Join us as we dive deep into the fascinating world of the biotensegrity model and its transformative implications for non-surgical orthopedics. In this enlightening exploration, we uncover the revolutionary understanding of the human body’s structure and function.
At the core of this episode lies the concept of biotensegrity, a paradigm-shifting approach that views the body as a dynamic, interconnected system of tension and compression. Unlike traditional biomechanical models, biotensegrity emphasizes the importance of tensegrity – the balance between tension and compression – in maintaining optimal health and movement.
Our expert guests will guide us through the principles of biotensegrity and its profound impact on non-surgical orthopedics. By understanding the body’s innate architecture and resilience, we unlock new avenues for healing and rehabilitation without invasive procedures.
Through captivating discussions, case studies, and practical insights, we’ll uncover how embracing the biotensegrity model can revolutionize our approach to musculoskeletal health. From addressing chronic pain to optimizing performance, this episode promises to empower viewers with knowledge and tools to enhance their well-being.
Don’t miss this enlightening journey into the world of biotensegrity and non-surgical orthopedics – it’s time to unlock the secrets of movement and vitality. Tune in to Wellness Warriors and embark on a path toward holistic health and wellness.
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all right well we’re back for another episode of Wellness warriors with Terren our non-surgical Orthopedic Specialist which we’re going to learn a lot more about today and then Shelby myself working over in more of the functional medicine world so welcome back yeah welcome uh it’s going to be an exciting day we get to finally talk about the biot Integrity model um I know that Shel is super excited she didn’t I didn’t Google it I didn’t I’ve been waiting weeks to find out about this find out what this little little object is what it means and what it’s for so um and that could be a great kind of I mean not segue but great way to start can we talk about this first because I really want you’re really excited about this little this little thing okay so so bioten segr so it’s kind of a different way of looking at how the body kind of is related to itself versus kind of true biomechanics which can we we think about biomechanics and how the body is moving together and this is a little bit more of thinking about it like a robot or a machine and more of a body and what a body can do so kind of one of the things you think about so we have bones so that’s kind of what the the the wood components in here are kind of depicting our our bones and structures but if we think about our body in terms of Bones and kind of a framework of Bones if we were to just put those up like they’re not going to stand up they’re not going to move they’re not going to be able to to do things in space and manipulate them the way that we want and everything is interrelated with that so say you have like a plastic figurine like you stand that thing up like it’s kind of stacked up on a framework but you have to have it perfectly aligned so it stands up so it doesn’t fall if the feeder is a little unbalanced all of a sudden it tips over um so this is a model kind of showing how we have a a combination of compression and tension forces holding everything together so these guys like this one doesn’t have anything supporting it nothing holding it up like a framework holding it up but it’s supported by the tension um so now what happens when we think about a body this thing can move and we can move different parts of it so I touch it here and pull a lever here but we’re actually moving over there as well sure so now the idea is and this is where it kind of comes into my world of of what’s happening and what’s causing breakdown yeah so I might be moving something over here but something over there is now moving too so this is like all of us think about compensation like my my knee hurts on the left so I think that might be why my back hurts like every time someone says I think that’s why it’s like yeah that’s probably why at least it’s a part of why I mean it’s it’s usually not like 100% like you have this knee injury so and that is going to cause your back to hurt or that is going to cause your shoulder to hurt or something like that but if we look at it and we know that we push here and it moves over to the other side um or we pull over here and it moves that whole structure so everything is impacted by one piece moving so again you you think about a shoulder moving through space and we have all of these different tensions and and movements all working together to try to make it happen and that is changing your balance both from your low back to your stance I mean we think about it when we’re like how do you throw a ball lean back you throw into it you get your whole body into it to get more power through it so it all makes sense but we just don’t really think about it this way so now when I see someone in kind of the the nonorthopedic or or non-orthopedic nonsurgical Orthopedic world or Orthopedic world we think what is going on and a lot of times someone comes in it’s like my shoulder hurts it’s like well yeah so we’re going to focus on what might be going on on the shoulder and what what might be breaking on breaking down there to cause your symptoms but what else is going on in the rest of the network um so if something again shoulder is hurting here what’s going on in the low back um a lot of times I’ll show people a picture of the low back and how we have or the back in general and we have this fibrous Network that connects everything so it’s kind of like an exoskeleton around everything too so now again that little tissue is pulled over here and that’s going to affect the whole body so instead of just focusing on the shoulder we can focus on other parts of the body to get that to feel better as well so in the orthopedic world you’re not just looking at okay single joint someone comes in my shoulder hurts you’re really looking at what else is going on that you need to address exactly and yeah and it’s it’s a difficult way to pull around because of course the shoulder is the thing that brought you in so that’s what I want to make feel better that’s what I want you to leave here saying yeah my shoulder was better after doing that and that’s where the the idea of just going into Orthopedics and fixing that and then going on we’re going to continue to break down and have other problems again and that’s why I tell so many of my patients that we can’t just we can’t just fix this and almost nothing that you do in the medical world do you fix right most often you’re you’re manipulating you’re managing and you’re figuring out ways to manage it in the future and that’s where so many of my patients it’s like so physical therapy is probably one of the number one things that they can do because they can take that with them forever like I can do things with a needle and I can make tissue calm down and I can make you feel better immediately um or relatively immediately um with injections that I do but I can’t you’re not going to have them in your back pocket every day when you have this breakdown so if we’re learning things and that’s kind of a great kind of segue into one of the first steps of non-surgical Orthopedics is physical therapy okay is that you will be learning how to move kind of learning how all of this impacts itself so and again one so so knees are probably one of the most common things that we see and so they come in with a knee pain or a knee problem and one of the first things we recommend is doing physical therapy a lot of places they probably either haven’t done physical therapy before or there’s certain treatments that we do that need physical therapy for the insurance company to cover further treatments and so they’ll have gone to a physical therapist and the physical therapist says well I know what you need you just need to do these kind you need to do this for four weeks and here’s your set of exercises and then you can go ahead and get that other treatment um many times that’ll fail because we’re again we’re not treating the problem we’re just I’m giving you something to make it feel a little bit better but you learning how to do the physical therapy pieces and learning how what you’re doing around the knees is actually affecting what’s going on in the rest of the body is going to be a huge benefit to you the other thing I tell people about physical therapy is that we’ve gotten to this point we’re broken down most of the time it’s not an injury I mean there’s a lot of injuries that have happened at some point in the in the road but there’s something that you do or have done and probably continued to do chronically that is actually breaking you down like we think about this model and something is a little bit off and if you’re not aware of that and most of us aren’t like we don’t our body just starts to make these little adjustments I mean numerous times have I seen people come back from physical therapy and they’re like oh yeah they pointed out that this isn’t working quite right it’s like well yeah and that’s why you’re breaking down so it’s not just physical activity that a physical therapist has you do they are breaking down your physical movements to make sure that we can help support what was broken down and help you maintain it in the long run and again and most of us will stop doing our Physical Therapy once our pain goes away right because it’s like well I don’t have pain we and one of the we don’t have that reminder we don’t have the thing that we think about so we don’t have the pain to say you need to do your therapy um you had someone tell you that you should do it for a while but that always lapses and that’s another good reason to have some go to a physical therapist compared to just do some physical physical therapy exercis that we’ve shown on a piece of paper because you have that extrinsic motivation someone is going to you have someone that you’re going to check in with and say did you do your exercises are you doing them or not and most of us like we either we don’t want to lie most people um and and we want to make other people happy and not that it only makes us happy to hear that you’re doing your exercises but we want you to be better and that’s the best way to make you better is to teach you how to move better so you are are breaking down Less in the future I think that’s such an important point because I see and I don’t know a lot of patients you know I’ll say oh have you done any PT they’ll bring up pain in their functional Med visit what what have you done you know have you done PT oh I’ve tried that it it didn’t work and I think sometimes the part is they forget it worked while they were doing it you know and it’s probably not a lifelong like you do this four weeks at PT you’re good for life because if you’re not continually doing it you’re probably going back to those bad compensatory mechanisms right but I think that’s a good point how do you address that if somebody’s like done PT it it just doesn’t work yeah part of it is I just make sure that they they’ve understood that piece of it and sometimes I will remind them because there’s frequently that I’ll get patients coming back like this was bothering me a couple years ago and you know it was doing well you did that injection and like all of a sudden like I look better and let’s just do that again it’s like well like think about everything else we were doing at that time too like we didn’t just give you an injection and you got better there were all of these things that kind of led up to you feeling better so a lot of times I will bring that up or I’ll say I’ll ask if they’re still doing their exercises and all kind of just that same conversation that we just had about how the body moves and how we’ve gotten to this broken down point and we need to make sure that we are and some of it is just mindfulness of how we’re moving I mean many times we kind of we forget about it we start to hike our shoulders up as a to give our shoulder more range of motion it’s like yeah I can lift my shoulder up and they you see them raise their shoulder way up before they’re actually getting their arm up and yeah that gives you a whole lot more motion but it’s not coming from your shoulder it’s a compensatory movement that isn’t really shoulder and now that just fatigues everything everything else in the network and starts breaking down now we’re pulling here which is starting to pull up on the neck and causing neck breakdown as well as shoulder breakdown okay and all that so um yeah just try to to talk with them and kind of say the number one I get is that I am active like I am doing things it’s like I know you’re doing things and that’s and you’re broken down and so so let’s figure out how that happened and it can be even someone who who’s very gym Savvy I mean even like myself like I know every exercise not every exercise I know many of the exercises I should do for different things but I break down too and I compensate I move things because our bodies are just great at finding efficient movement so if we find that efficient Movement we go to it and then we start breaking down in other ways but if you have someone there to like to catch it and tell you you’re doing that yeah and then you think about it and the next time you’re doing that exercise now you’re aware of it so it could be as simple as climbing stairs how is your body arranged when you’re climbing stairs what kind of accommodations can you use to get up those stairs or a ladder or something like that yeah so just try to yeah break it down kind to make it make sense and have them think about it in a new way that maybe they hadn’t before and some people are still very resistant they’re like no and sometimes it makes them hurt more and then that’s another thing where I can usually come in where we and definitely at reu I don’t just like send you off to PT and then we’ll see you back in six weeks every now and then that happens because it’s like it’s a very like they’re not in a lot of pain it’s just something is a little broken down they’re like I know something’s not right I want to do something to help it feel better in the future so yeah we will talk about that um let’s get you into PT and we’ll see you back and see if it’s gotten better and then we’ll go through some people are coming in and they have so much pain they go to PT and they’re in so much pain and they don’t get any better where we can do some injections along the way so they’re feeling better while they’re doing physical therapy learning these new things getting their body to compensate more or not compensate but move more efficiently in the way that need to and then they can continue to do pt so that’ll be another piece that like let’s if it bothered you too much to do it let’s try to back it up and make your body feel better while you’re doing physical therapy so we can see positive responses the end awesome well I think that’s great do you guys use braces too a lot okay okay and that’s and even just yesterday I had a conversation with the patient she was wondering like what can I do this was knee arthritis again probably one of the most common things that we see is arthritis is within the knees what can I do to slow down that arthritis and that’s I mean a concept that many people wonder and they’re like I wish that there was a cure technically there are cures for arthritis it’s just it’s moving right being aware of these breakdowns treating it before becomes big and broken down um and trying to help us out but again like last week we talked about medicine 2.0 and 3.0 if we’re just fixing what’s broken it’s harder to keep things functioning well where if we’re maintaining it early and making sure that we’re doing proper movements early we’re going to help so to get back to the orthotic question or braces um for knees a lot of times knees will kind of break down unevenly and I have this this is my model I use this all the time in patience most of the time we see one compartment breaking down so the knee has an inside compartment and an outside compartment as well as one underneath the kneecap most people um are going to break down to the medial side to the inside of the joint so when they’re walking that side is wearing and tearing a lot more than the outside is sure so we’re kind of walking like this every step that we take there’s a little bit more gravity pushing on that piece so we can put you in an O brace that opens you up a little bit so it actually can elever that joint so it’s less pressure on that medial component and a little bit more on the lateral component but then it just evens it out and it it’s a way of kind of delaying it or taking it back but again most people don’t like wearing braces so they’re like did you get that brace yeah do you wear it not really yeah so true and and all of us are kind of like that like we like our bodies to move free of resistance but sometimes that resistance is also positive because it it limits excessive movement it it limits our bodies kind of and this would be like a back brace like a lot of times it’s like well I can’t lift as well or I can’t bend as well it’s like that’s part of the issue it’s like you’re probably bending improperly and now we put this brace on you to keep you in a better alignment sure and then you’re not going to break down as much and we can actually delay that process of breakdown give you that support when we need it and most braces Believe It or Not don’t make you weaker and I think this depends too on how you wear it and how you’re educated on wearing it so i’ say a back brace is a big one that they’ll there’s studies that’ll show weakening of the core musculature if you’re wearing this brace but I never tell people to wear it all the time this isn’t something you should have on all the time this is something you should have on when you’re doing bigger activities when you are lifting when you’re outside going for walks or gardening or or yard work or housework things like that where you’re going to be bending stooping lifting where you might kind of put that spine into a vulnerable position sure um but I also tell people don’t just rely on the brace don’t lean into the brace and just kind of let your body kind of slump into the brace that you want to like when I wear it it makes me feel more aware of my body positioning so it’s like I’m going to actually activate my core a little bit more because you you can feel that it’s a bio feedback like you you slouch into it and you can feel that pressure on the on the back race so then you kind of lean out of it um same thing like this type of a knee brace isn’t going to make your knee weaker um and again we’re going to be we want you to be doing physical therapy exercises so you can strengthen everything else around the joint that joint is going to be extra supported so it’s not breaking down as much you’re not having as much pain you can do more painfree movements you can overall Get Better by using it in a smart Manner and sometimes I mean arthritis can be so Progressive that you do need a constant brace and sometimes it’s better to have a brace on the outside than doing a major surgery and now your kind of brace is on the inside side um kind of the same thing less less reliant on you putting it on and using it it’s always there um but sometimes the cost to get there is significantly greater than not having a surgery sure that kind of probably brings into kind of like the non-surgical versus surgical like that is the technically the big change is going toward surgery and I mean you you talk to a lot of surgeons and they are going to recommend conservative care first I feel many of them don’t give it as much of a solid effort because what they have to rely on afterwards they have a little bit more control with and most humans we like to have that control we like to be able to do something where if you’re just relying on a patient doing conservative things on their own and they’ve maybe tried a cortisone injection and it maybe got better for a little bit they can do something they can kind of quote unquote fix it and most often it’s not necessarily a fix they’re just they’re creating a change they’re going to cut something open there’s going to be soft tissue injury there’s going to be the body learning how to compensate Now for Something New um and there’s certain things where we need to do surgery I mean if you have a big giant piece of Chunk in your knee right like you can’t if that’s in the way of your movement then you need to get rid of that if it’s something that’s just broken down and every now and then causes you pain or maybe even constantly causes you pain but is not actually getting in the way of movement or you’re not completely unstable because of it there’s a lot of things that we can do to help you feel better like the bracing like the physical therapy and then we’ll get into some injections um later on which also puts into perspective the the thought of kind of like our non-traditional and I’ll probably even say our non-traditional non-surgical Orthopedics compared to Orthopedics so sure that’s a good point because you guys are using there a lot of people will come here I’ve had a cortisone it worked for a while did the you know two or three of them or didn’t work at all and then yeah it starts to okay the first one worked okay but then now it’s not working at all so do you see a lot of those patients who are following up definitely and I think you could you could probably say that in both worlds that you’re going to see some of our patients that go there I’m thinking less I mean most of our patients notice changes going in a positive direction um so cortical steroids um so your cortisone injection um usually the drugs we’re using are not actually cortisone but they are based on this steroidal anti-inflammatory model that steroid anti-inflammatory is actually going to break down your joint more so it’s going to stop all of that inflammation that we talked about and I think in last um topic we talked about inflammation and how the inflammation is bad and we want to put out that inflammation but at the same time we have good inflammation and we want that good inflammation to happen so we’re constantly breaking down some and we want to rebuild that but if we have a drug in there that is stopping inflammation from happening it can it can make you feel better if inflammation is the sole point of your pain but it may not make you feel any better because it may not be just the inflammation causing the pain it could be these the structural components or the cell Health within that joint um and the corticosteroid is going to cause more breakdown and that’s been study time and time again that’s why they won’t do more than usually three stered injections within a year because they know that they are causing breakdown to the joint and eventually it isn’t going to work at all because you had that much more breakdown and you can’t overcome those tissue changes with a drug that just stops inflammation yeah yeah I think that’s a good point so you said you see a lot of Nee arthritis what are you seeing as the biggest causes I know you said injury isn’t typically that but what what do you think the biggest contributing factor is I think it one of it I mean in inflammation in general so we talked about that before um and technically I mean it comes with age and there’s probably a good oh like 30% of Americans probably have some breakdown I want to say that something like 20% of those that have that breakdown are having that pain I suppose that the numbers are probably higher of where breakdown is actually happening and then the symptomatic I think is around like 20% or so of those that have arthritis that are having the actual pain because of it um and this comes from a lot of the things we talked about last week I mean it can be other inflammatory factors what else is going on in your body that’s causing inflammation one of the reasons we send people to you very often is to to find out their hormonal balance and what is going on inflammatory within their body that if we can help calm that down that their arthritis pain is going to be significantly less and I think I don’t know if there is a one kind of pure cause out there because you can look at I mean two people going through the same life and one will have a lot of breakdown arthritis and the next one may not and it could be from compensatory movements it could be from Little injuries in the past it could be from Little Habits Like You Might lean to one side more than the other side sure um so I don’t think that there would be one thing that you could really like look at and say that this is the cause or the number one cause I mean one great cause for knee arthritis is knee surgery and that would usually come from someone has had some type of an injury but it doesn’t even have to be an injury it can be chronic breakdown and if they do like a meniscus repair or or even a pulling out of meniscus that will lead to arthritis like that is almost a guarantee if you’ve had a knee Mis knee miniscus surgery you probably will have arthritis on that side and very commonly we’ll see that you look at X-rays and it’s like oh something happened here like oh yeah that’s the side I have my meniscus removed and you can just see that side is just completely collapsed um and then again we’ll try to work with the remaining tissue to try to help it is so say someone tears a meniscus and it’s a minor tear is there anything that that non-surgical Orthopedics can do to help that or is it like no you tear your miniscus surgery that’s it right and this is kind this is probably the coolest thing that we do in our kind of non-traditional non-surgical Orthopedic world is uh PRP platel rich plasma um you can do stem cells uh and that too depends on kind of is both kind of budget as well as kind of what you’re looking to repair usually that’s going to be more severe arthritis compared to like a meniscus tear so one of the reasons you talk to a typical orthopedist they’re going to say that meniscus isn’t going to heal or is going to heal very poorly because it doesn’t have a good blood supply our body needs blood to be able to heal because it brings in these platelets and the plat platelets are the things that we can then extract from your blood concentrate so they’re minimally processed so we are we’re just putting them in a centrifuge just to spin them down and then we pull out this High concentration of platelets inject that to the tissues around the joint as well as inside the joint as well as these little so we’re talking specifically KNE the little ligaments that help hold that meniscus in place so when we and we’re doing this all ultrasound guided so you can see all of these structures under the ultrasound and we’re injecting those specific locations putting these healing products in there so then the body can actually re cycle its ability to to heal that or otherwise if the blood isn’t coming there to send those signals it’s not going to heal so yeah so miniscus tears even moderate to severe miniscus tears as long as there’s not a lot of instability going on those are repairable using PRP and we can that’s been proven time and time again on uh uh Imaging studies so you look at an MRI even like an ACL that’s one of those where people are like you tear an ACL like you need surgery I think if it’s a complete ACL tear and everything is gone you probably do um but if you’re a very like you are not going to do surgery or maybe you’re kind of at that point in life where it’s like how much do I really need this ACL that’s still holding me a little bit that can actually regrow under an MRI you can look at an MRI before and after and you can see growth of that ACL tissue coming back together to help support the KNE and that’s with the PRP and stem cells that’s usually just PRP I say most studies show more PRP than the stem cells when they’re looking at those because I think it’s a little bit more accessible and a little bit more usual yeah uh and usual in the terms of U predictable they’re going to do the same type of thing although that can be different too so we look at PRP and we look at the the amount of platelets that you’re putting back into the body and there’s certain levels that they’ve looked at and the higher the level of platelets that you inject back in the more likely you’re going to have healing so if you go somewhere where they have a A system that doesn’t have as high of a platelet count you’re probably not going to see as good of results as somewhere else also if they’re just injecting that platelet into your joint itself you’re probably not going to see the results um or a much maybe only like 30% but if you’re injecting kind of all around the joints or kind of encompassing so the the biot Integrity model it’s not just the joint it’s not just right here in the knee that things are broken down it’s all of that stuff around the knee that’s actually causing that that breakdown as well so now if we’re supporting the outside of the knee hitting the retinaculum which is kind of like this The Joint capsular bag around it um the pieces that hold the kneecap in place the ligaments that hold the knee in place the things that hold the meniscus in place we’re supporting all of these things Al together and we can actually have a healthier joint in the end that can repair things like that ACL and it takes a good return to activity protocol if we just inject those in there and you go right back to everything that you were doing probably not going to work super well we need to give it a little bit of time to start laying down a good foundation I always tell people um a big cut in the skin it’s probably one of the best analogies that we can actually see you cut your skin I’m thinking like this is a big cut like I was going to go to the ER because it was pretty bad but I was like I didn’t feel like waiting so I just I’m going to cover it and we’re going to let it heal um you’re going to put a bandage on there and that thing is going to be you are going to protect it like you know good solid week like you’re not going to touch this thing you’re going to ease that Band-Aid off and you’re going to kind of clean around it and you’re going to like treat it really nicely and that’s usually about a week and this is kind of funny if you watch the next injury that you have you just kind of watch how you kind of baby it and think about it and how for the first week you’re very conscious about what’s going on there the next week and this I I like to think about it on your hands or or around something that you’re using a lot so now so you had that big cut on the top of your hand you’re not going to reach into things that are likely going to brush against it probably not not more than once right right yeah it might happen like when you don’t necessarily think about it but then you’re going to be more protectant of it you’re not going to be reaching in I don’t know into the car and or not under the hood um doing mechanic work if you have this big old gash and I suppose mechanics would be like no I do that all the time for sure they totally do um but we’re going to protect it we’re going to think about it we’re going to try to use something else to to help that area heal and usually again that’s probably about a week that we are very focused on it kind of the next week is like you know what I’m I’m better I don’t have to be as conscious about it I’m not babing it and cleaning it all the time but I’m still aware that it’s there and there’s that kind of scab over the top of it um but if you rip that scab off it hurts so you are still kind of like you’re conscious about it um and then after a couple weeks kind of you get into that third week and and now you can mostly forget about it you still know it’s there you can still feel it if you scratch across it it doesn’t feel like normal skin um but we’re getting back towards normal okay and usually yeah probably around that five six week Mark afterwards you’re like it happened don’t really think about it unless you really need to and that’s kind of the same with the body at that point when we’re looking at PRP we do want you to still do things because we’re going to continue to remodel for a long time um so initially when we look at say PRP is I mean one of the most common uh treatments that we do probably the first two months we’re seeing the most kind of foundation growth um kind of new so initially it’s inflammation then it’s going to be this um kind of proliferation phase where it’s putting things on top of what was already there and then we have this maturation phase that lasts you know up to 24 months after after you do something like PRP so probably the first three months is where you see the the first kind of gain like oh yeah I did that and I can tell that things are different and I’m feeling a little bit better I have more function back you might still have a decent amount of pain but that’s kind of okay we can still remind ourselves that something’s going on usually around six months is probably where we see people kind of plateau out as far as their pain relief but their body is going to keep working with that tissue and keep smoothing it out and making it kind of better more functional tissue so yeah this is a very long-term treatment it’s not just like you you do a PRP and you feel better some people do some people you do a PRP and within a few weeks they kind of go through that little baby phase and they’re like you know what I’m feeling way better I’m golfing I’m running I have no concerns uh we don’t want you to run that fast after PRP but you’re going to feel like you probably can okay um but yeah we can build those things up and it’s going to be that longer term kind of remodeling so that was a long way of getting to the will it fix the meniscus a lot of times it can it can go in there and actually remodel relay down kind of a foundational growth the body is going to come together um fix the tissue around it so that meniscus can heal better and we want some stress into that area too because if we don’t stress it then we lose all that Integrity all the U the oh what’s the word just the the signals that the body is sending because we the body needs that and needs that input to say this is the stress that it’s going to endure so this are the these are the things I need to do to it to make it feel better and healthier just like you put a cast on a wrist for a broken arm um you you get that cast off the muscle is weaker the joints are weaker because you haven’t been moving it for six weeks so we want you to be doing these things so it stays strong in the area awesome yeah so if someone’s thinking like I don’t really want to consider PRP because the downtime is probably more it’s probably not actually more downtime than if you were to go have that repaired surgically I mean you’re probably having more activity right and and this is one of those where we have to like really break it down and look at it because yeah you go into surgery you’re probably going to be feeling better pretty quickly right um because if say was a meniscus that was causing some irritation they go in there they take it out you recover from that kind of surgical wound on the outside and your your pain is less but what does the function look like in there if they’re actually going in there to repair a meniscus you’re going to be probably not weightbearing three months or more you’re probably not going to be running for at least six months um so if you’re actually going in there and repairing things and having your body repair things it’s going to take a long time you’re going to be down for a while um and we always think about it in the grand scheme of life it’s like do you want that quick reward right right for kind of feeling better right away or are you willing to put in a little bit more time and effort to see what will happen especially with that significantly increased risk of arthritis in the long term right because yeah I’m going to feel better now and I can go play softball this summer it’s like so now you go play softball this summer but now what happens in five years because it doesn’t take that long it’s not like it it doesn’t take like 20 years and you will have arthritis you take out that meniscus and within two to three years you are going to see x-ray breakdown of that bone wow so I mean it is doesn’t take long at all to see that breakdown and that and you’ll even talk to a lot of orthopedic surgeons that are are leaning away from doing meniscus repairs or miniscus removals I should say um because they see that breakdown they know they’re going to have more arthritis um and they will end up needing something more in the future so yeah that will cause you breakdown yeah yeah yeah do we want to do that now because yeah now in five years you might always have an achy knee after you do things um not able to do the things that you want you can’t get up and down off the floor like you want or it feels crickety when you’re trying to do that compared to I’m out of pain right now yeah but let’s look at the long term of where you want to be in 5 10 15 20 30 years okay oh that’s really great and when you guys are doing injections whether it be PRP stem cells um ha injections for the knee nerve injections you guys are doing I heard ultrasound guided almost almost everything is Guided by something and that’s kind of one of the things that’ll will set us apart and I think that in general non-surgical Orthopedics I think they typically do use some type of guidance and and that I I shouldn’t be shouldn’t put that blanket out there because there’s a lot of prol therapists out there so Prolotherapy is another word for these kind of non-surgical Orthopedics that are working with things like yeah Prolotherapy is just using High concentration of sugars compared to using your body product of of PRP um and then stem cells yeah the kind of the step above that um so ultrasound guidance um if you go through the right training you can really feel all of these things and you know kind of almost exactly where you are here at reu yes we almost always use some kind of an ultrasound guidance or x-ray guidance to be be able to put that medicine where we want that where we want and that’s something that um you can definitely see a change with patients both in Comfort level um their confidence in what you’re doing um as well as knowing that I’m putting the medicine where I want it to be right you’re not gu same right because and you hear from enough patients around where they’re like um say I mean carpal tunnel is one where it’s like I have these carpal tunnel symptoms and um what can you do for it or I’ve had a steroid injection in there and you talk about it and they just they they put a needle and they just put medicine in that area it’s like you know all the things that are there right right I mean number one the nerve I mean if you hit the nerve that causes pain if you’re just like if you’re outside of that carpal tunnel it’s not going to do you any good again it’s just stopping inflammation it’s not helping that nerve heal so one of the things we use a lot here is something called dextrose uh dextrose is the sugar compound I think we talked about a little bit last week with inflammation when we have the the mitochondria not working efficiently um they kind of turn off their borders um so now they’re they’re chronically inflamed and they’re kind of shut down we can give them this dextrose which gives them a little bit more energy A little B more life helps open up those channels so the body can heal back and forth a little bit give that power house back as well as reducing pain and improving function so the dextrose that we use for injection that’s we do that same thing into like a knee joint or um into the spinal canal if we if we want to do like our epidurals are very low do steroid and mostly dextrose which has this other completely different healing property about it um so in like a carpal tunnel we’re going to see the nerve we’re going to see the median nerve we’re going to see those other tendons around there on the Imaging yeah put the ultrasound over the top and you can see all of those structures and you can then you kind of like put a little donnut around that that median nerve so you can see it all um if I were to think about just dropping a needle in there it’s like am I in a tendon am I in the nerve am I even in the tunnel um I mean technically you should be close if you know what you’re doing but you could I mean one fraction of an inch off and I mean like teeny fraction of an inch and you can be again in a tendon in the carpal tunnel itself and then you’re not really getting that medicine where it needs to be and you’re only stopping inflammation and many times it’s not inflammatory I mean that’s why they cut open carpal tunnels um or carpal tunnel release they’re going to open up the top of that tunnel to relieve some pressure and if we can put medicine in there to separate all those tissues and have healthier signaling versus just putting in a steroid then we can see better improvements there so same thing going into a knee we use guidance to make sure we’re in the knee probably one of the most common ones that people have seen somewhere uh common ones comeing treatments would be hyaluronic acid or ha viso supplementation rooster com injections kind of goes by all of those different terms most people like if you say have you ever heard those rooster Combs most of them know that word they all the other ones are kind of like oh yeah that makes sense now yeah um so this hyaluronic acid visal supplementation is a uh a visal supplement it helps make your synovial fluid more viscous so more thick so we have a little bit more um and sovial fluid is a fluid within the joint so every joint has this kind of a lubrication fluid within it as we age that lubrication becomes less dense less viscous um so it loses its um it loses its compression Factor so um we have less shock absorption we have less fluidity between those two joint surfaces so we’re able to improve the health of that with some anti-inflammatory properties we can see healthier joints in the long run so a lot of people like like oh yeah I’ve tried those injections than they didn’t do anything one thing is most of them come in a series of shots so you have to have usually it’s um there’s a few of them that are single injection um there’s a few that are five injection just learn about a new one that’s a two injection um anyway so if you if you inject and you miss the joint and studies out there show that you’re probably about 80% accurate with joint injections if you’re familiar doing joint injections so if you’re new at doing joint injections you’re probably missing more than that if you’re kind of adept at doing joint injections without guidance you’re probably missing about 20% of the time that’s pretty high even in someone who has done a lot of them or thinks they’re pretty accurate and they would probably disagree with that um and of course that those numbers are kind of big numbers put together but even myself I mean I do a ton of injections on a regular basis and I use guidance for all my injections one of them is is fluoroscopic guidance and there is so I can see the joint I can see where I want to be I can get my needle into that area that looks right and feels right I start putting the contrast in and it feels right it feels like I have that pressure release like you’re in a joint and then you take the picture and you just have a cloud of contrast it’s like I’m not in the joint yeah yeah like I thought for sure I was in that joint um and then you just move the needle sometimes it’s a fraction of an inch or you just turn the bevel of the needle and then all of a sudden the contrast flows into the joint so now if I would have put that medicine which is a three-part medicine or say it’s a one part and I missed all of it it’s not going to do you any good it’s probably going to cause you irritation around the joint because now you put all this stuff outside of the joint that’s supposed to be inside the joint so you probably cause more irritation you didn’t help them at all because you didn’t get the medicine in there or say it’s a three-part series if you miss 20% of the time and you’re not using guidance I mean how many times did you actually get in that joint yeah you could be missing quite a few right and then say you do it regularly it’s like oh yeah it worked for a while and then it didn’t yeah it’s like again who gave the injection did they get it in the joint or not right um and again this can be so sometimes like well yeah that’s probably on a really big knee it’s like well sometimes that’s true but sometimes it’s a smaller knee I’ve had the same thing because then you have a smaller joint surface you know you don’t necessarily have a big of fusion which kind of expands that bag so then you might miss because you might just be on the outside your need has a bevel that’s proba good 16 of an and if only the tip of the bevel is in that joint you’re not getting all the medicine in there even though it feels like it’s going in there but then you get this thick viscous fluid and you might miss it so I mean these are all the things that I think about and I talk about while I’m doing my injections like yeah because I miss too um but then I have that guidance to prove that I’m there um ultrasound so if you’re using uh fluroscopy you’re probably I mean Almost 100% accurate I mean it’s hard to miss if you’re using fluoroscopy and doing it right it paints a pretty a nice picture it’s very yeah if you are if you’re missing I think you you kind of know that you missed and you kind of did it anyway yeah um which you shouldn’t do I mean that’s not medicine if you’re because that could be causing harm um when we are doing um ultrasound guided that probably brings up the accuracy to like 95% because there’s a chance that you could get some of that medicine not going in there but you can again usually see that on an ultrasound if you’re Adept at reading an ultrasound and getting that medicine in there you can see if the medicine is going into the joint or if it’s going into soft tissues um yeah but you need to be good at following your needle you need to see where the needle point is you need to make sure that you have all these things in L too which is a higher level skill to be able to follow an ultrasound and make sure that you’re putting the medicine where you want so that’s yeah where guidance can really come into play and there’s certain things that you need guidance if you’re doing spinal um spinal injections they were doing facet injections medial branch blocks epidurals you need that alter or that the floros fluoroscopic guidance to prove to the insurance company that you’re doing that treatment technically some things we can do ultrasound guided and be very confident like a coddle epidural you can be very confident that you’re in that coddle space But the insurance company wants to see the X-ray to prove that you’re in that space so some things we need it but almost everything we do it because it just adds our efficiency again patient Comfort patient confidence I honestly think patients feel a lot more comfortable with it they’re like oh you can actually see it you’re not just guessing because right Anatomy is so different so you’re thinking oh this like you said a small knee should be pretty easy to find landmarks but sometimes the joint caps feels a little bit different or it’s not where you would expect it so I do think it helps with patient comfort and outcomes it has to help with those right and I think again 100 100% I mean our the ha injections we do those or the viso supplementation most people that have NE arthritis that come here we do those I mean I I don’t have like hard fast numbers but easily I mean 70 80% of our patients that do those viso supplementation see improvements and it’s not necessarily going to be 100% like my knees feel great I have no problems but I mean at least 50% or more um improvement from that visco supplementation compared to most places are like well yeah you’re we’re not going to do that it’s not even going to make you feel better sure so yeah it does seem like those series do help and you know I think six months you can repeat that Series right yeah almost all Insurance there’s a few that that are different so they they on average they say four to eight months um but uh insurance company will cover it every six months there’s a few of them out there that won’t do it for at least a year okay um which I don’t really get either yeah and and it’s fairly expensive and it’s kind of funny when you look at the whole breakdown of the insurance world and what they’re willing to pay for and that they’re willing to pay for this super expensive knee replacement surgery but there’s a lot of studies out there that show that I mean at least and I can’t remember what the exact numbers are but I want to say that 15% of them could have been avoided if they would have just managed the nerve pain around the joint wow without even looking at the joint health itself um and then I I don’t know what the actual number of is how many of those surgeries and I want to say it somewhere around 40% could have been managed non-surgically um and have and again so we’re not by doing something like PRP uh stem cell surgery we’re not taking arthritis away we are not rec correcting that bone we are not like cutting things off and putting new things in there we can see some kind of filling in gaps of of cartilage breakdown so we can have a little bit smoother kind of joint surface rubbing against itself we can see improvements of the structure surrounding the joint again making the whole thing healthier um increasing the actual kind of the bioavailability of substances with The Joint so it just functions healthier and that with PRP we can see I mean there’s a lot of studies that show up to 76% increase in functionality so if you think about doing a PRP and 76% of them are getting better and again this might not be 100% but if we’re 76% better than we were or 76% of us think that we’re better than we were before that procedure I mean that’s huge that is because even I mean KN Replacements they’re not 100% I see a lot of people they’ll come and oh I had this replaced but I still have a lot of pain right and then you think about the the healing component of that I mean most of the patients that they’ll be like yeah within a year you’ll probably be back to normal um and this is usually within about six months we’re going to see we’re already seeing over 70% Improvement by about three to four probably six months we’ll say three months we’re probably about 50% Improvement um six months probably about 70% Improvement um and again we we’re seeing those improvements and it’s something that will probably have to be repeated again because we’re going to continue to break down I always give the analogy it’s like putting new tires on a car that you’re going to wear down those tires and then you need to put on a new set again kind of depends on what’s your alignment look like how hard are you riding it right I mean all of those things add into how long until you need to redo it and then genetics I mean that plays a piece too and how how well your body repairs um how much you break down how much are they talking to someone else about their inflammation and controlling that if we have inflammation controlled we have healthy diet we’re exercising we’re doing all these things we can see more Improvement we can see longer lasting improvements with do you see that like do you see people who are inflammation control they don’t have diabetes they have better outcomes compared to people who aren’t managing those things yeah yep yeah and it’s one of those things where it’s it’s hard because it’s not that if you have those things that you’re not going to be a good candidate for sure um but if you if we have everything as in line as we can we’re going to see better outcomes and that’s one of the things when we um when you look at what we do here at reu that’s part of the process we want patients to have a healthy lifestyle we want them to be eating well we want them to be controlling inflammation having good hormone control and if we have all those things going to physical therapy going to the gym we can pull all these together and we see even better outcomes we’re usually at the Top If we look at the those numbers we’re sitting around the top of of performers of people doing things like Prolotherapy part of that is the is guidance and our approach to doing prps and treatments like that um and the skill of the providers but some of that is just because of everything else around it making it better okay so I know we talked a lot about knees but the injections that you can do I mean you can really hit on a lot of different areas of paint even if it’s not a joint if it’s I have a lot of my patients who see you guys for migraines and it works really well whether they’re doing the nerve injections or they’re doing the Botox injections so can you talk a little bit about that like all the different body so I’ll probably put in so so this all kind of falls into the category of nerves and I had mentioned with not to go back to knees but with knees like a good 15% of them could have been treated if they manage the nerve pain around the joint so the same like um migraine certainly is a there’s a vascular component to it but it’s obviously nerves that are causing us pain every joint in our body has nerves that surround it and nerves that go to it and nerves that go away from it um I believe it’s called Hawkins law that every joint or the the things that are affected in one joint can be affected by those nerves that are inating that joint um so if we manage nerve pain we can really help manage the pain within the joint and this is part of our dextrose treatment that we use we’re going to Target the nerves so a lot of times we’ll talk about nerve injections but they’re not nerve blocks so most of the time I mean there’s a certain number where we will do an actual block of the nerve most of these injections are kind of we call them yeah um Paran neural injections so they’re around the nerve and not like in the nerve on the nerve so if we get close to the nerve and I’ll even tell people if we just kind of like you water a plant you don’t have to have the water on every single root you just put the water into the area and it will kind of disperse and the body will or the plant rots will pull it where it need but the body and these little nerves and vessels will do the same thing if we get the medicine in the vicinity of the nerves that we’re treating so if we can improve the health improve the kind of the nerve conduction um of that focused area that is actually going to have an extrapolating effect of decreasing inflammation of those tissues around because an irritated nerve and they’ll say a nerve can be irritated with a dimes weight of pressure so if we think I mean that tiny amount of pressure can cause a nerve to start sending poor signals um some sometimes it’s pain sometimes it’s just leaking out these substances that cause breakdown of the tissue around them because that tissue that or that the substances substance p and cgrp they’re meant to be there as a signal to heal but if there’s just this chronic kind of festering smoldering like we talked about last week um uh release of these chemicals it’s going to cause that breakdown and it’s going to irritate those systems so if we can turn down that volume of irritation we can increase the structure around it as well or the Integrity of the structure around it so we have healthier working cells um and that can improve overall outcomes that’s another reason why we perform really well with PRP is because we’re treating nerve pain around the joints or around the area as well as um the actual structures of the joint itself so when we think about things like migraine so often people get that the posterior scalp their the back of their head is where these migraines come from is from neck pain kind of tension headachy things that kind of get the they kind of trip the the wire of migraine and not always a migraine I mean that’s a whole huge concept as well but again you’re working with those patients in the in infammatory world and then we work with them kind of in that nervous and pain world and if we’re able to decrease that nerve irritation and decrease tension of those muscles in the neck we can help relieve some of that pressure so then if we have inflammation under control and we have these nerves functioning better we can see a decrease in migraines and again I never want to advertise that we will take away your migraines right we can and or we can decrease their frequency or decrease their intensity and say that’s what you hear most of the time is that things are getting better um they’re not gone but they’re better um so yeah and treating yeah nerves so I mean jumping back on the knee quickly there’s a set of nerves called the genicular nerves that we can Target and these are ultrasound guided they’re the knee nerves so genu is Latin for knee they’re the nerves that go into the knee and if we can treat those nerves we can see a lot of knee pain Improvement again versus just putting a steroid into the joint so we’re putting dextrose into the joint making the joint healthier we are treating the nerve pain on the outside of the joint making that healthier and then everything else functions better I mean same for feet I mean that’s probably pereral neuropathy I mean how many patients suffer from that whether it be diabetic and cause or um vascular and cause there’s a ton of different reasons why they’re going to have this kind of peripheral kind of extremity pain um and again not that we can and will make your I supp we can um but will we make it go away maybe I mean it’s another option out there I know my last job there was a guy like if you ever find a cure for for per neuropathy let me know it’s like so we don’t have a cure but we have all these things that we can do I had a guy um recently treating um who came in and he had pain I want to say it was somewhere around 10 years I feel like it was a little bit more than 10 years it could have been a little bit less doesn’t necessarily matter but he was told by multiple people that like his pain is going to be there he has some arthritis in the feet um and he has diabetes so these are going to be his symptoms like kind of figure out how to live with it more or less yeah um I saw him we started doing some nerve injections around the feet I did some tendon injections because we have there’s a ton of things going on around the feet right and we have joints we have nerves we have tendons we have ligaments we have all these different support things and they take on the load of the entire body and they’re far away from the heart and the nervous system so we have all of these like it’s like the Crux of where you probably have a lot of issues anyway we were able to I mean he was not sleeping because of his pain he was numb in the feet um he’s a drummer and so that was one of his passions but he wasn’t able to drum as well or as long because of this pain um the last time I saw him and this was probably I mean two three months of seeing him and he’s like my pain is big basically gone I mean he has a few little nerve symptoms here and there he saw his regular doctor and he’s like my foot pain is better and he’s like what yeah like how did where do I send right and that’s what he did and he found out where he went and he was yeah GNA say you know what I have these other patients we’re going to send them to see you to do something and again it’s usually not just one thing or the other so we don’t just do a joint injection we don’t just do a nerve injection or just do one injection again we look at this thing and there’s a ton going on yeah so we don’t just focus on one piece we try to get that whole thing feeling better and functioning better yeah that’s I mean chemically the body is so complex but also structurally so it’s you put the two of those together and it’s there’s so much that you can do so I think once you’re combining it it it can make some life-changing things happen right right so I want to touch on because we talked a lot last week about inflammation and how inflammatory sugar is so can you talk a little bit about the difference between if somebody eats dietary sugar which is of course always inflammatory but then you’re injecting dextrose sugar water talk a little bit about that go and it’s one of those things that it it’s almost difficult because I can’t tell you exactly how and where I think part of it is is the actual gut absorption of the sugar part of it is the fact that so we’re injecting sugar but we’re when we’re doing these caling injections we have a very low concentration of sugar so we’re looking at 5% dextrose okay and I’ll usually tell people I mean if you have if I do all of these injections it’s it’s way less than if you were to suck on a hard candy um so we don’t have that much sugar that we’re putting in but part of it is that it’s already going kind of directly to to the cells and the areas around the cells um so then that is going to be absorbed differently in those cells compared to the sugars that are going to go there um when they’re absorbed throughout the body and again the body needs some type of energy whether it comes from sugar or sugars I suppose um yeah glucose is how it has to get there the body just has to turn it into glucose like more of a complex carbohydrate opposed to a piece of bread process and again one that so we talked last week about how the gut is so crucial in in that inflammatory component so I mean the ingestion of the sugars is where the inflammation happens I think within the gut system itself compared to putting it in these peripheral areas where we can kind of focus what it’s doing but now if we jump that up to a high concentration of sugars we’re actually causing irritation and we’re causing inflammation so I mean that’s probably where you can see it’s probably that that threshold of how much sugar you’re putting in there so now we go to a higher concentration of sugar and it’s actually causing things to flare up a little bit okay so that’s Prolo therapy we talked about that just briefly um so yeah um now you’re injecting this High concentration of sugar to the points where ligaments attached to joints within the joints themselves and we cause this level of inflammation that the body now responds to so we talked last week about the body getting stuck in chronic inflammation where it’s just kind of smoldering and hovering and kind of ignoring what’s going on and not having open cell transport chains to be able to cause that healing now we are inducing a new acute inflammatory reaction that the body can respond to okay um again different when we’re using High concentration compared to low concentration and have that conversation frequently because yeah yeah we talk about the sugar injections and then these other sugar injections and then these blood injections but they don’t eat sugar so it’s a little confusing yeah yeah and then in diabetics I mean they’re frequently asking so I have diabetes how is this going to impact me and it’s going to be way less than a typical steroid injections because the steroids the cortical steroids will actually impact your body’s ability to process those sugars within the liver so now if we do this ster or this very lowd dose steroid injection with dextrose we are going to impact sugar is significantly less than one cortisone injection from kind of a standard Clinic yeah I have quite a few patients who they have diabetes and they’ve come from doing a cortisone injection at a regular clinic and it really does affect their blood sugar so you’re not seeing that effect with so very very minimally uh of course some people that have a very sensitive system because some of our injections we have a nano amount so we’re putting in um so most places they’re using so Kenalog is the most common they’re using about 40 milligram we’re using 4 milligrams so we’re using a tenth of what they use so if they do I mean they one injection it us to toone the body even if sometimes we’ll frequent injection I will I commonly see people every four to six weeks to manage pain so I mean that’s one of those things where we talk about pain management compared to pain cure so we’re going to do as many things as we can to try to help them feel better function better part of it is that the insurance company still hasn’t gotten on board with doing prps and regenerative medicine so that isn’t out of pocket cost many people can’t afford that especially when we’re getting older we’re on Social Security limited income you you can’t necessarily put that money into it because we have Healthcare and Healthcare is so expensive anyway with everything else so we’re going to do the things that we can do insurance covered so I may do these kind of lowd dose steroid dextrose injections sometimes once a month sometimes every six weeks to manage that pain and those people are able to continue to function and do the things that they need to do um and feel better around their bodies which is obviously important because then we can help decrease inflammation if we can keep them moving and keep them doing things keep them a little bit happier keep them sleeping so pain pain management so we kind of we look at multiple ways we can pain manage and we have these the dextrose nerve injections that’s going to help decrease nerve pain around joints migraines um other body aches back pain huge for back pain before coming we didn’t even get into back pain so many people experience back pain yeah and I say in back pain so I talked about so knees are one of the most common kind of arthritic things but I mean back a lot of times arthritic too but back pain um I mean that’s probably at least half of my patients are somewhere in the back pain um whether it be kind of high back neck uh low back um previous to coming here I mean back pain was one of those things like H there’s not much I can do I mean yeah there’s muscle relaxing they can help a little bit we can do steroids if you’re really flared up that might help you for a little bit um you don’t really want to do surgery because that’s kind of a mixed bag of what’s going to come out on the other end um and physical therapy but most people are like I’ve done physical therapy I don’t want to do that or it doesn’t it doesn’t cause that immediate change so by doing these Paran neural injections we can I see back pain reduced significantly in so many people and then we can do the non-steroid epidurals which again just kind of help calm all of that tissue down helps with radicular pain helps with um herniated disc kind of that pressure on the nerves helps decrease some of that and people are functioning better so they can do more therapy so they can maintain their improvements and then if we’ve done all of those things and maybe we’ve gotten them to a point where they’re like you know what I feel pretty good but I still have this breakdown I still have this stuff that’s going on and I want to improve that and that’s when we pull them into PRP if they can afford to do that out of pocket and it’s not crazy expensive I mean this is one of those things when I I talk so I use car analogies pretty frequently I mean how many people have a vehicle that they spend I mean car payments I mean you could spend anywhere from I don’t know 500 or maybe a little bit less but we’ll say $500 to ,000 on a new car every month um this procedure say a back PRP around here is probably two to three car payments depending on what your car payment is so reason I mean it’s it’s an investment but it’s reasonable and it’s an investment into your body yes the one body that you get right when you’re in it all the time it’s like yeah I have this fancy car that I drive to work yeah or I drive home just needs to like right has to get me to and fro but it does nothing else for me really um and you want it to be Dependable yes but we want our body to be Dependable too because again we’re going to be with that forever we’re not going to continue to trade up to a different body yeah can you imagine if you had the same car for like 100 years you your body would you maintain it exactly you would hope so right yeah and things like oil like you change the oil because you know if you don’t change the oil something big bad is going to happen you can let that oil get really old and it’ll still function for a while until one day it stops yeah yeah that’s such a good point and then everything is broken down and then to get that fixed is huge so if we are constantly maintaining we’re putting in good fuel we’re changing the oil regularly we’re maintaining things we’re making sure that they’re working well um that can make this body last way longer and that’s kind of what PRP is is getting that extra bit it’s giving a little bit more maintenance it’s going to resurfacing your rotors so you’re able to stop more in the future I mean all these cardies that we can think about the body if we put that investment into our body the only one that we have and you might only have to do that every few years I mean how often do you see this major repair for your vehicle and yet it’s never fun and it’s like ah I don’t want to do that and of course that gets in the way of needing to take care of our bodies too because we have these other expenses that are going on and we look at our insurance world right now and how we have these huge out of pocket costs so I could ring up your aut of pocket cost pretty quickly and you can reach your aut of pocket deductible or maximum but if we have maybe looked at doing that PRP sooner yeah um you might prevent reaching that maximum for that’s true some years again depending on who you are and what you’re dealing with but I mean again how you manage that money and the body so again there an expense and it’s investment into your body and into life but you can make yourself feel way better and function better and be happier and sleep better and eat better and exercise more and be there for your family and doing all of these things if we have some of this under control and so many people look at it and they’re like uh I’m just not ready for it yet and that’s not a it’s not a judgment because I’d even fall into the same boat I’ve been saying probably for the last six months like I should do another yeah Prolo or a PRP to my back because I we’re the worst patient I know because I I can feel that those things are there but life is busy and that it takes time and it takes money um and I know I should do it and I plan to do it um but I also am doing a lot of these other things to help manage it in between time and I’m very conscious of it I’m not just going back and and causing the same breakdowns that I have before um anyway so yeah and I think controlling pain is so important because pain it’s not just pain right like it’s a physical stress around the body which causes gut breakdown hormonal imbalance inflammation like it’s so much more than just oh my back just hurts I’m just dealing with it it’s like no it’s causing all of these it’s causing you to age more quickly because it’s so stressful on your body right I always tell people the B the body really doesn’t know the difference between physical or emotional mental stress so you having a super stressful day at work we’re aware of how bad that is for us but then also having this physical stress are constantly inundating us it’s just fatiguing our adrenals causing so many issues so it is important to deal with pain and then it just snowballs yeah so then you have all these things causing that that breakdown that adrenal fatigue and inflammation within the body and then we see more joint breakdown and we have more pain and to kind of try to cycle that back up and again it it is a it’s a battle and we work with it but that’s kind of what we have yeah yeah so people I just I just have some knee pain I’m like no it’s not just knee pain it’s so much more than just knee pain or back pain so defin important to to see you know someone who can help them address that whether manage it before it becomes really bad pain again because we let it go too far yeah and too much and then it is harder to manage and it takes more investment of of time effort money to be able to fix that or to again maintain it and get it back to a better operational standard yeah yeah absolutely okay uh what else I think one of the other pieces that we wanted to talk about a little bit so we talked a lot of the the things that we do here um some of the things that and I mean even more that we’re doing and kind of in the in the more immediate future of doing one of them is ozone therapy yeah so an ozone this will probably we could probably have a whole con conversation on ozone in the future but this can be something where we can inject it into joints and it’s it’s working on these different Pathways within the joint uh and within the body when we’re using it within the body to to calm down the inflammatory process so again inflammation is a thing that that causes anger and and again we’ve talked about cortical steroids breaking down inflammation but we don’t want to just turn it off we want to quiet it and if we can quiet inflammation and not turn it down we can see better outcomes we can see more pain relief we can see better functioning within the cells um then the other Theory with ozone is that we have these kind of um viral infections that we had young in life that start to creep up and cause issues later on in life there’s more studies coming out that there’s probably even these lowlevel infections going on within joints that are causing these breakdowns within the joints and if we’re able to impact that inflammatory reaction that infectious reaction within the joint um we can see improvements so um a lot of our patients are now we’re getting on doxic cycling which is an antibiotic that I mean it treats bacteria treats inflammation but and that’s could be one of the reasons why it treats some inflammation that it targets the right bacteria that inflammation is going on so you’re injecting that into the joint uh so it probably could be most of the time oral yeah a very lowd dose kind of a regular um lotos prophylactic kind of like you were thinking if or uh if someone has it for maybe acne when they were younger or say like a rosacea something like that um you might be on these low dose antibiotics um to be able to help prevent things but again if it can make our whole body’s function feel better less inflammatory I mean that’s probably going to bolster our immune system better than thinking about the worries of antibiotic stewardship which is is also important but again we’re you kind of have pros and cons about them so so that’s one thing but ozone is not the same type it’s not an antibiotic it’s just going to kind of make an an unhappy en for bacteria to live that’s the other nice thing about our dexos injection so I just come back on that that so I’ve been here three and a half years and I have had Pro one maybe two infections total that’s pretty low you do a lot of in injections and then sometimes like was it even I mean the one guy I know it was he had this reaction to drug that sometimes gets this kind of pseudo infectious reaction and it had a very low level of bacteria on there too but we just talked about it possibly being in the joint anyway and it’s one of those if you see this reaction you kind of need to treat with antibiotics or that was one that was maybe an infection and then maybe a few like kind of just very soft tissu is but dextris actually um helps prevent the growth of bacteria and even is a little bit bacterial Cal so it will actually kill bacteria a bit so all of our joint injection is going regularly again very low risk of getting an infection in there yeah and you guys are I mean doing how many injections a day do you think I know just to put it in perspective like one to two in three and a half years is probably like 1% yeah I mean and I am yeah on a regular day say like on Fridays when I do knee joint injections I mean I’m 30ish yeah joints that I’m injecting so super low likelihood of injection and if I’m doing like back injections like or or nerve injections I mean many of those patients and they they like to brag about it when they go to their friends like yeah I had like 50 injections it’s like yeah you did that’s not even exaggeration I am injecting the body probably a good 50 times for most like a low back or a knee pain something like that so it’s a lot of but these are like little itty bitty needles um similar in a way to acupuncture needles um so low trauma low bleeding again low risk of infection um not uncommon that you get some irritation around it but I’d say also pretty uncommon I don’t see a lot of people with irritation after their injections and yeah very well tolerated um every now and then you get pain but most of the time I say it’s somewhere probably between a mosquito bite and a fly bite like you can feel them and some of them are annoying so it make you jump a little bit but when it’s over yeah you really feel pretty good awesome and you’ll like immediate results in a good again 70 to 80% of people they will leave here feeling better than they came in with those type of injections so there’s not always the downtime of like when we’re talking PRP right right so and that’s part of what we do here too is that we we’re managing that pain even around a PRP so some people that’s one reason like if you look at big studies about PRP they talk about pain around injection and not just the pain of the injection itself the pain after the injection and a lot of times that’s this nerve pain that just kind of gets fired up and doesn’t get manage so a lot of PE patients we will manage that pain going into PRP so we get kind of that that smoldering irritating pain away after PRP we’re also able to be there to inject to calm down the pain so when pain is their bigger limiting issue we can actually manage that in the process too without putting steroids in there which then decreases its ability to heal so we’re actually we’re we’re working with them on both sides to help manage that pain and I again see positive results in the long run wow that’s great yeah yeah a few other things that are kind of coming down the pipeline um tissue modulation so actually like creating new meniscus or new cartilage within a joint I think that’s quite a ways down the pipeline of things that can be done um but usually that’s going to be supplemented by some type of a biologic like PRP or stem cells um something I should kind of quick touch on too is when we’re talking stem cells we are not talking um baby embryonic stem cells we are talking um either bone marrow stem cells mesano stem cells that are coming from your own body so guys are always harvesting from that patient’s body and their own here at reu currently we’re just doing bone marrow aspirate when we’re doing stem cells so we’re taking that out of the bone marrow these are these these cells that kind of they’re little baby cells they don’t know what they want to be yet but they’re programmed to become kind of anything so if we inject those into a joint they can have become cartilage tissue they can become meniscus tissue or ACL tissue like if you kind of get the area primed right it’s going to go there and turn into those tissues again it’s not going to be all all of a sudden you have a 20-year-old knee but we’re going to f fill in gaps and breakdowns and help repair that tissue um so yeah we’re not using baby stem cells these are all coming from your own body um and processed all right here in our lab again how we do it here everything like if we’re doing blood draws or we’re doing stem cells kind of it’s harvested right here it’s managed within our lab and then it’s given right back to you usually within the same day I’d say almost always within the same day yeah yeah that’s that I think that’s nice for patients too to know everything staying right here in house right yeah yeah so yeah it’s not sending out to a lab and then you kind of Wonder it’s like did they mix something up or not and overall our volume is is low enough that usually there’s going to be one person that comes in this processing and getting that injection back into their body so it’s like there’s we don’t have multiple things all with on the Shelf loading at the same time and then going back out and I say most of your um regenerative therapy locations are probably going to be like that too just kind of the manner of how you kind of um sequence treatments you’re probably going to you’re going to be very confident confident that you are getting your body product um it is minimally minimally manipulated um and so that makes it safe too when we think about the the FDA so there’s a lot of information out there that it’s not FDA approved and that FDA approval is interesting because it’s it’s our own body product being placed back into your own body to create changes within your body like we are not taking another drug and putting it in there to do something we just taking your body product and bringing it in to do it so like that raises a huge question like why do they say that and and it’s minimally process I mean it is spun down a center fuge so we are just spinning it down concentrating those platelets in one spot pulling it out and putting it back into your body and I say that is one thing we do call a platelet release a which we actually break down the platelets usually there’s different ways that you can do it but you kind of just deshell the platelet so if we kind of think about like a a boba if you want to say like a Boba T like those little bubble things yeah so they’re like these little platelets that have this something inside of it that will burst of flavor so we’re getting rid of that burst of flavor uh or the the burst the shell on the outside get the flavor so we can actually do things within the body and then it has all the growth factors the inflammatory mediators to be able to help us heal wow I mean there’s just so many options for patients to help them with whatever pain they may be having it is and we see a lot of the mutual patients and I would say a good majority of them are always feeling better which is awesome right yeah and and it’s always so there’s a difference I want to say between better and perfect yes because there are so many people that like when they come in and they broken down and they have pain and there’s things going on like for me to get you from Z to 100% happens um but that’s not going to be my expectation I usually expect to take you from like zero like I’m not functioning I’m things are really bad I can take you up to like 75 85 90% Improvement pretty regularly and have you feeling better on a regular basis and sometimes that’s maintenance from that point um where if we can keep you feeling that much better and yeah you’re still probably going to have some pain because usually when things have broken down when you’ve come in and you’ve had this problem there’s always going to be a little bit of that lingering and we’re human bodies we have we’re exposed to inflam inflammation things within our system um we’re eating foods that are in our system we are yeah not always making all of the right decisions all of the time right um so we just have those issues yeah all right so I mean we talked a lot about all of our different nonsurgical Orthopedics um kind of pain management things I mean there’s a lot more out there so one of the things I would say is if you are having some pain or some dysfunction or even having a question that like something just doesn’t feel quite right I mean certainly come in and give us a try um or find someone near you I mean when we think about nonsurgical Orthopedics um a lot of times you’re going to so you don’t usually don’t look for Orthopedic so a regenerative Orthopedic Specialist is probably where you’re going to find someone that does treatment similar to us and of course they’re they’re different kind of everywhere you go so here we’re at reu in Way Park Minnesota Central Minnesota I mean it’s a great place to get treatments there’s a lot of things around and people actually come here from all over to get their treatments as well um we’ve had NFL players we’ve had other kind of major sports people coming here to get their treatments done so again a great place to come if you’re like you know what I heard what they’re talking about on Wellness Warriors I love it I want to do it um come here I mean it’s a a great place to visit winter is a little colder summers are great um to be able to get yeah good treatments to be able to make you feel better in the long run um that we can treat chronic pain um whether it be coming from nerves whether it be back pain that you’ve had for years I’d say even if you have had it for a very long time can can still try it out because it’s usually something that you haven’t tried all the time we hear I’ve tried everything like well but have you there’s probably something that we have for you that you haven’t tried and there’s a select few that we’ve tried everything and everything that we have still doesn’t work so then we might send them back to surgery and surgery is still a good option if we have tried everything and that’s usually what they say surgery is the last result or the last option so let’s try these other options for some people so come give it a try see if we can make you feel better um again perfect may not happen but better likely will um it’s a great way to get your life back in a way if we can get pain under control sleep is better functioning is better diet is better usually exercise is better and it doesn’t even have to be exercise I know the word exercise kind of brings people down but just physical activity being able to right being able to move and do things and just yeah just having good physical movement or higher quality physical movement is definitely possible yeah absolutely well thanks we’ll catch us next uh next week we should have another Wellness Warriors don’t know what our topic is yet so we’ll figure it out right all right thanks everyone please note that the opinions expressed in the wellness War podcasts are those of Shelby terance and their guests that are meant to be educational and informative this podcast is not intended to provide any medical advice or replace the guidance of qualified Healthcare professional if you have specific concerns about your health we encourage you to schedule an appointment with us by calling us at 32 20 217 8480 to discuss your individual needs with our team of experts remember always consult with a healthcare professional before making any changes to your lifestyle or treatment plan