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Morgan Kalman

Sports Medicine

What are PRP (Platelet Rich Plasma) and Stem Cell Therapies?

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The Morgan Kalman Clinic provides regenerative therapies: PRP (platelet rich plasma) and Stem Cells (via bone marrow concentrate) to treat a variety of orthopedic/sports medicine conditions. Regenerative therapies offer an alternative to treatment of injuries and in some cases surgery. Some people have conditions that do not respond to standard treatment.

PRP and Stem Cells are gaining increased popularity in the sports medicine field nationally especially because it is more of a “natural” therapy by harnessing the power of your body’s own cells and platelets. The procedure is performed in the office setting with minimal risk, downtime and minimal pain.

If you have tried and failed physical therapy, cortisone injections, medication, or even surgery, PRP and Stem Cells may be just the right option for you. The same therapy used by athletes is available for everyone for treatment of acute and chronic tendon, ligament and muscle injuries.

Common Conditions Treated

• Partial Tendon Tears: Rotator Cuff, Achilles Tendon, Plantar Fasciitis
• Partial Ligament Injuries
• Overuse Tendon Injuries: “Tennis Elbow” “Golfers Elbow” “Jumper’s Knee”
• Hip, Knee and Shoulder Osteoarthritis

Some recent studies have shown PRP to be more effective than hyaluronic acid injections for osteoarthritis of the knee. Studies also support use of stem cells.

Sprains involve damage to ligaments, whereas strains are muscle or tendon injuries. While acute injuries generally are treated with rest, ice, and anti-inflammatory medications, chronic problems may not respond.

Regenerative therapy is a game-changing area of medicine with the potential to heal damaged tissues that are the result of injury, overuse or wear and tear over time. Stem cells have regenerative power; when they are injected into an area that needs healing, your body’s natural response is to accelerate the process and repair the damage. This is a non-surgical procedure involving the extraction and injection of your own naturally occurring stem cells.

PRP involves a blood draw in the office, like getting a standard blood test. The blood is then spun down in a special centrifuge, which highly concentrates the platelets in the blood. The resulting platelet concentrate is then injected directly into the damaged portion of the ligament or tendon under ultrasound guidance. Stem Cells via bone marrow concentrate involves extraction of cells from the back of the pelvis. Both, of course are under sterile conditions. The injured area and overlying skin first are anesthetized with a local anesthetic to reduce any discomfort from the injection. There is a period of several days of soreness after the treatment. Patients are discouraged from taking anti-inflammatory medications, such as Motrin or Aleve, since these can hinder the healing process. Tylenol is allowed during this time.

PRP injections are given approximately once every 6 weeks, and usually one to three treatments are required. Stem cells (via bone marrow) are generally one treatment annually. The actual injection takes only a few minutes. But the entire process, from drawing the blood or bone marrow, to spinning it down in the centrifuge, and then injecting it, can 30 minutes to an hour depending on the type treatment and area treated.

The risks from treatment are very rare and are related to the injection itself, not the solution injected. They can include localized infection, bleeding or bruising or, very rarely, temporary nerve damage.

The future of treating orthopedic and sports medicine injuries is now and includes the use of “Orthobiologics” such as PRP (platelet rich plasma) and Stem Cells.

The treatment may not be covered by insurance plans.

References are on file.

Please schedule a consultation to find out what treatment is best for you.

We look forward to seeing you soon.

Sports Specialization and the Young Athlete

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Is There Increased Risk of Injury?

The answer is yes according to this study performed at Ann & Robert H. Lurie Children’s Hospital of Chicago as reported in the April 2015 addition of the American Journal of Sports Medicine.

They examined 1190 (50.7% male) injured athletes between ages 7-18 from 2 hospital based sports medicine clinics and compared them with controls from the affiliated primary care clinics undergoing sports physicals (2010-2013).
There were 822 injured participants (49.5% male) and 368 uninjured (55% male). Injured athletes were older (14.1 vs. 12.9) and reported more total hours of physical activity (19.6 vs. 17.6 h/wk) and organized sports activity (11.2 vs. 9.1 h/wk).

The authors determined that sports specialized training was an independent risk for injury and serious injury. Previous studies have also demonstrated that “injury risk increases with age and training volume.”

COMMENT:

It is well known that the number of young children are participating in organized sports. There is no question that organized sports have many positive aspects in the growth of the young athlete. These include fun, exercise, socialization, and learning life skills. The potential downside is becoming too consumed with one sport to the point where pressure from parents, coaches and time spent can potentially eliminate these benefits, maybe even quitting the sport.

This study as well as others also shows us that specialization was an independent risk for injury.

While there are some limitations to this study the message is clear. Specialization results in more overuse injuries in the young athlete.

What can we do?

• Limit the number of teams in which your child is playing in one season. Kids who play on more than one team are especially at risk for overuse injuries.
• Do not allow your child to play one sport year round – taking regular breaks and playing other sports is essential to skill development and injury prevention.
• Conditioning that focuses on the total body, not the sport although sport specific conditioning can be part of the program

Do more to create an environment for healthy competition and sportsmanship, learning how to cope with the successes and failures that go with sport and life itself. Introduce some fun, a change of pace once in a while to keep things fresh.

While I understand that there are highly gifted athletes that excel in one area, let’s try to keep the young athletes in mind and allow them to achieve their potential while minimizing injury. After all, injuries do ultimately take their toll and may prevent achieving they level they sought to begin with.

The Importance of the Hip in the Throwing Athlete

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The Role of the Kinetic Chain

The Kinetic Chain is a term used by most sports medicine and exercise science professionals to describe a sequence or a chain of events that take place in order for an athlete to throw (Figure 1). For a pitcher, the sequence of events start from the push off of the rubber on the mound to the follow through where the pitcher rolls off of the mound.

When I evaluate a young throwing athlete I often am asked “Why Are You Looking at His/Her Hip, Shoulder When It’s the Elbow that’s the Problem.”

Unfortunately all too common as all they are concerned about is when he or she can pitch/throw again. The throwing motion is a very violent motion and it takes many moving parts at a high speed. If any of those parts is out of balance (weak, tight, pain) then the result can be less than optimum. Continued throwing in this unbalanced condition can result not only in injury, missing games but season ending and sometimes career ending injuries.

The hip like any other joint is subjected to fatigue as the result of the repetitive actions of throwing. The position of the hip “sets up” the upper extremity for the throwing motion. The lead (landing leg) hip lands in 5-25 degrees of internal rotation, setting the proper rotation. If the hip opens too early, it can result in increased stresses across the shoulder and elbow. If the hip opens too late, you wind up throwing across the hip and losing power. The trail hip stabilized the pelvis and controls the stride length.

In 2009 Dr.’s Aguinaldo and Chambers from Rady Children’s Hospital in San Diego, California did a biomechanical study of 69 adult pitchers throwing off and indoor mound. They showed that late trunk rotation was a cause of increases stresses across the elbow (load on ulnar collateral ligament).

What does this mean for the throwing athlete? The baseball season is a long one and these athletes are subject to fatigue, overuse and joint adaptions during the season. Loss of hip rotation, strength can gradually occur if not addressed resulting in increases stresses across the shoulder and elbow. Decreased hip rotation can also cause sacroiliac and back problems. What about velocity? You may be surprised to know that close to 50% of the velocity of throwing comes from the energy initiated below the waist. This is another reason why a complete training program including the pelvis, hip, scapula AND shoulder are critical to the success of the throwing athlete.

Numerous studies have shown that deficits and upper/lower body strength and flexibility can be correlated with injuries the shoulder and elbow of the throwing athlete.

Bottom line, let’s do our best to help our young throwing athletes. In addition to pitch counts (by age) and type of throw (by age) let’s allow our athletes to be prepared physically and mentally to enjoy the game as it is meant to be played.

I would recommend pre and post season evaluations to be sure any deficits are identified to hopefully prevent injuries and keep those shoulder and elbows healthy for a long time.