Stem Cell update – Looking positive, but let’s not get too excited
Many of you will have seen articles in newspapers about stem cells and the hope that they offer to arthritis sufferers.
Unfortunately, these articles are overstating the current evidence.
The truth is:
1. There is currently a trial running for injection of pure stem cells into osteoarthritic knees, measuring both pain and cartilage depth as outcome measures
2. This trial is about 50% complete and is showing some very good outcomes in pain and function in those who receive the injections, but very few have had their follow up scans yet.
3. The trial is still recruiting for suitable patients
4. Assessment for cartilage regrowth over all the trial patients is about 12 months off.
In a practical sense, this means that we are still looking for participants, but it doesn’t mean that we can say that this treatment will work for all arthritis, nor that we can prevent joint replacements.
In many cases, patents are not suitable for the trial because they don’t fit all the strict criteria. There is the option of seeking private treatment. Costs vary, but are several thousand dollars.
There have been some individual cases that have undergone stem cell therapy and shown regrowth of cartilage. This is certainly exciting, but until more people complete the trials, these are only individual cases.
We would ask that everyone assess the evidence well in making any decisions, and remember that there are many other non surgical options available for management of arthritis that we may recommend first.
One of the commonest presentations to a Sports Medicine clinic is for pain at the side of the hip that hurts to go up stairs and to lie on the side at night.
Many people assume this means that they have arthritis in the hip joint. Generally, this is not the case. In most cases, pain on the outside of the hip is from the tendons of the buttock muscles, where they attach to the bone.
Many others have been told they have “bursitis”. A bursa is a little fluid filled sac, like a water balloon containing a drop of fluid. It sits between 2 structures in the body, to allow them to glide safely past each other. There are a number of these on the outside of the hip. They can become inflamed, swollen and painful. It is VERY unusual for this to occur without an underlying cause. Cortisone injections can help to settle the inflammation, but it will usually recur within 6 weeks if the cause is not addressed.
SO WHAT ARE THE CAUSES?
Most people with pain at the outside of the hip have some issues with muscle activation around the hip, resulting in overload of the tendons.
There are many things that affect the muscle activity. These include, but are not limited to, age, menopause, previous back pain, hip joint pathology, recent illness, weight gain and poor exercise technique.
WHAT CAN I DO?
A great first line treatment is to use a tennis ball to massage through the buttock muscles twice a day. You can do this leaning against the wall. It will be uncomfortable, but with frequent massage, the tightness should start to reduce.
Pop a heat pack on for a few minutes after massaging and before going to bed.
Avoid sitting with your legs crossed and sleep with a pillow between your knees to take the tension off the tendon.
Once your pain starts to improve, get some advice regarding your exercise program and make sure your technique is right. The last thing you want to do is load it all up again.
WHAT IF THAT DOESN’T WORK?
You need an accurate diagnosis. Sometimes tendon tears are harder to get better.
Sometimes the pain is not from the tendons, but referred from structures in your back or elsewhere.
An ultrasound, X-rays and possibly and MRI may be required to establish your diagnosis.
From there, accurate advanced treatment can be commenced .
It is not uncommon for us to see people presenting with “heel spurs”.
Did you know that while heel spurs are seen in 45-50% of the population, about 1/4 of these will ever experience pain AND heel pain can occur just as commonly without a spur? Sometimes, seeing a spur on Xray doesn’t help our diagnosis at all!
PLANTAR FASCIITIS
Heel pain is commonly diagnosed as plantar fasciitis. The plantar fascia is a ligament, like a bowstring, that stretches taut under your foot to help keep the arch shape of the foot when standing. Too much load causes wear and tear. The wear and tear causes pain where the ligament joins to the heel.
However, when we see plantar fasciitis that is not getting better, it will often be because there are other structures that can cause the pain as well.
WHY IS MY HEEL SORE?
The foot is a very complex structure and requires a number of “helpers” to keep its arch. Tendons, bones, muscles and ligaments all play their part.
Any increased load through the foot can result in overuse of any or all of these structures.
Increased load happens when you increase your activity, have less support from your footwear, gain body weight or have an injury that alters your walking patterns.
WHAT CAN I DO?
If you develop heel pain, we suggest icing regularly, rolling a golf ball under the arch of your foot (not on the sore spot), wearing good supportive shoes and LOTS of calf stretching.
Anti inflammatory tablets can also sometimes help.
There are a number of taping techniques that can help with the pain, as well as gel inserts or possibly orthotics.
AND IF THAT DOESN’T WORK?
Make sure you check the diagnosis first.
If your diagnosis is definitely plantar fasciitis, there are more treatments that may be suitable. Many of these will need your Doctor’s help. Iontophoresis, corticosteroid injections, shock wave therapy and even PRP (platelet rich plasma) injections might be indicated.
If your diagnosis reveals that there are other structures causing or contributing to your pain, you may need further investigation to confirm this and possibly additional or other treatments to allow you to achieve complete recovery.
EXERCISE RELATED LEG PAIN
Many of us find that our legs get a bit sore when we get back into exercise,
but for some people the pain is enough to make them stop.
Pain in the lower leg with walking, running or riding can result from a
number of different problems.
SHIN SPLINTS
Many of you will already be aware of shin splints and stress fractures.
Shin splints occur when the lining of the bone is inflamed. These will often
hurt at the start of exercise but warm up if you keep going.
Stress fractures happen when shin splints worsen. The pain is worse, doesn’t
warm up and can hang around all night.
MY PAIN IS DIFFERENT – CAN IT STILL BE SHIN SPLINTS?
As Sports Physicians, we see a number of other conditions that are often
confused with shin splints.
A tightness in your legs that doesn’t stop until you do might represent
compartment syndrome, where the muscles are being squashed by tight lining
tissue of the leg. More rarely, you may have some blockage of the blood flow
into the leg muscles.
If your age is little higher than Michael Clarke’s batting average, the pain
in your legs may be referred from your back or be caused by issues with the
blood vessels higher up the legs.
WHAT CAN I DO?
There are a few basic steps to take if you start experiencing leg pain with
exercise
1. Check your footwear. Good supportive footwear will prevent or even
treat many of the causes of pain. Occasionally orthotics may be required.
2. Use ice, stretching and massage regularly.
3. Make sure that the muscles higher up in the leg around the hips and
pelvis are strong. If these muscles are doing their fair share, it reduces
the load on your calves.
4. Be aware that pushing on through pain could be doing you some harm.
AND IF THAT DOESN’T WORK?
Be sure to seek professional help. An accurate diagnosis will be the first
step to ensuring that you have your best chance of a complete recovery.
Dr Greg Harris and Dr Eloise Matthews are pleased to announce the commencement of a trial for treatment of lateral hip pain. Both are closely involved in the research, which is backed by Latrobe university.
If you have pain at the side of your hip, or know someone that does, you may be eligible to be included in this world first research.
Simply click on the link below for more information:
http://www.latrobe.edu.au/school-allied-health/research/lower-extremity-and-gait-studies/globe-hip-study/
If you would like more specific information or details, you can contact Charlotte Ganderton, the principle researcher, directly on (03) 9479 1389, email C.Ganderton@latrobe.edu.au or Twitter @GLoBEHip
Fortunately coccygeal pain (coccydynia) is a rare presentation to Sports Physicians. Unfortunately, it can be one of the most difficult to treat.
Science on its treatment is a little bit haphazard and developing a treatment algorithm often comes down to clinical experience.
In my mind, I divide coccygeal pain into those with a mechanical cause for problems and those without.
There is little doubt that most cases start with a mechanical component, but his often dissipates with time, leaving a more inflammatory or chronic pain type of pattern.
The commonest cause by far is trauma and the commonest trauma by far is a fall onto the tail bone. Initial pain levels vary from mild to severe.
In the early phases of an injury, ice, the use of a ring cushion and anti inflammatories may reduce symptoms and allow healing.
Unfortunately, many patients do not seek help at his stage.
As the duration of pain progresses, compensations begin to occur in the muscles and ligaments of the pelvic floor, resulting in further and ongoing overload of the coccyx and sacrococcygeal joint.
My approach to this pain is to throw my net wide. Initally, NSAIDS for 4-6 weeks, combined with a ring cushion as much as possible and a pelvic floor physiotherapy to address muscle and ligamentous tightness can be effective.
It is quite common for the sacrotuberous and other ligaments to be tight and scarred. As you will remember, many of the pelvic floor muscles insert into these ligaments and are often then reflexly higher in tone, resulting in further unbalanced pull on the coccyx.
Teaching the patient to be aware of this pelvic floor tone is imperative in the longer term.
Should that approach not work, guided corticosteroid injection may help. These can be done to the sacrococcygeal joint or to the paracoccygeal tissues. Patients may need 2-3 of these at 6-8 week intervals and may need some neuromodulation medications to reduce pain flares in response.
Radiofrequency denervation procedures may be contemplated, but, again, literature is sparse.
Recalcitrant cases can consider surgery (coccygectomy). This is not a popular option due to the risk of nerve damage, with resultant continence issues, but as a last resort, does have a pretty good strike rate for pain relief (around 70%).
At the end of January 2015, MP Sports Physicians will regretfully be saying goodbye to our current registrars, Dr Brendon Aubrey and Dr Matthew Chamberlain. We thank them for their efforts over the last 2 years and we will miss them as they progress to the next compulsory stages of their ACSP training. Hopefully they learned something along the way, but at the very least, had the opportunity to realise what a great and supportive medical community we have here on the Peninsula!
Farewell Matt and Brendon and our very best wishes for all your future endeavours.
We are, however, fortunate to be commencing 2 new registrars with our team, bringing with them a whole new set of strengths and a fresh outlook.
Welcome to Dr James (Jimmy) McLaren is New Zealand born, but happy to call himself an Aussie. He comes from an A&E background, is into extremeish sports and already has good sports experience, having looked after the Casey Scorpions VFL team for a few years. He will continue to work at Casey during his 2 year tenure with us.
Welcome also to Dr Sachin Khullar is Indian trained with extensive sports medicine and surgical experience. He is looking to call the Peninsula home for quite some time and will be helping out with the Frankston Dolphins this year.
Of course, here as always will be Dr Leesa Huguenin and Dr Greg Harris, as well as our continuing registrar, Dr Eloise Matthews. Together, we welcome both Jimmy and Sachin to MP Sports Physicians and look forward to our nxt few years together.
CYCLING IN COMFORT: It’s not just the lycra that needs to fit properly!
Cycling is no longer the “new golf” – the growth of cycling has been steady and consistent for many years now. Bike sales have exceeded car sales annually for over 15 years, and over half of all Australian households own one or more bicycles, making cycling the fourth most popular physical activity after walking, aerobics and swimming. All levels of government have recognised the benefits of cycling to the community in terms of amenity, traffic management, health and economics.
The Mornington Peninsula is one of Australia’s cycling ‘hot-spots’, with riders of all shapes, sizes and abilities enjoying the roads and trails either for training, commuting or just for fun. With this increase in activity there is of course an increase in the prevalence of cycling-associated injuries or pain.
Sore backs, knees, hips, shoulders and necks can frustrate riders at all levels, but most cycling aches and pains can be improved by ensuring that the bike and rider work together. It is rare for a bike to ‘fit’ the rider straight off the shop floor, and while most bike shops will offer a basic setup, it can sometimes take a more thorough assessment to get things right. As with any sport, it is often only possible to manage an injury by assessing technique and biomechanics, which is where a specialist musculoskeletal examination is needed.
At MP Sports Physicians we can now offer a thorough riding assessment, starting with the rider and then moving on to look at the bike. With the individual rider’s issues in mind we can then work on the combination of how the two should best fit together.
For more information please see our website, or call the Mornington or Frankston office. Patients can book an appointment for a Riding Assessment through either clinic.
In a study released on 1/10/13 in the British Medical Journal online, a meta analysis has found that in order to reduce the risk of death in people who have already had heart attacks, exercise is as good as many of the commonly used drugs, including ACE inhibitors and statins.
Exercise is also as effective as medication in the prevention of progression of pre diabetes to diabetes.
The really good news is that exercise is SUPERIOR to medication (including antiplatelet agents) in preventing death in patients who have had a stroke.
SO, don’t wait – get out there and start moving!
And if you are not sure where to start, you might like to consider one of our lifestyle programs – www.mplifestyle.com.au