The TOP Joint Treatment

Options of Today
VOL 1
CONTENTS
i. Introduction
ii. Platelet Rich Plasma
iii. Prolotherapy
iv. Stem Cell Therapy
v. Orthopedic Surgery
vi. Chiropractic
vii. Physical Therapy
viii. Acupuncture
ix. Fitness & Yoga
x. Supplementation & Nutrition
xi. Conclusion
xii. About the Authors
xiii. Sources
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INTRODUCTION
Today, technology has provided us with advaced therapies,
surgeries and methodologies for treating joint pain. From
regenerative injection therapy, to holistic and surgical
options, there are more ways to treat joint pain today than
ever before. More optins brings more confusion. We hope
to cut through the hype and showcase only the scientifcal-
ly-verifed information. But, our primary goal for whichphy-
sician.com is to help you live a mobile and pain-free life.
Joint and muscle problems come in all shapes and sizes. The soccer player tweaks his
knee, the tennis player turns his ankle and the weekend softball player hurts his shoul-
der. From overuse problems to acute sports injuries, muscle and joint pain will affect
every one of us.
In previous years, for those suffering from joint or muscle injuries, the only course of
action was to visit the family doctor and hope they had a remedy. If they did not, you
hoped they knew a specialist near by. Today, we have more options, and more informa-
tion. Today, the issue is the opposite.
There are too many unqualied prac-
titioners offering the wrong treatme-
nts to the wrong patients.
In this text, we will explain the regen-
erative, traditional and non-medical
options available. This Ebook is your
unbiased information guide to seek
out the best possible treatment and
regain your optimal joint health!
If you would like to
co-author the next
Ebook, please email us:
info@whichphysiciacom
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PLATELET RICH PLASMA THERAPY
By:
Doctor Bronner Handwerger, NMD
Platelet Rich Plasma Therapy (PRP) is a
natural therapy in which the patients own
blood cells are extracted, spun in a centri-
fuge to concentrate platelets and growth
factor, and then injected into the damaged
tissue to initiate an immune response for
the purpose of tissue healing. This regen-
erative treatment was rst used over 20
years ago by dentists to help with cancer
patients who needed jaw reconstruction.
The therapy has since been been used in
the eld of orthopedics as a way to heal,
strengthen and prevent future damage
to the tissue. Here are a few quotes from
other experts running PRP studies:
The success rate for the platelet-rich
plasma treatment, is between 60 and 75
percent, and a reduction in healing time
of 25 to 30 percent. (Halpern, Brian M.D.).

The side effects are very
limited as patients are utiliz-
ing their own blood, to which
there should be no negative
reaction. - (Pavlov, M.D.)
You may be asking yourself what is PRP
exactly? Well, some would tell you its a
necessary protocol to repair damaged
tissue anywhere on the body. Others may
tell you its an unproven placebo. Everyone
agrees that platelet rich plasma is made up
of platelets, plasma and a variable concen-
tration of white blood cells.
When activated, and injected into the
body, platelets release growth factors that
can accelerate healing of injured tissue.
By bringing a concentration of platelets
and growth factors, PRP stimulates mild
inammation that triggers the healing
process. The result is the formation of new
collagen which strengthens the damaged
tissue.
Numerous athletes have utilized PRP for
a variety of joint and tissue concerns. Here
are a few of them who have had platelet
rich plasma injections: Hines Ward, Andre
Johnson, Troy Polamalu, Joseph Addai.
Alex Rodriguez, David Ortiz, Nelson Cruz,
Kobe Bryant, Derrick Rose, Greg Oden
and Tiger Woods.
So why does it work? Due to poor blood
ow in these areas, injured tendons and
ligaments can be very slow to heal. As
a result, chronic pain and dysfunction
can ensue. PRP is injected to treat tears
and strains of the tendons and ligaments
where the blood and growth factor are not
prevalent. In cases where the injury is in
the rotator cuff, knee, elbow, hip and the
back, PRP is used to heal, strengthen and
regrow tissue. PRP has also been used to
reduce the pain and dysfunction caused by
osteoarthritis. New studies are currently
being performed which will further dene
the role of PRP and the issues for which it
can be used.
Case Study: Partial Rotator cuff tear and labral
tear. The patient had received cortisone shots
and physical therapy and was told surgery was
the only course of action. However, due to the
patients particular line of work, surgery was not
an option. Today, after completing two treatments
of PRP, he now has full range of motion, very little
pain, and normal function of the injured shoulder.
Prolotherapy (or proliferative therapy)
is injection to stimulate normal repair in
joint tissues, such as ligament, tendon,
cartilage and muscle. Physicians who are
trained and experienced in Prolotherapy
use a variety of approaches to stimulate
and nurture this normal healing process.
Most commonly a concentrated dextrose
or sugar solution combined with anes-
thetic is injected in small amounts using
a very ne small bore needle, so the main
procedure is well tolerated. Since your
body heals through a normal inammatory
process, it is important to avoid anti-in-
ammatory medications, such as ibupro-
fen, aspirin and cortisone injections, while
being treated with prolotherapy.
Prolotherapy has been used in a form
recognizable to contemporary practi-
tioners for at least 75 years; the earliest
substantive report appeared in the allo-
pathic literature when the technique was
referred to as sclerotherapy as a result of
the scar-forming properties of early in-
jectants. - Schultz L. A treatment for sub-
luxation of the temporomandibular joint. J
Am Med Assoc. 1937;109(13):10321035.
The term Prolotherapy rst appeared
in the 1950s when a surgeon, George
Hackett, MD, began using it to educate
physicians about a method that he be-
lieved could cure most cases of chronic
back pain. He believed that most back and
neck pain develops as we wear down the
supporting connective tissues that are
spread throughout our spine and all joints.
These ligaments, joint capsules, tendons
and fascial planes absorb a lot of stress
from daily life (such as manual jobs or play-
ing sports) and from traumas (such as falls,
car wrecks, sports injuries, etc). When
these tissues become weak or lax, muscles
have to work harder to stabilize the spine
or joint, eventually resulting in muscle
tightness, spasm and more pain. The key to
curing the problem is to stimulate repair or
regeneration of these connective tissues.
Then the muscles can heal themselves.
Physicians who use prolotherapy believe
that your body is designed to repair itself.
However, mainstream approaches to joint
pain routinely interfere with this repair
through the overuse of anti-inammatory
medications and cortisone injections. For
example two long term studies of corti-
sone injections for tennis elbow (a tendon
overuse injury at the elbow) have shown
patients do well in the rst few weeks. Yet
6-12 months later they are doing worse
than the patients who did not receive that
type of injection.
Our job as Prolotherapy physicians is
to stimulate a response from the body in
the right location, then coach patients to
avoid interfering with the repair process.
Most joint related pain can be treated
with Prolotherapy, even when surgery has
failed. For example, 8 years ago a 60 year
old family practice physician came to my
ofce from Dallas complaining of shoulder
pain that interfered with sleep and dif-
culty lifting his arm. He had a successful
rotator cuff surgery 4 years previously
with an extended recovery and time off
work. The pain slowly came back over the
previous year and had not responded to
physical therapy. Now the MRI showed
PROLOTHERAPY
9
8
By:
Bradley D. Fullerton, MD, FAAPMR
that the previously repaired tendon had
frayed and partially torn once again. He
was told that he needed to have a second
surgery and dreaded the downtime to
recover. He had learned about Prolother-
apy from a colleague and wanted to give it
a try. I treated him twice in late 2006 using
a dextrose solution. He had no downtime
from work or recreation and he was pain
free with full range of motion for 3 years.
He came back to Austin for one tune-up
treatment in 2009 and one in 2014 due to
mild recurrence of symptoms.
In 2011, we published a randomized, con-
trolled study in The Journal of Pediatrics
to address overuse injury of the patellar
tendon in teenage athletes, which can be
treated successfully with prolotherapy.
In fact, prolotherapy was safe and well
tolerated and resulted in more rapid and
frequent achievement of unaltered sport
performance, and asymptomatic sport
than usual care. This superior result
was evident even at one year after the
treatment.
In 2013, researchers at the University
of Wisconsin published similar results
in a similar study design when treating
osteoarthritis (i.e. degenerative arthritis)
of the knee. Researchers reported treating
30 patients showing symptoms of Os-
good-Schlatters disease. This is a common
condition that most insurers will allow cov-
erage for evaluation and diagnostic testing
to determine if you are a candidate for
prolotherapy. Despite a long and successful
history of prolotherapy treatments, most
physicians are not trained in this approach
of solving musculoskeletal pain. As a result,
most insurers still do not understand and
do not cover prolotherapy.
As in surgery, the skill of the prolother-
apy physician can make all the difference.
To maximize your results, make sure you
seek out a well-trained and experienced
physician.
In 1937, Louis Schultz, DDS, MD, published the frst
study showing that loose joints can be stabilized
through injection at the joint capsule of the jaw or
temporomandibular joint. In the Journal of the Ameri-
can Medical Association, chronic, painful TMJ problems
stabilize and people experience results that approach
entire satisfaction(JAMA)1. The evidence base for
prolotherapy using only dextrose is increasing though
ongoing studies.
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Stem cell therapy is the use of our own
adult stem cells to treat conditions that
may not respond to traditional thera-
pies. A stem cell is a type of cell that can
become any type of tissue. For instance,
if stimulated properly a stem cell might
become bone, muscle, cartilage or even
skin. This is a useful property because the
process can be used to repair injured or
damaged tissue of many types.
In orthopedics we use stem cell therapy
to aid in bone healing and regrowth of
tissue. There is some new information
that stem cell therapy can decrease pain
levels and prolong the need for joint
replacement in people with various stages
of osteoarthritis. This has provided some
hope for people who are not obtaining
relief with conventional treatments. The
process requires a physician who is experi-
enced in the harvest and use of stem cells.
Typically cells are taken from the back of
the pelvis bone with a needle. Fat can also
be used to harvest cells, but this requires
different preparation. The stems cells
are concentrated in a centrifuge and then
injected into the affected area.
The entire process takes approximately
30 minutes and can be done in the ofce
under a local anesthetic injection.
As with any treatment, success varies.
Some may obtain minimal change in
their symptoms and others may receive
signicant benet. One example is a 56
y/o professional who was on the verge of
a knee replacement for several years. He
was unwilling and unable to take time off
so he tried stem cells injection in his knee.
After a month his relief was signicant and
has lasted 9-12 months as of this writing.
Many have heard of the potential contro-
versy surrounding stem cells. This debate
centers around embryonic stem cells and
the FDA has strong regulations. Stem cells
used in orthopedics are adult stem cells,
taken directly from the patient and re-in-
jected without chemical manipulation.
Thus, you are getting a safe, legal injection
of your own concentrated healing tissue.
Stem cell therapy is not recommended
for those with lymphoma, leukemia or an
active infection.
If you are searching for stem
cells as a possible treatment
option you, should make
sure that you speak with a
professional who (a) is quali-
fed to make the cell harvest,
and (b) has experience with
the mechanical and clinical
nuances of the process. This
process is usually performed
by a licensed physician.
Use of stem cells for regenerative ther-
apy is typically not covered by insurance
and can have a cost range from $5,000
- $8,000.
STEM CELL THERAPY
By:
Dr. Scott Spann, MD
STEM CELL THERAPY
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12
Do you have knee or shoulder pain and
are fearful of visiting the doctor? Many
people are nervous about visiting an
orthopedic surgeon because the very title
includes the word surgeon. Many times,
the rst words I hear are, I dont want
any surgery. The reality is that the vast
majority of orthopedic issues are treated
non-surgically. Your orthopedic surgeon
is the most highly trained specialist
available for muscle and joint problems.
Most orthopedic specialists are trained
9-to-10 years beyond college before they
even begin treating patients. They are
also required to prove their orthopedic
competency every ten years through
rigorous testing. Due to that high level of
training, if there is a way to x it your joint
issue without surgery, your orthopedist
will know about it.
Here is what you can you expect when
you visit and orthopedist. When you visit
an orthopedic doctor, he or she will rst sit
and talk to you to nd out how and when
your pain started and where you feel it.
The goal is to characterize this pain and
devise a plan to relieve it. In most cases
an x-ray will be taken because it is one of
the most concrete methods of evaluation
that is available. Many times x-rays are
normal, but frequently they can identify
any problem within the bone. After a
thorough discussion of your problem and
evaluation of the x-ray, you should receive
an examination relating to the area in
question. If this is not sufcient, occasion-
ally further testing is performed such as
MRI or CT scan to visualize the soft tissue
and cartilage in the injured area. Once
all of those data points are gathered, the
doctor uses the ndings, knowledge base,
and experience to formulate a plan for
recovery. Most frequently this involves
some degree of rest, stretching, exercise,
natural or over the counter anti-inamma-
tories, and education. The majority of the
time, this is all that is needed.
Most orthopedists are experts in the
eld of regenerative medicine and can
offer treatments such as platelet-rich
plasma injection, stem cell treatment, cor-
tisone or viscosupplementation. Cutting
edge new treatments are constantly being
researched and evaluated for use in treat-
ment. It is only when structural injuries
or degeneration are present and do not
respond to conservative care, that you and
your orthopedist might discuss surgery.
According to the NCHS, only 5.3% of
orthopedic visits result in surgery, and
the majority of visits to an orthopedist
are for injury-related problems. If you do
need surgery, you should be comfortable
to know that your orthopedist is typically
highly trained to do so. According to the
NCHS, only 5.3% of orthopedic visits result
in surgery, and the majority of visits to an
orthopedist are for injury-related prob-
lems. If you do need surgery, you should be
comfortable to know that your orthopedist
is typically highly trained to do so.
The Hippocratic Oath that all doctors take
states, I will apply, for the benet of the
sick, all measures that are required, avoiding
those twin traps of over treatment and
therapeutic nihilism. I will remember that
ORTHOPEDIC SURGERY
By:
DR. THOMAS BURNS, MD
ORTHOPEDIC SURGERY
there is art to medicine as well as science,
and that warmth, sympathy, and under-
standing may outweigh the surgeons knife
or the chemists drug. Your surgeon should
exhaust all non-operative avenues before
discussing surgery. Also, you are the captain
of the team. You have hired the doctor or
surgeon to perform a task and you have
the right to evaluate and review the doctor
before, during, and after care. No decision
should be made without your approval and
understanding.
Pain and injury make us all apprehensive.
Your doctor should be part of the team to
answer questions, suggest treatment and
help to alleviate that apprehension. If you
are not on the same page as your doctor, feel
free to seek a second opinion. It is your body
and you remain the boss!
Treatment by an orthopedic physician is
routinely covered by insurance plans. Check
with your insurance carrier for details.

tment of the muscular system, the skeletal
system, and the nervous system. The
Association of Chiropractic Colleges
(ACC) denes chiropractic as a healthcare
discipline which highlights the bodys
natural healing powers, without the use of
drugs or surgery.
The most common side effect from chi-
ropractic treatment will be muscle or joint
soreness which is usually mild and sub-
sides within a day or two. The most serious
and controversial potential side effect
of chiropractic adjustment is vertebral
artery dissection (VAD). Overall, the risks
involved with chiropractic adjusting, when
properly applied by a licensed chiroprac-
tor, are very low and should be considered
a safe option for treatment.
The most common complaints that a
chiropractor will hear are regarding low
back pain and neck pain. More than 80%
of people will experience back pain during
their lifetime. Herniated discs, facet and
joint irritation, arthritic changes, muscle/
tendon strains, ligament sprains, and fas-
cial distortion encompass the vast major-
ity of the causal factors. Other injuries or
ailments that chiropractors will commonly
see are tension headaches, migraine
headaches, adrenal fatigue, bromyalgia,
and kidney stones/disease (not necessarily
directly treated by chiropractors but this
patient walks in with back pain).
Chiropractors will have success stories
about treating systemic disease; however,
chiropractic specically targets muscle,
ligaments, tendons, nerves, and bones. It is
noteworthy that although the general con-
sensus is that chiropractors address the
spine, a chiropractor will be trained in all
joints of the body and overlying capsules,
tendons, ligaments, muscle, and fascia. It
is not uncommon for an individual to walk
in with neck or low back pain and for the
chiropractor to also address any shoulder/
hip/knee pain. It is important for patients
to divulge any areas of discomfort, even if
they feel it is unrelated.
Chiropractic care is covered by most in-
surance companies. Some insurance plans
may require preauthorization by a primary
care provider. Be sure to check your
plan as you may need to specify that you
would like chiropractic coverage if it is not
provided. Chiropractors may also accept
individuals who have been in automobile
accidents or workers compensation cases.
Chiropractic is the third
largest doctoral-level health
care profession after
medicine and dentistry.
Although the practice of
chiropractic continues to
expand, treatment is
centered around the
chiropractic adjustment
which is done either by hand
or by instrument. The deliv-
ery of the adjustment is a
science which requires years
of dedication and training to
develop the precision needed
for effective treatment.
Chiropractic is a branch of alternative
medicine that focuses mainly on the trea-
CHIROPRACTIC
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14
By:
Dr. Ian Aheard, DC
CHIROPRACTIC
During your rst visit to a chiropractor
your doctor will perform a comprehensive
history and examination and will provide
you either with a diagnosis or refer you
for further evaluation. The evaluation
may require an MRI, X-ray, or a referral to
another specialist. If the doctor deems you
are a suitable candidate for chiropractic
care he will perform a report of ndings.
The report will include his ndings, his di-
agnosis, his treatment plan, and any other
recommendations. Some chiropractors
will treat on the initial visit and some chi-
ropractors choose to wait until the second
visit. Treatment will vary, but most likely a
patients treatment is focused around the
adjustment.
Following the adjustment, a patient
may receive a therapeutic modality. This
usually consists of ice, heat, electrical
stimulation, or ultrasound. Lastly, you may
receive some exercises and home care
recommendations. Although this is an
overview of a chiropractic ofce visit, you
will nd that every chiropractor differs
in their approach, but ultimately has the
patients best interest in mind.
Chiropractors usually have different
sub-specialties and certications. If you
feel that a certain provider does not ll
your needs, there may be another provider
nearby that will. Your treatment goals are
another aspect you must consider. Most of
the population falls into the get me out of
pain ASAP category. Others are looking
for long-term wellness programs and ways
to take control of their injury or their
health. You will nd chiropractors that
cater to both. Lastly, it is generally recom-
mended that patients seek care for their
injury sooner rather than later. A low back
sprain/strain that happened yesterday
typically has a better long term prognosis
than a chronic low back pain that has been
present since your car accident 10 years
ago.
You can typically nd physical therapists in
outpatient clinics, hospitals, inpatient rehabilita-
tion facilities, skilled nursing facilities. They also
offer home health services. Therapists must
take and pass the national licensure examina-
tion that credentials them to practice physical
therapy.
Many orthopedic conditions will benet
from physical therapy. This includes diag-
noses related to sports injuries, ligamen-
tous sprains, muscle strains, osteoporosis,
osteoarthritis, joint replacements, pre and
postoperative treatment, degenerative disc
disease, and low back pain. A prescription
or referral can be made for physical therapy
from any physician. The physical therapist
will evaluate and assess a persons biome-
chanical and musculoskeletal limitations and
design a treatment program based on the
injury or condition being treated, as well as
the patients individual needs and goals. The
physical therapist will then communicate this
plan of care to our physician.
Physical therapists employ many different
approaches to treatment. Common ap-
proaches and techniques include therapeutic
exercise, manual therapy, soft tissue mobili-
zation, functional training, and therapeutic
modalities like electrical stimulation, ultra-
sound, and mechanical traction. Physical
therapists utilize evidence-based practice
to determine the best, and most up-to-
date treatment options for their patients.
There is ample evidence supporting phys-
ical therapy as an effective conservative
treatment option for many orthopedic and
musculoskeletal conditions. A research
study by Rosedale et al investigated the
efcacy of physical therapy exercise in-
tervention in patients with knee osteoar-
thritis.* The study concluded that patients
who underwent exercise interventions
in physical therapy had much better pain
and functional outcomes at 2 weeks and
3 months compared to the control group
who received no exercise interventions.
Chronic neck pain is another disorder
that affects many people. A research study
found that 22% - 70% of the population
will have neck pain at some point in their
lives.* Of that population, approximately
44% of patients with neck pain will devel-
op chronic symptoms. The same study also
found substantial evidence supporting
the use of physical therapy with favorable
outcomes following treatment of cervical
radiculopathy suggesting 70-90% of this
population can experience improvement
with physical therapy.
If you have an injury or condition that
results in physical impairment, loss of
function, or pain, ask your doctor about
physical therapy as a treatment option.
Depending on what state you live in, you
may be able to access a physical therapist
directly. Most insurance companies cover
physical therapy services. Check with your
current health care provider to determine
the details for coverage in your plan.
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16
PHYSICAL THERAPY
BY:
Rachel Lindhart, PT,
Dalila Arntson, PT, FAAOMPT
PTs address any physical or
neurological impairments
limiting normal daily activi-
ties. They are also tasked with
cardiovascular and pulmonary
care, wound care, pediatrics,
geriatrics, and neurologic.
Womens Physical therapists
are required to obtain a grad-
uate degree, either a masters
degree or a clinical doctorate,
from an accredited nationally
recognized physical therapy
program.
Physical therapy is a form of conservative
treatment for many common orthopedic
conditions. Physical therapists are muscu-
loskeletal movement specialists who aim to
improve a persons function. This includes
increasing strength, range of motion, mobili-
ty, as well as decreasing pain.
PHYSICAL THERAPY
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18
Acupuncture and traditional Chinese
medicine (or Eastern Medicine) has been
practiced for over 3000 years and is based
on numerous ancient medical texts. In this
discipline, disease and dysfunction is typi-
cally viewed as a disorder of harmony, and
treatment is directed towards restoring
that harmony and balance in the body.
Acupuncture is one of the most ancient
Eastern Medicines. Acupuncturists utilize
very thin stainless steel needles to stimulate
and treat specic points around the body.
These points directly correspond to differ-
ent organ systems. This treatment can be
used to promote health and treat a range of
symptoms caused by diseases or disorders.
Acupuncture appointments can include
solely acupuncture, or in combination of
Chinese medicine therapies including, but
not limited to: cupping, electro-acupunc-
ture, ear needles, Chinese herbal medicine
and/or nutrition. These are typically 1-to-2
hours long and can be very relaxinglike
a massage.
Most people know acupuncture for
pain management (i.e. psoriatic arthritis,
sciatica, degenerative disc disease, ar-
thralgias, and myalgias), but, being around
thousands of years, acupuncture has far
numerous other uses including:
Fertility, PMS, hot fashes and other
womens health,
Nerve disorders including neuropa-
thy, post surgical neuropathy,
Stroke and heart disease,
Chronic colds,
Psychological conditions,
Stress, and many other conditions.
I am a naturopathic doctor, but I have
found acupuncture to be extremely bene-
cial for many of my patients. One exam-
ple is a 35 year old patient who had been
suffering from neck pain from a degener-
ative disc disease for 4 years. The patient
had localized neck pain with intermittent
numbness and tingling down both arms.
Her range of motion was slightly affected,
but overall intact. She had also complained
of intermittent occipital headaches. I
chose to treat her with acupuncture. After
the rst session, the patient noticed im-
proved range of motion and reduced pain.
After 6 months of weekly treatments, she
now has minimal discomfort in the neck,
and full range of motion.
For patients new to acupuncture, there
are concerns of whether it will hurt, skep-
ticism of its efcacy, and confusions over

insurance coverage. Although coverage
varies greatly and needs to be checked on
an individual basis, more insurance plans
are covering this elective treatment. Be-
cause the needle being used so thin, most
patients dont feel the needle insertion.
Oftentimes, most feel relaxed during and
post treatment. Overall, there have been
very few complications reported with
acupuncture and serious adverse events
are rare.
To nd the appropriate expert, make
sure you start by researching credentials
and patient feedback. All acupuncturists
have to pass state and sometimes national
exams, but be sure your acupuncturist is
well educated. Id strongly suggest asking
questions about the process as well as ex-
pectations. If the acupuncturist does not
adequately answer your questions and put
you at ease, then do not seek their help.
ACUPUNCTURE
By:
Dr. Ann Marie Nguyen, ND, LAc
Acupuncture is becoming more widely used in the
conventional medical community. In 2006, 59% of
physicians believed acupuncture to be effective as
a complementary therapy. Additionally, one in four
hospitals now offer some type of complementary
medicine. An estimated 3.1 million Americans are
using acupuncture. 70% of these sessions were for
pain or discomfort.
Most people view personal training and
yoga as a means to lose weight and stay t,
but the reality is they are primarily
preventive measures. A consistent
personal training and yoga, or deep
stretching routine prevents injury to
connective tissues by strengthening the
muscles around the joints.
Yoga lengthens the body, creating neces-
sary space between vertebrae and joints
which increases blood ow to that area;
therefore preventing painful issues like ar-
thritis. If someone is already experiencing
chronic pain or has had surgery, participat-
ing in personal training and yoga can help
ease pain, speed recovery, correct posture
and relieve any stress associated with the
injury.
Personal trainers create programs that
are specically designed for the individ-
ual. Detailed focus is applied on not just
rehabbing the current issue, but alleviating
pain and preventing further injuries from
occurring. Deep stretching activities like
yoga can also be very effective in the relief
of joint pain, muscle soreness, and any
other discomfort from overuse, injury or
recent surgery. It is always important to
have someone with proper certications
By:
Elyssa Tommer, Master Trainer
(ACE, NASM or other highly regarded pro-
gram) to assist you in building a strength
training routine).
When done correctly and consistently,
personal training can be effective for:
Improving range of motion
Injury prevention
Relieving pain
A well-educated personal trainer will
teach the individual a safe and effective
routine designed to keep people out of
the doctors ofce. Knowledge of cor-
rect form, use of equipment, and body
alignment are important components in
the prevention of further pain or injury.
Ongoing participation is recommended for
continued health.
Personal training and yoga can be health-
ier and more therapeutic alternative to
prescription drugs. Unfortunately, most
insurance companies do not cover person-
al training or yoga at this time other than
through a limited number of physical ther-
apy visits. If an individual is part of a well-
ness program or Health Care FSA through
their employer, they may nd discounts on
preventive health care which can include
As humans, we face joint
problems throughout our
lives. As a personal trainer,
I am seeing an increasing
number of clients for these
reasons;
1. Rehabilitating a shoulder,
knee, back or hip injury
2. Rehabilitation from
the debilitation of a
recent surgery
3. Alleviating aches or
reducing pain
4. Preventing or
combating depression
5. Arthritis and osteoarthritis
FITNESS & YOGA
21
20
FITNESS & YOGA
a gym membership, but typically not a
Personal Trainer. It is always a good idea
to talk to your companys human resource
department and nd out your options.
When looking for a personal trainer or
yoga instructor it is good to dene your
goals and ask a lot of questions. Before
going into any personal training session
or yoga class, the trainer and instructor
should be well aware of your reason for
being there. Whether it is to prevent
injury to your muscles or joints, alleviate
joint pain, help overcome depression, or
to rehabilitate an old injury after surgery.
Make that point crystal clear to help
yourself get exactly what you need out
of every session or class. Then, have a lot
of fun with your new healthier and more
active lifestyle!
23
22
These days, consuming a typical diet is no longer nutritious or recommended. As
a society, we are eating far less fresh and natural foods and gravitating towards the
more convenient foods for our hectic lives. Vital nutrients, found in fruits, vegetables,
nuts and seeds, provide our tissue with the vitamins and minerals it needs to repair
itself. A scarcity of these nutrients in the body can cause symptoms of pain, inam-
mation, and weakness. As a nutritionist, to protect my own and my clients joints, I
recommend a diet rich in protein, minerals, fatty acids, and anti-inammatory foods
like avocado, pineapple, salmon, chia seeds and turmeric. Another understated issue
surrounding joint problems is obesity. Excess fat in our blood also increases inamma-
tion in our joints
What you eat can make a big difference. Our research
has found that eating a high fat, high carbohydrate fast
food breakfast promotes infammation that lasts for sever-
al hours after consumption of that fast food breakfast.
- Dr. Jamie McManus, MD.
Fat cells and toxins tend to latch onto one another, so the body protects itself from
toxins by producing more fat cells. Receiving most nutrients and vitamins from foods
can be difcult on a budget or, for example, in certain areas where fresh and super
foods are not readily available. So in order to get your daily requirement of vitamins,
minerals and omega 3s, sometimes its necessary to supplement. I recommend a good
omega 3, 6 and 9 oil (sh oil), a D, K, and A, a multi-mineral, and, for stressed joints,
glutamine to help relieve the tissue, and glucosamine to give your cartilage something
to sustain itself under duress. As long as my clients understand the balance of proper
nutrition and supplementation then I have done my job as a Nutritionist.
A lot of people ask me if joint pain and injury
can be xed by a specic nutritional supple-
ment or regimen. The answer is not simple. In
my profession, when someone comes to me
with tissue damage (joint, muscle, cartilage),
I rst look at what they are consuming daily,
then I make recommendations based on their
current diet. Most people do not supplement
with cartilage-support so in the cases where
their joints are being worn without repair, I
will recommend a glucosamine regimen. Glu-
cosamine is a compound we produce natural-
ly in the body, but as we age, we produce less
and less glucosamine. Hence, the importance
of supplementation. Glutamine is another an-
ti-inammatory supplement I recommend to
heavy lifters, athletes, and anyone straining
their joints.
As a registered dietitian I have seen
numerous cases where proper nutrition has
completely changed the comfort level of my
clients, especially for those suffering from
pain in their joints. I have worked with one in
particular client, a distance runner, who had
been suffering from joint pain in her knees
caused by a reduction in cartilage, or cushion,
between her knees. I recommended she start
supplementing with glucosamine immedi-
ately. Although glucosamine already exists
in our cartilage, our bodies stop producing it
as we age so supplementation, especially for
athletes, is crucial.
By:
Charlotte, RD/LD
NUTRITION & SUPPLEMENTATION
NUTRITION & SUPPLEMENTATION

After one month of consistent intake with
glucosamine powder in her protein shakes,
she showed remarkable improvements.
Everyone, regardless of their age or health
status, should seek nutritional advice from a
credible source. In most states, that person
is a registered dietitian. However, seeing an
RD can be costly depending on where you
go. If you are not able to afford customized
nutrition from a certied professional, use
any free resources you may have available to
you. But as always, light to moderate exercise
combined with a proper intake of natural
foods (grown) and supplements, is strongly
suggested.
25
24
As scientists, we physicians and professionals are trained and obligated to look for
reproducible facts in our quest for better health care. Additionally we are always
striving to nd ways to treat our patients or clients in the most effective manner.
We are in an era of medicine in which new treatments
are becoming available all the time. The most exciting
new developments have been in the feld of regenerative
medicine. There is still much to learn, but a large body of
evidence is surfacing in favor of using regenerative medi-
cine as one of our tools for treatment. In the feld of or-
thopedics there have been many new advances and many
myths. Sometimes these two cross. Sometimes myths
become facts as we learn more about a subject and devel-
op reproducible information.
While no form of treatment is effective 100% of the time, we search for treatment
modalities that give us the options we want for our patients. Regenerative therapies
are surfacing as viable alternatives, or at least viable adjuncts, to traditional treatment
for musculoskeletal problems. While they may not replace more traditional forms of
treatment, they appear to be on a track to be a part of the mainstream.
CONCLUSION
By: Thomas Burns, MD
As an example, we have yet to nd a modal-
ity that will restore the cartilage in a worn
knee. Traditional treatment involves exer-
cise, medication, cortisone and/or Viscos-
upplementation injections (hyaluronic acid).
If the pain remains too great to function,
knee replacement may be the nal option.
Unfortunately, regenerative medicine
has not been proven to replace cartilage
although some have claimed it can do just
that. Injection of prp or stem cells has been
shown to decrease pain, at least tempo-
rarily, so the patient no longer requests a
knee replacement. Is this success? I would
submit that the answer is yes. Our goal is
to improve the lifestyle of our patients and
it is sometimes determined by the level of
pain and function. If we can improve their
physical and psychological state with an
injection as opposed to a surgical procedure
then have we not succeeded?
The eld of regenerative medicine is
evolving and will continue to do so for the
foreseeable future. We will sift through
the anecdotal references and claims of un-
substantiated cures as well as the peer-re-
viewed literature and nd the consistent
benets of this genre of treatment. We
believe that regenerative medicine is here
to stay.
CONCLUSION
27
26
Dr. Thomas Burns is a Board Certied
orthopedic surgeon and currently Chief of
Staff at the Hospital at Westlake Medical
Center. He has advanced sports medicine
specialty training from the prestigious
Steadman-Hawkins Sports Medicine Clinic
in Vail, Co. Dr. Burns is a team physician
for the United States Ski Team and travels
the world caring for our countrys athletes.
He currently treats athletes of all ages in
his Austin, TX practice.
Dr. Scott Spann is is a Board Certied
orthopedic surgeon with fellowship train-
ing in spine surgery. He is a past NCAA
swimming champion and SEC swimmer of
the year. He continues to pursue research
and development of new techniques for
spine surgery and the use of regenerative
orthopedics through stem cells.
Dr. Bronner Handwerger is the owner,
Chief of Medicine at Integrative Health
Solutions in San Diego, CA. He is a panel
member for the White House Commis-
sion on Complementary and Alternative
Medicine, and a member of the American
Association of Anti-Aging Medicine as well
as the American College for Advancement
in Medicine. He is also a Faculty member
at The Institute For Human Individuality
at the Southwest College of Naturopathic
Medicine, and was the Chief Medical Of-
cer for the prestigious Blood Type Clinic.
Dr. Ian Ahearn holds his Doctorate in
Chiropractic and Masters in Science in
Sports Science and Rehabilitation from
Logan College of Chiropractic where he
graduated Magna Cum Laude. Dr. Ahearn
specializes in sports performance and
musculoskeletal function as he has part-
nered with members of the ABA, MLB, and
NFL. He currently practices at Point Loma
Chiropractic in San Diego, California and
also consults at Point Loma Sports Perfor-
mance, a multi-sport development facility.
Dr. Bradley Fullerton is is board certied
in Physical Medicine and Rehabilitation.
He is the past president of the Texas Phys-
ical Medicine and Rehabilitation Society
and president-elect of the American
Association of Orthopaedic Medicine. He
serves as faculty for the American Acad-
emy of Physical Medicine and Rehabilita-
tion training on musculoskeletal ultraso-
nography and publishes regularly
in these areas.
Rachel Lindhart is a Physical Therapist at
The Hospital at Westlake MedicalCenter
and at Westlake Rehab & Wellness. She
graduated from Texas State University
with her Doctorate in Physical Therapy.
Rachel is a member of The American
Physical Therapy Association.
Dalila Arntson is a Physical Therapist and
currently Manager of Rehab Services at
The Hospital at Westlake Medical Center
and at Westlake Rehab & Wellness. She
graduated from Texas State University
with her Masters in Physical Therapy. Dali-
la is currently a fellow and member in the
American Academy of Orthopedic Manual
Physical Therapists.
Dr. Ann Marie Nguyen holds a Doctorate
in Naturopathic Medicine and a Masters in
Acupuncture and Chinese Medicine, both
from Bastyr University, a world renowned
institution dedicated to the education
and advancement of the natural health
sciences. Dr. Nguyen is an active member
of the American Association of Naturo-
pathic Physicians and is on the Board of
Directors of the California Naturopathic
Doctors Association.
Elyssa Tommer is certied Master Trainer
through National Academy of Sports
Medicine and is a 200-hour certied Yoga
Instructor. She encourages her clients to
not only strengthen the body but also the
mind and spirit, believing that well
rounded perfect health comes with
balance of the three. She is the author of
TheWellnessDoer.com where she writes
about health, food, her travels and living a
positive lifestyle.
Charlotte Lund is a registered dietitian
through the Academy of Nutrition and
Dietetics. Her mission is to educate and
guide through professional knowledge on
proper nutrition to prevent any diseases
and injuries. She wants to improve the
knowledge on holistic and quality and
decrease the emphasis on dieting, rather
eating quality before quantity. A healthy
lifestyle can be taught but also requires
motivation and accountability not just
to your dietitian but also to yourself. She
also owns the virtual dietitian website
CLA360.org.
ABOUT THE AUTHORS
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