I recently viewed this course on Medbridge for my continuing education, Orthobiologics and Regenerative Medicine: Rehabilitation Implications. I found it to be beneficial and wanted to share. The instructor is John O’Halloran, PT, DPT, OCS, ATC (retired), CSCS (retired), cert MDT, Certified SCTM-1 Practitioner. 

 

As he stated, 560 million people are affected by osteoarthritis (OA) and the number one leading cause of disability worldwide. He decided to do this course due to the rapid emergence of regenerative medicine to treat OA non-operatively and feels PTs today should be highly informed and provide patients with the best evidence available. 

 

Here is what I took from the course:

 

Platelet-rich plasma (PRP) – blood is drawn, placed in a centrifuge, separate white and red blood cells, left with the platelets. Platelets are the number one factor for healing. 

 

Stem cells – taking from bone marrow or adipose, huge chondral potential to regrow cartilage. 

 

In this course, he presented a Systematic Review and Meta-analysis of PRP clinically compared to other therapies in the Treatment of Knee OA. Comparing PRP to viscosupplementation, cortisone injection, and placebo injection. At 6 months, PRP is as effective, in some studies,  more effective for pain, function, and stiffness. 

 

PRP is used to delay the process of the breakdown of the OA. There is a difference on how it is provided. Landmark-based provider vs. ultrasound guided.

 

Things for the patient to consider when finding their provider: Preparation of the platelets (how many cc’s injected) and how experienced is the provider (sports fellowship trained in ultrasound guided vs. regenerative medicine non-fellowship trained or ultrasound guided trained)

 

Stem cells from adipose tissue from 2022 study for treatment of knee OA. 2 year follow-up on pain and function at 6 months showed overall improvement, and at 24 months, pain and function plateaued. Mild OA patients did better than severe. Bone marrow – 19 studies, bone marrow group was more effective. Helps you go through the stages of healing to put a stop to the bouts of inflammation and buy some time. 

 

Research so far has not shown that the treatment can rebuild damaged joints in patients with prolonged OA or advanced OA.

 

More effective: Stem cells or PRP: Bone Marrow Aspirate Concentrate is equivalent to PRP for the Treatment of Knee OA at 2 years: A Prospective Randomized Trial. Both are equally effective according to clinical trials up to 24 months. PRP costs much less. 

 

Protocol for PRP/Stem Cells: comes down to stages of healing.

Week 1: lie low

Weeks 2-6: light stretching and low level exercises, ROM

After 6 weeks: start stressing the tissues

 

Supplements – Glucosamine and Chondroitin

Limited studies. Things to consider: purity of the product, it is not going to rebuild cartilage or prevent breakdown of articular cartilage, 30% placebo effect. 

 

Viscosupplementation – indication to improve quality of synovial fluid. Systematic Review and Meta-Analysis in British Medical Journal stated that viscosupplementation in the majority is no better than placebo. 

 

Role of Practitioners for treatment of OA: Individualized programs 

1. Avoid impact loading
2. Kinetic chain evaluation
3. Unloading braces
4. Aquatics
5. Avoiding processed foods
6. Dropping weight

 

Lastly, Journal of Orthopedic and Sports Physical Therapy: revealed evidence that pre-hab before TKA, one will have better effects in a positive way after surgery.

 

Sarah Falvey, PT

Knee Pain Unveiled: Exploring the Root Causes

 

Knee pain can be a perplexing and persistent problem for many individuals. It’s a common issue, but what you might not know is that the source of knee pain can often be found outside the knee joint itself. Knee pain is not always a straightforward matter. It can originate from various factors that extend beyond the knee joint. To help you understand this complexity, we’ll dive into these factors and their connection to knee pain.

 

1. Biomechanical Issues: Your knee is part of a larger kinetic chain that includes your hips and ankles. Problems in these neighboring joints, such as hip instability or ankle mobility deficits and misalignment, can lead to altered gait patterns and increased stress on the knee.

 

2. Muscle Imbalances: The muscles around your knee play a crucial role in stability and function. Imbalances in strength or flexibility, particularly in the quadriceps, hamstrings, and calf muscles, can cause knee pain.

 

3. Overuse and Repetitive Stress: Activities like running, jumping, or squatting can strain the knee joint over time. The source of this overuse isn’t necessarily the knee itself – it could be related to improper technique or muscle imbalances elsewhere.

 

4. Nerve Compression or Irritation: Nerve issues in the lower back or thigh regions can lead to radiating knee pain. Conditions like herniated discs or sciatic symptoms may be the real culprits behind your knee pain.

 

5. Inflammatory and Systemic Conditions: Conditions such as rheumatoid arthritis, osteoarthritis, or gout can cause inflammation in multiple joints, including the knee.

 

6. Referred Pain: Pain can be referred from one area to another. Hip or lower back problems may send pain signals to your knee, making it seem like the knee is the primary source.

 

7. Environmental Factors: Factors like prolonged sitting, poor ergonomics, and inappropriate footwear can contribute to knee discomfort. These environmental issues need consideration in your treatment plan.

 

Treatment plans for knee pain can vary depending on the underlying causes, severity of the pain, and individual patient needs. A well-rounded approach to treatment often combines multiple strategies to address the specific factors contributing to knee pain. Here are some examples of treatment components that may be included in a comprehensive knee pain treatment plan:

 

1. Therapeutic Exercises: Physical therapy is a cornerstone of knee pain treatment. Therapists design exercise programs to improve muscle strength, flexibility, and joint stability. Specific exercises may target the quadriceps, hamstrings, calf muscles, and hip muscles to minimize deficits to support the knee joint.

 

2. Manual Therapy: Hands-on techniques performed by physical therapists and assistants, such as joint mobilization and soft tissue manipulation, can help improve joint mobility and reduce pain.

 

3. Biomechanical Assessments: Evaluating the patient’s gait and movement patterns can reveal any issues with posture, alignment, or movement that may contribute to knee pain. Custom orthotics or shoe recommendations may be provided to address these problems.

 

4.Pain Management: In some cases, pain management techniques may be necessary, such as the use of non-steroidal anti-inflammatory drugs (NSAIDs) or prescription medications to alleviate pain and reduce inflammation.

 

5. Bracing or Taping: Depending on the nature of the knee pain, bracing or taping may be recommended to provide support, stability, and pain relief during physical activity.

 

6. 6. Modalities: Physical therapists may use modalities like electrical stimulation, and/or hot/cold therapy to temporarily manage pain and inflammation.

 

7. Education: Patients are educated in proper body mechanics, ergonomics, and activity modification to prevent further knee injury. This can include advice on posture, footwear, and exercise technique.

 

8. Activity Modification: Patients may be advised to modify or temporarily avoid certain activities that exacerbate their knee pain.

 

9. Home Exercise Programs: Physical therapists often provide patients with home exercise programs to continue their rehabilitation and maintain progress outside of clinic visits.

 

10. Follow-up and Progress Monitoring: Regular follow-up appointments and progress assessments are crucial to adjusting the treatment plan as needed and ensuring the patient is achieving their goals.

 

Treatment plans are highly individualized, and the specific components and duration of treatment will vary based on the patient’s diagnosis and response to therapy. A collaborative approach involving the patient, physical therapist, and, if necessary, other healthcare professionals, is key to achieving the best outcomes in managing knee pain. Call Red Canyon Physical Therapy today to schedule your initial evaluation today!

What is Dry Needling?

Dry needling is a manual treatment method that healthcare providers use for management of pain and issues with movement quality that stem from musculoskeletal conditions. With this method, the provider inserts a thin needle into or near the area of pain, trigger points, or related symptoms. A common method of dry needling is called Trigger Point Dry Needling that focuses on targeting myofascial trigger points in the muscles. Trigger points occur when the muscle is overused which can cause an energy crisis resulting in muscle fibers not receiving adequate blood supply. When this happens, the muscles aren’t getting the oxygen and nutrients that it needs to return to a resting state causing pain and increased sensitivity. Trigger Point Dry Needling stimulates these areas to help bring back normal blood supply to clear built up acidity and release tension. With this method, people will often feel muscles contract or twitch as the muscle relaxes and resets. Another method of dry needling is called Neurologic Dry Needling which evolved from Trigger Point Dry Needling with greater focus on needling the system versus the points in order to treat all types of neuromusculoskeletal conditions. This method is based on peripheral and central neurologic principles and works to deliver treatment locally, segmentally, and systemically. The goal is to improve inflammatory responses, improve blood flow, and reduce muscle guarding. Ultimately, both dry needling techniques help to  relieve pain, increase blood flow, and improve mobility for most people.

 

What Type of Pain Does Dry Needling Treat?

Dry needling can be used to treat a multitude of musculoskeletal conditions to address pain and mobility restrictions that can occur from scar tissue, myofascial tension, trigger points, and other connective tissue issues. Some conditions include:

• Lower back pain
• Neck pain
• Headaches/Migraines
• Shoulder Pain
• Muscle Strains
• Osteoarthritis
• Overuse Injuries
• Post-Surgical Recovery
• Generalized Muscle Tension
• Range of Motion Restrictions
• Joint Issues
• Tendinitis
• TMJ Pain/Dysfunction
• Pelvic Pain

What to Expect During and After Dry Needling Treatment?

Each time you receive dry needling, your licensed physical therapist will assess each treatment area via palpation (use of hands to feel the muscle tissue). Following the assessment, your provider will use a sterilized needle to work on the treatment area. The needles are always single-use and disposed of immediately in a sharps container. The needle is surrounded by a plastic tube that helps to guide with placement of the needle in the appropriate treatment. Some people fear that the needles will be extremely painful, but because of how thin the needles are along with technique, needles are able to penetrate the skin with little to no sensation. Once the needle is in place, your tissue can response with reduction in tension or an involuntary muscle contraction when a trigger point is released, which can feel uncomfortable, but this sensation is short-lived and people often times feel immediate changes.

It is common to experience soreness in the area following dry needling for 24-48 hours, but it will resolve on its own. It is a similar feeling to the soreness that one would feel after strength training or a hard workout. Soreness can be managed with ice, heat, and gentle stretching. Other recommendations to further assist the healing process include:

• Drinking Plenty of Water: Hydration can help to avoid or reduce sore muscles by helping to flush out toxins, transport nutrients into cells, and regulate body temperature and pH balance.
• Exercising: As long as your pain doesn’t return, it is helpful to stretch, work your muscles, and continue your daily activities. Movement helps to improve mobility and blood flow.
• Massaging Your Muscles: Massaging helps to further relax muscles and stimulate tissues to improve blood flow and encourage reduction in tension and soreness.

Who Can Perform Dry Needling?

Dry needling is regulated differently from state to state on which healthcare professionals can perform dry needling. Healthcare providers that can generally perform dry needling consist of physical therapist, chiropractors, and athletic trainers. Regulations and requirements vary from state to state. In the state of Maryland, athletic trainers are not permitted to use dry needling as a course of practice. Maryland law requires that licensed physical therapist undergo 80 hours of training prior to eligibility to practice dry needling, therefore are highly trained compared to other requirements in other practicing states.

Acupuncture vs. Dry Needling

Although acupuncture and dry needling both use the same type of myofilament needles for treatment, the two methodology and theories are very different. Acupuncture is a treatment developed with theories centered in Eastern Medicine beliefs with the idea that illness and pain occurs when the body’s vital energy doesn’t flow freely. Acupuncture is guided by needle placement along meridians that can help to restore physical, mental, and emotional equilibrium. Dry needling on the other hand was a development of Western Medicine beliefs are targets the source of pain from a musculoskeletal or neuromusculoskeletal approach. Although clients may see the similarities on the surface, the function of the two professional approaches are very different.

 

Dry needling is a very helpful technique in the rehabilitation process, but it is simply another tool in the toolbox for physical therapy treatment. Dry needling is best when paired with other treatment approaches to help relieve pain and improve function. The best way to know what will work for you to relieve your pain and improve your function and quality of life is to schedule an appointment with a physical therapist to diagnosis your pain, create an individualized plan of care, and help you get back to feeling better. Here at Red Canyon, we are ready and excited to be able to help you! Schedule today!