Tips On Eliminating Back Pain At Home

Tips On Eliminating Back Pain At Home

#1 Perform Mckenzie exercises. Lay flat on your stomach with your forearms flat on the floor at shoulder height. Rise up on to your elbows so that your spine is an extension. Then lift your chin and hold for 3 minutes.

#2 Use capsaicin cream. Capsaicin is the substance found in chili peppers that makes them spicy. It is a commonly known, natural pain reliever. It has been shown to affect substance P, a neurotransmitter involved in pain transmission. To use: apply topically, at least twice per day, for maximum relief.  Please note:  when applying, follow directions as it can cause eye damage and should use disposable gloves.

#3 Get some exercise. It seems counter-intuitive but the less you move the more pain you will experience. Low impact, moderate intensity exercise is the safest option. Listen to your body and avoid movements that trigger pain. Take 5-10 minutes to warm up prior to exercising. Walking will do. Always include static abdominal/ core exercises like a plank or glut bridge.

#4 Follow an Anti-Inflammatory Diet. Reducing inflammation throughout your body can have a profound effect on joint pain overall.  Following an anti-inflammatory diet is the easiest way to reduce system-wide inflammation. Examples of good diets include the Mediterranean Diet or a diet rich in fish, nuts, & fruit.

#5 Lose excess weight. As we gain weight, stress, and pressure on the lower spine and back muscles increases. Increased abdominal weight at the front of the body can cause an increased arch in the spine and may lead to increased stress on pain sensitive tissues. Losing weight reduces the tendency to arch the back and relieves pressure on the lower spine.

If your back pain is persistent or excruciating, you should see your personal physician urgently. In fact, for any chronic back pain, injury or ongoing issues, it is important to speak with your physician.

If you are near Indianapolis, Indiana, you would benefit from seeing Dr. Robert Silbert, of PM&R Associates.

Contact him for a consultation at  (317) 794-2759

What are the Different Types of Stem Cells?

What are the Different Types of Stem Cells?

The foundation of the body’s natural growth and development relies on stem cells. Stem cells contain the ability to renew and produce new cells that can replenish damaged tissues.  Stem cells are delivering excitement in medical research.

The human body contains 300 trillion cells that are entirely specialized for specific functions such as the brain, heart, muscle tissue, bone and fat. Each cell type has a precise function and lifespan that is dependent on the desired activity of each cell.

For instance, blood cells live for a few months and are replaced every day. However, brain cells may last for a lifetime. Stem cells originate from the embryo, placenta, fetus, and other human body tissues.

Studies about stem cells remain controversial. Some studies show that these cells can generate the cell types of their resident tissue whereas some stem cells can generate other tissue types.

Embryonic Stem Cells (ESCs)

Embryonic stem cells are obtained from the embryo after in vitro fertilization, not from fertilized eggs in a woman’s body. ESCs are considered as pluripotent stem cells, meaning they can become any type of cell in the human body and they are found during the early stages of development.

With this understanding, stem cells have the potential to develop other cells like skin, nerve and intestine for transplantation purposes.

Induced Pluripotent Stem Cells (IPSCs)

IPSCs are stem cells that are genetically recoded to an embryonic cell-like state by expressing genes that maintain the properties of embryonic stem cells. Further research is needed about induced pluripotent stem cells, but they can be useful for developing drugs, modeling diseases and medicine transplantation.

Researchers find these cells as a breakthrough discovery to help reprogram cells and repair tissue damage.

Mesenchymal Stem Cells (MSCs)

Mesenchymal stem cells are also known as stromal cell types since they are derived from connective tissues (stroma) surrounding other organs and tissues. MSCs are multipotent cells that can differentiate into bone cells, cartilage cells, muscle cells and fat cells.

These cells may also be useful for transplantation and tissue repair. Immunorejection is not a problem since the donor and host remains the same.

Adult Stem Cells (ASCs)

Adult stem cells, also known as ‘somatic stem cells’ are more specialized than others. These cells are identified in organs and tissues including the brain, bone marrow, blood vessels, skeletal muscles, skin, teeth, etc.

Based on research, they can self-renew indefinitely and they can generate cell types from which they stemmed from. For many years, ASCs have been used to treat leukemia and other bone or blood disorders.


At PM&R Associations we do a number of regenerative medicine therapies, including stem cell therapy when it is a fit. To find out if you are a candidate for stem cell therapy, or to find out more information contact us today. We are located in Indiana, and Dr. Silbert is a leading expert in the field.

At PM&R, we use only adult MSC cells.

Contact our office at (317) 794-2759.

Treatments for Knee Osteoarthritis – What Does The Latest Research Say?

Treatments for Knee Osteoarthritis – What Does The Latest Research Say?

For years we have known the use of steroid (cortisone) injections inside a joint (intra-articular) is bad for the joint.  Now we have the proof.

A recent clinical study published in the Journal of The American Medical Association answered the question: Is the use of steroid medications inside a joint good or bad for the joint?

The objective of the study was to determine the effects of intra-articular injection of a synthetic cortisone preparation every 3 month on progression of cartilage loss and knee pain. Read on to learn about what was learned…

What Happened In the Study?

The study had 140 patients divided into two groups of 70 each.  In one group, a steroid medication (40 mg of triamcinolone acetonide) was injected into a knee every three months, and in the other group, saline (biologic salt water which has no effect on the body) was injected every three months.  An MRI was done on each patient at the end of two years to assess the results.

The results of the study showed the group that had steroid medication injected had significantly greater cartilage volume loss and no significant difference in knee pain, when compared to the group with intra-articular saline injections. These findings do not support the use of steroid injections for knee pain.

What is Synovitis?

Synovitis in inflammation of the synovial membrane which lines all joints.  This inflammation can be destructive to both cartilage and bone. Synovitis is common and is associated with progression of structural characteristics of knee osteoarthritis. Intra-articular corticosteroids could reduce cartilage damage associated with synovitis, but has adverse effects on cartilage and particularly bone.

The use of intra-articular triamcinolone compared with intra-articular saline resulted in greater cartilage volume loss without significant difference on knee pain severity between treatment groups over the two-year study period.

What is the Alternative to Steroid Injections?

The alternative to the use of steroid (cortisone) injections is to use something else that is effective in relief of joint pain and at the same time to stimulate the joint to regenerate or heal.  At PM&R Associates, we have several alternative “medications” that we can inject.  The one we usually use first is dextrose diluted to the correct concentration.  This is the weakest regenerative medication we can use, but it usually works if the arthritis is not too severe.  Typically, repeat injections are required, but we do not charge extra for dextrose.  Stronger is Platelet Rich Plasma (PRP).  Platelets are in the patient’s blood.  Blood is obtained, the platelets are separated and then injected into the joint.  PRP injections typically work better and last much longer than dextrose and there is an out of pocket charge.

If necessary, commercially available growth factors can be added to the PRP.  The strongest and longest lasting treatment is stem cells.  These can be obtained from adipose tissue (fat) or bone marrow.  Commercially available growth factors can be added to the stem cells to help ensure a good result.

These findings and recommendations would apply to any joint.

More information is available at our website  Visit the website and set-up a consultation, here at PM&R Associates, we will be happy to discuss your condition and the treatments you have available to you.

  • The article quoted above is: Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain
    in Patients With Knee Osteoarthritis  A Randomized Clinical Trial
    JAMA May 16, 2017 Volume 317, Number 19, 1967-1975.
  • To read the study, go to gov, Identifier:NCT01230424
The Difference Between a Sprain and Strain

The Difference Between a Sprain and Strain

Individuals with active lifestyles are commonly prone to injured muscles, tendons and ligaments. The soft tissues are more likely injured during exercises, sports and athletic activities. However, even simple daily activities may cause a musculoskeletal injury.

In finding out whether the amount of pain you have is a sprain (tear) or a strain, it is better to consult a doctor for proper assessment. These types of injuries may take a longer amount of healing time, even after the provision of appropriate treatment.

What is a Sprain?

A sprain is a stretch or tear of a ligament, which is a connective tissue that stabilizes the bones. The severity of a sprain may be categorized by the extent of tissue tearing, pain, swelling, and the force on joint stability.

Body areas that are most susceptible for sprains are the knees, ankles, and wrists. With extreme tension on the ligaments of the ankles, the foot can turn inward and a sprain can occur.

Symptoms of a Sprain:

  • Tenderness and bruising
  • Joint or muscle pain
  • Inflammation
  • Swelling

What is a Strain?

A strain is a damage to muscle fibers and tendons. Tendons are fibrous tissues that attach muscles to the bones. A strain is also known as a ‘torn muscle’ or ‘ruptured tendon’.

With similarity to sprains, a strain can be a stretch in a muscle or tendon. It can also be a partial to complete tear in both the muscle and tendon fused together.

The type of sports that may jeopardize athletes to suffer from strains are basketball, volleyball, football, soccer, boxing, hockey, long jump and running. Tennis players and gymnasts are prone to hand strains due to several gripping required in these sports. Elbow strains regularly occur in sports that demand throwing, such as racket.

Symptoms of a Strain:

  • Pain
  • Muscle spasm
  • Swelling
  • Inflammation
  • Muscle weakness
  • Cramping

At PM&R, we treat various types of injuries and see sprains and/or strains in various parts of the body. Our experts can assess your exact issue and the best course of action to recover and heal properly.

Call us today at 317-565-2848.

What to Expect During Radio-Frequency Neurotomy Treatment

What to Expect During Radio-Frequency Neurotomy Treatment

A radio-frequency neurotomy is a musculoskeletal medicine procedure that is done to cauterize or burn the small, short nerves that carry pain from the spinal facet joints to the spine, interrupting the pain pathway. Its purpose is to stop pain from the spinal joints (facets) for six months to one year.

What Happens?

X-ray equipment (fluoroscopy) is always used. The patient lies down and the to-be injected area is numbed with a local anesthetic (Novocain) and then two needles are directed to the target area. Electrodes are inserted into the needles and motor stimulation is done to ensure that the spinal nerve is not being stimulated. Radio waves are sent through the electrodes to create the heat in the needles.

Are There Side Effects?

You may experience a sensation similar to a sunburn following the procedure. This is normal and temporary. If severe, additional medications to treat this side effect are available. However, complications for this procedure are low.

How Will I Feel?

Although this is thought to be painful or uncomfortable, the painful part mainly resides in the positioning of the needles. Since the area is numbed, the actual burning itself is not painful. Post-procedure pain medication is usually provided to limit any discomfort.

Most people report feeling relief as soon as the post-procedure medication begins to wear off. So, the results of the procedure are quick.

This procedure doesn’t restrict you from your activities and daily life. However, if you choose to do sedation, we recommend not driving or operating machinery until 24 hours.


If you are interested in learning more of want to know if you are a candidate, we would love to see you for a consultation.

Contact PM&R at 315-565-2848.