{"id":380,"date":"2015-07-17T15:13:10","date_gmt":"2015-07-17T15:13:10","guid":{"rendered":"http:\/\/stadiasportsmedicine.com\/info\/?p=380"},"modified":"2017-09-26T14:38:02","modified_gmt":"2017-09-26T14:38:02","slug":"chronic-orthopedic-pain-des-moines","status":"publish","type":"post","link":"https:\/\/stadiasportsmedicine.com\/info\/2015\/chronic-orthopedic-pain-des-moines\/","title":{"rendered":"Ten Things You Should Know About Chronic Orthopedic Pain"},"content":{"rendered":"<h2 style=\"text-align: left;\"><\/h2>\n<h3 style=\"text-align: left;\"><strong style=\"font-size: 13px;\">1. Chronic tendonitis is      not a problem of inflamed tissue.\u00a0      It is a problem of painful scarring within the tendon that usually      will not get better on its own.<\/strong><\/h3>\n<p style=\"text-align: left;\">Tendons are strong, yet flexible bands of tissue that connect muscle to the bones around your joints.\u00a0 Tendons and muscles work together to create a pulling force that enables you to move your joints.\u00a0 This allows you to bend, walk, jump and move in many different ways.\u00a0 When tendons are damaged, movement in a joint can be very painful and limit your range of motion.\u00a0 Tendons are injured by either outright trauma or by repetitive injury (damage to the tendon from overuse in work, exercise or activity).\u00a0 When tendon is traumatized, it tries to heal itself, but often scar tissue eventually forms within it.\u00a0 This scar tissue causes pain.\u00a0 As it worsens, the injured tendon will limit your ability to move the joint and do the activities that you need or like to do.\u00a0 If something doesn\u2019t change, the pain in your joint will likely become worse over time.<\/p>\n<p style=\"text-align: left;\">Surgical treatments for chronic tendon pain are often unsatisfying and carry long recovery times.\u00a0 Nonoperative management is the recommended approach, and more often than not is successful.\u00a0 In general, conservative treatments that are effective are the ones that damage the involved tissue in a controlled way and jump start the body\u2019s healing processes to promote normalization of the damaged tissue.\u00a0 This approach might seem counter-intuitive, but research supports it.\u00a0 Options at Stadia Sports Medicine for management of chronic tendon pain include:<\/p>\n<ul>\n<li><a href=\"http:\/\/stadiasportsmedicine.com\/info\/2015\/astym-treatment-for-chronic-injury\/#.Vytk5ISDGko\" target=\"_blank\">Physical therapy with ASTYM<\/a> \u2013 a form of soft tissue massage that promotes healing.\u00a0 Stadia was the first clinic in the city of Des Moines<a href=\"http:\/\/stadiasportsmedicine.com\/info\/wp-content\/uploads\/2015\/07\/SHINING-A-LIGHT-ON-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-489\" title=\"SHINING A LIGHT ON (1)\" src=\"http:\/\/stadiasportsmedicine.com\/info\/wp-content\/uploads\/2015\/07\/SHINING-A-LIGHT-ON-1-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/stadiasportsmedicine.com\/info\/wp-content\/uploads\/2015\/07\/SHINING-A-LIGHT-ON-1-300x300.jpg 300w, https:\/\/stadiasportsmedicine.com\/info\/wp-content\/uploads\/2015\/07\/SHINING-A-LIGHT-ON-1-150x150.jpg 150w, https:\/\/stadiasportsmedicine.com\/info\/wp-content\/uploads\/2015\/07\/SHINING-A-LIGHT-ON-1-100x100.jpg 100w, https:\/\/stadiasportsmedicine.com\/info\/wp-content\/uploads\/2015\/07\/SHINING-A-LIGHT-ON-1.jpg 800w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a> to offer <a href=\"http:\/\/stadiasportsmedicine.com\/info\/2013\/astym\/#.VytlDoSDGko\" target=\"_blank\">ASTYM<\/a> as a treatment tool, and Dr. Carlson trained with the founder of the technology.\u00a0 Patients considering ASTYM should consider Stadia, which has the most experience with this approach of any clinic in Des Moines.<\/li>\n<li>Guided injection therapy with minimal pain.\u00a0 Options include:\n<ul>\n<li>Corticosteroid (cortisone) injections<\/li>\n<li><a title=\"Platelet-Rich Plasma Injections (PRP):Harnessing the body\u2019s own healing process\" href=\"http:\/\/stadiasportsmedicine.com\/info\/2014\/prp-des-moines-platelet-rich-plasma-des-moines\/\" target=\"_blank\">Platelet-rich plasma injection<\/a> (see below)<\/li>\n<li>Prolotherapy (using dextrose, or sugar water).\u00a0 Prolotherapy involves the injection of a safe irritant substance at the area of soft tissue injury.\u00a0 There is evidence that this is a useful treatment approach to help control or eliminate chronic pain.<\/li>\n<li>Stem cell therapy (coming in 2015)<\/li>\n<\/ul>\n<\/li>\n<li><a title=\"Tenex Health TX: Tenotomy; Des Moines Tendon Pain Doctor\" href=\"http:\/\/stadiasportsmedicine.com\/info\/2013\/tenex-health-tx-des-moines-tendon-pain-doctor\/\" target=\"_blank\">Tenotomy<\/a> (see below) \u2013 a minimally-invasive technique that helps physically eliminate scar tissue within a tendon.\u00a0 This approach preserves healthy tissue and results in more rapid recovery times in comparison to standard surgery.<\/li>\n<\/ul>\n<p><strong> <\/strong><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>2. There are good      treatment options for chronic tendon and joint pain that don\u2019t involve      surgery.<\/strong><\/p>\n<ol style=\"text-align: left;\"><\/ol>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\">Nobody wants to have surgery if they don\u2019t need it.\u00a0 At Stadia, our bias is to find the most appropriate treatment for you.\u00a0 In most cases, this does not involve surgery.\u00a0 Over 90% of all orthopedic problems never require surgery, so we spend most of our time finding inventive and effective ways to manage the 90% of cases that can avoid surgery.<\/p>\n<p style=\"text-align: left;\">Our therapy staff eliminates the pain from tendonitis about 80% of the time using tools like ASTYM and directed exercise.\u00a0 We also keep patients on their own at home with home-based therapy protocols when appropriate and when the patient desires it.\u00a0 We offer patients multiple options for procedures that can reduce or eliminate their pain.\u00a0 See below for more information on some of these.<\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>3. Ultrasound technology      has revolutionized outpatient orthopedic care by reducing pain and      improving accuracy of guided procedures.<\/strong><\/p>\n<p style=\"text-align: left;\">Many research studies have documented increased accuracy and better clinical response when ultrasound is used for injection guidance.\u00a0 For example, in one study, injections of the shoulder joint were successful in only 55% of blind injections and 72% of x-ray guided injections, but were successful in 94% of injections done with ultrasound.\u00a0 Acromioclavicular joint (the joint between your collar bone and shoulder blade) injections are successful in 45% of blind injections, vs. 100% of ultrasound-guided injections.\u00a0 Statistics are similar in other joints of the body.\u00a0 Procedural pain has been shown to be lessened by approximately 50% with the use of ultrasound.\u00a0 Having this technology in place allows doctors to inject joints in the office that cannot routinely be reached without imaging guidance.\u00a0 This allows us to easily access virtually any joint in the body with ease and precision, and with a minimum of patient discomfort.\u00a0 In-office hip injection, for example, significantly decreases work-up time in patients presenting with hip pain.\u00a0 Ultrasound guidance also expands treatment offerings for chronic tendonitis, including tenotomy for conditions such as epicondylitis, achilles or patellar tendonitis and plantar fasciitis.\u00a0 Even carpal tunnel syndrome can be managed with the use of ultrasound in the office.\u00a0\u00a0 Finally, the use of ultrasound in the office for diagnostics is extremely cost-effective relative to more expensive tests such as MRI.\u00a0 In many cases, ultrasound is as, or more accurate than MRI for soft tissue diagnosis. \u00a0It is particularly effective in the shoulder and elbow.<\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>4. Platelet-rich plasma      is a promising treatment for chronic soft tissue and joint pain.<\/strong><\/p>\n<ol style=\"text-align: left;\"><\/ol>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><a title=\"Platelet-Rich Plasma Injections (PRP):Harnessing the body\u2019s own healing process\" href=\"http:\/\/stadiasportsmedicine.com\/info\/2014\/prp-des-moines-platelet-rich-plasma-des-moines\/\" target=\"_blank\">Platelet-rich plasma (PRP)<\/a> involves the injection of a patient\u2019s own blood into an area of tendon (or joint) injury.\u00a0 Specifically, a patient\u2019s own blood is prepared prior to injection by being spun in a centrifuge so that the platelets can be isolated for injection.\u00a0 Platelets contain many factors in them that promote wound and tissue healing, allowing injured tissue to regenerate itself.\u00a0 PRP shows promise as a useful therapy when more conservative measures have failed.\u00a0 At Stadia we utilize the Harvest PRP system, which provides an optimal concentration of platelets for injection to the injured area \u2013 something that has been shown to be important for the best clinical response.\u00a0 We also use ultrasound guidance for all PRP injections, to increase the likelihood of a good response to treatment.<\/p>\n<p style=\"text-align: left;\">Injecting your own blood into an injured area may sound crazy, but there is a growing body of evidence that PRP is an effective treatment tool.\u00a0 For example, surgical repair of partial tears in the elbow ligaments of pitchers takes an average of a year after surgery to return to full activity.\u00a0 PRP was shown in one study to return 16 of 17 athletes to throwing within 15 weeks of the procedure.\u00a0\u00a0 PRP has been shown to be superior to steroid injections for the management of plantar fasciitis, tennis elbow, Achilles and patellar tendonitis and other soft tissue injuries.\u00a0 Multiple medical studies also have shown recently that PRP appears to be an effective treatment for the pain associated with osteoarthritis.\u00a0 Most of these studies involve the knee, but there are also studies confirming effectiveness in the ankle and hip.\u00a0 A study looking at PRP in the knee by researchers from the Hospital for Special Surgery has shown that PRP improves pain and function, and in up to 73% of patients, appears to delay the progression of osteoarthritis \u2013 an otherwise progressive disease.<\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>5. Tenotomy is a      minimally-invasive procedure that is a great alternative to surgery for      patients with chronic tendonitis.<\/strong><\/p>\n<ol style=\"text-align: left;\"><\/ol>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><a title=\"Tenex Health TX: Tenotomy; Des Moines Tendon Pain Doctor\" href=\"http:\/\/stadiasportsmedicine.com\/info\/2013\/tenex-health-tx-des-moines-tendon-pain-doctor\/\" target=\"_blank\">Percutaneous tenotomy<\/a> is a procedure that can be used to help heal chronic tendon pain that is not getting better with traditional non-operative measures.\u00a0 It involves the removal of scar tissue from an injured tendon, and can be thought of as a bridge between traditional surgical tenotomy and other non-operative treatments.\u00a0 Outcomes seem to mimic that of surgical treatment, with less post-procedure pain and more rapid recovery, as well as lower overall costs.\u00a0 There is a reported 80-90% success rate among patients not responding to conservative therapies, with an ever-increasing number of studies showing this as an effective treatment tool in the properly selected patient.<\/p>\n<p style=\"text-align: left;\">Percutaneous tenotomy is done entirely under local anesthesia, with the patient comfortable and alert for the entire procedure.\u00a0 Ultrasound is first used to identify the area of tendon injury, and then appropriate skin markings are made.\u00a0 Following this, using a small needle and ultrasound guidance, local anesthetic is injected into and around the area of tendon injury.\u00a0 Once the area is anesthetized, a special tool is inserted into the scarred tissue.\u00a0 This tool delivers ultrasonic energy that is specifically designed to break up and remove damaged tissue safely and quickly, without disturbing the surrounding healthy tendon tissue.\u00a0 Total treatment time for this procedure averages 15-20 minutes.\u00a0 After the scar tissue is removed, the tiny opening is closed with a steri-strip.<\/p>\n<p style=\"text-align: left;\">Following tenotomy, patients are discharged to home, with over-the-counter pain relievers usually adequate to control post-procedure pain.\u00a0 Restrictions following this procedure are going to be individualized, but in general, following tenotomy, you can expect a return to full activity by about six weeks; and with thousands of procedures performed in the United States, there have been no reports of significant complications to date.<\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>6. Physical therapy,      whether home-based or supervised, often can be used to control or      eliminate chronic orthopedic pain.<\/strong><\/p>\n<p style=\"text-align: left;\">We are big believers in the power of <a href=\"http:\/\/stadiasportsmedicine.com\/info\/category\/physical-therapy\/#.VytmL4SDGko\" target=\"_blank\">physical therapy <\/a>to take patients who are struggling with chronic pain and make them whole again.\u00a0 Many, many studies bear this out.\u00a0 Studies also confirm that properly directed home programs can be effective to achieve pain control in the right patients.<\/p>\n<p style=\"text-align: left;\">Stadia Sports Medicine\u2019s physical therapists utilize the latest in therapy techniques designed to speed tendon healing and promote more rapid recovery from injury.\u00a0 We do not rely on techniques such as electrical stimulation or therapeutic ultrasound which are commonly used in therapy settings but which have not been shown to be effective for these problems.\u00a0 Our approaches to patients are grounded in the medical literature.\u00a0 Stadia Sports Medicine was the first clinic in Des Moines to utilize the <a title=\"ASTYM\" href=\"http:\/\/stadiasportsmedicine.com\/info\/2013\/astym\/\" target=\"_blank\">ASTYM<\/a> technique with our patients, having used it since our opening in 2006.\u00a0 ASTYM was developed by Dr. Carlson\u2019s fellowship director at Ball State University in Muncie, Indiana, Tom Sevier, M.D., who went on to found Performance Dynamics \u2013the company that trains clinicians in the ASTYM technique.\u00a0 Thus, practitioners at Stadia have experience with ASTYM going back to the 1990\u2019s, and our therapy staff has a broader depth of experience with this technique than any other physical therapy group in Des Moines.<\/p>\n<p style=\"text-align: left;\">At Stadia, we strive to keep a patient\u2019s therapy course as short as possible while still achieving treatment goals.\u00a0 Although we love treating our patients, and we would love having you in our office, we know that you would rather be doing other things.\u00a0 We respect that by insisting that a patient\u2019s therapy always be moving toward a defined goal, and then redirecting if progress is not being made.\u00a0\u00a0 Finally, having M.D.\u2019s and P.T.\u2019s in the same office together provides a unique, collaborative atmosphere that makes for optimal patient care.<\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><strong>7. Back pain is usually      controllable.<\/strong><\/p>\n<ol style=\"text-align: left;\"><\/ol>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\">Back pain is one of the most common problems that presents to any sports medicine or physical therapy office.\u00a0 Fortunately, it benefits from a systematic approach to evaluation and treatment.\u00a0 Based on the age of the patient and their appearance in the exam room, we can usually send a patient home with a plan to address their back pain.\u00a0 If the patient fits a certain pattern in the office, home exercise might be suggested.\u00a0 Home exercise in this case is always done with direction, supplying the patient with a specific program and reviewing proper technique with the patient prior to their leaving the office.\u00a0 In other cases, obtaining additional diagnostic studies or bringing a patient in for in-office, supervised physical therapy might be deemed appropriate.\u00a0\u00a0 Regardless of the approach taken, the assumption is always that we can get a patient\u2019s back pain under control, without the use of chronic medication.<\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><strong>8. Your biomechanics      (the way your body moves and works) usually lead to chronic pain problems,      and properly evaluating and addressing this helps treatment.<\/strong><\/p>\n<p style=\"text-align: left;\">Chronic pain problems don\u2019t just spring up out of nowhere.\u00a0 The groundwork for them is usually laid over a long period of time.\u00a0 One of the things that often contributes to breakdown of a tendon or joint is faulty mechanics (in the body, \u201cbiomechanics.\u201d).\u00a0 Causes of faulty biomechanics run the gamut from chronically tight muscles, which can place undue strain on joints, to flat feet, which can place strain on the legs, knees and back.\u00a0 Muscle weakness patterns tend to develop in people over time, leading to ways of compensating for this weakness that are ultimately self-defeating.\u00a0 It is important that physicians who are seeing patients with orthopedic pain be aware of these weakness patterns and look for them when patients present to their office.<\/p>\n<p style=\"text-align: left;\">When patients at Stadia are evaluated, their biomechanics are always taken into account.\u00a0 This information is used to help formulate an individualized treatment approach that works for the patient.\u00a0 This gets to individual root causes and helps reduce the likelihood of pain becoming a chronic problem.<\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\"><strong>9. Sports Medicine is      not just for athletes.<\/strong><\/p>\n<ol style=\"text-align: left;\"><\/ol>\n<p style=\"text-align: left;\"><strong> <\/strong><\/p>\n<p style=\"text-align: left;\">Since 1989, the American Board of Medical Subspecialties has recognized Sports Medicine as a distinct non-operative physician specialty.\u00a0 Since only 10% of all musculoskeletal problems ultimately go to surgery, the idea of training clinicians whose focus is optimal treatment for the other 90% is sound.\u00a0 Moreover, when problems that are being evaluated by a Sports Medicine physician ultimately are found to require surgery, Sports Medicine physicians can direct patients to the most appropriate surgeon for the job \u2013 something that is difficult for patients to determine on their own.\u00a0 In this sense, we feel that it is best for Sports Medicine physicians to practice in an independent setting, where what drives referral to a surgeon is expertise and not institutional affiliation.\u00a0 Stadia Sports Medicine is the only independent Sports Medicine Practice in Des Moines.\u00a0 Sports medicine physicians typically offer the following services within the context of their practice:<\/p>\n<ul>\n<li><strong>Office-based diagnosis and care of      musculoskeletal injury (joints, bones, muscles, spine)<\/strong><\/li>\n<li><strong>Consultation for medical problems that      relate to exercise (asthma, bone density problems, exercise-associated      abdominal pain, anemia, <a href=\"http:\/\/stadiasportsmedicine.com\/info\/2016\/concussion-doctor-iowa\/#.VytjPYSDGkp\" target=\"_blank\">concussion injury<\/a>, etc.)<\/strong><\/li>\n<li><strong>Evaluation of endurance athletes to help      establish training zones for optimal training.<\/strong><\/li>\n<li><strong>Establishment of exercise prescription      protocols for patients desiring to start exercise for the management of      established medical problems. <\/strong><\/li>\n<li><strong>Nutritional advice pertaining to sports      participation\/exercise<\/strong><\/li>\n<\/ul>\n<p><strong> <\/strong><\/p>\n<p><strong> <\/strong><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>10. You still have time      to address your pain, but you have to act now.<\/strong><\/p>\n<ol style=\"text-align: left;\"><\/ol>\n<p style=\"text-align: left;\">If you are on a high-deductible health insurance policy and have met your deductible, or if you have flex funds to use prior to the end of the year, you still have time to look into treatment options this year.<\/p>\n<p style=\"text-align: left;\">No matter what your age, if you are having orthopedic pain, physician-directed Sports Medicine can help.\u00a0 Stadia Sports Medicine is Des Moines\u2019 first Sports Medicine practice, founded in 2006.\u00a0 If you want your pain eliminated, give us a call today.\u00a0 We\u2019re here to help.<\/p>\n<p style=\"text-align: left;\">&nbsp;<\/p>\n<p><script>\n  (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){\n  (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),\n  m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)\n  })(window,document,'script','https:\/\/www.google-analytics.com\/analytics.js','ga');<\/p>\n<p>  ga('create', 'UA-61699326-1', 'auto');\n  ga('send', 'pageview');<\/p>\n<p><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>1. Chronic tendonitis is not a problem of inflamed tissue.\u00a0 It is a problem of painful scarring within the tendon [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":489,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10,1],"tags":[82,81,83,80,16],"class_list":["post-380","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-athletes-patients","category-general","tag-tendinitis","tag-tendon","tag-tendonosis","tag-tenex","tag-ultrasound-guidance"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/posts\/380","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/comments?post=380"}],"version-history":[{"count":12,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/posts\/380\/revisions"}],"predecessor-version":[{"id":636,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/posts\/380\/revisions\/636"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/media\/489"}],"wp:attachment":[{"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/media?parent=380"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/categories?post=380"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stadiasportsmedicine.com\/info\/wp-json\/wp\/v2\/tags?post=380"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}