Knee Hurt

Author: Mokhtar

  • Advanced Biologics takes biological innovations to the next level through a merger with Isto Biologics

    Advanced Biologics takes biological innovations to the next level through a merger with Isto Biologics

    CARLSBAD, Calif., Oct. 18, 2023 /PRNewswire/ — Advanced Biologics (commercially known as Biologica Technologies), a California-based company known for their innovative biological solutions, today announced their successful merger with Isto Biologics, a global leader in regenerative and autologous therapies.

    The merger will seamlessly integrate Advanced Biologics’ proprietary products into Isto’s valued and growing portfolio of allografts within their Influx™ line.

    “We are pleased that our entire Advanced Biologics/Biologica team will be joining forces with Isto Biologics,” said Amit Govil, president of Advanced Biologics. “This merger brings together the clinical, commercial and research-driven expertise of both companies and a shared commitment to helping patients heal faster.”

    Advanced Biologics has maintained a commercial partnership with Isto Biologics since 2020, catalyzed by the development of Isto’s Integrative Bone Matrix, SPARC™. SPARC is a novel inductive bone matrix derived from Advanced Biologics’ proprietary tissue processing method used in their signature allograft, OsseoGen®. SPARC is known for its increased levels of osteoinductive, chemotactic, angiogenic and proliferative growth factors.

    The integration of Advanced Biologics’ product commercialization initiatives into Isto’s growing allograft portfolio provides a unique opportunity to help patients heal faster and enable both customer bases to benefit from the broader product range.

    “Over the past four years, our partnership with Advanced Biologics has been impressive,” said Harry Holiday, Chairman of the Board of Directors of Isto Biologics and Managing Director at Thompson Street Capital Partners (TSCP). “Investing in Advanced Biologics and entering into this strategic combination strengthens the extensive biologics portfolios of both Isto and Advanced Biologics, paving a path forward for continued growth and patient healing.”

    “Through this merger, our combined team will now have greater clinical expertise and deeper customer support to provide our champion surgeons with the best products available in the market,” said Don Brown, CEO of Isto Biologics.

    About Advanced Biologicals/Biologics Technologies

    Advanced Biologics (ABC) is a three-way, Orthopedics this week – Prize for new technology winning biological company focused on developing innovative and clinically relevant biological solutions for a wide range of medical specialties. To better serve customers, Advanced Biologics formed Biologica Technologies in 2015 as a separate, standalone company that will serve as its sales, marketing and clinical research group. Advanced Biologics’ core technology provides the ability to access intracellular growth factors (GFs) found in allograft tissue. ProteiOS® Growth Factor and OsseoGEN® Cellular Bone Matrix are among the first products based on the technology and possess the highest concentration of GFs within their respective biological categories. The company is privately held and headquartered in Carlsbad, CA.

    About Isto Biologics

    Isto Biologics is a leading biologics and cellular therapy company in the orthopedic sector. Isto Biologics focuses on helping patients heal faster through innovative bone regeneration solutions and cell-based therapies. The company’s flagship product offerings include the market-leading Magellan® Autologous Platelet Separator and bone growth products, including InQu® Bone Graft Extender & Substitute, and the Influx™ product family.

    For more information, visit istobiologics.com

    SOURCE Advanced Biologicals

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  • New treatment option for hand osteoarthritis identified

    New treatment option for hand osteoarthritis identified

    Osteoarthritis

    Relief could be on the way for people with painful hand osteoarthritis after a Monash University and Alfred Health-led study found that an affordable existing drug could help. Until now, no effective treatment existed.

    Published in The Lancetthe article examined methotrexate, a cheap, effective treatment for inflammatory joint diseases such as rheumatoid arthritis and psoriatic arthritis. It has been widely used in Australia and worldwide since the early 1980s.

    Researchers found that methotrexate reduced symptoms in people with hand osteoarthritis (OA). A weekly oral dose of 20 mg for six months had a moderate effect on reducing pain and stiffness in patients with symptomatic hand osteoarthritis.

    Hand osteoarthritis is a debilitating condition that causes pain and affects function, interfering with daily activities such as dressing and eating. It can significantly reduce the quality of life. About one in two women and one in four men will experience symptoms of hand osteoarthritis by the time they turn 85.

    About half have inflamed joints, which cause pain and are associated with significant joint damage. Despite the high prevalence and burden of disease, no effective medications exist.

    Senior author Professor Flavia Cicuttini, head of Monash University’s Musculoskeletal Unit and head of rheumatology at The Alfred, said the study identified the role of inflammation in hand osteoarthritis and the potential benefit of targeting patients experiencing painful hand osteoarthritis.

    “In our study, as in most osteoarthritis studies, pain improved in both the placebo and methotrexate groups in the first month or so,” Professor Cicuttini said.

    “However, pain levels remained the same in the placebo group but continued to decrease in the methotrexate group at three and six months, while still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group.

    “Based on these results, the use of methotrexate may be considered in the treatment of hand osteoarthritis with an inflammatory pattern. This provides physicians with a treatment option for this group, which tends to sustain more joint damage.”

    Professor Cicuttini said that in patients with hand osteoarthritis and inflammation, the effects of methotrexate were visible after about three months and it was very clear after six months whether it was working.

    At that point, patients and their doctors can decide whether to continue or stop. This is very similar to what we are currently doing with other forms of inflammatory arthritis.”

    Professor Flavia Cicuttini, Monash University

    The NHMRC-funded randomized, double-blind, placebo-controlled trial of 97 people assessed whether methotrexate 20 mg weekly reduced pain and improved function compared to placebo in patients with symptomatic hand osteoarthritis and synovitis (inflammation) for six months.

    Participants with hand osteoarthritis and MRI-detected inflammation were recruited from Melbourne, Hobart, Adelaide and Perth.

    Professor Cicuttini said the results could provide relief for people with hand osteoarthritis, which was particularly common in women during the menopause.

    “Further studies are needed to determine whether the effect of methotrexate lasts longer than six months, how long we should treat patients and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation,” she said.

    Professor Cicuttini now plans to conduct a follow-up study to answer these questions, specifically whether women who develop hand osteoarthritis around menopause and often have severe pain and joint damage can benefit.

    Source:

    Magazine reference:

    Wang, Y., et al. (2023) Methotrexate for the treatment of hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel group, double-blind, randomized, placebo-controlled trial. The Lancet. doi.org/10.1016/S0140-6736(23)01572-6.

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  • October 2023 Schedule — Bone Talk

    October 2023 Schedule — Bone Talk

    Bone+Buddies

    Bone Buddies Virtual Support Group: October 2023 schedule

    Join the Bone Buddies Online Virtual Support Group this October! Weekly sessions cover topics ranging from diet, exercise, treatment and more!

    • Saturday, October 7: Practice session at 10am CT; September healthy eating roundup at 11am CT

    • Wednesday, October 11 at 5:30 PM CT: Practice session

    • Saturday, October 14 at 10am CT: Bone Buddies presentation on stem cell therapy

    • Thursday, October 19 at 2:00 PM CT: Healthy Eating Session

    • Saturday, October 21: Practice session at 10am CT; Review of the stem cell presentation at 11am CT

    • Saturday, October 28: Practice session at 10am CT; Open Forum/Best Practices at 11am CT

    If you would like to join one of the sessions, please email Elaine Henderson at eshenderson214@gmail.com for the Zoom links. Feel free to share the meeting information with others who may be interested in attending!

    About Bone Buddies

    The Bone Buddies virtual online support group is open to everyone and typically meets on the second Saturday of every month at 10 a.m. Central Time on Zoom. On weeks when there is no support group meeting, the group usually meets on Zoom on all other Saturdays at 10 a.m. Central Time for free practice sessions.

    A discussion about healthy eating also takes place every third Thursday at 2:00 PM Central Time on Zoom. You can submit questions to a registered dietitian. She will then receive an overview of the questions. She will also answer your questions if you attend the meeting.

    Group meetings are a fun, relaxing way to learn new information about bone health and managing osteoporosis. It can also be a great way to meet others dealing with low bone density.

    Send an email to Elaine Henderson at eshenderson214@gmail.com for the Zoom links. Feel free to share the meeting information with others who may be interested in attending!

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  • Running Injuries with Scott Greenberg

    Running Injuries with Scott Greenberg

    In this podcast episode I discuss running injuries with Scott Greenberg and how you can get started with running athletes.

    Additionally, we discuss some of the newer techniques that Scott has used, including the use of blood flow restriction training in this population.

    Show notes

    Scott is a passionate sports medicine physician with more than 20 years of experience working with Gator athletes, professional athletes and University of Florida Olympians, with a focus on injury prevention, rehabilitation, sports testing, sports performance and running medicine. He is a proven leader and communicator with extensive business and management experience. Scott is the current Manager of Operations for UF Health’s Department of Rehabilitation and director of their Sports and Orthopedic Physical Therapy residency programs. He is a dynamic invited lecturer at the national and state levels. Scott is membership chairman of the American Academy of Sports Physical Therapy and previously served as chairman of the Running Special Interest Group.

    Social tools for COS:
    –Twitter: @runsaferunfast
    – Instagram: @scottgreenberg.dpt



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  • What are some common knee injuries that may require surgery?

    What are some common knee injuries that may require surgery?

    knee injuries Knee injuries are disruptive at best, but can lead to pain and damage in the long term if you don’t get the right treatment. Knowing when to have knee surgery can save you from chronic pain and complications. Learn about the most common types of knee injuries that require surgery to repair.

    A knee injury occurs when part of the knee is broken down due to overuse or trauma. These injuries are common in people of all ages, especially athletes. The reason these injuries are so common is that our knees are one of the most used joints in our entire body, making them susceptible to damage and blunt force during physical activity.

    Knee injuries that may require surgery

    Among the knee injuries that often require surgery, these are the most common:

    ACL tears

    ACL tears are very common in athletes, but they can happen to anyone during a sudden twist. This injury occurs when the anterior cruciate ligament (ACL) is torn. This is one of the ligaments that keep your knee stable and is often torn due to rapid changes of direction during sporting events.

    Fractions

    Fractures in the kneecap, medically referred to as the patella, are often caused by trauma. This can be the result of a fall or a direct impact on the bone.

    Torn meniscus

    The meniscus is the rubbery cartilage that sits between the tibia and the femur. It acts as a shock absorber for shock, so if it is torn it can lead to painful instability in the knee.

    Patellar tendonitis

    The patellar tendon is the tendon at the front of the knee and connects that shin bone to the quadriceps. Patellar tendonitis is common in skiers, runners and athletes due to the repetitive motions and stress of their sport.

    Bone and Joint Specialists Orthopedic and Spine Center features highly qualified physicians with extensive experience and skills in the field of bones and joints. The team here is ready to treat your knee injury with precision and care. If you are interested in working together to find a solution for your knee injury, call us at 219-795-3360 or schedule a consultation online.

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  • Which graft is better: patellar tendon or hamstring tendon for an ACL

    Which graft is better: patellar tendon or hamstring tendon for an ACL

    The two most common areas where a surgeon can take a graft to replace your ACL are the patellar tendon and the hamstring tendon. If this is new information to you, please refer to our previous blog on where the most common areas for an ACL graft are. Also keep in mind that the patellar tendon and hamstring tendon are the most common but not the only sources for an ACL graft.

    As you read the differences below, it is important to remember that your surgeon will choose the graft site for your ACL surgery. In some cases, due to a previous injury or surgery, one or more of the graft sites may not be feasible. The good news is that our ACL rehabilitation app, Curovate, has a protocol for hamstring tendon, patellar tendon, quadriceps tendon, allograft, and non-surgical ACL rehabilitation.

    Overall, the patellar tendon is the more stable ACL graft and has a lower re-injury rate compared to the hamstring tendon graft. Read the advantages and disadvantages of each graft site in the table below.

    Hamstring Graft Surgery (HT)Patellar tendon surgery, also called bone-patellar-bone surgery (BTB).
    1. The surgery takes longer and the tourniquette, a device used during surgery to restrict blood flow in the leg, stays on longer21. The knee is stiffer after surgery2
    2. The knee moves more freely forward and backward when tested with a KT-1000 Arthrometer machine2a device that measures the forward and backward movement of your lower leg compared to your thigh.2. Increased knee pain when kneeling on the ground3
    3. During a period of 15 years after surgery, more reinjury was reported.33. Over a period of 15 years after surgery, increased stiffness and difficulty straightening the knee were reported3.
    4. The need to perform another surgery to address problems with the first surgery is called revision surgery. The revision rate for hamstring operations increases by 0.65% within 1 year and by 4.45% within 5 years4.4. The 1-year revision rate is 0.16% and the 5-year revision rate is 3.03% for patellar tendon graft surgery4.
    5. Hamstring muscle strength reduced by 15%1. Muscle strength is the maximum force you can exert in the shortest possible time.
    6. Muscle strength decreases by 11% when stretching the knee2. Muscle strength is the amount of force a muscle can produce during maximum effort.
    7. There is increased instability in the knee when force is applied to it2. Instability is unwanted movement in a joint.

    Conclusion

    Based on the research reviewed in this blog, the patellar tendon has a lower re-injury rate and is more stable at 1 and 5 years after ACL surgery. However, the location of the graft should be discussed with your surgeon and ultimately the surgeon will decide the most suitable area for the ACL graft.

    If you have had ACL surgery and want clear daily, weekly and monthly guidance for your knee extension and daily exercises for your recovery, try our Cuorvate app. Curovate offers video-guided daily exercises, weekly range of motion goals and exercises, progress tracking, the ability to measure your knee and hip range of motion, and in-app chat with a physical therapist.

    If you need more tailored help during your ACL recovery, check out our Virtual Physiotherapy page to book your 1-on-1 video session with a physiotherapist.

    acl knee physical therapy 1080x1080 2
    Download it on Google Play

    Other recommended blogs

    References

    1. Ageberg, E., Roos, HP, Silbernagel, KG, Thomeé, R., Roos, EM, akademin, S., Gothenburg University. (2009). Knee extension and flexion muscle strength after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendon graft: a cross-sectional comparison 3 years after surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 17(2), 162-169.
    2. Beynnon, B.D., Johnson, R.J., Fleming, B.C., Kannus, P., Kaplan, M., Samani, J., and Per Renstrom. (2002). Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts A prospective, randomized study. The Journal of Bone & Joint Surgery, 84(9), 1503-1513.
    3. Leys, T., Salmon, L., Waller, A., Linklater, J., and Pinczewski, L. (2012). Clinical outcomes and risk factors for re-injury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. The American Journal of Sports Medicine, 40(3), 595-605.
    4. Rahr-Wagner, L., Thillemann, T.M., Pedersen, A.B., and Lind, M. (2014). Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the Danish Knee Ligament Reconstruction Register. The American Journal of Sports Medicine, 42(2), 278-284.

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  • 2024-2025 Orthopedic Research Fellowship @ Kettering Health

    Kettering Health is pleased to announce a partnership with Orthopedic Associates of SW Ohio and extend an invitation to ambitious individuals looking to improve their residency application and further develop their foundation in clinical research. Fourth-year medical students and graduate medical students (DO/MD applicants only) with an interest in orthopedic surgery are encouraged to apply for a funded clinical research fellowship in Dayton, Ohio.

    Position: Orthopedic researcher

    Duration: 12 months (July 2024 – July 2025)

    Place: Kettering Health Campuses, Dayton, OH

    Salary: 1099 Contract with Biweekly Allowance ($800/week or $1600/biweekly or $3200/month @ $38,400/year)

    The goal of the Orthopedic Surgery Residency Program at Kettering Health is to develop competent, caring, versatile, practice-ready orthopedic surgeons. We focus on providing high-quality evidence-based treatment; the orthopedic assistants are involved in the coordination and delivery of that care during the educational experience. Residents are instructed by a host of dedicated general and fellowship-trained orthopedic clinical faculty, many of whom practice with Orthopedic Associates of SW Ohio.

    The Orthopedic Research Fellow will work closely with clinical faculty and orthopedic residents as an Orthopedic Research Fellow. In all aspects of the orthopedic specialty, research fellows will be pioneers in the coordination and conduct of clinical orthopedic research examining a broad scope of general and subspecialty orthopedic surgery. The research fellow will have the opportunity to work with clinical faculty whose interests are similar to their own, as well as a wide range of sub-specialty orthopedic surgeons. Previous experience in academic or clinical research, particularly with previous peer-reviewed publications, is preferred but not required to apply. Consider submitting writing samples if this applies to your experience with your application. In addition to the experience gained in the field of clinical orthopedic research, the orthopedic researcher can expect to enhance their residency application with robust exposure to clinical orthopedics and orthopedic surgery, further develop research skills that will be important in their medical career, networks with orthopedic faculty and residents and may be able to demonstrate their own technical skills. The experience will be invaluable as they pursue a career in orthopedic surgery.

    Responsibilities of research staff:

    – Collaborate with industry to establish cadaver workshops for orthopedic implants and research

    – Ambassador of Virtual Reality Training with Orthopedic Resident and Guidance with PrecisionOS

    – Collaborate with orthopedic residents and faculty by organizing quarterly research meetings and overseeing all department clinical research projects.

    – Create and evaluate clinical research questions, coordinate relevant literature searches and plan clinical trials

    – Preparation of manuscripts, posters and oral presentations related to orthopedic clinical research

    – Attend all relevant conferences, including the preparation of research abstracts, posters and presentations (registration and costs covered for activities related to research presentations at academic and clinical meetings across the country)

    – Coordinating and managing orthopedic medicine interns during the summer period

    – Educate patients and enroll them in research studies (may include calling and coordinating follow-up with patients).

    – Some examinations require participation in a clinic and physical examination, as well as the use of specific equipment.

    – Collaborate with the hospital clinical research team, EMR clarity team and IRB to ensure appropriate research oversight/integrity and patient safety.

    – Collect, organize and analyze clinical data

    – Maintain and develop relationships with industry partners to support research efforts

    – Working closely with Dr. Brent Bamberger, orthopedic surgery program director and clinical orthopedic faculty.

    Registration procedure:

    – Interested applicants should apply to the Orthopedic Surgery Residency Program Coordinator, Machele Maus (This email address is being protected from spambots. You need JavaScript enabled to view it.), with the following:

    – Declaration of interest (maximum one paragraph, 250 words or less)

    – CV (including USMLE/COMLEX 1 and 2 scores)

    – Read subject line: Orthopedic Research Fellowship Application – [Full Name]

    – Writing sample

    – Two letters of recommendation

    Talk to our 2022-2023 Research Fellow: Madison Messmer: This email address is being protected from spambots. You need JavaScript enabled to view it.

    https://secure.ketteringhealth.org/grandviewmeded/residency/orthopedic-surgery.cfm

    Questions about the position or the application process can be directed via email to Machele Maus or Madison Messmer.

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  • Save Our Bones Bulletin: Newly Discovered Genetic Pathway for Bone Formation; 3D scans can predict the risk of fractures; Evolutionary biology and bone regeneration

    Save Our Bones Bulletin: Newly Discovered Genetic Pathway for Bone Formation; 3D scans can predict the risk of fractures; Evolutionary biology and bone regeneration

    New research enriches our understanding of bone function and provides insight into maintaining its quality and strength. This bulletin delves into three new studies that point the way to the future of bone health.

    First we’ll look at a report on the genetics of bone loss. Scientists have identified a protein that plays an important role in regulating the genes that control bone regeneration.

    Next, you’ll learn about a group of Finnish scientists who are using 3D modeling to revolutionize the way we assess bone health and predict fracture risk.

    Finally, we look at a report from the PhyloBone project. The project’s leaders are using techniques from evolutionary biology to identify and study proteins in the bone matrix that may have the power to regulate bone regeneration.

    Study focuses on genes for another new osteoporosis drug

    A new study published in The FASEB Journal linked the expression of a certain gene to reduced bone loss in postmenopausal women.

    Researchers have identified a gene that regulates the high mobility group AT-hook 1 (Hmga1) protein. This protein regulates the expression of genes that convert bone marrow-derived mesenchymal stem cells (BMSCs) into cells that build new bone.

    Relevant excerpt

    “Tests on rats showed an increase in Hmga1 expression during bone formation, but a decrease when the rats underwent ovariectomy, which simulated the conditions of menopause. Introducing more Hmga1 to these rats led to a remarkable recovery in bone resorption.

    Yihe Hu, PhD, from Zhejiang University in China, the lead author, noted: “Our study showed that Hmga1 prevents bone loss by promoting the osteogenic differentiation of BMSCs in osteoporosis rats, suggesting that Hmga1 could be an important therapeutic target for osteoporosis. are.”1

    Unfortunately, when Dr. Yihe Hu calls “therapeutic target,” he is referring to a potential new osteoporosis drug that would be developed, marketed and sold by Big Pharma. Nevertheless, new information about the genetic pathways that lead to bone formation is welcome, as it could also prove to have non-pharmaceutical applications.

    Short content

    A new study identified a genetic pathway that increases bone formation. Researchers discovered that a protein called Hmga1 regulates the expression of genes that instruct bone marrow-derived mesenchymal stem cells (BMSCs) to become bone-building cells. Increasing Hmga1 in rats with induced bone loss led to restoration of bone loss.

    3D modeling can provide more accurate assessments of bone health

    Researchers in Sweden have developed a method to create a 3D model of a patient’s bones based on information from 2D X-ray images.

    The report, published in the Journal of Bone and Mineral Research, concluded that they were able to identify thousands of patients at risk of fractures who would be overlooked by current assessment methods.

    Relevant excerpt

    Lorenzo Grassi, associate professor of biomedical engineering at Lund University, was responsible for evaluating the method. He explains that the new method uses 2D X-ray images of bone density measurements to produce 3D models of the femur.

    “The shift from 2D to 3D is performed using a computer-simulated template that describes how bone geometry and density varies in the population.”

    The 3D model of the femur can be used to simulate various situations and scenarios that could have an influence, for example in the event of a fall. Information that makes it easier to estimate the risk of fractures.”2

    Grassi developed 3D simulations using data from 400 study participants who had previously undergone X-ray-based bone mineral density assessments. When he compared the accuracy of each method in predicting which patients would break their hip over the next decade, the 3D simulation provided a more accurate prediction.

    This new method could provide patients with a more comprehensive understanding of their bone health compared to DXA scans. However, because the modeling uses the information from the 2D X-ray, it would complement rather than replace DXA technology.

    Short content

    Researchers in Sweden developed a method for creating a 3D model of a patient’s bone from 2D DXA scans. Their 3D model proved to be more effective than DXA scans in predicting fractures.

    Evolutionary biology provides new data on bone regeneration

    Scientists in Finland have discovered hundreds of non-collagenous proteins in the bone matrix that may play a role in bone formation and regeneration.

    Their research, conducted as part of the PhyloBone project, uses the principles of evolutionary biology to identify molecular mechanisms that maintain bone health.

    Relevant excerpt

    “Since the bone matrix, which constitutes the majority of bone mass, plays both structural and regulatory roles, non-collagenous organic components play a key function in bone regulation. For example, it is known that few non-collagenous proteins, such as osteopontin, play an important role in bone formation. However, the bone matrix consists of hundreds of proteins that are still poorly understood and that may play an important regulatory role in bone regeneration and osteoporosis.

    “Our project has identified 255 proteins in 30 species of vertebrates. The aim of the project is to serve as a valuable resource for further research in bone regeneration, osteoporosis and related areas,” says Dr. Puigbò, co-principal investigator of the PhyloBone project.”3

    The project will continue to conduct studies to determine the regulatory role of bone proteins. They have shared their data on these understudied proteins with the scientific community, with the aim of encouraging further research and new discoveries in the field of bone matrix proteins.

    Hopefully, this research will lead to new knowledge on how bone regeneration can be supported and enhanced through behavioral and lifestyle changes. However, it may also stimulate the development of new drugs against osteoporosis.

    Short content

    Finnish scientists have identified hundreds of proteins in the bone matrix that may play a role in bone formation and regeneration. They have made their data on these underdeveloped proteins available to the scientific community, which will hopefully lead to more research and new discoveries.

    What this means for you

    New research offers new insights and information. We can apply this knowledge in our pursuit of stronger, healthier bones.

    The connection between the latest scientific research and an informed, drug-free approach to bone health is at the heart of the Osteoporosis Reversal Program. The Save Institute uses scientific research published in mainstream journals to ensure its drug-free approach is the safest and most effective method for reversing and preventing osteoporosis.

    As science advances, it increasingly emphasizes the importance of diet, exercise and lifestyle as the key tools for maintaining healthy bones and ensuring a robust, long and independent life.

    References

    1 https://www.revyuh.com/news/lifestyle/health-and-fitness/how-to-avoid-the-risk-of-osteoporosis-study-suggests-a-new-way-to-fight-brittle- bone disease/

    2 https://www.news-medical.net/news/20230913/New-method-could-improve-prediction-of-osteoporotic-fracture-risk.aspx

    3 https://medicalxpress.com/news/2023-08-bone-regeneration-osteoporosis-evolution.html



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  • Management of complex regional pain syndrome (CRPS)

    Management of complex regional pain syndrome (CRPS)

    By Russell Seemler, South Chandler Clinic

    Living with Complex Regional Pain Syndrome (CRPS) can be a challenging and disabling experience. However, physiotherapy can tackle CRPS. Physiotherapy is an essential part of the overall treatment plan for CRPS and is usually tailored to the specific needs of the individual and the severity of their condition.

    What is complex regional pain syndrome?

    Complex regional pain syndrome (CRPS) is considered by some to be the most painful medical condition in the world. CRPS is considered an injury or malfunction of the peripheral and central nervous systems, manifesting as extreme pain and other physiological symptoms rolled into one. or more limbs of the body. These symptoms can last for months to years and, if not treated, can become permanent.

    Diagram of complex pain syndrome.

    The causes and triggers of complex regional pain syndrome

    The central nervous system consists of the brain and spinal cord. The peripheral nervous system consists of all other nerves in the body, minus the brain and spinal cord. The peripheral nerves deliver signals to and from the brain and spinal cord to different parts of the body. An injury to one of the peripheral nerves is believed to be the initial onset of CRPS. An injury such as a broken bone, a strain or sprain, a burn, a cut, surgery or something as minor as a needle stick can also be the first onset of CRPS.

    In some cases, infections or blood vessel problems can also trigger the cascade to CRPI. Once an initial injury occurs, signals from the peripheral nerves to the brain tell a person that he or she has been injured. The brain then sends signals to different parts of the body telling them to start releasing chemicals that will trigger many physiological responses in the body necessary to initiate the healing process. One of the first things a body does to protect and heal itself is send out chemicals and nerve signals that cause swelling, increased blood flow to the injured area, and pain. These are normal parts of the healing process.

    Signals from the brain

    With CRPS, a major problem is that the signals from the brain that cause pain, swelling, and increased blood flow never go away. Even after the injury has completely healed. The brain then tricks the body into believing it is still injured, even though it is not. As this continues, the signals can become stronger and stronger to the point where constant, extreme pain lasts for months to years and even permanently.

    There is no clear reason why someone who breaks their arm, for example, gets CRPS, while many others who break their arm do not. However, they have discovered that CRPS is more common in women than in men and that the risk is greatest around the age of 40. However, it can occur in either sex at any age.

    Treatment of complex regional pain syndrome.

    The symptoms of complex regional pain syndrome

    Signs and symptoms of CRPS can vary slightly from person to person depending on what stage of the condition they are in. Some patients may have all the symptoms mentioned or just some. Also, symptoms may change over time depending on how long ago CRPS started.

    • Extreme pain – burning, tingling and crushing/squeezing pain
    • Changes in skin color – the skin may become more pink, red, purple or blue compared to the other limb
    • Changes in hair or nail growth in the extremities – brittle nails and increased or decreased hair growth, depending on the person
    • Skin changes – the skin becomes shiny and thin
    • Sweating changes – excessive sweating or less sweating compared to the other limb
    • Skin temperature – although people feel like their leg is burning, when they touch the limb it is very cold.
    • Increased joint stiffness and reduced movement in the joint
    • Increased muscle tightness and spasms in the limbs
    • Osteoporosis – shown on x-ray
    • Allodynia – severe sensitivity to normal skin touch, as if being touched after a sunburn

    As the condition progresses and lasts longer, people may also experience:

    • Atrophy of muscles in the limbs due to reduced use
    • Short-term memory problems
    • Difficulty coming up with words while speaking
    • Irritability
    • Depression
    • Increased swelling in the extremities
    • Sensitivity to noise and vibration

    Research has also shown that people in pain have difficulty distinguishing between the injured right and left legs when looking at a photo of the same body part. Many with CRPS have the same problem, as they cannot determine if it is a right or left hand or leg when they look at a photo.

    Treatment for complex regional pain syndrome

    There are many forms of treatment for CRPS, although treatment will be individual for each person depending on their signs and symptoms. What works for one CRPS patient may not work for another, and a combination of treatments may also be necessary.

    • Physiotherapy

    • Your physical therapist will work with you to develop a treatment plan to help you manage your condition. Because the symptoms of CRPS vary, the approach to care will also vary. CRPS treatment is based on how regular and severe your symptoms are. More importantly, physical therapy is focused on helping you achieve your personal goals.

    • Medicines

      • Bisphosphonates – to prevent bone reabsorption, help with osteoporosis
      • Corticosteroids – to prevent inflammation and swelling
      • Botox – for muscle spasms and tightness
      • Drugs for nerve pain – Gabapentin, Amitriptyline, etc.
      • Over-the-counter medications for pain/inflammation – ibuprofen, aspirin, naproxen
      • Topical creams for pain – usually lidocaine

    • Procedural**

      • Sympathetic nerve blocks – they have been shown to help in the short term, but long term benefits are usually not seen.n
      • Spinal cord stimulator – a surgical procedure in which a stimulator is placed directly into the spinal column to control the signals traveling from the brain to the body using electrical stimulation.
      • Surgical sympathectomy – A procedure in which sympathetic nerves that travel from the brain to the affected limb are surgically severed to prevent pain signals from reaching the limb. This is a controversial operation because some doctors think it causes CRP.S

    • Psychotherapy

      • Many people with CRPS develop anxiety, depression and even PTSD. Seeing a psychiatrist or psychologist for help is a highly encouraged treatment strategy.

    • Eating pattern

      • Maintaining a well-balanced diet has been shown to reduce symptoms of CRPS

    • Sleep

      • Maintaining a consistent sleep-wake cycle has been shown to reduce symptoms of CRPS. Because the body regulates hormones such as cortisol, it can worsen pain and sympathetic nerve symptoms.

    *These medications are still in the research phase and are considered experimental
    **It is recommended to try non-procedural treatments before procedural treatments due to reduced risks and potential complications.

    Therapist helping patient with complex pain syndrome.

    How physiotherapy can improve complex regional pain syndrome

    Physical therapy is one of the best treatments for CRPS because of its ability to preserve limb function. Physical therapy will focus primarily on maintaining limb function by using stretches and exercises to keep the muscles loose and strong and the joint moving. In addition, PT can also help with pain relief and edema/swelling. There are many types of physical therapy treatments that have been shown to be helpful.

    • Desensitization therapy – a treatment aimed at reducing allodynia

      • This treatment involves lightly stroking various types of textured objects over the affected or unaffected limb to retrain the pain receptors in the area. The purpose is to tell the pain receptors that light touch should not cause pain in a limb. And to stop sending pain signals to the brain.

    • Graded Motor Imagery (GMI) – a treatment that focuses on retraining the distinction between the right and left limbs and restoring function while reducing pain to the limb

      • This treatment style uses images of right and left arms or legs in different positions.
      • In phase one, the patient only needs to determine whether a limb is a right or left limb.b
      • For phase two, the patient only needs to remember to move the same-sided limb into the correct position; no movement takes place. This turns on the premotor cortex areas of the brain.
      • During phase three, the patient moves the limb on the same side to the position shown in the image.
      • The goal is for all phases to be performed pain-free. And that the next phase will only start if the previous phase is performed pain-free and with 100% accuracy

    • Mirror Box Therapy – This treatment is used to restore function and reduce pain in the affected limb

      • The affected limb is placed in a box that is not visible to the patient
      • A mirror attached to the box is aimed at the unaffected limb. This causes the patient to see a mirror image of the unaffected limb.
      • The mirror image visually tricks the brain into believing it is the affected limb.
      • The patient then performs exercises, stretches, desensitization therapy, graded motor imagery, etc. with the unaffected limb. However, they look in the mirror all the time and trick their brain into believing that the affected limb is performing all movements pain-free.

    • Edema massage/edema taping

      • This treatment focuses on controlling swelling and edema in the area
      • Various massage and taping techniques promote swelling and edema to leave an area. This usually reduces pain, restores normal blood flow, and increases mobility and strength in an area

    CRPS is a serious and extreme pain condition that can be disabling. Physical therapy treatments are the best strategies to maintain function and relieve pain.

    If you think you have CRPS based on the information above, contact your doctor immediately. The sooner a diagnosis is made, the better your chances of going into remission for CRPS. Patients with CRPS should adhere to their physical therapy program. Care and communication with their care team will ensure that the treatment plan is optimized for their specific needs and goals.

    CRPS can be challenging to treat, but with a comprehensive approach that includes physical therapy, individuals can experience improved function and less pain. If you are ready to see a physical therapist, make an appointment with us.

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  • Game-Changers for Bone Health and Aging: The Power of Vitamin E, Tocotrienols, and Geranylgeraniol with Dr. Barrie Tan + BoneCoach™ – BoneCoach™

    Game-Changers for Bone Health and Aging: The Power of Vitamin E, Tocotrienols, and Geranylgeraniol with Dr. Barrie Tan + BoneCoach™ – BoneCoach™

    Ready to hidden power of age-old nutrients proven that it benefits your health and your bones?

    Do you want to learn why people with osteopenia, osteoporosis and… those affected by bisphosphonates may benefit of what is in the annatto plant?

    Interested in breakthrough compounds that many consider “aging game changers” for heart, liver, bones, blood sugar, oxidative stress and much more?

    Search no further!

    I had the privilege of working with Dr. Barrie Tan, a leading scientist and pioneer specializing in vitamin E research. Dr. Tan shared the revolutionary science of tocotrienols and geranylgeraniol and their crucial role in this intervention and prevention of osteoporosis.

    Episode timeline

    0:00 – Episode begins

    2:24 – Meet our guest, Dr. Barrie Tan

    4:03 – Dr. Tan’s discovery of the annatto plant and his motivation for studying it
    7:48 – An introduction to tocotrienols, geranylgeraniol and their differences

    9:48 – Understanding vitamin E and the meaning of tocopherol

    19:01 – The function of geranylgeraniol

    20:53 – Benefits of tocotrienols for osteoporosis and bone health

    30:31 – The reason behind Dr.’s specific research Barrie Tan

    32:17 – The role of geranylgeraniol in MK4 synthesis and its importance for bone health

    39:19 – Benefits of MK4: Kidney stones, calcification of the arteries and dementia

    41:34 – Discussion on preclinical and animal studies on geranylgeraniol, its effects on bone turnover, stiffness and its benefits for people taking bisphosphonates

    47:52 – Overview of 20 clinical studies on tocotrienols and their various benefits

    57:02 – Summary of key studies and results specifically focused on tocotrienols

    1:00:17 – Dr. Tan elaborates on recent studies, insights about statins and other crucial findings

    1:06:35 – Guidance on where to find the exact dosages and amounts of the nutrients and ingredients discussed

    Sources mentioned

    **Show notes @ https://bonecoach.com/drbarrietan-vitamine

    Below you will find resources from Dr. Barrie Tan!

    >> CLICK HERE TO SAVE 10% ON ANNATROL BONE SUPPORT

    >> Click here to use the code “BONECOACH” for your copy of Dr.’s Vitamin E book. Barrie Tan!

    What can you do to support your bone health and this podcast?

    1. Press the “Subscribe” button on your respective podcast player (i.e. Apple, Google, Spotify, Stitcher, iHeart Radio and TuneIn). Never miss an episode that can help improve your bone health.

    2. Leave a review. The more positive ratings and reviews and the more subscribers we have, the more people can find us and get the answers to the questions they need. Thank you! 🙂

    3. Tell a friend about The Bone Coach Podcast or share via text, email or social. Do you know of a Facebook group where people can benefit from this information? Feel free to hit any of the share buttons below.

    About Dr.Barrie Tan:

    Dr. Primarily a scientist with a PhD in chemistry/biochemistry, Barrie Tan was previously an assistant professor at the University of Massachusetts Amherst (Chemistry, Food Sciences and Nutrition). For the past 35 years, Barrie has immersed himself in the world of vitamin E and is considered one of the world’s foremost experts, credited with commercializing tocotrienol in three major natural sources: palm, rice and annatto. His first discoveries involved palm and rice, but due to their high tocopherol content they also lacked potency. Barrie continued his research and was soon rewarded when he found the best in class tocotrienol in the annatto plant! Barrie’s relationship with Annatto spans more than twenty years and multiple clinical trials in chronic diseases. He was rewarded again when he discovered geranylgeraniol, an endogenous nutrient important for promoting healthy aging.

    Medical disclaimer

    The information shared above is for informational purposes only and is not intended as medical or nutritional therapy advice; it does not diagnose, treat or cure any disease or condition; it should not be used as a substitute or substitute for medical advice from physicians and trained medical professionals. If you are under the care of a healthcare professional or are currently taking prescription medications, you should discuss any changes in your diet and lifestyle or possible use of nutritional supplements with your doctor. You should not stop prescribed medications without first consulting your doctor.

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