Inflammation and OA

Osteoarthritis (OA) was previously considered non-inflammatory. It is now well recognized that inflammatory mediators are produced and can be measured in joint fluids of patients with OA. This inflammation is a major risk factor in cartilage loss, pain, swelling, and stiffness. When management and treatment of OA consists of anti-inflammatory components, patients can improve their function and decrease pain levels. Platelet-rich plasma (PRP) is a cell therapy, that uses one’s own blood through joint injections, to reduce inflammation. Platelets are a high source of concentrated growth factors and inflammatory mediators. Platelets in PRP release many types of anti-inflammatory proteins that signal cells that lead to suppression of inflammation in OA.

 

Goldring and Otero. Inflammation in Osteoarthritis. Curr Opin Rheumatol. 2011; 23

Xie et al. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014; 16

What is Cupping and why does Michael Phelps swear by it?

What is Cupping?

Cupping is a therapy in which glass jars or cups are suctioned onto the skins surface with negative pressure. Traditionally, cupping has been used in Chinese medicine for 1000s of years to open up meridian pathways to allow Qi to flow through. When Qi flows freely throughout the body one enjoys good physical, mental and emotional wellbeing.

Cupping uses suction and negative pressure to drain excess fluids, stimulate the parasympathetic nervous system (relaxation) and increase blood flow to muscles and skin. It can be used along Meridians and acupuncture points to clear colds and flus and stimulate specific organs, it can also be used along fascial lines across the body to specifically treat fascia and muscles

Why treat fascia? Fascia is connective tissue (has an appearance like a spider web) that covers everything within our bodies – muscles, bone, nerve, organs etc. – it is the 3D glue that holds everything together.  It is what allows our muscles to slide/glide efficiently.  A fascial dysfunction can restrict range of motion, decrease blood flow to an area, and cause pain and toxin build up.

Cupping is different than most manual therapy in that the majority of other techniques use compression, whereas Cupping decompresses (lifts, separates and stretches) tissue to release adhesions and break down existing scar tissue, relax muscle spasms, and decrease trigger point pain. It has also been shown to decrease tissue changes (scar tissue formation) and inflammation following trauma.

What are the marks left by cupping?

The circular marks left behind from a treatment are not bruises and are rarely sensitive to the touch. They are static blood, lymph, cellular debris and toxins being released from deeper tissue layers. Marks can vary in pattern and color and can last anywhere from 3 days to 2 weeks.

So who can benefit from Cupping?

The short answer is anyone, but especially those with joint or muscle pain/tension, headaches, frequent colds or flu that are not getting the relief they need from regular massage therapy. Cupping is historically very effective in treating chronic overuse injuries such as bursitis, tendonitis and other myofascial pain syndromes such as runner’s knee, tennis elbow, and low back pain.

– The Knee Clinic Calgary

Platelet Rich Plasma (PRP): How does it work?

Platelet rich plasma, commonly called PRP, has been promoted widely as a potential treatment for helping injured musculoskeletal tissues to heal.  Platelet rich plasma contains high concentrations of several growth factors.   Platelet rich plasma has been used worldwide for multiple indications of knee pain, most commonly accelerate ligament healing or to augment tissue repair.  The mechanism of action of PRP is well understood, with ongoing research being done to further refine when and how PRP injections can be performed for maximal efficacy.  There are myriad ways in which PRP can help joint osteoarthritis, including the anabolic effects of the growth factors found within PRP.  There is a well-documented anti-inflammatory effect as well as cell proliferation and scaffolding to help create tissue remodeling.  PRP has also been found to improve tissue stiffness, making cartilage more resilient to future wear and tear.

The philosophy behind using platelet rich plasma to augment tissue healing is based upon growth factors that are present in an individual’s own blood.  Platelets naturally gravitate toward an injured area of the body and the alpha granules, which contain the growth factors, are released by the platelets.  For platelet rich plasma, blood is drawn from a patient and the platelets are spun down with a centrifuge to much higher levels than are normally seen in a person’s own blood.  These concentrated platelets are then injected into the injured or surgically repaired area.

Over the last few years, platelet rich plasma has emerged as an accessible and relatively inexpensive source of growth factors to treat musculoskeletal injuries.  PRP contains growth factors that are very important for musculoskeletal healing, such as TGF-beta, platelet-derived growth factor (PDGF) insulin-like growth factor (IGF-I) in fibroblast growth factor (FGF).  The growth factor concentration in platelets, coupled with the normal platelets that are present in blood, are sufficient to yield increases of measurable growth factors in the blood to help reduce knee pain.  Laboratory studies have confirmed that PRP has beneficial effects on ligament fibroblast migration and the differentiation and production of collagen.  This means that it assists with healing knee pain.  In addition to the effects of the growth factors directly on healing, platelet rich plasma has also been reported to enhance the gene expression of important healing factors.

The future of PRP is encouraging. Using the patient’s own growth factors and platelets is cost effective and research does indicate that it facilitates repairs in both basic science and animal models.  While ongoing studies are still required, it is widely believed that the use of biologic agents to enhance healing is the next major breakthrough in sports medicine for treating knee pain.

(Source: Steadman Phillipon Research Institute via drrobertlaprademd.com website).