How Body Composition Analysis gives unique window into overall health

How Body Composition Analysis gives unique window into overall health

One of the unique tools that we have at the San Francisco Institute for Integrative and Regenerative Medicine is an Inbody 770 Body Composition Analyzer that measures Bio-Impedance, which is based on the amount of resistance that your body provides to an electrical that is passed through your hands and feet. There are many scales that purport to do this but only the Inbody 770 is actually measuring your body, without using calculations that are based on an average based on the population. Major research institutions like Stanford, UCSF and Mayo use this specific device for looking at fluid distribution in Heart Failure and Dialysis patients and most professional sports teams use this for optimizing their players potential.

Bio-impedance allows us to accurately detect Muscle mass, differentiate between subcutaneous and visceral fat, look at intra-cellular to extracellular fluid concentrations and only the most advanced machines are able to accurately calculate Phase Angle, which is a marker of Cellular permeability/integrity. The Inbody is able to calculate each of these for your whole body as well as each individual limb and the torso separately. This allows you to track your progress with your fitness routine, establish a baseline when you are in your peak fitness so you can reference it with your health regimen or provide another metric of healing from an injury.

With an injury, we will see a decrease in Phase angle (cellular integrity) and in most cases we will be able to detect increase extra-cellular fluid indicating swelling. In some cases, we may see a subtle difference that could indicate that we should take a closer look at the biomechanics of the side showing up abnormal.

Bio-Imepdance Analysis for detecting body composition has traditionally been used in the realm of athletic trainers focused on modifying your physical activity regimen. In the hands of an Integrative and Regenerative Medicine physician, body composition analysis appears more as a reflection of exercise in the context of hormonal, musculoskeletal, nutritional, gastro-intestinal and metabolic health.

For instance, Body Fat and Muscle mass can be dramatically affected by malabsorption happening due to imbalances in the gut flora and food sensitivities. Correcting these variables based on functional medicine testing will be much more important than changing an exercise regimen. Likewise, uncontrolled blood sugar levels could be the most significant factor effecting visceral fat. When it comes to phase angle, it is more of a reflection of inflammation in the body, which can be due to chronic immune stimulation in the digestive tract, untreated Sleep Apnea, life stress, deconditioning from lack of exercise, hormone imbalance, over exposure to toxins with lack of detox support, metabolic stress from over consumption of refined grains and fructose, and much more.

The Inbody 770 allows us to get an overall metric of your health that is easy to track as we work on optimizing your body through an Integrative and occasionally,when injured, Regenerative Medicine approach to healing. The device automatically exports your data to a website that has an associated app for Mobile devices so you can track your progress and access that data easily.

In the age of personalized medicine, a blend of innovative and comprehensive testing can give us insight into your unique anatomy and physiology. This can provide clinically relevant data in order to optimize health regimens towards a positive state of health. In many cases, the interventions necessary to address the variables affecting our data requires unique treatment protocols, tailored to you. The San Francisco Institute for Integrative and Regenerative Medicine is dedicated to providing this service and leading the way towards a medicine of the future that is personalized, preventative and comprehensive.

You can learn more about Body Composition Analysis on the Inbody blog:
https://www.inbodyusa.com/blogs/inbodyblog

The Inter-Relationship of Integrative and Regenerative Medicine

The Inter-Relationship of Integrative and Regenerative Medicine

The Inter-relationship of Integrative and Regenerative Medicine

It seems like for every chronic medical condition that has hitherto been relegated to disease management, we are finding a use for stem cells to help address underlying causes and provide more lasting cures. Regenerative Medicine is the use of growth factors or stem cells derived from the patient or donor sources in order to stimulate the body’s innate healing capacity. Many body parts have a limited capacity to heal based on limitations in blood flow, chronic inflammation, and the formation of scar tissue. Using growth factors and stem cells, we can overcome these limitations by supplying the necessary ingredients for healing directly to the area.

Local injections of stem cells and growth factors can start healing in areas as diverse as musculoskeletal conditions, hair regrowth, facial rejuvenation, erectile dysfunction, scars, wound healing, and more. Using more advanced techniques of cell isolation, we are able to treat more systemic degenerative conditions by infusing stem cells and growth factors intravenously. These have a systemic effect on the immune system and can re-initiate healing in areas that had previously been thought to be chronically injured.

Recent research published May of 2017 in Cell by researchers at UCSF demonstrated that using stem cells for hair regrowth has revealed that the process of regeneration is more complex then simply injecting stem cells into the area that you are trying to stimulate growth and repair. It turns out that for hair to start to regenerate there are specific immune cells that are responsible for activating stem cells in the area. The exact mechanisms of regulating these immune cells were not detailed in the article but previous research shows that genes linked to hair loss are related to the same type of immune cell dysfunction.

In my experience, there are common pathways that mediate immune dysfunction and any medication or gene therapy that bypasses addressing these common pathways is missing the point. The underlying causes of Immune dysfunction stem from over stimulation of the immune system from chronic infections and food/chemical sensitivities, nutrient and hormone deficiency, toxic burden, metabolic dysfunction, excessive stress, chronic pain, lack of sleep and either over-training or de-conditioning. Addressing these underlying causes requires expertise in Functional Medicine. Aside from optimizing the host, many conditions require optimal medical management in order to prevent further decompensation.

For instance, a good conventional medical doctor will pick up on sleep apnea causing hypertension and prescribe a CPAP machine to maintain open airways at night and may be able to help lower blood pressure without using medicine.

An integrative medical doctor may help you treat sleep apnea by helping you to lose weight by optimizing nutrition, hormones, gastro-intestinal health, detoxification, metabolic health, stress levels, treating chronic pain and associated musculoskeletal strain patterns, and reconditioning. With sustained weight loss and progress in the above domains, in many cases we won’t need a CPAP machine to maintain open airways at night in order to prevent the need for hypertensive medicines.

In the case of Sleep Apnea, using an assistive device (CPAP) to maintain open airways at night can be part of the solution because untreated sleep apnea can make all of the underlying causes of sleep apnea worse. There are structural causes as well that may require referral to maxillofacial specialists or ENT doctors. Integrative Medicine means knowing when to make the appropriate referral and utilizing the full spectrum of medical care necessary to achieve effective and sustainable solutions for medical problems.

If we come back to hair loss, we now know that injecting stem cells into a scalp that has immune dysfunction is ineffective. This illustrates the necessity of the inter-relationship between Regenerative Medicine and Integrative Medicine, which is the prudent combination of Functional medicine and Modern Bio-Medicine. The San Francisco Institute For Integrative and Regenerative Medicine is dedicated to pioneering the intersection of these two novel fields that build on a solid foundation of the latest breakthroughs in modern bio-medicine.

Hypothyroidism and Functional Medicine

Hypothyroidism and Functional Medicine

Hypothyroidism and Functional Medicine 

This recent NY times article refers to a study showing that ‘thyroid disease is over diagnosed and over treated.’ The study used blood levels of TSH (thyroid stimulating hormone) for diagnostic criteria and prescribed Synthroid (synthetic T4) for those in the abnormal range. A number of clinical signs and symptoms associated with hypothyroidism were followed and were not shown to change even as the TSH came back down into normal limits. The conclusion was that TSH is not a good indication of thyroid health and these clinical signs and symptoms do not seem to respond to synthetic T4.

The problems with this study are a good indication of the pitfalls of modern medicine. I see patients with hypothyroid symptoms, like morning fatigue, constipation, dry hair, skin and nails, cold intolerance and trouble losing weight in spite of exercise, all the time. Patients may show up with plantar fasciitis or other degenerative conditions of the musculoskeletal system due to the edema in the soft tissue that is a clinical sign of hypothyroidism. This is classically referred to as a “woody edema” because it takes a few seconds of pressure to sink into the skin then leaves a heavy impression. This is due to protein in the extracellular space that draws the fluid in but adds viscosity to the fluid. This has a different appearance than swelling of the lower extremity due to heart failure or venous insufficiency.

Using a combination of lab tests, patient history taking and physical exam it is apparent whether a patient is hypo, hyper or eu (normal) thryoid. The lab analysis needs to include free T4 and free T3 in order to know whether a patient is converting from T4 to T3, which is the more biologically active, but shorter lived, thyroid hormone. There are many reasons why you can have a normal TSH and still be hypothyroid, including inability to convert T4 to T3, increased reverse T3 (binds to the same receptor but has no effect), and thyroid receptor resistance (much like insulin resistance seen in diabetes).

The problem with this study is that there is more to hypothyroidism than hypothyroidism. In many cases, the underlying cause of hypothyroidism is adrenal fatigue and the underlying causes of adrenal fatigue are multi-factorial. This includes a multitude of systemic stressors such as sleep apnea, food sensitivities, hypo and hyper-glycemia, overuse of stimulants, chronic infections, nutritional deficiencies, other hormonal imbalances due to andro or menopause, insomnia, chronic pain and its causes, over training syndrome, and exposure to environmental toxins. This is where conventional medicine gets lost. It is a lot of keep track of but it is what is actually happening. This is why Functional Medicine is essential for understanding hormone pathology and why conventional Endocrinologists (hormone specialists) are missing the boat in many cases.

There are correlations in the musculoskeletal world with Orthopedic surgeons and Pain managements specialists who burn nerves, steroid away inflammation and cut through connective tissue to surgically remove damaged tissue. These solutions are equally myopic in their diagnosis and treatment in many (but not all) cases. The field of regenerative medicine is about knowing the diagnosis but also knowing the diagnosis behind the diagnosis. Maybe it is because I grew up playing chess, but you never win when you only think one move ahead. You need to be thinking three moves ahead. Good medicine, preventative medicine, works like this whether it is managing hormones or healing meniscal tears and back pain.

The take away by the NY Times reporter was that perhaps the clinical signs and symptoms are just a sign of ennui (weariness from lack of excitement) due to our current cultural and political atmosphere. That sounds like a diagnosis from the New York times journalist, not a doctor. And it doesn’t solve the problems caused by untreated hypothyroidism and its underlying causes.

If you have hypothyroidism or any of the above mentioned signs and symptoms that may be undiagnosed hypothyroidism, search for a functional medicine doctor in your area to evaluate the underlying causes of your hypothyroidism. In some cases, using a different medicine such as Nature-throid or a compounded T4/T3 combination product may be more effective at relieving clinical signs and symptoms. When we treat the underlying causes it is possible to get off of the medicine altogether, which in conventional medicine is viewed as a required life long chronic medication. If you are in the area, book an appointment with me at the San Francisco Institute for Integrative and Regenerative Medicine to get a thorough evaluation of your overall heath.

Cultivating, not hacking, the Microbiome

Cultivating, not hacking, the Microbiome

Cultivating, not hacking, the Microbiome

In this recent New York Times article, biohacker Josiah Zayner decided to attempt to fix the imbalance in his microbiome by consuming antiobiotics and then ingesting a friend’s sweat, saliva and feces in order to recolonize his digestive tract. You can watch the short film and read more here: https://www.nytimes.com/video/opinion/100000005015342/gut-hack.html?smprod=nytcore-iphone&smid=nytcore-iphone-share

In the past five years of evaluating thousands of patient’s microbiomes before and after treatments, while recording their subjective and objective response to various treatments, I have learned that there is no one size fits all approach to treating the microbiome.

Good medicine always starts with a good diagnosis. Bad medicine always starts with a generic approach that is attempted instead of a thorough analysis of the problem and its underlying causes. In a field that doesn’t have enough strong research to support any standardized approach, I can already tell you that any standardized approach would be missing the point.

In Traditional Chinese Medicine, the insight is to always look at the patient fresh, the color of their skin, coating on their tongue, tone of their voice, body type, emotional tone, quality of the pulse. When we attempt to interact with the microbiome, it is these levels of attention to detail that help to guide us towards a successful treatment of microbial imbalances and other sources of inflammation such as food sensitivities or pesticides that may be effecting our microbiome as well.

The sad part of this film is that Josiah felt this was his only option since he had seen conventional gastroenterologists who had no experience working with the microbiome. He was displaying IBS-D symptoms and potentially he could have found a gastroenterologist to prescribe Xifaxin, which is an FDA indicated antibiotic for the treatment of Irritable Bowel Syndrome- Diarrhea type. This is simply 14 days of antibiotics which will help to lower bacterial overgrowth effectively. I have used this in many cases of bacterial overgrowth that were resistant to more natural antibacterial agents such as Thyme and Oregano oil, goldenseal, or colloidal silver. I never use it without attempting to recolonize with high dose probiotics. Many gastroenterologists will use VSL #3, which is a prescription strength probiotic. Even recolonizing doesn’t prevent a return of the previously overgrown species. They are never completely wiped out and always have the potential to return, especially early on in the treatment process. One component of the treatment that can reduce the likelihood of recurrence is reducing dietary sugars that are summarized by the acronym FODMAP. In my experience, after 14 days of xifaxin, and high dose probiotics, if patients return to a diet high in FODMAP foods, they will often have a recurrence in bacterial overgrowth. The drug company that makes Xifaxin showed that there was often a recurrence of symptoms every 42 days, which may require subsequent rounds of the same antibiotic in order continue to be free from the symptoms of IBS-D. I have found that after prolonged periods of maintaining a low FODMAP diet and a retest confirming the correct balance of the digestive flora, patient may re-introduce FODMAP foods slowly. The Monash group has more data on this approach. But this is just one of many potential imbalances that could lead to the symptoms that fall under the ICD-10 diagnosis of IBS-D.

IF however, Josiah had a parasite or yeast overgrowth or as I commonly see on tests, all three, then simply taking an antibiotic would not treat his problem and may make his yeast problem worse, for instance. Often times, antibiotics are how patients end up with a digestive imbalance in the first place. It is because the antibiotics that are used for upper respiratory infections (most were viral anyways) kill off beneficial flora like lactobacillus and bifidobacteria, while leaving other strains, such as the bacteroides phyla, unaffected. Yeast flourishes during antibiotics as well and often finds time to root itself into the soil of the digestive tract. Detecting yeast can require more than just doing a stool test. Often times it will not culture out on the test but patients will have many of the symptoms of yeast overgrowth in the digestive tract. I couldn’t help but think about that at the end of this Short Film where it shows that Josiah has developed a sweet tooth. Maybe those antibiotics + an unknown stool transplant cultured yeast in his digestive tract, which is notorious for giving patients a sweet tooth.

I always make the analogy of farming to teach patients how to relate to manipulating the digestive tract. A conventional doctor looks at the same stool test results that I order, sees “weeds” growing in the soil and simply tries to use the most effective “weed killer” to remove the weeds. A holistic medical doctor sees weeds and looks to the soil to determine why the weeds are growing in the first place. What feeds those weeds? Do they like sun or shade? Dry or damp soil? High in phosphorus or nitrogen? When I look at the microbiome, it is about using the safest and most effective “weed killer”, while cultivating the soil to grow a healthy flora and fauna. In order to do this correctly, it requires an understanding of the environment in the present and in the future as it is changing dynamically, which involves a combination of science and collective wisdom derived from experience.

When attempting to manipulate the microbiome, which can affect everything from autoimmune disorders to dermatologic conditions and joint inflammation, it is important to do so in a controlled manner under the guidance of a professional with the capacity to understand the complete picture, to read between the lines of the tests and look at the person, as well as use the most effective and safe treatment. I always tell patients who shy away from more potent treatments in favor of less effective but “safer” treatments, that the safest treatment is to do nothing. To attempt to manipulate the microbiome uneffectively through herbal combinations can often result in further imbalance. Many patients become dejected by the process but in my experience even patients who have suffered from problems for many years and have many failed prior attempts can do well when a fully informed approach is used.

Sometimes the biggest contributors to gut health can be mind-body, hormonal, dental, or environmental. Stepping back and looking at the patient as a whole can often times change the context in which the unsolvable condition arises so that it no longer becomes unsolvable. The San Francisco Institute For Integrative and Regenerative Medicine utilizes a synthetic approach that brings together multiple systems and offers systems-based treatment that changes both the context and cause of the problem. Come in for a consult to learn more about what this means for you.

The Biomechanics of Running

The Biomechanics of Running

The Biomechanics of Running

This New York Times article brings up a short section on preventing injury while learning how to run. It briefly mentions that there is little evidence to support stretching prior to running and offers an anecdotal report of a few exercises that may be beneficial instead. Read the rest of the article here: https://www.nytimes.com/well/guides/how-to-start-running

In the past five years of regularly treating injured athletes, many of whom were runners or cyclists that compete in marathons and triathalons, I have learned that there are some common pathways by which the body breaks down. These are also the same ways that we need to address building it back up and preventing injury from the outset. I agree that light stretching prior to a run is unlikely to dramatically change your biomechanics if the real reason you are tight is due to weakness in another area.

Strength training on the other hand, takes time and dedication and cannot be simply incorporated into a pre run workout. There are many variables that effect the ability to activate weak or injured muscles including severity of the injury to the tendon of that muscle, other weak or injured muscles that support that injured muscle, as well as structural alignment and ligamentous laxity of the joint or the neighboring joint. When I evaluate patients, I assess each of these areas osteopathically as well as on ultrasound. There is no magic formula to treat every one but this type of assessment can reveal where the dysfunction is in any given case. The correct treatment requires an integrated approach of structural realignment, strength training, therapeutic stretching, neuromuscular education and on occasion regenerative injection therapies like Prolotherapy, Platelet Rich Plasma, Stem cell or Neural Prolotherapy. Regenerative injection therapies are required when ligaments become overstretched because ligaments have a limited capacity to heal themselves. They may also be required if the muscle or tendon injury is too severe or chronic or if the damage is to other soft tissue areas such as cartilage, meniscus or labrum.

Neural-Prolotherapy treats the superficial nerves that feed back into the underlying tissue where the pathology is located. This in turn supports a healthy neurologic environment for the tissue to heal. More evidence has accumulated that soft tissue injuries can be mediated by inflammation in the fat pad adjacent to them where small nerves release the mediators of inflammation and start the process of creating adhesions and scar tissue. Treating both the injured structure and the overlying neurologic environment helps to address this problem from both directions. Aside from a robust biomechanical assessment, many times these biomechanical dysfunctions are simply a manifestation of more systemic inflammation. Addressing digestive imbalances, which may mediate chronic immune stimulation and thus chronic inflammation, as well as hormone imbalances, which may be predisposing the patient to injury can be the most important dimension of healing.

How do I prevent injury while learning to run or running long distances as a more seasoned athlete? The answer is not orthotics and it is not simply to work on activating your gluts through clams, or rolling out your IT band. It certainly is not what the New York Times suggested anecdotally doing a few squats and lunges prior to running. If you want to get serious about preventing injury, come let a professional assess your biomechanics and look a bit deeper at your overall health with a functional medicine analysis. In order to prevent root causes, we need an assessment of those root causes prior to recommending a generic prescription.

Increasing Incidence of Colorectal Cancer in Ages 20-40

Increasing Incidence of Colorectal Cancer in Ages 20-40

A recent New York Times article cites a growing trend in Colorectal cancer, which has doubled and quadrupled for populations under 50 since 1950 for colon and rectal cancer respectively. Known risk factors include eating red meat, heavy alcohol use, Smoking, lower fiber diet, Type II Diabetes and Irritable Bowel Disease.

While conventional doctors are at a loss to explain the increase in Colorectal cancer in younger populations, as a functional medicine doctor the answer seems obvious. More and more patients are coming into their primary care doctors with digestive disorders due to imbalances in their microbiome and food sensitivities, which can be caused from chronic use of antibiotics, immunosuppressive steroids or other medications like Acutane. These can also be due to contamination of the food supply with potent pesticides, which are known carcinogens like Glyphosate, a common chemical used to reduce disease in GMO (Genetically Modified Organism) crops.

Click on this link to read the original article:

Colon and Rectal Cancers Rising in Young People

Further study of the microbiome has revealed that the contribution of our digestive flora to our health is much greater than we had ever anticipated. Pathogenic bacteria, yeast or parasites can upset this balance causing chronic immune stimulation that sets up a chronic inflammatory response in the body. Inflammation in the digestive tract than sets up malabsorption of nutrition and increased likelihood of food sensitivities due to increased intestinal permeability.

In the past 10 years more sensitive microbiome analysis tools have become available and we now have the ability to detect imbalances and pathogens that would usually go undetected on a stool test at Quest or Lab Corp. We can learn about markers of malabsorption of protein and various fats, levels of immune stimulation and intestinal permeability, biomarkers of healthy flora and overgrown flora as well as cultures to detect pathogenic bacteria, yeast and parasites. We can then tailor a treatment to your particular needs given those results. This may include digestive enzymes to aid with malabsorption, a probiotic fit for your specific condition, nutrients to help reduce inflammation and heal the lining of the digestive tract and nutraceutical or pharmaceuticals to treat any pathogenic flora.

Outside of the content of the food that we eat, an increase in environmental pollutants as well as food chain contaminants and anti-nutrients like Glyphosate and high fructose corn syrup create a more inflamed gut, which cultivates the wrong flora.

Food sensitivities that develop due to increased intestinal permeability continue the inflammatory process by exposure to typically benign foods like romaine lettuce or lemon. Detecting these food sensitivities is often debated due to flaws in some of the more popularly used lab tests for occult food sensitivities. I recommend using ELISA ACT Bio-Technologies, which evaluates both IgG (symptoms often delayed by 3-7 hours) and T Cell mediated (symptoms can be delayed by 3-7 days), which make up the bulk of food sensitivities. Most immunologists will not test for T Cell mediated immune reactions and the test is not offered at Quest or Lab Corp. Because it is not offered on this mass level and is performed by a specialty lab only, it is viewed as not reliable by most conventional immunologists. Other delayed food sensitivity tests do have their flaws like being machine automated, which will pick up more false positives such as an immature red blood cell being recognized as an immune reaction due to its larger size, as well as only testing for IgG and thus missing any T Cell mediated reactions. I have found the ELISA ACT test very reliable and when my patients test each of these foods it often has profound results that are reproducible.

Addressing other nutritional deficiencies including proteins, healthy fats, minerals and vitamins can be an important adjunct to optimize the system in which the healing of the gut takes place. Hormone imbalances can be caused and can cause digestive imbalance so lab evaluation for these factors can be critical to successful treatment in some cases.

Mind-body exercises, stress reduction, environmental health ( i.e. mold exposure), proper sleep-wake cycle and a healthy Musculoskeletal system all can play into digestive health. The above testing should be a part of a coordinated functional medicine evaluation to determine what the key factors are that contribute to the digestive imbalance. On some level, all of these systems should always be working together, which is the ideal state of health.

With an increasing rate of colorectal cancer in younger populations seemingly without cause, all of the above factors which contribute to a more inflamed digestive tract but are not currently part of the conventional medical paradigm should be strongly considered for inclusion. Until that point the San Francisco Institute for Integrative and Regenerative Medicine will continue to treat patients in a way that provides a model for the future.

Integrative Osteopathic Regenerative Medicine

Integrative Osteopathic Regenerative Medicine

Integrative Osteopathic Regenerative Medicine

Regenerative Medicine is the use of agents that contain or stimulate the production of growth factors and stem cells that are part of the body’s innate healing mechanism. The field has matured over the past 20 years and has recently gained more recognition due to high profile athletes utilizing regenerative medicine procedures to accelerate healing.

In 2016, Steph Curry suffered an MCL injury in the middle of the Western conference finals. The very next day, he and his doctors decided to utilize platelet rich plasma to accelerate his recovery. He was back out on the court two weeks later and did not need to miss any games for the rest of the playoffs.

In the medical community, traditional establishment physicians have been slow to embrace regenerative medicine due to lack of evidence as well as lack of training in the technique. A meta-analysis published in June 2016 in the American Journal of Sports Medicine looked at 18 studies testing platelet rich plasma, which showed a significant benefit for the treatment of tendon injuries. An important point of this study is the content of the injection was Leukocyte Rich Platelet Rich Plasma, which contains higher levels of growth factors than Leukocyte Poor Platelet Rich Plasma.

The technique of assessing and injecting is equally as important as the content of the injection, especially when treating more complex structures like the hip, shoulder, knee, low back and neck. Most conventional sports medicine and pain management physicians have been trained to inject steroids, which often involves a single injection placed into the joint or around a nerve.

In contrast, an Osteopathic approach to Regenerative Medicine involves assessing the biomechanical forces that have caused the pain generator(s). As an Osteopath, assessing posture, gait, and structural alignment all play into what can cause something as simple as a tendon injury. Osteopathic Manipulative Medicine is a technique that utilizes knowledge of the biomechanics of the musculoskeletal system to realign vertebra, ribs, hips, shoulders as well as more subtle inter-osseus strains and craniosacral restrictions. Many times part of the reason why a muscle won’t fire or is overactive is that it is stuck short or long due to misalignment of a bone which needs to be brought back into its proper position through the correct utilization of manual medicine techniques.

As a Prolotherapist, assessing for ligamentous laxity of the affected joint and related joints is an important part of looking for joint instability that can cause arthritis and tendon injury. Ultrasonography also plays an important role because after assessing the biomechanics of muscle imbalance, postural alignment and ligamentous laxity, we can then assess those structures under ultrasound to get a more precise diagnosis of the location and degree of the injury.

The administration of regenerative agents, be it concentrated Dextrose, Platelet Rich Plasma, Amniotic Membrane Derived Growth Factor, Adipose or Bone Marrow derived Stem Cells, should be Ultrasound or Fluoroscopically guided to ensure the correct placement of the solution. Ultrasound also allows for monitoring the progress of healing during the weeks after the injection so the correct level of physical therapy and neuromuscular reconditioning can take place at the right stage of healing.

Knowledge of the proper functional exercises to train the body to work together as a whole is as important as any of the above steps. The rehabilitation process is often different after a regenerative injection than it would be after attempting to treat the injury with physical therapy from the outset or after surgery. Depending on the extent of the original injury, type of regenerative agent used, location of the injections and stage of healing, the physical therapy program will need to be modified and tailored to the patient. This is where a combination of Osteopathic and Regenerative Medicine principles are necessary to move back from the state of injury to health and wellness.

Lastly, and sometimes most importantly, systemic conditions like autoimmune disease, digestive imbalances, poor sleep, hormone and nutrient deficiencies, can significantly affect the body’s innate healing capacity. Addressing these underlying physiologic conditions requires an intimate knowledge of both Conventional Internal Medicine and Functional Medicine. Knowing the lab tests and pros and cons of conventional treatments allows for fully integrated care. Functional medicine is about looking deeper at the roots of our health so we can optimize the system in which disease arises. I often use the metaphor of tending to a garden. We can identify weeds and uproot them or spray them with a weed killer, which helps to manage symptoms, but looking at the soil and conditions in which those weeds are growing allows us to address the underlying cause and prevent the need for management of these symptoms.

Regenerative Medicine practiced in isolation from the larger milieu of Integrative and Osteopathic Medicine can work in simple cases and may be all that is required. The correct placement of a high quality regenerative agent into the pain generator may be all that is required for healing up the problem that brings a patient to the doctor. Even in these straight forward success cases, by not addressing the deeper roots, the problem may return in the future or show up elsewhere. In more complex cases, looking deeper is necessary and can make the difference between a successful outcome and a failure of Regenerative Medicine.

As the popularity of the field continues to grow and more physicians come on board, the need to further clarify the correct method of evaluation, treatment and rehabilitation will become more apparent. Even the current Regenerative Medicine speciality clinics are often dressed up pain management doctors applying principles that applied to the injection of steroids. Integrative Osteopathic Regenerative Medicine is about knowing how the body is put together and how to rebuild it. Applying these principles requires knowledge of biomechanics, manual medicine, musculoskeletal ultrasonography, orthopedic examination and functional rehabilitation as well as Integrative and Functional Medicine.

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