for example.
     
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  39. drak

    drak Professional

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    For my wife especially the stem cell/PRP injection will be to try to heal/regenerate as much of the articular cartilage as possible - she has lateral tibia and femur articular cartilage damage. I think of the stem cells as the seeds and PRP as the fertilizer. I had one shot and so will she, stem cells work up to one year.

    The FDA shut down the Regennexx procedure where they took the stem cells and cultured them for a few days or weeks - they now do that procedure in the Cayman's only I believe. There are differing techniques to "harvest" the stem cells, my Doc uses a simple gravity based one after doing the adipose fat (mini liposuctin) withdrawal. You basically have to harvest them and very soon (within a few hours I think) use them. Regenexx has had good success form what I have read, they are also very expensive compared to the one here - are they worth it? I cannot answer that.

    There is also controversy over whether adipose or bone marrow works better - this will all get figured out in the years ahead, we are now at the infancy in this area. There are many studies/trials now underway.

    My procedure was done as a ligament/tendon tightening as well as some likely cartilage damage and I also have stage II osteoarthritis, so I did it as a preventative procedure as well.
     
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  40. drak

    drak Professional

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    One injection (stem cell and PRP). I did not play tennis for 5 weeks, then started slowly. Started stationary biking after 3-4 days and quickly built up to my normal hour workout. Keep in mind I had no recent serious injury and could still do all activities before injection, but had soreness in my knee. The major improvement seemed to kick in at around the 8-9 week post precedure mark. I'm now playing hard 4.5 tennis 4-5 times a week, even added singles past few weeks and feel pretty darn good for 57 yrs young. Getting prepared for Senior 55+ 9.0 sectionals in later June.
     
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  41. Posture Guy

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    Drak....thanks for that great info, much appreciated. And I'm very glad to hear how well you responded to that protocol, that's terrific.

    I'm looking at doing this this winter. I'd like to do what I can to heal the articular surface damage from my fall years back. I can play hard 4.0-4.5 tennis, and the more diligent I am about doing my own stuff, the better the knee does, but it intrinsically feels different than the left and will get a bit stiff and tender post-tennis. Hasn't limited me yet and I don't expect it to in the near term, but I'm thinking long term. I want to be playing singles for a long time. I'm 52 now, nowhere close to being done with singles.
     
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  42. drak

    drak Professional

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    I did it for the idea it could help me now and hopefully significantly extend my playing years via a healthier and longer lasting knee. I will likely get my right knee done this Nov/Dec when I usually have a down period.
     
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  43. PigPen

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    Posture,

    What are the Egoscue exercises fro straightening the knee? After PT, the surgical leg is almost straight when lying down or sitting but eventually it cannot fully straighten.

    Thank again.
     
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  44. Posture Guy

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    The technically correct answer to that question is that it depends on WHY the knee doesn't fully straighten. The short and more helpful answer is that the ecise using the tower, supine groin progressive, is VERY helpful for this.

    As an example, I had meniscus surgery about 15 months ago. The surgeon has an in-house PT shop and for what they do, they're pretty good. I have my pre-surgical appointment with the guy who will do my PT. He tells me my quad will shut down. "Always happens". I tell him "i'll bet you $20 mine doesn't". He doesn't take the bet but he laughs, saying "I don't want to take your money."

    Tells me it will take weeks before the knee goes to full extension. By this point I just nod. So I get the surgery, go home, and that night I'm in the tower. Does it hurt? Hell yeah. But I know there's nothing structurally to damage, it's just inflamed, so I just breathe through it and it's ok. I do it again the next day, better still. I go in for my first PT appointment, about 48 hours after the surgery. He checks range of motion.

    "Damn, your knee is almost fully extending, that's crazy." And at 10 days, I was generating full knee extension.

    Then he tests my quad function.

    "Hmmm, your quad didn't shut down."

    The tower is a very powerful ecise for putting the knee back into a sound position.
     
    #94
  45. adventure

    adventure Banned

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    Just skimmed through, but this sounds like an amazing result.

    And to think, these procedures will only become more refined and effective in the years to come. Likely more affordable as well.

     
    #95
  46. Posture Guy

    Posture Guy Professional

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    Yes, the field of regenerative medicine is very exciting. We're seeing some very positive results already, and this field is VERY early in its maturity cycle.

    Hopefully insurance companies will start to realize that a few injections of stem cells is a LOT cheaper than a knee replacement, and will start to cover some of the costs for these procedures.
     
    #96
  47. drak

    drak Professional

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    My wife who is now 9 days post stem/cell/PRP and about 4-5 weeks post scope surgery will be an acid test as she had significant articular damage. She also had a much higher (almost extreme) pain/soreness reaction to the treatment - in terms of time. My reaction was severe but that only lasted 18-24 hrs and then I had nothing more than some soreness that was gone within a week. Her severe reaction (pain) lasted 4-5 days and she had to take a lot of Oxycontin where I was off all pain meds after 24 hrs.
    Apparently 1 in 10 can have a reaction like this and it's due to huge response by the body's immune/healing system hyper activated by the stem cell/PRP which is actually a good thing (long term). I'm guessing that since she was not that far from her scope and had a lot of damage/healing already going on that this really exacerbated this "healing response" - at least that is the hope. For her it wasn't the intense pain/throbbing by itself, but how long it lasted compared to mine.
    Her recovery from the stem cell is so far much slower then from the scope. I'm guessing (hoping) that in the next 2-4 weeks the hyper healing from the stem cell/PRP will really kick in after the initial reaction and she will feel a ton better.I will keep you posted on her progress.

    Drak
     
    Last edited: Jun 12, 2013
    #97
  48. Posture Guy

    Posture Guy Professional

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    first, Drak, good luck to your wife. I wish her (and you) all the best in this process and I appreciate you sharing your experiences.

    I just had a VERY interesting appointment with one of the top prolo/prp/stem cell guys in Texas. I"m gonna have to write it up, but it gave me a completely new perspective on meniscus injuries, as well as a better understanding of stem cell therapy.

    And he does what Drak's guy does. What Regenexx does for $20k, he does a pretty similar thing for about $1200, and he uses some technologies they don't that make absolute sense to me.

    Will try to write something up this weekend about it.
     
    #98
  49. drak

    drak Professional

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    awesome, great to get some similar techniques from other sources, looking forward to your write up.

    Drak
     
    #99
  50. Posture Guy

    Posture Guy Professional

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    ok, finished with a client a bit early so figured I'd write a few things up while still fresh.

    So I was playing a couple of weeks ago and the next day my knee felt swollen, painful and stiff. Never had that reaction before. Disconcerting. Took a week off, did our tower ecise close to daily, knee got better but still felt stiff, limited ability to flex it. There's a guy in Austin who is known as a leader in the field of regenerative medicine. We've communicated for years, he's a fan of Egoscue and I've heard nothing but good things about him. We had never met until we were both speaking at a health expo a few months ago.

    So, I called and he worked me in. Some quick xrays showed the bones are in a great position, not even a hint of any arthritic change, bone spurs, still have great spacing, all that stuff. So that was encouraging.

    Then he breaks out an ultrasound machine and says he's gonna look at the meniscus as he believes that's where the problem is. He says that he thinks MRIs are virtually worthless for diagnosing meniscus issues and he'll be demonstrating why in a few minutes. My knee is on his table, bent. He takes an ultrasound tour of the knee and the meniscus actually looks pretty good. It's basically intact, there might be a few areas with minor degenerative change, but all in all it looks good. He says that an MRI would conclude my meniscus was fine.

    But, he tells me, the odds are that the meniscus has separated from the tibia and that when the knee moves into extension, that is where the issue will be seen. So under ultrasound, we slowly straighten the knee and you can see the meniscus lose adherence to the tibia and get pushed up and out of position.

    "that's your problem. An MRI wouldn't see it, and surgery can do nothing for it."

    So I ask what we can do and he just smiles. "Prolotherapy will fix this." We talk about it at length, the difference between prolo, prp and stem cell therapies and when one would be indicated over another. For me, he says if it were him he'd just do about 4 prolo injections spread over a 4-6 month time frame and see how the knee responds. His guess is that the knee will be feeling great and by that point a new ultrasound exam will show the meniscus adhering to the tibia.

    We talk about stem cell therapy. Long discussion shorter, he does it and thinks there's absolutely a place for it. His preference is to remove marrow from the hip, process it a bit, then inject it into the afflicted area. He precedes that with prolo to 'prep' the site, follows it with PRP to 'fertilize' the stem cell injection, but said it's unclear how much of the benefit one gets is from the stem cells versus simply the prolo.

    He says that "people have fallen in love with the next new thing, they get entranced by technology" and right now stem cells are "it". And he sees good results with it, too, but he also sees people get VERY good results with straight prolo when done the way he does it. One thing he did that is apparently different than most prolotherapies is after injecting the solution, he injected ozone into the joint. He said that when they added this they saw a marked improvement in outcomes. He said it does a number of things, but it's akin to creating a hyperbaric chamber for the knee, seems to activate more of the body's intrinsic healing response, and helps better diffuse the prolo solution.

    We talked about possibly doing a stem cell injection process this winter when I typically stop playing for a couple of months. I hate the cold. But if the knee is doing really well, chances are we'll just stop with the prolo and track things over time.

    He did say that the position my femurs and tibias are in is really good and that misposition there is one of the key contraindications or limitations to a strong clinical outcome, so I'm grateful for my Egoscue work in helping preserve the integrity of my knee position. Now hopefully we can get the meniscus to begin adhering to and tracking with the tibia, and then things should be pretty good.
     

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