I’m Dr. Thomas Grove, board certified physician and sports medicine fellowship trained. In our practiced we try to get people down the path of healing using a more conservative route than surgery. We do this by avoiding unnecessary elective orthopedic surgeries and pain pill prescriptions. We use regenerative medicine treatments, injecting the body’s own healing cells and growth factors, platelets, stem cells, and exosomes into painful areas.
Anytime you have an ache or pain and it goes away on its own, these platelets, stem cells, and exosomes are responsible for helping you promote that healing process. In regenerative medicine we can take those cells, concentrate them down into a injectable form using little needles.
I use image guidance, when injecting these cells using musculoskeletal ultrasound. This helps get the healing cells to the area of injury within a half a millimeter. This is important because we want to get as close as we can at the anatomical structures causing the patients their clinical symptoms. This helps promote a better healing experience.
Targeting the problems area more accurately helps restore function. If we can get a decrease in pain we can help get you back into the game. If you or a loved one are suffering from chronic aches or pains and they or you are considering a surgery, maybe you already had a surgery and you’re still having some issues, contact our office.
Lower back pain
A very common problem we see is lower back pain. It’s still a leading cause of disability. A problem in treating lower back pain is the possible confusion or inaccuracy of your MRI results. I want to take a moment here and explore this concept that we have of pathology versus the reality.
When we look at lower back pain, we see, almost every day, someone who comes in with an MRI result. They will give us the file and say: “Hey, look at my radiology report. My back looks horrible!” This person may have some degenerative discs, maybe some herniations, maybe facet joint arthritis. Some may have spondylothesis. But those problems on MRI may not be the pain source generator.
I want to refer to a 2015 study in the American Journal of Neuroradiology (1). In this study researchers led by the Mayo Clinic looked at over 3,000 people who had no back pain and sent them for imaging. What they found was that among these 3,000 people there were a lot of problems and a lot of pathology BUT no pain whatsoever. This reinforces this idea that the pathology and imaging report frequently does not line up with what your reality is, meaning where your pain is coming from.
Are MRIs sending people to back surgery who may not need back surgery?
Now once we hit the about 80 years old people in this study, these older folks had disc degeneration still with no back pain, they found that in 96% of them, there was disc height loss from disc dehydration or disc desiccation. They also found very high percentages of facet degeneration, spondylothesis, etc., so we’ve got a lot of people that are walking around with major pathology on their imaging report, but they have no pain whatsoever.
So when we’re looking at a treatment plan for people who come into our clinic with back pain, one would think it is reasonable to base a treatment plan on more clinic information than to rely solely on an MRI. This would include a physical examination. We do use MRIs to rule out fractures, cancer and other problems that would require surgical attention.
Returning to the subject of unnecessary elective surgery, we want to avoid these surgeries because of the complication rate we see. Research has shown sometimes 15% maybe 60% or more in terms of serious complication rate for these invasive back surgeries. Surgeries like lumbar fusions where your chances of needing a subsequent surgery after that first surgery is very, very high.
Remember in terms of basic biomechanics that our backs are the major weight bearing joint. Think about all the weight and all the forces coming from the legs into the torso. If we’re walking, we’re running, we’re jumping, squatting, lunging, it’s a lot of force that goes through the lumbar, low back regions.
In a lumbar fusion, doctors fuse part of the motion chain or kinetic chain. When that happens we’re going to have a lot more force going right above and right below the level of that fusion. So again, what does that inevitably lead to? A wearing out of those structures right next to where the fusion is. This is referred to as adjacent segment disease.
In these surgeries, the patient’s motion is changed forever. These are not simple surgeries you can just take back. Once you start putting rods and screws and metal into the spine, it is very difficult to go back in and remove all that foreign material.
In many people, we can take care of a lot of these back pain issues more conservatively whether it’s just rest, or maybe utilize regenerative medicine such as platelet rich plasma or perhaps more advanced cellular therapies such as stem cell therapy and hopefully avoid an unnecessary surgery.
Bone Marrow Mesenchymal Stem Cells in the Treatment of Chronic Low Back Pain
A back pain that goes away on its own
A very common thing that we see is back pain that completely resolve on its own. There is a lot of research that suggests maybe 80 or 90% or so of those major lumbar disc herniations go away on their own without any sort of surgical intervention. It is worth exploring non surgical options especially when considering complications. These complications include death, strokes, heart attacks, blood clots, infections, major bleeds, paralysis, numbness, and weakness.
I have over 10,000 hours in the orthopedic surgery suites. I’ve had a a very blessed by having a journey of training where I can get the exposure of all these other sort of modalities. But when you’re looking at the the particular area that we’re dealing with here, again, the spinal cord can be exposed to damage reulting in permanent damage, even paralysis.
When surgery should be explored
There are certain problems that you absolutely would need surgery for. Okay. If you got a major sort of compression of that spinal cord, you wake up or you have a major car accident, for example, you fall off a roof, and you’ve got major pinching of the spinal cord and your legs are going numb, your arms are completely numb, or you’re having a hard time completely breathing on your own or if you had a big bone fragment, pinching on a nerve. Certainly those are things you need to address. Here we are talking about more the elective sort of surgeries.
The anatomy of the spine and surgery
By far the most common thing that we see in terms of the source of back pain is a simple sprained ligament. For athletes, I’m sure at some point you maybe you’ve sprained your ankle. When we think about an ankle sprain, it’s just a little ligament, right? It’s a ligament that attaches a bone to a bone. We have a lot of spinal ligaments. They are very strong structures. Most of the time the bones will fracture before you ever tear one of these ligaments. The spinal ligaments are incredibly strong. I did not understand this until I was teaching in the medical schools, teaching the cadaver courses and injection techniques, and so forth. When you put your hands on these ligaments you feel how strong they are. They have to be because when you understand the biomechanics of how we’re walking, running, jumping, sprinting, there’s a ton of force that goes through these structures.
But, even if you have a little bit of inflammation, a little bit of over-stretching, a little tear or sprain of these ligaments, the back can become incredibly painful. I had a back issue myself. I had a iliolumbar ligament strain. This ligament attaches the lower backbones to the pelvis or ilium just off to the side. I discovered regenerative medicine at a very young age. This is back when I was playing football for the University of Nebraska. I was a linebacker there and I got the injections and saved my back from having a surgery. That was a big aha moment. I’m like, “Oh my gosh, this is what I have to do the rest of my life. This is amazing. I want to share this with the entire world.” I spent over a decade of training in muscular skeletal ultrasound to learn how to diagnose issues and target the injections. I also do a good proper hands-on physical exam. We just got two new machines here in the clinic. Very excited that we’re we’re up to date with technology.
Physical examination of the low back
Many times surgery is done on an anatomic structure that has nothing to do with what your pain is. We just talked about a study how common it is to an MRI report showing damage but that damage is not causing any pain. Someone’s MRI may show a disc bulge disc bulge for example but their true source of their pain is somewhere else, not necessarily the disc . It is almost every day someone comes in, they give me their MRI and they say oh look “I got a disc bulge we got to fix the disc.” I then try to reproduce their pain by gently pressing on the disc area. When I press on the area and the patient shows no pain we’re lose confidence that the disc is actually causing those symptoms. We would not want to send this person to surgery. If you’ve got true what we call discogenic back pain, almost always you’re going to have something called sitting intolerance. You’re sitting on a chair and you’re putting pressure directly down onto those discs, and causing some of your symptoms.
So, if you’re walking in the clinic, without crutches in a wheelchair and you’re sitting upright in the table, chances are it’s probably not your disc that’s causing your issues. Many times doctors go around chasing the image results and spinal surgery results.
When you’re a specialist in muscular, skeletal, and sports medicine, you have to master the hands-on physical exam. We got to do a good hands-on physical exam to verify where the source of your pain is coming from.
Part 2
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References
1 Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, Luetmer PH. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. American Journal of Neuroradiology. 2015 Dec 1;36(12):2394-9.