Best Initial Knee Stretch "The Hammy" (Knee OA, Part 3)

Your hamstring tendons start on your pelvis and insert behind and below your knee. In almost every person, these tendons tighten with time.  Stretching your hamstring tendons is one of the best exercises you can do for your knee and back.  One study found "individuals with and without osteoarthritis of the knee are able to demonstrate immediate beneficial adaptations to a stretching intervention."
Reference

I recommend do a set of 3 hamstrings stretches, 3 times PER DAY.  Stretching multiple times per day is better than stretching only once a day or not at all.  You may be surprised with your improved flexibility if you are consistent about stretching.  See the video below for a simple stretch that can done anywhere.  I call it the "Hammy Stretch".



Start by placing your leg on a step, or low table.  Keep your back straight and your toes pointed toward the ceiling.  Then, simply hinge forward at your waist.  You will likely feel the stretch in the back of your thigh, knee and calf.

Consistency is the key to improvement.  Try this simple exercise and it will help your overall knee health and improve your ability to straightening your knee.  Hamstring stretching is like sunscreen, it is best to start early and continue to stretch throughout your life.

As always, check with your own doctor before beginning any exercise program.

Next time, we reveal the simple yet highly effective way to strengthen all of the muscle of your legs.

AM
TotalTendon

Kobe Bryant goes to Germany Again

Kobe Bryant recently went to Germany again to be treated with "Orthokine".  From his recent instagram post, it looks like he also received accupuncture.  (See below)  The  combination of treatments may make it difficult to determine which one could be responsible for any improvement he may feel.

Sports Illustrated also just published an article about Kobe's treatment.

No details about the condition of his knee prior to the treatment.  Many clinicians and researchers are working on a variation of this treatment----platelet-rich plasma.  

AM

Platelet Rich Plasma and Knee Arthritis

Knee arthritis is a very common problem for patients worldwide.  With the aging of the population this will become one of the most important medical issues to address with biologic therapies.

Conflicting results have recently been published about the use of platelet rich plasma in the treatment of knee arthritis.  Filardo, Kon et al found no significant differences between PRP and hyaluronic acid injections.  (see full abstract).  Conversely, Cerza et al did find significantly better clinical outcomes when patients were treated with PRP vs hyaluronic acid injections. (see full abstract) The version of PRP used in these two studies were different.  The first study also used three injections and the second four weekly injections.  Clearly, more research is needed to clarify the value of PRP for knee arthritis and determine the optimal formulations and techniques.

AM
TotalTendon

See the video below for a brief description of knee arthritis

Kobe Bryant Regenokine Orthokine Treatment Explained

Kobe Bryant (LA Lakers) is having another Orthokine or Regenokine treatment after averaging 29 points per game in his 15th season in the NBA.  Is it because of a blood derived treatment he had done on his knee?  Other elite athletes such as Alex Rodriguez (NY Yankees) and Fred Couples (PGA Golfer)  have been treated with Orthokine in Germany.  But what is Orthokine?  That is a question that needs to be answered.

Orthokine is a form of autologous conditioned serum (ACS) that contains a high concentration of a molecule called IL-1 RA.  This stands for interleukin-1 receptor antagonist (IL-1 RA).  Interleukin-1 (IL-1) is an important mediator of inflammation and tissue damage.  Balancing IL-1 with IL-1 RA is important.  Read more about IL-1/IL-1 RA

Orthokine to the best of my knowledge is only available in Germany and has mainly been used to treat knee osteoarthritis.  A study of 376 patients was done comparing Orthokine (ACS) with hyaluronic acid (HA) and saline injections for knee osteoarthritis.  The "effects of ACS were significantly superior to those of HA and saline for all outcome measures and time points."  See Abstract of Article

From the available evidence, it appears as though this is a reasonable treatment.  I do not, however, know many of the details.  This treatment is not available in the United States.  It is produced by incubating a patient's blood in a sterile container with beads over a period of 6-8 hours or more.  The IL-1 RA and other growth factors are concentrated and injected back into the patient.

This is different than platelet rich plasma (PRP) in that PRP is made at the point of care and can be delivered back to the patient within 15-20 minutes.  No incubation period is needed.  

Allan Mishra, MD

@BloodCure

Sports Press about Kobe and the treatment:  
http://www.hoopsworld.com/kobe-readying-for-german-knee-procedure

Platelet Rich Plasma and Cartilage Restoration

Platelet rich plasma was debated in a scientific session at the International Cartilage Research Society Meeting in Miami Florida this week. Dr. Allan Mishra, Dr. Vannini, Dr. Randelli and Dr. Johnson all spoke about PRP. It was moderated by Dr. Alberto Gobbi.

The discussion after these presentations centered around what type of PRP to use for what indications. It is clear that we need better data. The best published clinical data for tendon related injuries and disorders right now supports the use of PRP that is concentrated to 4-5x baseline platelets with an increased concentration of WBCs. See PRP Reference List.

Most studies so far have NOT been well controlled. However, Dr. Randelli (from Milan, Italy) presented the preliminary results of his prospective randomized controlled trial showing how PRP at a concentration of 4-5x baseline with increased WBCs DECREASES pain after arthroscopic rotator cuff repair and may improve healing in small and medium sized tears. Excellent work.

Several papers, posters and presentations at the meeting supported the use of PRP for cartilage restoration. Level one human data (randomized controlled trials), does not yet exist.

More soon.

AM

Total Tendon