Leg Power Predicts Brain Power

Save your brain by strengthening your legs.

Here are a few bullet points from a recently published study by Claire Steves et al from Kings College in London about leg power and brain function.  

1.  Leg power is correlated with cognition over a 10 year period

2.  Leg power also correlated with total gray matter in the brain.

3.  Fasting blood glucose and diabetes status were other variables associated with cognition.

So, if you want to maintain your brain function over time, stop eating donuts and get your legs in shape.

One simple program is to walk more often and more vigorously.

The other is considering starting the PowerKnee Program.  This is a simple program that activates your primary leg muscles, stretches your hamstrings and uses an exercise bike to strengthen all of your lower extremity muscles.  I have been recommending it to strengthen knees but now the data is clear.  Strengthen your knees and you will also strengthen your brain.

The QuadCrunch helps to activate the quadriceps muscle.   (From the PowerKnee Program)



The results of Steves' study are important because they were conducted in twins over more than a decade.  This means that it is more likely that improved leg power results in better cognition because they controlled for genetics in addition to a variety of other factors.

AM
Total Tendon

Platelet Rich Plasma better than Shock Wave for Jumpers' Knee

Jumpers' knee also known as patellar tendinitis is a common problem for basketball and volleyball players among other athletes.  Patients treated with platelet-rich plasma for this condition when compared to shock wave treatment improved more at six and 12 months after treatment.  See abstract below.

This paper adds to the mounting data suggesting PRP is a valuable treatment for chronic tendon related problems such as Jumpers' knee.

MRI of Patellar Tendinopathy

Also Known as Jumpers' Knee

AM

TotalTendon

Am J Sports Med. 2013 Feb 13. [Epub ahead of print]

Platelet-Rich Plasma Versus Focused Shock Waves in the Treatment of Jumper's Knee in Athletes.

Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A.

Source

Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.

Abstract

BACKGROUND:Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes. PURPOSE:To compare the effectiveness and safety of platelet-rich plasma (PRP) injections and focused extracorporeal shock wave therapy (ESWT) in athletes with jumper's knee. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:Forty-six consecutive athletes with jumper's knee were selected for this study and randomized into 2 treatment groups: 2 autologous PRP injections over 2 weeks under ultrasound guidance (PRP group; n = 23), and 3 sessions of focused extracorporeal shock wave therapy (2.400 impulses at 0.17-0.25 mJ/mm(2) per session) (ESWT group; n = 23). The outcome measures were Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, pain visual analog scale (VAS), and modified Blazina scale. A reviewer who was blinded as to the group allocation of participants performed outcome assessments before treatment and at 2, 6, and 12 months after treatment. Nonparametric tests were used for within-group (Friedman/Wilcoxon test) and between-group (Kruskal-Wallis/Fisher test) testing, and the significance level was set at .05. RESULTS:The 2 groups were homogeneous in terms of age, sex, level of sports participation, and pretreatment clinical status. Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessments. The VISA-P, VAS, and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up (P = .635, .360, and .339, respectively). The PRP group showed significantly better improvement than the ESWT group in VISA-P, VAS scores at 6- and 12-month follow-up, and modified Blazina scale score at 12-month follow-up (P < .05 for all). CONCLUSION:Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper's knee in athletes.

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 Significantly Improves Pain and Function for Patellar Tendonitis

In a randomized controlled trial, platelet rich plasma significantly improved pain and function in patients with patellar tendinopathy (also known as patellar tendonitis).  In the study, PRP was compared to dry needling.  The PRP used in the study contained concentrated platelets and white blood cells, also known as leukocytes (prepared via the Biomet Biologics GPS system).   Both groups were also given an eccentric exercise program.

“Importantly, we also showed that PRP is both clinically and statistically significantly better than dry needling based on the Victorian Institute of Sports Assessment  (VISA) score of patella tendinopathy symptoms.”  (See Full Article)

MRI showing significant patellar tendinopathy

This important data contributes significantly to the growing body of evidence suggesting PRP has value in the treatment of tendon related disorders.  


AM (@bloodcure)
Total Tendon

Treatment of Patellar Tendinopathy with Platelet Rich Plasma

"Clinically Meaningful Improvements"

Statistically Significant Improvement (Pain and VISA Scores) 

Gosens et al, worldwide leaders in platelet rich plasma research have shown in their latest article how previous treatments influence outcomes.  This is a critical component to understanding outcomes.  This data suggests that previous treatment with cortisone or surgery may slow a healing response.  As the clinical research evolves, these crucial factors must be taken into consideration.  

See the recently published abstract below.

Allan Mishra @bloodcure  Total Tendon

Int Orthop. 2012 Apr 27. 

Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.

Gosens T, Den Oudsten BL, Fievez E, van 't Spijker P, Fievez A.

Source

Department of Orthopaedics and Traumatology, St Elisabeth Hospital Tilburg, Tilburg, The Netherlands, 

Abstract

PURPOSE:

The aim of this study was to evaluate the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP). Additionally, this study examined whether certain characteristics, such as activity level or previous treatment affected the results.

METHODS:

Patients (n = 36) were asked to fill in the Victorian Institute of Sports Assessment - Patellar questionnaire (VISA-P) and visual analogue scales (VAS), assessing pain in activities of daily life (ADL), during work and sports, before and after treatment with PRP. Of these patients, 14 had been treated before with cortisone, ethoxysclerol, and/or surgical treatment (group 1), while the remaining patients had not been treated before (group 2).

RESULTS:

Overall, group 1 and group 2 improved significantly on the VAS scales (p < .0.05). However, group 2 also improved on VISA-P (p = .0.003), while group 1 showed less healing potential (p = 0.060). Although the difference between group 1 and group 2 at follow-up was not considered clinically meaningful, over time both groups showed a clinically significant improvement.

CONCLUSION:

After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/or surgical treatment showed the improvement.

Platelet rich plasma is being studied worldwide (US, Europe, India) as a potential treatment for knee osteoarthritis.  The evidence is immature but it does suggest PRP may have a role in the management of this very common problem.

In the study outlined below, PRP was compared to a standard treatment of hyaluronic acid.  

"Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up."

AM

TotalTendon

Am J Phys Med Rehabil. 2012 May;91(5):411-7.

Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic Acid.

Spaková T, Rosocha J, Lacko M, Harvanová D, Gharaibeh A.

Source

From the Associated Tissue Bank of Faculty of Medicine UPJS and University Hospital of L. Pasteur (TS, JR, DH); and Department of Orthopaedics and Traumatology, Faculty of Medicine, P. J. Safárik University and University Hospital of L. Pasteur, Kosice, Slovakia (ML, AG).

Abstract

OBJECTIVE:

This study aimed to find a simple, cost-effective, and time-efficient method for the preparation of platelet-rich plasma (PRP), so the acquired benefits will be readily available for multiple procedures in smaller outpatient clinics and to explore the safety and efficacy of the application of PRP in the treatment of degenerative lesions of articular cartilage of the knee.

DESIGN:

The study was designed as a prospective, cohort study with a control group. A total of 120 patients with Grade 1, 2, or 3 osteoarthritis according to the Kellgren and Lawrence grading scale were enrolled in the study. One group of patients was treated using three intra-articular applications of PRP, and the second group of patients was given three injections of hyaluronic acid. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index and the 11-point pain intensity Numeric Rating Scale.

RESULTS:

On average, a 4.5-fold increase in platelet concentration was obtained in the PRP group. No severe adverse events were observed. Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up.

CONCLUSIONS:

Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis. Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects 

Unactivated Platelet Rich Plasma Proves Better

In a recently published study by Han et al published in the Journal of Bone and Joint Surgery (JBJS June 2009, American Volume), unactivated platelet rich plasma "stimulated chondrogenesis on Day 14 and osteogenesis on Days 28 and 56, whereas thrombin-activated platelet-rich plasma acted as an inhibitor of such events. In addition, inflammatory cells were detected in demineralized bone matrix samples that were mixed with thrombin-activated platelet-rich plasma. These cells were not present in matrix mixed with platelet-rich plasma alone." (See Full Abstract)

This data clearly supports the use of PRP that has NOT been activated by thrombin and/or calcium. This unactivated form of PRP has also proved useful for chronic tennis elbow. See References

AM
Total Tendon

Stanford Football Player returns after PRP

A Stanford football player who had chronic severe patellar tendonitis has returned to play this year after being treated with platelet rich plasma by Dr. Mishra.
Click here to read the full story.

Total Tendon

Apex PRP.com

San Francisco Chronicle Article: "Miracle Cure"

The San Francisco Chronicle calls platelet rich plasma a "Miracle Cure". To read the full story, click here.

Join the FREE Total Tendon Network to interact with patients and providers familar with platelet rich plasma as a treatment.

For more information:

Total Tendon, ApexPRP, Tendon Tips.com

Pioneer PRP Story on ABC TV

ABC TV in San Francisco just aired a story about the pioneering of platelet rich plasma for tendon related problems such as tennis elbow or patellar tendonitis.

Link to ABC TV Story about Stanford Football Player

To learn more about PRP visit: ApexPRP

Join the Total Tendon Network to have the most up to date information and interact with other patients and providers.

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