Turmeric for Tendonitis, Arthritis, and Cancer

The golden spice turmeric, commonly found in many tasty Indian dishes, contains an interesting and potentially valuable therapeutic component.  Curcumin, found in turmeric, modulates several  cellular pathways and has been used as a nutraceutical supplement to combat inflammation.  Importantly, turmeric has been found to have a high safety profile.  This is consistent with its use for thousands of years in India and China.

Research studies have shown turmeric can modify tendon inflammatory pathways.  (Ref)  One study found "curcumin can improve the quality of tendon rupture healing, and thus represents a promising strategy in the management of injured tendon tissue."  (Ref)

Tumeric / Curcumin may also be of value in the treatment of osteoarthritis by decreasing inflammatory pathways.  "Short-term supplementation with curcuminoids attenuates the systemic oxidative stress in patients with osteoarthritis.  These antioxidant effects may account for the reported therapuetic effects of curcuminoids in relieving osteoarthritis symptoms.  (Ref)  Some clinical studies suggest using Tumeric / Curcumin may result in better improvements in pain and walking when compared to using chondroitin and glucosamine supplements alone.  (Ref)  Finally, some formulations of curcumin have been specifically found to reduce the pain associated with knee arthritis.  (Ref)  (See chart below)




Recently, curcumin has also been studied as a cancer treatment.  It has been shown to inhibit a variety of pathways connected to cancer cell growth.  It may also enhance the cytotoxic effects of chemotherapy thereby enhancing its efficacy.  Much more work needs to be done but these early cancer studies have confirmed cucurmin's excellent safety profile.  I started to wonder if we should consider taking curcumin to prevent cancer.

Bloodcure's take home message for turmeric is to consider it for tendonitis and arthritis symptoms.  The data suggest the supplement is safe and it may be a natural way to treat these very common disorders.  Consider a dose of 500 mg to 1500 mg per day that contains black pepper extract.  The black pepper helps with absorption of the turmeric.

As always, check with your personal physician prior to initiating any new supplement as each of us is unique.

AM
TotalTendon

Platelet Rich Plasma beats Surgery for Tennis Elbow

Treatment of tennis elbow using platelet rich plasma (PRP) resulted in an average of 83% improvement in pain scores at one year compared to baseline in a recently published study of 110 patients by Karaduman et al.  The surgery group had 46% improvement in pain scores.   Mayo elbow scores were also higher in the PRP group.  (See graphs below)  

The study used the Biomet GPS PRP device and the Nirschl surgical technique

This is an interesting study comparing the value of PRP versus a commonly recommended surgical procedure.  The data suggest PRP is a safe and effective alternative to the much more invasive and expensive surgical procedure.

AM

@bloodcure

Total Tendon

See abstract and reference below:

Karaduman et el 2016

Abstract

Purpose

To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique.

Method

A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements.

Results

VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength.

Conclusion

The PRP seems to be better for pain relief and functionality in the short and mid-term periods.

Keywords

• Nirschl surgical technique; 
• Platelet rich plasma (PRP); 
• Chronic elbow tendinosis

Will Biologics Revolutionize Musculoskeletal Care?

The economic costs of musculoskeletal care in the United States is approaching $800 billion or about 5.7% of annual GDP.  (Ref)  These costs are expected to increase significantly as our population ages.  This is clearly not a sustainable path.  A recent article published by the American Academy of Orthopedic Surgeons (AAOS) suggests the "early evidence is promising" for biologics to revolutionize musculoskeletal care.  (AAOS Article in full)

Biologic therapies represent a rapidly evolving frontier similar to arthroscopy in the 1970s and 1980s.  There will always be a need for continued research and development but the data supporting treatments such as platelet rich plasma (PRP) and stem cell treatments for tendinopathy and arthritis is increasing significantly.  PRP is now a recognized treatment for chronic tennis elbow that has been shown to be better than surgery.  (See Ref)  The number of PRP articles on PubMed now is over 8000 and the Google Trends for PRP is rising rapidly. (See Graph)

Biologic orthopedic procedures are in the process of revolutionizing the options available for patients for difficult problems such as arthritis.  It is an exciting time to execute on these point-of-care biologic treatments.   Continued progress will demand hard work and innovation by elite motivated teams in order to produce transformative outcomes for patients.


AM
TotalTendon

PowerKnee Program

DareToBeVital.com  Knee pain is a very common problem.  There are many potential remedies but one that is often ignored is diet and exercise.  This led me to develop the PowerKnee Program.  It is a simple set of exercises that may help improve the pain associated with a variety of knee problems including arthritis.  The exercises help address quadriceps strength, hamstring flexibility and overall lower extremity fitness.    This program can be found at PowerKnee.com.  Pass on the link to your friends and colleagues.

POWERKNEE PROGRAM (See Videos below)
1.  QuadCrunch (TM):  Perform a set of 3 hold for 5 seconds, 3 times per day
2.  Hamstring Stretch:   Perform a set of 3, hold for 5 seconds, 3 times per day
3.  Exercise Bike:          Ride for 30 minutes, 3 times per week, Record calories

Also, maintain or work toward your ideal body weight.  Losing even a small amount of weight may improve your knee pain and function.

Get going today on the #PowerKnee Program.  Pass on the link to your friends and colleagues.

Text "KneePain" to 22828 for a FREE newsletter to help with Knee Pain








DareToBeVital.com

DO NOT BEGIN ANY EXERCISE PROGRAM WITHOUT FIRST CHECKING WITH YOUR DOCTOR.
THIS WEBSITE IS FOR INFORMATION PURPOSES ONLY.  CONSULT WITH HEALTHCARE PROFESSIONALS TO DETERMINE IF IT IS RIGHT FOR YOU.

AM
TotalTendon

Biologic Orthopedics, Forbes, Sports Illustrated and ESPN

This week the Rothman Institute in Philadelphia has organized a meeting dedicated to exploring biologic orthopedics and sports medicine in a unique format.  The group has invited researchers and clinicians from around the world to participate with elite media representatives from Forbes, Sports Illustrated, and ESPN among others.  Dr. Noriyki Tsumaki from the the 2012 Nobel Prize winning CIRA Center in Kyoto Japan will also be lecturing.  Discussion about the FDA regulation and economics of biologic orthopedics will also occur.

Stem Cell and Biologics in Sports Medicine Summit

The meeting represents a special opportunity to bring together a unique group of individuals that are interested in how to best treat tendonitis, arthritis and other orthopedic conditions with stem cells, platelet rich plasma and other biologic therapies.  The moderators of the scientific panels will be editors from world renowned publications.  I expect to have spirited discussions about the state of the art in 2014 in addition to perhaps identifying novel pathways that lead to transformative treatments for professional, collegiate and weekend warrior athletes.

I will report my finding in this space and will tweet out real time information via:  @BloodCure

AM
TotalTendon

Biologic Orthopedic Society crosses over 2500 Member Mark

The Biologic Orthopedic Society (BOS) is a group of professionals dedicated to the research and development of biologic treatments for musculoskeletal injuries and disorders.  This group has now grown to over 2500 members worldwide.  Much of the group's focus has been on the use of platelet rich plasma, stem cells and bone marrow concentrate (BMC) for tendonitis, arthritis and degenerative spinal disc disease.

The growth of the Biologic Orthopedic Society (BOS) is a testimony to the rapidly rising interest in biologic solutions to difficult musculoskeletal problems.  Significant progress has been made in terms of better published data supporting the use of biologic therapies in the last 2-3 years.  Clearly, more information and research is still needed.  As the group continues to grown, more and more connections are being made.  Ideas and projects are advancing.  All of this should give hope to those patients in search of better treatments.  Many hard working professionals are striving to deliver better biologic options.  

I'll predict within another 5-10 years, we will be staggered by how much will be accomplished.

Thanks to my many colleagues and friends within the BOS for a fantastic journey so far.

If you are a professional working in the area, please consider joining the group.  

Biologic Orthopedic Society

AM

Total Tendon

QuadCrunch (TM) The Best Exercise for Your Knee

Quadriceps (Quad) muscle activation is crucial for both athletes and patients.  It is the foundation of any knee muscle development plan or rehabilitation protocol.  Too often neuromuscular activation is ignored or incompletely addressed.  

The QuadCrunch exercise is a simple and effective way to enhance muscle activation and to increase muscle tone.  If executed consistently, the entire quadriceps muscle and especially the VMO (Vastus Medialis Qbliqus) will be more functional.  

The QuadCrunch can be done alone or in combination with a variety of other leg stretches and exercises.  It can be done to simply improve knee strength or it can be used for patients with a variety of knee related problems such as arthritis, kneecap instability, tendonitis or after surgery.  

The video below outlines how and why the QuadCrunch can help both athletes and patients.

QuadCrunch Video
Try a set of 3, Hold for 5 Seconds Each, 5 Times per day

Please share this post with anyone who would like to enhance their knee function and post any comments below.

AM

TotalTendon.com

Please do not start any exercise program without consulting your physician first.

Best Initial Knee Exercise: The QuadCrunch (TM) (Knee OA Part 2)

There are dozens of knee exercises you can do to strengthen the muscles around your joint.  One crucial muscle to strengthen is the quadriceps or "Quad".  Too often, however, this muscle simply does not cooperate.  We need a simple way to get started.  We need an exercise than can be done anywhere, anytime without any equipment.  Now, we have one, the QuadCrunch (TM).  

The QuadCrunch (TM) helps initiate and reinforce the contraction of the most important component of the Quad---the Vastus Medialis Obliquus or VMO for short.  

QuadCrunch (TM) Video

Simply, straighten out your leg and place your fingers over the inside portion of your thigh just above your knee.  This is where the VMO lives.   With your leg fully straight and your heel on the ground, push your leg toward the ground and try to contract the muscle.  If you are successful, you will see your kneecap move.  The reason to put your fingers on your muscle is to help your brain know it is contracting the muscle.  This helps reinforce the contraction.  

I recommending doing a set of 5 contractions, holding each contraction for 5 seconds, 5 times per day.  

This elementary exercise is often ignored but serves as the foundation for more advanced strengthening programs.  It can be helpful for people who want to strengthening their legs for any reason.  It may also be useful for patients with knee arthritis, patellofemoral pain, knee tendonitis and even meniscus tears.  (Always check with your doctor before beginning any exercise program)

Good luck and get started today.  Remember, this exercise can be done in shorts, pants and almost anywhere.  Simply place your fingers on your quad muscle and straightening your knee with your heel on the ground.  It is best if your are sitting on the edge of a chair.  

It is best to record how many sets per day you do.  That will help you be compliant with the exercise.  We will discuss exercise compliance more in a later post.  

Post any questions, comments or suggestions below.

AM

TotalTendon

Platelet Rich Plasma Significantly Improves Outcomes for Tennis Elbow in a 230 Patient Study

The American Journal of Sports Medicine (AJSM) has just published the largest study evaluating platelet-rich plasma.  The 230 patient study was conducted over the course of more than five years and represents the work of dozens of clinicians and researchers.  Overall, it is clear from the data that the use of PRP to treat chronic tennis elbow results in significant reductions in pain and elbow tenderness compared to an active control of needling of the elbow without PRP.  It is also safe and cost effective compared to cortisone and surgery.  This type of study is time consuming and expensive but will help guide patient and physicians decisions about how to best treat chronic tennis elbow.

Here is a lay press article on the article from Healio.

Read the full AJSM Abstract below.

AM
Total Tendon


Platelet-Rich Plasma Significantly Improves Clinical Outcomes in Patients With Chronic Tennis Elbow
A Double-Blind, Prospective, Multicenter, Controlled Trial of 230 Patients

1. Allan K. Mishra, MD*,†, 
2. Nebojsa V. Skrepnik, MD, PhD‡,
3. Scott G. Edwards, MD§, 
4. Grant L. Jones, MD‖, 
5. Steven Sampson, DO¶,
6. Doug A. Vermillion, MD#, 
7. Matthew L. Ramsey, MD**, 
8. David C. Karli, MD, MBA†† and 
9. Arthur C. Rettig, MD‡‡

1. ^†Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California
2. ^‡Tucson Orthopaedic Institute, Tucson, Arizona
3. ^§Division of Hand and Elbow Surgery, Georgetown University Hospital, Washington, District of Columbia
4. ^‖Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
5. ^¶The Orthohealing Center and The Orthobiologic Institute, Los Angeles, California
6. ^#Orthopaedic Research Clinic, Anchorage, Alaska
7. ^**Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
8. ^††The Steadman Clinic, Vail, Colorado
9. ^‡‡Methodist Sports Medicine, Indianapolis, Indiana
10. Investigation performed at Department of Orthopaedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California

1. *Allan K. Mishra, MD, Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025 (e-mail: am@totaltendon.com).

Abstract

Background: Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy, also known as tennis elbow. Previous studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy for tennis elbow.

Purpose: To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at least 3 months of symptoms and had failed conventional therapy. There were no differences in patients randomized to receive PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled with or without PRP. Patients and investigators remained blinded to the treatment group throughout the study.

Results: Patient outcomes were followed for up to 24 weeks. At 12 weeks (n = 192), the PRP-treated patients reported an improvement of 55.1% in their pain scores compared with 47.4% in the active control group (P = .094). At 24 weeks (n = 119), the PRP-treated patients reported an improvement of 71.5% in their pain scores compared with 56.1% in the control group (P = .027). The percentage of patients reporting significant elbow tenderness at 12 weeks was 37.4% in the PRP group versus 48.4% in the control group (P = .036). At 24 weeks, 29.1% of the PRP-treated patients reported significant elbow tenderness versus 54.0% in the control group (P < .001). Success rates for patients with 24 weeks of follow-up were 83.9% in the PRP group compared with 68.3% in the control group (P= .012). No significant complications occurred in either group.

Conclusion: Treatment of chronic tennis elbow with leukocyte-enriched PRP is safe and results in clinically meaningful improvements compared with an active control group.

The Biomet Biologics GPS device was used to prepare the PRP for this study.