Interview with Regenerative Medicine Leaders: Part 1

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Regenerative Medicine

 

Regenerative Medicine is an exciting, expanding field of medicine.  Stem cell technology is quickly expanding in the area of musculoskeletal conditions.  As physiatrists, we routinely treat musculoskeletal injuries and are therefore, perfectly aligned to be leaders in this new realm of medicine.

 

In this edition, we meet Dr. Malanga who is involved in stem cell research and clinical application, as well as active in the education of other Rehab Physicians through the AAPMR’s Regenerative Medicine course.

 

This is an excerpt from the full length article in the AAPMR CORE newsletter, for which I am editor.  In this section, Dr Malanga discusses the research and efficacy behind platelet rich plasma and stem cell technology.


Dr. Malanga

 

 

 

 

 

 

 

Gerard A. Malanga, MD

Founder and Partner; New Jersey Sports Medicine and New Jersey Regenerative Institute Cedar Knolls, NJ

Clinical Professor, PMR, Rutgers University- New Jersey Medical School

Chair, AAPM&R Regenerative Medicine Task Force   .

 

“I believe that PRP (platelet rich plasma) is effective for treating many musculoskeletal conditions.  I have personally been able to publish review articles on the topic and feel that the literature is supportive of PRP.  Also, I was fortunate to be part of a multi-center study, along with Dr. Kenneth Mautner of Emory University, looking at PRP in the treatment of tendinopathy1.   Several factors affect the efficacy of PRP: the absence of red blood cells, the concentration of PRP relative to serum concentrations, and the presence/absence of leukocytes.

 

Other than tendinopathies, the other area that many clinicians have found difficult to manage is a diagnosis of degenerative arthritis, such as in the knee, particularly in those under the age of 60.  This is an ever increasing common problem with very few treatment options.  Many patients have tried and failed a variety of nonoperative treatment measures that include: medications, strengthening and physical therapy, various injections and yet remain limited by pain.  Many are offered a total knee arthroplasty, a procedure that often requires a reduction of activity level after surgery.  It is this population, I believe, that may be better treated with mesenchymal stem cell therapies.

 

Several years ago, I researched and developed expertise in the use of bone marrow stem cell therapies in the treatment of various cartilage and osteoarthritic conditions as well as for meniscal tears.  This involved a great deal of review of various journal articles in journals that I had never before read.  I have been fortunate to learn from and exchange experiences with many other physicians around the country who are pioneers in this area.

 

Thus far, the results from stem cell therapies are promising and each year the techniques and experiences continue to improve.  There continues to be a great deal of more work to be done in this area to solidify the scientific evidence for these Orthbiologic treatments and I am excited to be working with physicians across the country who share interest in this area of medicine.”

 

 Dr Malanga is leading an upcoming review of the literature for both techniques in the medical journal PMR; and is leading the task force on Regenerative Medicine for the medical society, American Academy of Physical Medicine & Rehabilitation.  Dr Malanga has been a leader for years in the field of musculoskeletal care and I feel quite fortunate to learn from him over the years and I look forward to learning more about this very exciting therapy.

 

Good Luck!

References:

  1. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review.

http://www.pmrjournal.org/article/S1934-1482(13)00003-8/pdf

 

 

Why Finding an Osteopathic “Function Expert” Might Be the Best Way To Treat Your Pain

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150px-Muybridge_human_male_walking_animatedThe physicians at Valley Sports and Spine specialize in Physical Medicine & Rehabilitation. Their proven methods identify the root of your pain and prevent further injury.  

 

Are you struggling with pain in your neck, back, or knees? Have you been back and forth to your regular practitioner but still have no idea what is causing the discomfort? Have you considered being evaluated by a function expert? You may be surprised to find that osteopathic medicine can offer you the relief you have been looking for and so much more.

What is a Function Expert?

Physiatrists, also called function experts, specialize in the nerve, muscle, and bone functions of the body. Another way of stating this is to say that they are experts in how the body moves. While a general practitioner may be looking specifically at your aching knee, a function expert will be looking at your back, hips, and ankles simultaneously and watching how they are all working together in support of your knee.

Why Movement Matters

The body is a machine with many working parts that all have a job to do. Like a machine, if one part starts to get worn out and stiff, it can cause a chain reaction of stress throughout the system. The bones, muscles, nerves, joints, and connective tissue are all an interconnected system that work together to produce movement. If a specific area begins to have trouble the body will naturally compensate and attempt to shift the stress to another area. An example of this is a runner with knee pain. Once evaluated by a function expert it is identified that the runner is actually suffering from a stiff ankle. The ankle’s limited motion when running is putting extra stress on the knee. Once identified, specific exercises can be very effective at restoring the ankle’s mobility and eliminating the knee pain.olderStretchers

Why Choose Rehabilitative Medicine?

Rehabilitative medicine is about more than just your specific injury. Physiatrists evaluate each patient as an individual. Diagnosis and treatment of an ailment involve learning about the patient’s lifestyle and hobbies and understanding how their life is being affected by their current limitations. Understanding a patient’s daily activities can help the practitioner find clues to the greater cause of the ailment. Additionally, this type of consideration helps to create a treatment plan that can accommodate the patient’s lifestyle and hopefully allow them to continue conducting their favorite activities. Patients get the satisfaction of knowing that not only is their chief complaint being addressed but that they also are reducing their risk for further injuries.

For more information about function experts, please visit our website at http://valleysportsandspine.com and find out what Valley Sports & Spine Clinic can do for you!

The Future of Medicine will be Regeneration

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Sports Medicine is rapidly changing.  The old days of giving steroid injections for every ache and pain are numbered.  Most treatments for sports injuries are not able to treat the root cause.  In stead, treatment has been aimed at controlling the symptoms through medications or devices.  In fact, many traditional treatments (think steroid injections) can damage tissues like cartilage and tendons.

Regenerative Medicine is a game-changer.  It is has the potential to heal damaged tissues and organs.  It has three elements: Rejuvenation, Replacement, and Regeneration.

Rejuvenation: Rejuvenation means enhancing the body’s natural ability to heal.  Some tissues like skin heal very quickly after injury; but others like organs, tendons, and nerves heal poorly or slowly.  Recent research has shown that these tissues possess stem cells and the ability to heal better than previously thought- rejuvenation is the branch of medicine aimed at optimizing the body’s ability to use these healing processes.

Replacement: Replacement is exchanging damages cells/tissues for healthy ones from either a living or deceased donor.  Think of kidney transplants, or knee meniscus and Achilles tendon transplants.  Also, technology exists that allows your own cartilage to be grown in a lab and transplanted back into a damaged knee.

Regeneration: Regeneration involves delivering specific types of cells or cell products to diseased tissues or organs, where they will ultimately restore tissue and organ function, as defined by the Mayo Clinic.  Examples are inserting stem cells or growth factors into a damaged tissue.  We commonly use Platelet Rich Plasma injections for tendon and joint injuries for this very reason.

Regenerative medicine may provide the definitive treatment for many of the degenerative problems faced by Sports Medicine like back or knee pain.  Valley Sports & Spine Clinic focuses on the emerging evidence in this field to provide cutting-edge treatments and protocols for our patients.

We can help you!

 

Ethan Colliver, DO

Valley Sports & Spine Clinic Giving you Back your Life

Medicine Delivered at the Speed of Sound!

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Dr Colliver & Crew after finishing up some Ultrasound training

Dr Colliver & Crew after finishing up some Ultrasound training

Last week was busy with several after-work activities.  One of these evenings was spent with Blacksburg Physical Therapy, reviewing musculoskeletal ultrasound.  But first, I should explain that I have known this amazing group longer than any other physical therapy group, and they have always impressed me.  For example, when a patient has a particularly difficult time in rehabilitation, we will do a “co-visit”- which is when the physician and the physical therapist meet the patient together and review the rehab plan. Also, we have done training together on Postural Restoration Institute courses and practiced Manual Medicine together.  So when they asked me to come review Musculoskeletal Ultrasound, of course I said YES!

At first, I went over my standard spiel on examination of the shoulder.  But that quickly devolved and soon everyone was looking at everyone else’s various musculoskeletal oddities, like the distal biceps pain of the professional powerlifter.  This group quickly figured out how Ultrasound is very efficient, diagnostic, and has lots of applications in the therapy setting.  This allows us to quickly evaluate shoulder pain; but also, foot, ankle, knee, hip, elbow, wrist and hand pain.

In this world of instant social media, selfies, Tweets, etc, musculoskeletal ultrasound allows the physician and patient to instantly see what inside the body looks like and how it reacts with motion.  MRI can’t even do the things that Ultrasound can!  But it does take a lot of training; and as the leading musculoskeletal ultrasound physician in the New River Valley, I feel excited to introduce this approach to as many providers who could benefit from this technology.

Thanks again, Blacksburg Physical Therapy, for a great evening.  Keep practicing.

 

Good Luck!

Valley Sports & Spine Clinic Giving you Back your Life

Dr Ethan Colliver

Muscle & Bone Health in Aging

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The muscle and bone systems are constantly changing and reacting throughout our lives; and the effects are different for men and women, but remarkably similar. Both muscle and bone will undergo a normal decline as we age; somewhere around the age of 25 in men.  Muscles lose strength and power for various reasons:

1. muscles lose mass: there is a decrease in muscle fiber size and a decrease in muscle fiber quantity, starting at the age of 25, due to decreases in estrogen, testosterone, and Insulin-like Growth Factor-1 (IGF-1).
2. loss of motor units: the number of motor nerves that innervate muscle cells decreases
3. less muscle protein synthesis
4. loss of aerobic capacity: this is multifactorial in itself
5. loss of synchronization of the firing of motor units: also, multifactorial, such as with prior sciataca or disc herniation

Bones lose mass as we age because of several reasons:
1. loss of sensitivity of bones to muscle: loss of testosterone, IGF-1, and estrogen decreases bone response to mechanical stimulation by muscles and result in loss of muscle mass.
2. loss of muscle mass, area, and strength: due to loss of IGF-1, estrogen, and testosterone and this loss of muscle can also decrease the stimulation on bones.
3. increased bone resorption: due to loss of estrogen and testosterone

You can counteract this decline in bone and muscle health with strength and endurance training. Regular strenuous exercise (20-60min, 3-5 days/week)increases muscle strength and power, aerobic capacity, and bone density. Currently, no medications are approved for the treatment of muscle loss that occurs with aging and some treatments, including testosterone, can have dangerous side effects. For bone loss, exercise can increase the stimulation on bones by muscles and improve power and balance to decrease your risk of falls. Many medications exist for treating thin bones, including testosterone in men, but it appears that exercise can be as effective and both treatments should be implemented.

If you are concerned about your bone and muscle health, you should check with your doctor to see if an underlying medical condition is present, or if this a natural process with aging. Your doctor may prescribe medications and exercise to treat your issues.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life

Dr Ethan Colliver

 

What is the True Value of a Physician?

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Have you ever thought about how your Physician is unique?  Have you ever thought about how much training goes into making a Physician?  In my case, it is about 14 years… some physicians take even longer.  It is remarkable to think that there is a group of people in society who will wait so long on beginning their career and families so that they gain so much training.  And trust me, it is a good thing… you want the brightest, most dedicated people working on your health. However, Medicine is rapidly changing.  Physicians are losing compensation yearly and have little voice in current discussions about Healthcare policy in Washington.  Do you think, at this rate, that Medicine will continue to attract the best and brightest if they continually look at decreasing compensation and control; or will current bright physicians stay in their current positions?

If you want to read more on this discussion, please read this insightful article: Value

Sincerely,
Ethan Colliver, DO

Patient Satisfaction & Medicine

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Here is a link to an interview between two brilliant Physiatrists discussing patient satisfaction and medicine.  The guest is Dr. Brian White from Columbia University at Cooperstown, New York.

I had the privilege of training with Brian White, DO, through medical school and internship. Dr. White is a great friend and colleague and we share similar interests. He has a great skill of taking complex issues and putting them into concrete concepts, using simple examples and analogies.  He has definitely been a fantastic teacher for me, and I think we all could learn more about how healthcare is changing, unfortunately not always in the best direction.

This may be a continuing forum and I hope to put a link about an interview with yours truly in the future!

Thanks!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver