Osteoarthritis - Ask Dr. P

What is Red Light Therapy, and Can it Help Arthritis?

by Pain Doc | Feb 13, 2022 | Arthritis, Red light therapy

Red light therapy (RLT) is a type of treatment provided in clinical and cosmetic settings that incorporates red light to improve the skin’s appearance, such as reducing fine wrinkles, scars, redness and acne. It is also used in the medical setting to help reduce pain and increase healing in the joints, such as tendinitis, sprains/strains, and arthritis.

Red Light Therapy is also known as:

Phototherapy
Photodynamic therapy
Photobiomodulation
Low-level laser light therapy*
Low-power laser therapy*
Cold laser therapy*
Biostimulation
Photonic stimulation

*this is a misnomer, because red light therapy does not use laser energy.

Interest in red light therapy emerged decades ago when NASA conducted experiments on growing plants in space and healing injuries to astronauts. Results of this research pointed to a connection between red light and positive, biological effects on human tissues. This ability of light (photons) to alter biological activity in living cells is called photobiomodulation and is the means by which RLT achieves therapeutic benefit.

What is Light?

Understanding this requires some basic knowledge of how the eye works, and physics.

First of all, vision is possible only in the presence of light. This means light must bounce off objects in your visual field and enter your eye, which then “translates” the bounced light into an image that is perceived by your brain.

But how do we perceive color? White light is actually made up of wave energy that propagates in multiple wavelengths. It is this difference in wavelengths, the molecular properties of all objects, and the design of the human eye’s retina that creates the perception of color. Objects that appear a certain color reflect the wavelength of just that color into your eye and absorb all other wavelengths. For example, a red shirt reflects the red wavelengths and absorbs the blue, orange and yellow wavelengths. Altogether, these component wavelengths of white light is called the visible spectrum of the electromagnetic spectrum, which is shown here:

Electromagnetic energy exists as an electrical field with a magnetic field 90 degrees to its axis and propagates at the speed of light. The electromagnetic spectrum is the range, in wavelengths, of electromagnetic energy existing in nature, from the very tiny wavelength gamma ray (.0001 billionth of a meter) to the very long wavelength of AM radio (100 meters). Light is in between these extremes and is the only EM waves humans can see, between the wavelengths of about 380 to 700 nanometers (nm, billionths of a meter).

When light passes through a crystal prism, it bends. Since light is made up of different wavelengths, the component EM waves of white light behave differently (bend at different angles and speeds) as they enter the prism and can now be visually distinguished from one another as separate colors in a band: red, orange, yellow, green, blue, indigo, violet. Similarly, rainbows form when suspended rain droplets bend the sun’s light and separate it into its component colors.

RED light is the longest wavelength of visible light, while VIOLET is the shortest. As the electromagnetic wavelength increases, the frequency (the number of times the wavelength passes a fixed point, measured in hertz – Hz) decreases, and so does the amount of energy it carries. So, the very small wavelength/high frequency gamma and x-rays carry a lot of energy and are dangerous to tissues. You may have heard that ultraviolet (UV) light can cause skin cancer. This is because much of its energy is absorbed by the skin, where it does damage to cells. Red light, being the longest wavelength of light, doesn’t have the energy level of UV and therefore does not pose danger to tissue; in fact, as we will discuss later, it has beneficial effects to tissues.

How Does Red Light Therapy Work?

Red light therapy is used to:

Improve wound healing
Reduce pain in joints
Treat tendonitis
Reduce headaches
Reduce stretch marks
Reduce wrinkles, fine lines and age spots
Improve psoriasis, rosacea and eczema.
Improve appearance of recent scars
Improve hair growth in people
Improve acne

It’s well established that light can initiate biological change in living organisms. Perhaps the most well-known is photosynthesis, the series of biochemical reactions where sunlight energy catalyzes the formation of sugar (glucose molecules) in plants. Photons from light get absorbed by tiny structures in a plant called chloroplasts, which provide the biological machinery to synthesize glucose (basically, stored energy) from inorganic carbon dioxide and water.

Another example of light effecting change in living tissue is vitamin D formation, where the pre-cursor of vitamin D is created when UVB light strikes 7-dehydrocholesterol molecules in the skin

Sunlight catalyzes Vitamin D synthesis in skin

With red light, the pathway is likely similar. Many research studies have been conducted over the years to uncover the mechanism behind red light photobiomodulation; i.e. the nature of its therapeutic effects. What is definitely known is that the red light wavelength (in the 660-700 nm wavelength range) tends to get absorbed in the nucleus and mitochondria of cells, in locations called chromophores. Mitochondria (image below) are the structures where energy is generated for the cell, much like the previously mentioned chloroplasts in plant cells. The nucleus contains the DNA, which is the template for protein synthesis.

We also know that photons can “excite” electrons – the tiny charges that orbit atomic nuclei. Cells and all their parts including the mitochondria are of course made up atoms. An “excited” electron means a movement of an electron to a higher energy orbit (further from/ less attracted to the nucleus).

In short, red light stimulation increases the energy state of electrons in sick tissues, enabling faster/enhanced reaction between adjacent molecules, as electron interactions between atoms are the basis of all biochemical reactions. This may translate into the cell “speeding up” its activities, particularly respiration (ATP formation from glucose via the Krebs cycle, i.e. energy production) as well as waste elimination and gas exchange. Redox signaling is the term used to describe this activity, and is the leading hypothesis for the mechanism of red light photobiomodulation.

With enhanced cellular signaling:

If the cell is a fibroblast, it could lead to faster wound healing, as fibroblasts migrate to the injury/damaged site to synthesize and lay down collagen fibers.
If the cell is a stem cell (undifferentiated cell), it could enhance the transformation of stem cells to fibroblasts or chondrocytes, which make collagen and cartilage, respectively.
If the cell is an epidermal cell, it could mean faster cell turnover to clear out abnormal cells in skin conditions such as eczema and psoriasis.

Cells are programmed to respond to specific extracellular signal molecules for development, tissue repair, immunity, and homeostasis. Errors in signaling interactions may lead to diseases such as cancer, autoimmunity (such as rheumatoid arthritis), and diabetes. Given this, it is feasible to assume that if red light therapy can enhance cell signaling, it can benefit these cellular functions and support tissue healing and pain reduction.

Red Light Therapy is Shown to Reduce Inflammation

Many studies found that red light reduced inflammation in tissues. Inflammation is the body’s response to injury or some kind of irritant and is characterized by redness, swelling, and pain. It involves a complex series of steps involving multiple protein clotting factors in the blood and tissues.

Inflammation also involves several types of cells involved in the reparative process, including macrophages (“cleaner” cells that remove debris), basophils (a type of white blood cell that secretes histamine and heparin to make blood vessels more leaky and manage clotting), and fibroblasts. It also involves cytokines—chemical signaling molecules that cells use to communicate and coordinate activities within themselves and with each other.

Inflammation often gets out of hand at the injury/ damaged tissue site and contributes to the problem by increasing pain and delaying healing. In fact, diseases like arthritis, irritable bowel syndrome, vascular disease, diabetes, and even Alzheimer’s disease involve chronic (ongoing) inflammation. This is the basis for the utilization of anti-inflammatory medications such as steroids and non-steroidal medications (NSAIDs) like Tylenol and Ibuprofen for inflammation.

The inflammation-reducing ability of red light therapy is likely due to its ability to enhance cell signaling and molecular flow in the cell. One study notes that overall reduction in inflammation is one of the most reproducible effects of photobiomodulation [from red light]. This is particularly important for inflammatory diseases affecting joints; acute trauma, lung disorders, and brain injuries resulting in inflammation.

Another proposed model to explain how light therapy works is photon-mediated ion channels in cell membranes (image below). Basically, ion channels are the passageways in membranes (think tiny gated doors) where ions flow through, which require energy to open. An electrical gradient is formed as the ion concentration differs on either side of the membrane, and this gradient can be used to drive movement of molecules into and out of the cell, very much like voltage. In fact, this is how neurons produce nerve impulses. Red light photons may be able to activate these ion channels, thereby boosting efficiency of ion flow and helping the cell maintain equilibrium.

Ion channels create energy potential in cell membranes

Should You Try Red Light Therapy for Arthritis?

Given its photobiomodulation ability, red light can be a useful, self-administered treatment for skin conditions and tissue injury/pain. It has powerful effects of improving cellular function to diseased/ injured tissues, which can improve recovery and healing. Being lower frequency, it is not harmful to the body, unlike UV light.

However, red light therapy should not be considered a “magic bullet” for “curing” things. Every person is different, and if you have complicating factors in your health and/or your condition is advanced, it may not work as well. While the human body has remarkable regenerative and healing abilities, there are limitations.

For example, in the case of advanced degenerative osteoarthritis of the knee or hip, much of the cartilage has worn away, and there are multiple areas of exposed bone. Normal, healthy cartilage that lines joint surfaces is smooth and resilient to pressure. Unlike the epidermis (skin), it does not regenerate very well, so if you lose quite a bit of it or tear it, it cannot regrow back to normal.

Osteoarthritis of the knee

But, if you are at the very early stages of osteoarthritis, red light therapy can be very helpful in arresting its progression. Arthritis usually appears mid-age, but if you engaged in heavy contact or heavy impact sports such as football and gymnastics, it may start earlier. What happens is tiny disruptions in the cartilage start to gradually separate, much like how a tiny crack in your windshield “grows” in length as your car absorbs shock from the road each time you drive. These tiny separations then form pits in the cartilage, which widen. Bone is exposed, inflammation sets in, and you’re on your way to an eventual knee or hip replacement some years later. But if you apply red light therapy to the tiny disruptions as they form, there is a much better chance of arresting their progression by stimulating cartilage growth. The red light will energize chondrocytes, the dormant cells embedded in the cartilage matrix tasked with maintaining it, and can stimulate the proliferation of chondroblasts, the cells that secrete collagen matrix.

You can still apply red light to an advanced osteoarthritic knee for palliative purposes, since red light can suppress inflammation and therefore provide some degree of pain relief. If doing so allows you to stay on your feet a couple more hours in a day, then that is definitely a positive benefit to your quality of life.

A good solution for applying red light therapy to the knee is the 120 LED wrap. It is a flexible pad containing 120 light emitting diodes (LEDs) with each diode containing one (1) 660 nm red light emitter and two (2) 850 nm infrared emitters. You wrap it around your knee and hold it in place with an elastic band that comes with it, and press a button.

Alternatively, if you are patient, you can use a red light torch device. This requires you to hold it in place for a couple of minutes. The good thing about the torch is that you can target small areas. For example, if you know you have a cartilage tear on the inside of your knee joint, you can press the torch over it and concentrate the light on that one spot. The torch is also good for small joints; i.e. knuckles.

As always, when you self-treat conditions use a multi-pronged approach: improve your diet, get enough rest, drink enough water every day (sometimes not easy to remember!), avoid ingesting toxins as best you can (nix smoking, alcohol, processed food, excessive pollution); get fresh, clean air by walking where there are lots of trees; exercise/ move often to strengthen your muscles and heart, and avoid negative thinking, which elevates stress hormones. Do all these things consistently and you can rest assured that you are giving your body its best chances for recovering from disease and pain.

How to Manage Hip Stiffness and Pain

by Pain Doc | Jun 14, 2021 | Hip Pain, Pulsed EMF

The hip joints are a key component to stabilization and ambulation of the human frame, so if you are experiencing problems with one or both of your hips, it is going to cause some loss of basic movements required by common activities of daily living, which translates to a reduction in quality of life. It is therefore imperative that you be mindful of your hip health at all times: take care not to place excessive shock trauma and repetitive stress to your hips; engage in exercises and stretches that condition your hip stabilizers.

Hip bone, or os coxae

The hip joint, or acetabulofemoral joint is a ball and socket type joint that supports the weight of the body in a static (standing) position and ambulatory position (running, walking). Its two articulating parts are the femoral head of the femur (upper leg bone) and the acetabulum of the pelvis (coxae), a bowl-like depression lined with cartilage.

Your hips bear quite a bit of repetitious force every day, and if you run and/or play sports that involve jumping and landing such as basketball or gymnastics, then those hip joints are really taking a pounding.

mountain bike shocks

The hip/pelvis complex, like a $10,000 mountain bike, is designed to absorb shock from multiple planes while simultaneously enabling movement. A high-end mountain bike can be ridden over uneven ground and can withstand shock forces from bumpy terrain, drops and jumps thanks to a multiple- jointed frame outfitted with shock absorbers. Like the mountain bike, the hip/pelvis complex enables the human body to absorb shock while ambulating.

The hip joints are balanced under the coxae, with the femoral heads partially inserted into the acetabulae and held in tightly by strong but stretchable capsular ligaments. Smooth, nearly frictionless cartilage lines the femoral head and the acetabulum. Comprised mainly of water molecules bound by proteins, cartilage is able to absorb shock and rebound, since water is incompressible. In youth, cartilage is thicker, suppler and more resilient than in those past age 40 but as you age your cartilage thins and is less capable of absorbing repetitive shock; hence the difficulty of running for exercise as you age.

Major hip muscles

Rear view of the hip muscles.

The Ilia and ischia of the pelvis serve as broad attachment points for the hip stabilizer muscles: gluteus maximus and minimus, psoas, adductor brevis and longus, and the deep hip rotator muscles (gamellus, piriformus). These are the hip mobilizers and shock absorbers that give the hip joints their main function of propelling the body on flat and uneven ground, and stabilizing them when the upper body needs a stationary anchor such as during heavy lifting.

So what are the main types of hip problems?

The most common problem that affects the hips is osteoarthritis. With so much pounding forces absorbed daily, the hips are prone to degenerative changes more so than other joints with the exception of the knees. Tiny fissures appear in the cartilage and gradually expand over time, like a windshield crack that grows longer from the constant dips and bumps of driving. The cracks turn into pits, and the hip joint starts to lose its smooth, fluid movement; giving way to clicking, stiffness, and limited range of motion. Although osteoarthritis is often referred to as a “degenerative joint disease,” this term is not entirely accurate. There is indeed a degenerative process involving progressive loss of articular cartilage, but there is also a reparative process in response to this degeneration that involves new bone formation, osteophyte growth, and remodelling. The dynamic process of destruction and repair determines the final disease picture.

In advanced hip osteoarthritis, the pit erodes all the way down to the bone, and at that point you start getting pain in your hips, and where there is pain there usually is inflammation. The hip capsule may fill up with inflammatory exudate, increasing the internal pressure of the hip joint and adding to the stiffness.

Normal hip joint vs. osteoarthritic hip

Risk factors, or things that will increase your chances of prematurely developing hip osteoarthritis are:

Previous injuries to one or both of your hips – a fall, sports injury, car accident, etc.
Participating in sports or other activities that involve high impact landings
Being overweight for much of your adult life
Smoking, as smoking restricts oxygen to tissues which is needed for maintenance and repair
Genetic factors – having a parent who got premature hip osteoarthritis

The genetic factors likely involve protein mutations that render the cartilage’s ability to bind water less efficient, making it extra vulnerable to shocks. They may also involve abnormal production of synovial fluid by the cells of the synovial tissue that surrounds the joint. Synovial fluid is analagous to motor oil in a car’s cylinder– it minimizes friction between the moving parts, so if production of synovial fluid is low, you will get erosion of the articulating surfaces; i.e. the cartilage on the femoral head and the acetabulum, accelerating the disease process.

Iliotibial band syndrome

Another form of hip pain and stiffness may be from iliotibial (IT) band syndrome. The IT band is a broad ligament that originates on the iliac crest of the hip bone; passes over the greater trochanter of the femur (that hard bump you can feel on the sides of your hips, right underneath the skin); and then inserts into the lateral epicondyle of the proximal tibia (lower leg bone). This is a condition that some runners get, and involves strain to the ligament and tenderness at its insertions points. It most often causes pain on the side of the knee, but can also cause diffuse, broad pain over the entire hip. Tenderness and pain at ligament insertion points (into the bone) typically involve micro-tears from mechanical stress, and/or inflammation to the periosteum, the thin layer of tissue where the fibers attach to the bone.

Xray of an aneurysmal bone cyst affecting proximal femur

Aneurysmal bone cysts, a benign but potentially destructive bone tumor may occur in the femur near the hip. It involves the growth of a tumor inside the bone, filled with fluid and blood. Normal bone is replaced by the tumor, which deforms and weakens the bone, making it prone to fracture. ABCs typically start in the first 20 years of life and can remain into adulthood if not dealt with. Make sure to rule this out before doing any physical therapy for hip pain; aneurysmal bone cysts are easily identified on X-ray.

There are other pathological conditions that affect the hip that can cause pain and stiffness, such as slipped capital femoral epiphysis (another pathology common to youth), fibrous dysplasia and other bone disorders but won’t be discussed in this article. Just know that these can be a long-shot cause of hip pain, and can be usually ruled out on X-ray.

Those with hip pain or discomfort due to progressive hip osteoarthritis know the consequences:

Very stiff hips upon waking in the morning, that improves up to a point as the day goes on.
Laborious walking; takes extra effort to move your legs
Aggressive movements like jumping and running are out of the question
For some, burning pain in the hips
Can’t stand for very long; have to sit

For those who have medical insurance, it’s a matter of time before they elect to have an artificial hip inserted.

So what should you do if you have hip pain from osteoarthritis, and are years away from considering hip replacement?

Here’s what I recommend:

Change your Diet: what you choose to eat day to day has the biggest influence on your health. Make 80 percent of your diet plant-based; and of that amount, about half of it raw (uncooked). Suggestions: green leafy vegetables such as chard, collard greens and spinach for the cooked; red leaf and green leaf lettuce, red cabbage, and endive for the raw. Basically, vegetables with purple and red hues are the best as they are rich in anti-oxidants.

Include protein, about 10 ounces per day. Organic grass fed meat, deep water fish, sardines, and pastured eggs are good choices. Whey protein and pea protein powder are also good.

Include fats high in Omega 3 fatty acids, and some saturated fat. Fats are a component of cell membranes especially in nerves, and they are a needed energy source for your body. Salmon, mackerel, eggs, nuts and seeds are good choices.

And of course, drink water throughout the day to stay hydrated. We humans are almost 80% water, and you lose water from your body with every exhalation.

Reduce daily stress in your life: if your life is stressful, make an effort to remove the stress. Stress has an adverse effect on your health and well-being. It can raise blood pressure, blood sugar, cholesterol and cortisol levels, which promote fat weight gain.

Get some negative ions: negative ions are abundant in nature; i.e. the outdoors. They can neutralize harmful positive ions that are plentiful where there is pollution and electronics; i.e. cities. Take off your shoes and socks, and walk on grass in a nearby park. This will “ground” your body, discharging some of your positive ions and equalizing your electrical charge with the Earth’s.

Do low-impact exercises for fitness: you don’t have to go crazy to get a good workout. Using your body’s own weight is sufficient. Planks, squats, pushups, crunches, and lunges are great. For weights, use kettlebells. Cycling can be a good exercise for those with early osteoarthritis of the hip, as the pedaling moves the hip in a non-weight bearing position.

Lastly, use a Pulsed EMF mat daily. Pulsed EMF is considered “energy medicine.” It is the external application of electromagnetic fields similar to those produced by your body, to augment the potential energy the body uses to help drive biological activity; i.e. molecular movement such as blood flow and nutrient transport. This can improve blood circulation and cell membrane transport of nutrients, proteins and wastes; thus improving cell function. In weak tissues, Pulsed EMF can stimulate healing by energizing reparative cells. Can Pulsed EMF help cause worn cartilage to regenerate? Several studies such as this one found that pulsed EMF can upregulate the expression of a gene that controls cartilage production in chondrocytes. It’s definitely worth a try.

Some studies show that Pulsed EMF can help cartilage regenerate.

Go here for more info on Pulsed EMF.

To recap, your hip joints are essential to a high quality of life. They serve to ambulate you, and enable your body to perform basic movements required of daily living such as lifting, carrying, and bending. They are also prone to degeneration, so be mindful of the health of your hip joints – avoid repetitive, high-impact activities that may accelerate degeneration. If you like running, change your running stride to one that more resembles fast walking, where there is minimal to no change in height of your head as you run and therefore minimal impact to your knees and hips upon heel strike when running. In fact, if you run, focus the impact of your foot on the ball of your foot as it contacts the ground, not the heel. Running can be good for health, and your bones, when done right – not too aggressively; with moderation.

Are You On Your Way to Getting Arthritis?

by Pain Doc | May 8, 2014 | Uncategorized

Arthritis, which translates to “irritation of a joint,” has the potential to develop into a debilitating condition that can significantly reduce your activities of daily living (ADL) and quality of life. It involves pain, stiffness and understandably a reduced ability to move and engage in exercise. Lack of exercise/ mobility promotes weight gain, which can make the arthritis worse as the joint surfaces bear increased weight.

If the pain is strong enough, sufferers resort to over-the-counter medications such as acetaminophen (Tylenol, Paracetamol), NSAIDs, or non-steroidal anti-inflammatories (Ibuprofen, Naproxen); and if the pain is severe, opioid drugs. All of these drugs have dangerous side effects, which become more significant if they are taken long term. This includes liver damage, gastrointestinal problems, muscle and joint pain, and for opioids, constipation, nausea and drug addiction/dependency.

Today, I will address specifically osteoarthritis, or OA. It is the most common form of arthritis and is the major cause of disability in persons aged 65 and over. Osteoarthritis affects primarily the weight-bearing joints such as the ankles, knees, hips, lower spine and lower neck. It starts out non-inflammatory (unlike rheumatoid arthritis, which is an inflammatory auto-immune form of arthritis) and involves gradual wear and tear of the cartilage surfaces of the ends of the bones that form the joint. In advanced stages, the damaged cartilage triggers mild inflammation (swelling, increased vascularity, increased pain) and the condition is better described as inflammatory osteoarthritis.

Osteoarthritis has systemic risk factors and local risk factors.

Systemic risk factors include age, sex, race, bone density, genetic factors, nutrition and hormonal status (which is related to age).

Black Americans have a higher incidence of OA than white Americans; however the association may be rooted in demographics/ cultural factors rather than genetics.
Reduced production of human growth hormone (HGH) and the sex hormones (estrogen, testosterone) are associated with reduced cartilage pliability; i.e. increased brittleness and less thickness.
Cartilage is thought to be highly vulnerable to oxidative stress (free radical damage, oxidation), and high doses of vitamin C and D are protective against the development of OA. Smoking, pollution and a diet high in processed food are factors that promote oxidative stress.

Local risk factors include obesity, occupation, prior joint injuries, existing joint instability, sports/physical activities and congenital joint abnormalities.

Obese individuals experience increased pressure in their weight bearing joints when standing or sitting. This can force water content out of the cartilage and lead to small tears which then lead to larger tears and “bone on bone” contact within the joint.
Occupations that involve repetitious trauma/ forces to the joints increase risk for OA.
Sports, especially football, basketball, long distance running and gymnastics can result in accelerated cartilage degeneration especially after age 40.
Prior injuries/ trauma that subluxated or misaligned a joint will predispose it to accelerated OA as the joint loses its normal mechanical function. The joint surfaces may not articulate properly, and weight distribution along the surface may become uneven following trauma.
Congenital anomalies such as scoliosis and fused vertebral segments can also alter normal joint movement and promote accelerated OA.
Weak muscles can deprive joints of protection and stability, predisposing them to OA. Weak muscles are related to sedentary lifestyles, whether by choice or secondary to an incapacitating condition like advanced Type 2 diabetes.

The bottom line:

If you have systemic risk factors, think in terms of diet and nutrition to ward of their effects. You can’t control aging, you can’t control your sex and race, but you can control the level of oxidative stress in your body and you can “down-regulate” genes that may predispose you to arthritis by adopting a healthy diet and lifestyle.

If you also have several local risk factors for OA, think in terms of minimizing their effects. Unstable joints from prior injuries can benefit from targeted exercises that strengthen the joint; perhaps some occasional spinal and/or extremity adjustments from a chiropractor or therapist; supports/orthotics as applicable; and avoiding activities which over-stress the affected joint. For example, if you have a spondylolisthesis, it’s best to avoid running and instead do speed walking or use an elliptical machine to get your cardio exercise.

If you are suffering from chronic pain in your muscles and joints, nerves and ligaments, stay tuned for a new multi-media educational course being developed, Get Rid of Pain Forever. To receive notice of its launch, visit here.

Spinal Stenosis – What it Is, and What to Do

by Pain Doc | Sep 14, 2013 | Leg Pain, Sciatica

Spinal Stenosis

Recently, Carrie Ann Inaba, one of the judges of the show Dancing With the Stars publicly announced that she has been suffering for quite some time from cervical spinal stenosis– a condition in which the canal that encases the spinal cord in the neck narrows and obstructs nerve tissue. She explained how her condition impacts her life, limiting her from doing the things she loves to do. To Carrie Ann’s dismay, she no longer dances with a partner for fear of getting whiplash and paralysis. That’s quite unfortunate for someone whose entire career revolved around dancing.

Although spinal stenosis is a generalized term for narrowing of the spinal canal by any cause, the most common type, which will be discussed here, is the type caused by osteophytes— growth of bony projections that narrow the openings where nerves pass through. Advanced osteophytic activity is also referred to as spondylosis. When it is severe enough to narrow the spinal canal (foramen) it then creates the condition known as spinal stenosis. For your information, other forms of spinal stenosis are those caused by herniated discs, spondylolisthesis, tumors or any mass that encroaches into the spinal canal.

In her article, Carrie Ann mentioned that spinal stenosis is a form of arthritis and that she is anxious to find a cure for it. Unfortunately spinal stenosis is not one of those conditions that can resolve on its own with rest, exercise and time and other non- invasive measures. And since the inflammation from spinal stenosis is secondary to irritation of nerves, it is technically not a type of arthritis. That is why anti-inflammatory medications have minimal effect on the pain associated with spinal stenosis, which is typically deep, sharp and radiating in nature.

Spinal stenosis occurs when vertebrae, the bones that comprise the spinal column gradually morph in a way that constricts the spinal foramen (canal), or space where the spinal cord resides. When there is less space for the spinal cord to move, it is subject to more abrasion with spinal movement; i.e. bending and turning your neck. The cord (actually, meninges or covering of the cord) rubs against sharp edges of the bony projections into the foramen with movement causing inflammation and injury to the nerve tissue, sometimes causing sclerosis (hardening). In advanced cases, especially cases of lumbar spinal stenosis (due to the more significant weight burden) the narrowing gets so advanced that there is constant pressure on the nerve roots. At this point, it is an emergency situation as renal function and sensation to the legs are affected.

Signs of advanced spinal stenosis include paresthesias, sharp pain with movement, weakness in the extremities, and muscle atrophy in legs and/or arms. Symptoms can be permanent if not treated early.

And what is the treatment for spinal stenosis? First of all, doctors will usually order MRI and x-ray to determine extent of narrowing. If it is caught early, physical therapy and lifestyle modification is recommended. The goal is to slow down or stop the progression of the narrowing.

Surgery is the only option for advanced cases. Since spinal stenosis involves physical structures compressing nerve tissue, there are surgical procedures that can enlarge the spinal canal by scraping off the encroaching bone material and buy the patient more time. Since bone is comprised of live cells, the movement of bony projections (called osteophytes) into the spinal canal is still likely after surgery and many who have had such spinal decompression surgeries develop the same problem several years later.

It’s not quite evident why some people suffer from spinal stenos more than others. But those who have a history of physical trauma to the spine like car accidents, sports injuries and falls are at a higher risk. The theory is that the injury event disrupts the normal alignment of the spinal segments resulting in accelerated wear and tear over time; much like how a loose screw in a machine accelerates mechanical failure. Some orthopedists hypothesize that the appearance of bony projections is the body’s attempt to fuse and stabilize adjacent vertebrae so they can no longer move separately; thus reducing the probability of injury. However, the nerves that share the space with the vertebrae get damaged in the process. If this theory holds true, then it is an inherent design flaw of the body’s self-healing mechanisms.

Also, heavy smoking and obesity, and general poor health can increase your chances of developing spinal stenosis.

I’m sure more than one doctor broke the news to Ms. Inaba that there basically is no “cure” for spinal stenosis once it is in its advanced stages, which appears to be her case based on her own description of her symptoms. It is a mechanical condition that mandates mechanical intervention. No amount of drugs will cure spinal stenosis from advanced osteophyte formatioin. Her only option at this point is spinal decompression surgery to widen the spinal canal and hope that the nerve tissue did not sustain permanent damage.

The best strategy for dealing with spinal stenosis is prevention. If you sustained injury to your spine from a car accident (even a low impact one that did not require medical treatment), a sports injury (including repetitious trauma like that related to gymnastics and football) or slip and fall, realize that “the seed” for spinal stenosis may have been planted in you already. If your injury event was over five years ago, get an x-ray to identify any levels where osteophytes are present; these are the sentinels of potential areas of spinal stenosis as they identify areas of biomechanical weakness. If there are some, the first course of action is to not worsen things. Avoid or reduce activities that regularly place trauma to your spine. Engage in specific exercises that strengthen the neck and lower back to offer more stability. Stretch often (yoga is a great choice) and take care of the insides of your body as well with proper diet, nutrition, hydration and adequate rest.

Lastly, the Cervical and Lumbar Posture Pump is a home rehabilitation device that tractions and separates vertebrae to hydrate the discs and increase nutrient absorption which can slow down the progression of spinal stenosis if done diligently on a regular basis. I have personally used them in my practice, and patients reported positive results.

Prolotherapy: A Controversial Remedy for Muscle and Ligament Pain

by Pain Doc | May 28, 2011 | Uncategorized

Prolotherapy, short for proliferation therapy is a controversial technique that involves a series of injections of an inactive irritant substance into a painful joint, or area where ligaments or tendons insert into bone. The injected substance can be dextrose, phenol, saline solution, glycerol, lidocaine, or even cod liver oil extract. Prolotherapy injections are intended to artificially initiate the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue.

Some of the signs that might benefit from prolotherapy include:

Joint laxity, such as in the shoulder, that does not resolve with standard treatment
Distinct tender points at tendons or ligaments as they attach to the bones
Unresolved, intermittent swelling or fullness involving a joint or muscle
Popping, clicking, grinding, or catching sensations in joints
Temporary benefit from chiropractic manipulation or manual mobilization
Aching or burning pain that is referred into an upper or lower extremity
Recurrent headache, face pain, jaw pain, ear pain
Chest wall pain with tenderness along the rib attachments on the spine or along the sternum
Spine pain that does not respond to surgery, or where there is no definitive diagnosis despite X-rays, MRIs and other tests.

So why is prolotherapy considered “controversial?” Because, according to the federal government (Health Care Financing Administration) there is currently no strong, compelling study that proves prolotherapy can cure cases of soft tissue pain. A “strong” study is one that has at least several hundred test subjects; has a control group (who get a placebo, or fake treatment) and is done in a “double-blind” methodology where the test subject and the administering doctor do not know if the injection is a prolotherapy agent (only a third member of the research study knows). However, there are numerous studies in the literature using smaller test populations (less than a hundred) that support prolotherapy as an effective treatment for pain.

A 2005 study entitled A systematic review of prolotherapy for chronic musculoskeletal pain (Clin J Sport Med. 2005 Sep;15(5):376-80) analyzed major studies on prolotherapy and reached the following conclusion:

Two RCTs (randomized controlled trials) on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy
Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations.

There is a research project at the University of Wisconsin involving prolotherapy to treat knee osteoarthritis that is due to publish its results soon.

So, if you have chronic musculoskeletal / joint pain, especially related to trauma, that has not resolved with cortisone injections, chiropractic, physical therapy, personal training, surgery, and time, prolotherapy may be worth investigating. The good thing about it is that it is generally safe.