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Ask Dr. C – Episode 3- Inversion Traction and Neuropathy

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OK, I rarely do three blogs on the same topic in a row, but man you guys are coming up with great questions! Hence, here’s Episode 3. Let’s dig in.

How come when I use an inversion table, my back pain goes away, even after a few minutes, and doesn’t come back for many days?

I love this question because it’s a great way to teach about how the spine works. The answer to this question involves Silly Putty. Why?

Silly Putty, for those that remember it, is the definition of a viscoelastic structure. If you place a book on it and walk away, when you come back it will be flat, but it’s like rubber when you throw it against the wall. This property of deformation when a long duration force is applied is called vicious and being rubber-like when a short duration force is applied is called elastic. Hence a structure that has both properties is called viscoelastic.

The discs in your spine are also viscoelastic. When you sit for any time, this is like placing the book on the Silly Putty and your discs flatten slightly. However, when you walk, your discs are elastic. They easily resist force and act as shock absorbers for your spine bones.  However, unlike Silly Putty, in your spine, all of this works through water.

Your spinal discs have water in them that is held there by chemicals called GAGs (glycosaminoglycans). When you walk, that water is moved in and out of the disc and this process is called imbibition. When you sit, that water leaks out of the disc and isn’t replaced. When your discs age, they lose cells that produce those GAGs which hold onto the water. Hence, your discs become more able to flatten. See my video below for more information:

When your discs can’t hold onto water and flatten, the facet joints at that level get overloaded and the disc bulges and irritates nerves, When your discs can soak up water due to imbibition (like walking), they gain height and take the pressure off of these areas.

When you go upside down on an inversion table, the pulling on the spinal column also pulls water into your discs. This water stays there when you’re active and is pushed out when you sit. Hence, at some point, the water gets pushed out enough that you need to replace it, which is then replaced by more inversion traction.

Can PRP or Stem cells help a person who has neuropathy ( burning and painful feet ) due to possible sciatic nerve damage?

In short, likely. Meaning that the growth factors in platelets are capable of helping nerves. How does that work?

When people have “neuropathy” this means that the nerves are damaged. The most common form of this problem is called “peripheral neuropathy” which is when the nerves that go to the feet are damaged. In our experience, there’s also usually a heavy overlap between this condition and irritation of the L5 and S1 nerves in the low back. This is often the case even when the doctor that diagnosed the neuropathy didn’t really consider the contribution of the low back in his or her diagnosis.

Hence, for us, treating peripheral neuropathy causing numbness, tingling, or burning in the feet is often about treating the nerves that go to the feet (tibial and peroneal) as well as the spinal nerves in the low back. One way to do that is through platelet lysate hydrodissection. What’s that?

Platelet lysate (PL) is a derivative of platelet-rich plasma, which is when the doctor concentrates the platelets in your blood. These platelets have healing growth factors which include Nerve Growth Factor, which can help damaged nerves heal. PL is made by breaking open the platelets to get more highly concentrated growth factors. This is then used for hydrodissection and epidural injection. What’s that?

Hydrodissection of a nerve involves using ultrasound guidance to break up scar tissue around a damaged nerve. The nerve is imaged with ultrasound and then a needle is used to inject platelet lysate around the nerve to free it up from the scar. The PL then has growth factors capable of healing the damaged nerve. For more information, see my video below:

Epidural injections occur in the spine around damaged or irritated nerves. PL can be used in the same way here. This injection is commonly performed using x-ray guidance.

By combining these two treatments, we can often help patients who have been diagnosed with neuropathy.

The upshot? I love answering questions! Keep ’em coming and tomorrow I’ll try to write a blog more in keeping with my usual!

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14 thoughts on “Ask Dr. C – Episode 3- Inversion Traction and Neuropathy

  1. AndrewE

    Can injecting stem cells/PRP into the bone underneath cartilage help strengthen cartilage that is beginning to wear? Thank you.

    1. Chris Centeno, MD Post author

      There has been much research on this issue lately and while nobody is 100% sure, it’s likely that treating the subchondral bone likely has a positive impact on the cartilage. This is why we are more frequently treating the bone as well as the joint.

  2. DAVID WATSON

    How risky is Hydrodissection of a nerve involves using ultrasound guidance to break up scar tissue around a damaged nerve, and Epidural injections occur in the spine around damaged or irritated nerves. PL can be used in the same way here. This injection is commonly performed using x-ray guidance…How long for results ? Thanks

  3. David Watson

    Is there any benefit to having stem cells re-injected in knee’s after 3 years ?

  4. Kay

    Questions:
    1. More on inversion therapy- If there is damage to the low back/sacral ligaments does inversion cause more damage long term by stretching already loose floppy ligaments?
    2. How are calcific changes to the nuchal ligament addressed? Would extracoporeal shockwave therapy be of benefit to “break up” the calcifications pre-PRP/Stem Cell procedure? If not then how would you get rid of those calcium deposits?
    3. Explain the benefit, if any, of the nucca cervical xray as compared to MRI/Plain film/DMX. I know these have a secondary “read” by a neuroradiologist. Comparable to DMX for assessing CO-C1 instability?
    4. During flouroscopic guided procedures how is the patient protected and is the exposure adjusted for size of patient and area imaged? Dentist shield the thyroid typically, ovaries are often shielded for example. Shouldn’t a patient be concerned their physician is well trained in flouroscopy, not someone who just bought a used mini c arm and blasts away? How does this affect a stem cell procedure or already damaged cartilage (chondrocytes)?
    5. How do different prolo solutions affect PRP/Stem outcomes:

    PRP/Stem
    Dextrose + Sodium Chloride = What outcome +/-
    Dextrose + Sarapin= What outcome +/-
    Dextrose + Sodium Morrhuate= What outcome +/-
    Dextrose + Polidocanol= What outcome +/-
    Dextrose + Pumice= What outcome +/-

    How the heck does liquid sandpaper (pumice) get out of the tissue? By itself (no PRP/Stem)does any of these cause scar tissue as opposed to regeneration and how? What does each do to the tissues injected? What could adversely happen?
    6. What can be done about a non-union stable clay shovelers fx? Do they become unstable with age? How about if the “stable” fx is painful?

    Am I being too greedy with questions? Sorry.

  5. DavidB

    I have ‘severe’ stenosis in two joints of my neck and particularly troublesome is the nerve going to my right shoulder and part of my right arm. Is this type of platelet treatment likely to help that or is surgery the only option? Is the PL treatment typically covered by medicare?

  6. William Schoff

    Can platelet lysate hydrodissection help if the cause of the neuropathy is chemo therapy?

  7. David O’Connell

    Dear Dr. Centeno, I came across this article on other procedures being developed for cartilage replacement. Because it uses components approved as safe and effective by the FDA, (BMP2 and VEGF inhibitors) is the procedure something that could be used or develop quickly by clinics such as yours; ones that continue to do research and use actual time tested proven approaches to your specific therapies? Being that the source they used for skeletal stem cells seems to be what you already are doing with bone marrow aspirate (the same procedure?) PRP and other cell sources. Links to the article are listed below.
    Articular cartilage regeneration by activated skeletal stem cells
    https://www.nature.com/articles/s41591-020-1013-2
    Researchers find method to regrow cartilage in the joints
    https://medicalxpress.com/news/2020-08-method-regrow-cartilage-joints.html
    Thanks for all you do

    1. Chris Centeno, MD Post author

      Yes, I have seen this, it’s an animal model, no data from humans yet.

  8. Vikas Maheswari

    Hey Chris, Sorry to drop this here. Am quite nervous today, as am leaving for stem cell procedure with a bone augmentation procedure for the treatment of AVN in the right hip, stage III at your clinic at hyderabad, India. Got an appointment tomorrow. I would be very happy if you or Dr Venkatesh Movva can supervise my treatment. Please don’t deny. It would motivate me a lot.

  9. Co Barley

    Hello – both of my knees are arthritic, have torn and mascerated meniscus and occasionally buckle when I walk and lock when I get them in certain positions. I also have large.sacks of synovial fluid behind my knees.

    The surgeons at a very highly respected university say I need knee replacements
    . I did a.little.research and learned that some companies are working on meniscus implants but i think they won’t be available for.several years. My thinking is why.not repair the.meniscus surgically and do something about those sacks. At the same.time. why not use my stem cells to help my knees heal.

    I also saw your blog about how your back nerves can affect your knees. I have degenerative.scoliosis and my root nerves do act up.

    I am being treated by a chiropractor for my scoliosis and he has recently expanded his practice to offer plasma enriched blood treatments and stem cell treatments with core cells.

    I read about this stem cell treatment and the.author says that the.process of.preparing the therapy kills the
    stem cells So the objections are useless.

    Your thoughts

    1. Chris Centeno, MD Post author

      First, a chiropractic office is great for manipulations, but NOT a good place for minimally invasive procedures. Yes, if your chiropractor is telling you he’s offering stem cell treatments from birth tissues, that’s a scam. He may not know enough about the science to realize he’s being scammed. However, I wouldn’t waste your money on fake stem cell therapy delivered at the wrong spot by a nonexpert. As to whether you’re a candidate from real stem cell therapy, which would come from your body, I would need to see your images to determine that.

  10. Matthew McEachran

    I have adhesive arachnoiditis of the lumbar spine that is causing pain and weakness in my legs. Most of the scar tissue is in the central canal. Is it possible to treat this with nerve hydrodissection?

    1. Chris Centeno, MD Post author

      That may be possible, although that has not been a common use of this technology to date.

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