Treatment of Achilles Tendinosis with Shock Wave Therapy

An article from Jan 08'in the JBJS (Journal of Bone & Joint Surgery), that documented low energy shockwave therapy was effective in treatment of non-healing achilles tendinosis. The randomized controlled trial showed that 64% of patients receiving shock wave(group I) were completely recovered or much improved, versus 28% of those who received an eccentric loading exercise program (group II).

The study looked at 50 patients who have had pain for > 6months & failed conservative treatments.

http://www.ejbjs.org/cgi/content/abstract/90/1/52

I have been treating many patients lately (more than 50, with various injuries including achilles tendinosis, plantar fasciitis, tennis elbow, & bicep tendonosis with favorable results. I have all patients complete questionnaires 6 weeks after their initial treatment to determine a useful role for shockwave in my practice.

Ultimately I invision a protocol implementing various modalities to maximize the body's innate ability to heal itself. Furthermore, I am exploring the potential role of hyperbaric oxygen therapy.

I will soon post results from the 150 or so shock wave treatments I have done. However, larger studies requiring double blinded methods are required so that we can learn more about shockwave therapy.

Multi Center Clinical trials of Platelet Rich Plasma Underway

Many trials are in the pipeline in efforts of obtaining FDA approval for PRP injections. There is a multi-center placebo controlled double blinded study underway looking at plantar fasciitis(heel pain) & lateral epicondylitis (tennis elbow).

http://www.biomet.com/patients/clinical_recruitment_recover.cfm

Also, Thanks to the many patients inquiring about info on docs around the country performing PRP procedures. Feel free to contact any of those listed in the link performing this particular study. At some point I may have a list of various PRP docs out there to help patients out. Please Continue to send requests.

On another note, we are currently examining the efficacy of Platelet Rich Plasma with osteoarthritis. We are collecting objective data on all patients injected.

January 08' Platelet Rich Plasma Enhances Tendon Healing

A new article from the Journal of Cellular Physiology presented some new insights into the role of PRP in tendon healing. After injecting PRP into mice patellar tendons, accelerated healing was demonstrated. The PRP had an 8.8 times platelet concentration above baseline versus whole blood.

Circulation derived cells play a key role in tendon healing. Blood flow is very important in connective tissue regeneration. Tendons typically have a poor blood supply (only 1/3 of the amount found in muscles). This study showed increased quantity of these healing cells in the early phase of tendon repair. Unfortunately, these helpful cells normally disappear with time. Therefore prolonging their presence is advantageous. Also increased type I & III collagen and macrophages were increased; supporting that PRP promotes tendon healing

http://www3.interscience.wiley.com/cgi-bin/abstract/117880365/ABSTRACT?CRETRY=1&SRETRY=0

A need to Clarify Platelet Rich Plasma use in International athletes

A new article from the British Journal of Sports Medicine Nov 07, reviews PRP (Platelet rich Plasma) use in sports medicine. After a good thorough review, they point out that using growth factors is considered a doping violation by the WADA (World Anti-Doping agency). THE WADA created in 1999 to promote, coordinate, and monitor the fight against doping in sports. The WADA prohibits use of a particular growth factor, Insulin like growth factor (IGF-I). However scientific literature has shown that IGF-I is not increased in PRP. This misunderstanding of PRP may create an ironic situation where this cutting edge technology may be available to the weekend warrior, but not the Olympian. Keep in mind that "growth factors" are different from "growth hormones."

As PRP use increases so does the need for the scientific community to comprehend it's applications & mechanism of action. Hopefully the application of PRP will be recognized as a natural and safe alternative to promote healing in high level athletes and the weekend warrior alike.

Growth Factor Delivery Methods in the Management of Sports Injuries:The State of Play http://bjsm.bmj.com/cgi/content/abstract/bjsm.2007.040071v1

Ultrasound Guided Platelet Rich Plasma Injections

A growing number of physicians are using musculoskeletal ultrasound to guide various injections. As a leading imaging technique in Europe, ultrasound is safe, economic, convenient, & effective in diagnosing many injuries. The technology has dramatically improved and allows us to visualize nerve & tendon fibers. While the quality is not quite MRI caliber, ultrasound allows for dynamic (motion studies). In other words, ultrasound allows functional evaluation of an injury with movement, whereas MRI takes a still image. Also, ultrasound has color doppler that shows areas of blood flow changes (called neo vascularization). This allows us to deliver the PRP within a millimeter of the target site, or even discover other regions that are affected.

Ultrasound technology continues to grow. I just upgraded to this Sonosite portable machine with color doppler.