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● ARIZONA
PHOENIX
Fred Arnold, DC, NMD
Kent L.
Pomeroy, M.D.
SCOTTSDALE
Michael Cronin, N.D.
David Tallman, DC, NMD.
TEMPE
Robb D.
Bird, NMD
TUCSON
Jorge B. Cochran, ND.NMD
● ARKANSAS
Merl
B. Cox, D.O.
●
BRITISH COLUMBIA
Christoph Kind, N.D.
●
CALIFORNIA
ANAHEIM
AREA
Hanson
Wong, M.D.
Howard Rosen,
M.D.
AUBURN
Rodney Van Pelt, M.D.
BAKERSFIELD
Payam Kerendian, D.O.
BEVERLY HILLS
Behzad Emad, M.D.
Payam Kerendian, D.O.
CLOVIS
Kevin Wingert, M.D.
GARDEN GROVE
Howard Rosen,
M.D.
GLENDALE
G. Megan Shields, M.D
IRVINE
Allan
Sosin, M.D.
Los Angeles
Donna Alderman,
D.O.
Marc Darrow, M.D
Hanson
Wong, M.D.
Los
GATOS
Joshua M, Donaldson, N.D.
Marin County
Paul
Handleman, D.O.
John Monagle, NMD
Monterey
Howard Rosen,
M.D.
SAN
DIEGO
Andrew
Kulik, D.O.
Gary Matson, D.O.
SAN FRANCISCO EAST BAY
Donna Alderman,
D.O.
SAN FRANCISCO NORTH BAY
Paul
Handleman, D.O.
John Monagle, NMD
San
Ramon
Richard I.
Gracer, M.D.
SANTA
BARBARA
Allen
Thomashefsky, M.D.
SANTA
CRUZ
Joshua M, Donaldson, N.D.
SANTa monica
Peter Fields, M.D.,D.C.
SANTa
ROSA
Justin Hoffman, NMD
Temecula
Edward A.
Venn-Watson, M.D.
UKIAH
AREA
Rodney Van Pelt, M.D.
● COLORADO
BOULDER
Gary Clark, M.D.
BROOMFIELD
Christopher J. Centeno, M.D.
John
R. Schultz, M.D.
COLORADO SPRINGS
Mary Harrow, D.O,
DENVER
Joel A. Berenbeim, D.O.
Thomas Ravin, M.D.
FORT COLLINS
Mark Kelley, N.D. LAc
LITTLETON
Jo
Ann Douglas, M.S.,D.O
PARKER
John
A. Littleford, D.O.
STEAMBOAT SPRINGS
Jon Freckleton, D.O.
● CONNECTICUT
AVON
Valley Sports Physicians & Orthopedic
Medicine
Paul Tortland, D.O.
Albert Kozar
WEST
REDDING
Perry M.
Perretz, D.O.
● DELAWARE
SOUTHERN NJ
Scott R. Greenberg, M.D.
SOUTHERN PA
Brian J.
Shiple, D.O.
● FLORIDA
ORLANDO AREA
Nelson Kraucak, M.D.
ORMAND BEACH
Hana Chaim, DO
Clearwater
Felix Linetsky, M.D.
PLANTATION
Alvin Stein,M.D.
SARASOTA/TAMPA BAY
Mark Walter, M.D.
Wellington Chen, M.D.
Matthew Burks, M.D.
TAMPA BAY AREA
Felix Linetsky, M.D.
Robinson Family Clinic
● GEORGIA
WARNER ROBINS
E.
Glynn Taunton, D.O.
MARIETTA
Robert C. Shuman, M.D.
● HAWAII
HAIKU
Kevin Davison, N.D.
HILO
Liza Maniquis-Smigel, MD
Honolulu, Hawaii
Liza Maniquis-Smigel, MD
● ILLINOIS
CHICAGOLAND
Ross Hauser, M.D
PEORIA
Yibing
Li, M.D.
Jay Harms,
M.D.
WESTERN ILLINOIS
Anwer Rasheed, M.D.
● INDIANA
CLARKSVILLE
Steven
M. Johnson, D.O.
LAFAYETTE
Carolyn
G. Kochert, M.D.
Mishawaka
Mark S. Cantieri, D.O.,
● IOWA
CLINTON
Anwer Rasheed, M.D.
IOWA CITY
John
Macatee, DO.
WEST DES MOINES
Jacqueline M Stoken, D.O
● KANSAS
KANSAS
CITY AREA
K. Dean Reeves, M.D.
TOPEKA
Doug Frye, M.D.
● KENTUCKY
LOUISVILLE
Steven
M. Johnson, D.O.
● LOUISIANA
NEW ORLEANS AREA
Thomas K. Bond, M.D.
● MARYLAND
Rockville
Ingrid Gheen, M.D.
● MASSACHUSETTS
MALDEN
Albert V. Franchi, M.D.
WORCESTER
Jon Trister, M.D.
● MICHIGAN
Howell
Jerald Gach, DO
SHELBY TWP
Robert Krasnick,
M.D.
Southfield
Jerald Gach, DO
WARREN
Robert Krasnick,
M.D.
● MINNESOTA
EXCELSIOR/Menahga
Mark T. Wheaton, M.D.
MINNETONKA
George H. Kramer, M.D.
● MISSOURI
KANSAS CITY
Edward McDonagh, D.O
ST. Peters
Michael J.
Adams
● MONTANA
HAMILTON
Mark Kelley, N.D. LAc
● NEVADA
CARSON CITY
Alfred N.
Grimes, M.D.
RENO
Andrew C.
Wesely, M.D.
● NEW JERSEY
BLAIRSTOWN
Walter R. Grote, D.O
CENTRAL NJ
Edward Magaziner, M.D.
WAYNE/NORTH NJ
Robert
Kramberg, M.D.
SOUTH NJ/PHILADELPHIA
Scott R. Greenberg, M.D.
(Cherry Hill)
Joseph P. Mullane, M.D.
(Hamilton)
Brian J.
Shiple, D.O.
(Springfield PA)
●
NEW MEXICO
Albuquerque
R. Dean Bair, D.O.
James
E. Baum,
D.O.
SANTA FE
James
E. Baum,
D.O.
Jonas R. Skardis, DOM
● NEW YORK
BALDWIN
Pandu Tadoori, M.D.
BUFFALO AREA
Timothy L. Speciale, D.O.
BROOKLYN
Neil Raff, MD, CNS
David Zirkitev,
P.A.
EAST MEADOW
Christopher Calapai, D.O.
FLUSHING
Neil Raff, MD, CNS
HICKSVILLE
David Borenstein, M.D.
MANHATTAN
Richard Ash, M.D.
David Borenstein, M.D.
John H. Juhl, D.O.
Robert Kramberg, M.D.
NEW YORK METRO AREA
Perry M. Perretz, D.O.
Edward Magaziner, M.D.
Scott R. Greenberg, M.D.
ORANGE
Neil Raff, MD, CNS
ROCKLAND
Neil Raff, MD, CNS
WESTMINSTER
Neil Raff, MD, CNS
● NORTH CAROLINA
ASHEVILLE AREA
Stephen
Blievernicht, M.D.
CARY
Catherine Duncan, D.O.
Huntersville
Dr. Mark Hines
● OHIO
AKRON/CANTON
Vladimir Djuric, M.D.
BLUFFTON
L. Terry Chappell, M.D.
CENTERVILLE
Rick
Buenaventura, M.D.
CINCINNATI
Michael J. Bertram, MD
TOLEDO
AREA
Jay W. Nielsen, M.D.
● OKLAHOMA
BROKEN ARROW
Shirley J.
Welden, M.D.
● OREGON
ASHLAND
Allen
Thomashefsky,M.D.
EUGENE
Thomas
Peterson, M.D.
HILLSBORO
Kevin C. Wilson, N.D.
LAKE OSWEGO
Noel S. Peterson, N.D.
MEDFORD
Carl Osborn, D.O.
OREGON CITY
Joanne Gordon, ND,MS,PT
PORTLAND
Rick Marinelli, N.D.
Chiaoli
Lu, ND. LAc. DAOM.
Patrick Chapman, N.D.
Joshua David,
N.D.
REDMOND
E. Payson Flattery, D.C.,N.D.
SALEM
Donald McBride, Jr, ND
● PENNSYLVANIA
BALA CYNWYD
Harvey Kleinberg, D.O.
BETHLEHEM
James F. Frommer, M.D.
ELKINS PARK
Kab S. Hong, M.D.
JEANNETTE
Martin
P. Gallagher, M.D., D.C.
MEADVILLE
Paul Peirsel,
M.D.
PITTSBURG
Paul S. Lieber, MD
SOUTHERN NJ - PA
Scott R. Greenberg, M.D.
Allan Magaziner, D.O
Edward Magaziner, M.D.
SPRINGFIELD
Brian J.
Shiple, D.O.
WOMELSDORF
Peter J Blakemore, D.O,
● SOUTH CAROLINA
GREENVILLE/SPARTANSBURG
Robert Schwartz, M.D.
CHARLESTON
Marc N.
Dubick, M.D.
MOUNT PLEASANT
Patrick
Lovegrove, D.O.
● TENNESSEE
BRENTWOOD
Mark L.
Johnson, M.D.
CLARKSVILLE
Rafael Prieto, M.D.
JACKSON
Marcus
E. Meekins, M.D.
MEMPHIS
Marcus
E. Meekins, M.D.
NASHVILLE
Mark L.
Johnson, M.D.
● TEXAS
AUSTIN
Mihnea Dumitrescu, M.D.
David
K. Harris, M.D.
Brad Fullerton, M.D.
DALLAS
Michael Ellman, M.D.
DENTON
Carlos
J. Garcia, M.D.
FORT
WORTH
Gerald Harris, DO
Dennis E. Minotti II, D.O
David E. Teitelbaum, D.O.
HOUSTON
Robert Battle, M.D.
Adam Weglein,
D.O
HOUSTON AREA
Joseph
G. Valdez, M.D
John P. Trowbridge
MESQUITE
Michael Ellman, M.D.
PARIS
Gregg
Diamond, M.D.
Norberto Vargas, M.D.
PLANO
Michael Ellman, M.D.
RICHARDSON
Gregg
Diamond, M.D.
Norberto Vargas, M.D.
SAN ANTONIO
Annette M. Zaharoff,
M.D.
SHERMAN
Gregg
Diamond, M.D.
Norberto Vargas, M.D.
SUNNYVALE
Gregg
Diamond, M.D.
Norberto Vargas, M.D.
TOMBALL
Shaun Lehmann, M.D.
Curtis Fandrich, D.O.
● UTAH
PARK CITY
Harry Adelson, N.D.
Kenneth Hurwitz, M.D.
SALT LAKE CITY
Harry Adelson, N.D.
E. Alan Jeppsen
SPANISH FORK
David Taylor Roberts, M.D
● VERMONT
WINOOSKI
Jonathan
E. Fenton, D.O
● VIRGINIA
ALEXANDRIA
Robert H. Wagner,
M.D.
BLUEFIELD
Lenny
Horwitz, DPM
FAIRFAX
Mayo
Friedlis, M.D.
McLEAN
David Wang, D.O.
VIRGINIA BEACH
Lisa
Barr, M.D.
● WASHINGTON
ISSAQUAH
Jena
Schliiter., M.D.
SEATTLE
AREA
Richard
A. Sandler, M.D.
JoAnna Forwell, N.D.
Adam R.
Geiger, N.D.
● WEST VIRGINIA
MORGANTOWN
Nori Onishi, D.O.
● WISCONSIN
EAU CLAIRE
Deborah Raehl, DO
WAUWATOSA
Neal Pollack, D.O.
MILWAUKEE
William
J. Faber, D.O.
|
ORTHOPEDIC
MEDICINE: A NON-SURGICAL APPROACH TO CHRONIC PAIN
Lawrence
Cohen, M.D.
When asked what I do,
I hate to say "I'm in pain management," because the focus of my
practice is really pain resolution. By the time someone reaches a pain
specialist, they have failed standard interventions such as
physical therapy,
medication and even more invasive procedures such as epidural steroids. They
have persisting pain that leaves them less effective in the home, at work, and
in their personal relationships. I was trained with a physical medicine
education to utilize medications, physical or occupational therapies,
psychology, and a few injection techniques for
tendons, bursae or muscle
trigger points. This approach proved inadequate for so many of my patients. I
began searching the alternative medicine world for treatments that worked.
This led me to the
field of Orthopedic Medicine, a group of physicians who are utilizing
alternative techniques to deal with complex pain problems. The direct cost
savings can be tremendous; just think of the cost of one back or
neck surgery
that might be avoided or the cost of years of
chiropractic care,
Physical therapy,
or physician and emergency room care. Indirect savings can be greater when
adding the return to work someone who otherwise might be out on disability or
worker's compensation for life.
The focus of this
therapy is on the structural component. This might be the sprained or strained
ligament, tendon or muscle- or the "somatic dysfunction" of the
chiropractor or osteopath. One of the most important lessons regarding
structure is that the underlying problem may not be where the pain is. The
injured area is typically tender only to careful examination, and may be quite
distant from the area where pain is actually felt.
I see many patients
involved in car accidents with persistent
neck pain and
headaches who have
undergone expensive and unnecessary
MRIs, EMGs, physical therapy and
chiropractic treatment aimed at the
cervical spine, when careful examination
might have focused treatment at the real source of their pain elsewhere.
In some instances the
perpetuating problem results when the head is whipped to the side, the scalene
muscles yank on their insertion into the first rib and pull it up out of
alignment. This results in a super sensitive spot where the first rib attaches
to the T1 spine, and muscles around it remain severely triggered, referring
pain up the neck to the head, down the medial scapula and down the arm. In
this case, osteopath mobilization followed by
Prolotherapy to the ligament
that joins rib to spine and trigger point injections of the remaining
triggered muscles, will resolve the head, neck and
shoulder girdle complaints.
For others, the
problem occurs following an accident in which they bounce back into the car
seat at their mid thoracic spine. This can depress one or two segments of the
thoracic spine, reversing the normal kyphotic curve. Here, the posture changes
to compensate, straightening out the
cervical curve and shortening the paraspinal muscles. Restriction and triggering at mid-thorax refer pain up to
the skull and neck. The pain is felt in the neck and head-not in the back!
When asked to flex their neck, patients typically cannot reach their chin to
their chest. Osteopathic mobilization, often facilitated by
Neural therapy
block to the paraspinal musculature, will allow resolution.
In another common
accident scenario , the person is jamming on the brake with the right
foot
while the left foot is hanging loose and the seat is tethering the
pelvis.
This may displace the right cuboid (a small bone in the foot) or, worse, may
cause a torsion that shifts the pelvis out of alignment with respect to the
two iliac bones, or to the sacrum that sits between. The low back may be
painful with either one of these conditions, yet the foot, where the injury
really occurred, rarely is. Either one of these conditions can alter the
patient's posture, gait and stance, resulting in chronic head or neck pain.
Osteopathic mobilization and occasionally
Prolotherapy is necessary to obtain
correction and relief.
Finally, there are
pain patients where the structural problem is in the neck. These patients
typically are okay as long as they keep seeing the chiropractor or physical
therapist every few days, but they can't resolve the pain.
x-rays may show
some
arthritis, spondylosis, and
degenerative disc changes, which frequently
get the blame for the pain.
Here the structural
problem involves the ligament and tendon attachments to bone. There may be a
strain or sprain (micro avulsion or rupture of fibers as the insert into
bone), with local tenderness on palpitation, causing reactive muscle
triggering, which generates much of the pain a patient feels. In addition,
recurring somatic dysfunction in the cervical spine returns within hours or
days after each chiropractic or PT treatment.
The most effective
treatment is prolotherapy, a way of repairing the ligament and tendon injuries
and shutting down the "C" pain fiber irritation present. In
prolotherapy, a hyperosmotic 12 percent
dextrose and lidocaine solution (which
may be combines with a chemical irritant as well) is injected in small amounts
at the attachments of tendon and ligament to bone. This induces the body's
healing
inflammatory response to repair strained and frayed ligament, or
merely tighten existing
ligaments, made lax by narrowing of disc or joint
spaces through degenerative processes. Through repeated injections, the
treated ligaments can have as much as 140 percent the strength of controls (in
animal studies). Prolotherapy can be used at the neck, low back, knee,
shoulder (see
Prolotherapy to the shoulder videos), or any joint to prevent progression of arthritis and eliminate pain.
© Lawrence
Cohen, M.D.
The opinions expressed
here does not necessarily reflect the views of the other member physicians of
getprolo.com.
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