Orthobiologic Therapies PRP & micronized fat (Lipogems): How it works and Why it’s worth it!

 

Orthobiologic Therapies PRP & micronized fat (Lipogems): How it works and Why it’s worth it!

Many people with musculoskeletal pain are familiar with corticosteroid (i.e. “cortisone”) injections, which are meant to reduce inflammation.  However, inflammation is often necessary for healing...it's a good thing!  Inflammation after injury recruits the body’s own natural healing factors. 

Another approach is to deliberately induce the body’s own healing mechanisms to repair damaged tissue.  These methods, often termed "orthobiologics,"  can be a longer-term method of musculoskeletal treatment, and is a great alternative to the more well-known corticosteroid injections.  The subtypes of orthobiologic therapies that Drs. Hyman and Chimes perform are platelet-rich plasma injections (PRP) and micronized fat aka 'm-fat' aka Lipogems.   

PRP or platelet-rich plasma directly stimulates the body's healing factors to come and pay attention to an injured area.  Drs. Hyman and Chimes perform PRP or platelet-rich plasma injections to treat arthritis and tendon/ligament or cartilage tears.  This technique involves using high-resolution ultrasound to inject the solution, involving a high concentration of a person’s own platelets, directly into or around damaged tissue.  Platelets, when activated, secrete a number of different growth factors that stimulate and regulate inflammation in the damaged tissue, resulting in a natural healing response. The blood is drawn from the patient at the time of the visit, placed in a centrifuge where it is spun in order to separate and concentrate the platelets from the rest of the blood, and this “platelet-rich plasma” is then injected into the injury site.  The aim is to inject healing growth factors directly into the damaged area, providing the patient’s body with the tools needed to naturally heal itself.  When effective, the improvement can last for 1-2 years.

Micronized fat, or Lipogems, involves harvesting a patient's own fat (adipose tissue), usually from the belly or flank, and breaking down the fat into smaller parts.  We harvest the healing factors that include a large number of healing factors and some stem cells, and once processed (after ~30-45 mins) we inject that micronized fat into the injured area.  Drs. Hyman and Chimes prefer this method for more advanced arthritis and large ligament, tendon or cartilage tears.  This can be effective enough to be surgery sparing in many cases.  When effective, the improvement can last for up to 3 or more years.

The two methods listed above are a means of strengthening ligaments and tendons, providing longer-term relief for a multitude of chronic musculoskeletal problems including, but not limited to knee pain, hip pain, shoulder pain, osteoarthritis, and different varieties of joint pain.  We have had great success using orthobiologic therapy in many of our patients.   These therapies are not covered by traditional health insurance companies.  Patients  who have invested money in their own care, however, find that orthobiologic therapy may provide them long-lasting relief and help them to avoid future visits, ultimately lowering their medical bills.  

Because we respect the time and money of our patients at Lake Washington Sports & Spine, we take several measures to optimize the patient’s experience when having orthobiologic therapy performed. These include:

1.       An initial consultation, to make sure that orthobiologice therapy is the right choice for the patient

2.       A discussion about which form of orthobiologic therapy is the best choice for the patient

3.       Always using ultrasound-guidance to make sure we are placing the solution in the correct location

4.       Coordinating the patient’s care team, including physical therapists, chiropractors, personal trainers, physicians and other clinicians

Drs. Hyman and Chimes hope that by utilizing these cutting-edge, non-surgical techniques they can help their patients overcome chronic issues that impede their ability to live an active and healthy lifestyle!  

Pregnancy and Chiropractic Care

 

Pregnancy and Chiropractic Care

 

• According to published research and the American Pregnancy Association, approximately 50 - 70% of all pregnant women experience back pain during their pregnancy and 50% to 75% of women experience back pain during labor.

 

• In addition, one out of 5 women suffer from Pelvic Girdle Pain (PGP) or Symphysis Pubis Dysfunction (SPD) at 36 weeks gestation and almost half of the women suffering from Pelvic Girdle Pain 3 months after delivery, continued to report symptoms 1 year after delivery.

 

• Low back pain and PGP respond well to chiropractic care. A lack of care or prompt treatment can result in prolonged symptoms, delayed recovery and ongoing symptoms which may last for months or years postnatally. It can also have a significant impact on a woman’s emotional and psychological well-being both during and after pregnancy. 75% of pregnant patients who received chiropractic care during their pregnancies stated that they found relief from pain.

 

• Dr Allison Hyman is certified in the Webster Technique which is used to care for pregnant patients. The International Chiropractic Pediatric Association (ICPA) defines Webster Technique as, “A specific chiropractic analysis and diversified adjustment for pelvic balance during pregnancy allowing for optimal fetal positioning (head down/anterior) for an easier, safer birth. The goal of the adjustment is to reduce the effects of sacral subluxation and/or SI Joint dysfunction. In so doing, neuro-biomechanical function in the pelvis is improved.”

 

• Webster Technique is used to correct potential musculoskeletal causes of intrauterine constraint. Intrauterine constraint is defined as any force external to the developing fetus that obstructs the normal movement of the fetus. The technique is used throughout pregnancy as well as for women in the eighth month of pregnancy with breech presentation.

 

• Some effects of pelvic/sacral misalignment during pregnancy include:

• -Low Back Pain

• -Intrauterine constraint

• -Pelvic Girdle Pain (PGP/SPD)

• -Pain/tightness in the gluteal region, legs and groin

• -Numbness, tingling, or weakness in the legs

• -Decrease in pelvic diameter/mobility

COVID-19: we are open for Telemedicine!

The fine doctors at Lake Washington Sports & Spine are open for telemedicine as of 3/17/2020

We want to be a valuable resource to help patients as they navigate issues related to their musculoskeletal health during this trying time

We can be reached at  (425) 818-0558

Friday Faves: Office

• Varidesk turns any table or desk into a standing workstation! We've had them for years and our staff loves them https://amzn.to/2SusOQK

• Ergonomic mice can take some getting used to, so try a few and choose your personal best https://amzn.to/2KU3Wzu

• Swopper stool helps engage core muscles with 3 dimensions of movement. https://amzn.to/2UbYw78

• Topo mat for standing desks helps encourage position changes while standing https://amzn.to/2KYnoew

6 Tips for Staying Fit on Vacation

Spring Break is just around the corner, which means traveling and spending time outside the normal routine.  So, how do you enjoy yourself without sabotaging your diet and fitness progress?  Here are some tips to relax, unwind, and stay fit!

1. Pack accordingly

Before you leave for your trip, make sure to pack exercise essentials like workout clothing, running shoes, resistance bands, a jump rope, and headphones.

2. Utilize wait times for movement

Flying to your vacation destination guarantees you will spend hours sitting on the plane (sedentary).  Why not utilize your time at the airport to burn some calories?  Walk, plank, lunge, & squat!

Dr. Hyman planking during a flight delay @ SeaTac

3. Schedule time to workout (with your travel companions)

A week or more of unhealthy diet choices and no workouts will make it feel impossible to get back on track once you return home.  The simplest way to make sure workouts happen is to prioritize them at the start of the day (even before breakfast).  30 minutes of increased heart rate and sweat will do the trick!    

Nashville vacation marathon training.  Great way to see the city!

4. Hit the hotel gym

If you know your day ahead will not allow for exercise, wake up 30 minutes earlier and visit the hotel gym.  Do it bright and early so you don't have time to make excuses (like too tired, too full, etc).

Dr. Chimes and baby Jim staying active!

4. No gym?  No problem!

There is legitimately NO EXCUSE not to workout; all you need to stay fit is your own body weight.  Try 3 sets of the exercises below, or check out Youtube for some other great options.

15 Triceps dips

15 Lunges

12 Burpees

10 Push-ups

1 Minute plank

15 Jump squats

40 bicycle crunches

Pre-breakfast sweat sesh in Cabo

5. Walk or bike, don't drive or taxi!

Walking and biking are win-wins: physical activity and sightseeing.  See your destination by foot or 2 wheels to burn extra calories and mindfully experience your surroundings. 

I insisted my friend and I walk the 4 miles uphill on a country
road to San Gimignano.  We earned our pasta for sure!

6. Chose your indulgences wisely & sparingly

It's easy to fall into the "I'm on vacation, I deserve this!" mentality when it comes to eating.  Unfortunately, your body doesn't take a holiday from storing unused calories as fat.  Pick a portion of one meal a day for your treat.  For example, if you need to have those fries, balance the meal with grilled fish or chicken and a large salad.  Need that dessert?  Make sure you eat a veggie-loaded entree and pass on the alcohol.  Another tip- follow an unhealthy meal with a healthy one.  It's all about balance.

Fish tacos from 1&Only Taco in Cabo San Lucas

LWSS Does Hot Yoga!

LWSS Does Hot Yoga!

In the next iteration to better understand the exercise preferences of our patients and exercise-specific injuries, the LWSS team decided to try out hot yoga! (Prior to trying out hot yoga, we tried out Barre3). 

Like Barre3, most of us were new to hot yoga too.


Prior to class:
-Different yoga studios heat their rooms at different temperatures. We recommend having your first class in a “warm” room, 80-90F degrees. We attended class at Shakti East Vinyasa Yoga in Bellevue which was an excellent temperature for an intro class. 

-Hydrate well, starting the day prior to class. 

-Bring a yoga mat and large towel to class (or rent from the studio).

-Arrive ~20mins early to class to register, set up your mat, and acclimate to the room prior to starting class!


What to expect:
-Yoga is often thought of as a moving meditation. Rooms are quiet and the emphasis is focusing on the breath and pose. 

-Keep breathing…

-Instructors will cue you and being in the back of the room will help you understand how to move through the poses. 

-Keep breathing...the breath is the first priority but hard to master.



Final thoughts:
Hot yoga is a great way to get the therapeutic benefits of a moving meditation while increasing your heart rate. There are different types of hot yoga; hatha is a gentle introduction to postures, vinyasa focuses on the flow between postures, power is designed to be more intense than vinyasa, and Bikram is a series of 26 postures that are distinct from each other and arguably the most challenging. We enjoyed the vinyasa class at Shakti, but can also recommend the more demanding/hotter classes at Hot Yoga Inc., and Ashram Yoga Bellevue (Bikram style) in the downtown Bellevue area.

Dr. Gary Chimes on the Moving2Live Podcast!

We're excited that our own Dr. Gary Chimes (and his dog Bucky) are interviewed on the Moving2Live Podcast

Check it out!

http://moving2live.blubrry.com/2018/02/28/podcast-9-18-dr-gary-chimes-lake-washington-sports-and-spine-part-1/

Physical therapy…What’s the Point? Q & A on PT with Dr. Hyman

1.  What’s the goal of physical therapy (PT)?

The primary goal of physical therapy is to optimize your body mechanics, so that you may return to sport or chosen physical activity.

While pain relief is not the primary purpose of physical therapy, most often the pain goes away and stays away when body mechanics issues are corrected.

Ideally, all persons with a sports or back injury should see a physical therapist first, before seeing a medical doctor.  The majority of the time, physical therapists will lead you successfully back to full function without a hitch.  In some cases, problems persist despite physical therapy, and then ideally your physical therapist will refer you to a musculoskeletal specialist medical doctor.  I like to use a 4 visit threshold — you should see improvement in PT within 4 visits, and if not, then seeing a specialist doctor is appropriate.  Why not first see your primary care physician?  Well, in most cases your primary care physician will rely on a physical therapist to evaluate and treat an injury.  So if you’ve already been responsible enough to participate in PT, then you’re ready for specialty care with a sports medicine physician.

2.  What should you expect from a PT visit?  

Expect to arrive 10-15 mins early, dressed for exercise.  The sessions usually last 45-60 minutes.  During the initial assessment the physical therapist will get to know you and your problem by taking a history and performing an extensive physical examination. Each follow up session typically involves some period of reassessment (i.e. talking about how you’ve been doing since last session), a physical examination to check biomechanics, sometimes an intervention (i.e. hands on treatment that might feel like massage, stretching, or joint manipulation), and then additional exercise instruction.

We expect you to attend physical therapy sessions once or twice per week for several weeks before we follow up together.  Typically within 4 visits a person will notice some improvement.  The overall duration of physical therapy depends on several factors including the complexity of a condition and its chronicity.

3.  Why spend the time and resources to participate in PT?  Why don’t you just hand me a printed exercise handout?

A physical therapist is a medical exercise specialist, and they are able to design a customized exercise program to help you achieve your particular exercise goals. Each person’s body mechanics are different.  It is the physical therapist’s expertise to understand what normal flexibility and strength looks like.  Every person has areas of inflexibility and areas that are weaker than what is optimal.  Often making tailored corrections to your flexibility or weak areas will make all the difference and allow you to return to full function.

Exercise handouts are designed to treat the “average” person in a general sort of way.  Perhaps up to 50% of the time this approach works.  However, we take your recovery seriously, and we prefer better odds.   With physical therapy intervention for most conditions, the likelihood of improvement goes up to 75-85% in our experience.

Sometimes I’m asked why I can’t just teach the exercises at our office visit.  The simple answer is that I’m not a specialist in teaching people how to properly exercise.  Additionally, most physical therapists understand how to assess biomechanics on a more sophisticated level than most specialist physicians.  So they can both assess complex biomechanical issues, and they are experts in creating an exercise plan to correct those issues.  Just to overemphasize, when I have an injury or issue, I personally go to see a physical therapist because I won’t appreciate my weak spots nearly as well as a physical therapist.

Dr. Hyman, what are steroids and why do we use them?

Debunking Steroid Myths
Most people associate steroids with bodybuilding or injections, but steroids are also naturally occurring meaning that the body can make its own steroids. Steroids that are administered from outside the body, often in the clinical setting, are called “exogenous” steroids. 

The most commonly thought of steroid is “cortisone.” People will use the term “cortisone” interchangeably with steroid. 

So, what are steroids, really?
Steroids are hormones. Hormones are chemicals that signal cells to perform an action at the tissue level. In this case, steroids might signal nerve cells to calm pain signals and are also the most potent anti-inflammatory drug, meaning it will stop a cell from releasing other chemicals that promote inflammation. In our clinic, we use steroids to independently relieve pain by calming the nerve signals that carry pain signals and to suppress inflammation. 

We traditionally use steroids almost anywhere and everywhere—it has been a ubiquitous drug, either given by mouth or injected. Typically, we are using injectable steroids in our practice. Why? Because we have the ability to figure out the specific tissue that is the source of pain and thereby can target that tissue with the injected steroid. If you take steroids by mouth, it goes through the entire system and has a larger chance of affecting cells in your whole body, potentially causing a variety of side effects.

What are the potential side effects of injected and systemic steroids?
Some of the most common and usually temporary steroid side effects are insomnia, mood swings, flu-like symptoms, weight gain, increase in blood sugar, abnormal menses, and palpitations. A reduction in bone density is one longer-term adverse effect of exogenous steroids. Again, steroids are hormones and hormones can have both tissue level and systemic effects. For example, melatonin is a hormone that helps our body sleep and melatonin can be influenced by steroids, thereby creating the side effect of insomnia. Steroids can disrupt all other hormone pathways. While not always true, injected steroid may minimize those systemic side effects. 

And the truthfully, there are probably still some systemic effects of steroids because we have these little blood vessels nearby injured tissues that take up the injectable steroid. So there may be some systemic effects even when injected, potentially. 

Additionally, there is some evidence to suggest that injectable steroids can be damaging to tissue; steroid injections into the knee can degrade the cartilage more quickly and steroid injections may also increase the chance of rupture in some tendons. 

What can steroids help with?
It is important to note the risks of steroids and ensure appropriate use. When steroids are used in a targeted and appropriate manner, they can be a wonder drug; decreasing swelling, reducing pain, and restoring mobility. Typical uses for steroid include: swelling in a soft tissue, bursitis, adhesive capsulitis (frozen shoulder), and epidural injections into the spine. Steroid injections into these areas carry relatively low risk with great potential improvement for carefully selected patients. 

FAQ

I’ve been prescribed Prednisone (oral steroids) in the past and it helped. Why not try that?
Again, there is a greater side effect profile with oral steroids because they are distributed throughout the body. The benefits of an oral steroid may also be more transient and may not be prescribed at a high enough dose to be effective. 

How often can I have a steroid injected?
Short answer: it depends on the body part. In weight-bearing joints—like the ankle, knee, and hip—we try to be stingy with steroid and maybe not use it at all. Steroid injections in these joints may last only a few weeks and there is evidence that steroid can increase the rate of cartilage loss in the knee. In contrast, epidural steroid injections into the spine may be given liberally as a tool to prevent surgery and promote an active recovery. Insurance only pays for surgery and steroids for most musculoskeletal and spine pain whereas other treatments may be a better option. Other therapies like prolotherapy, PRP (platelet rich plasma), stem cells, and viscosupplementation are not covered by insurance but may be the better option.