What is Spinal Stenosis?

What is Spinal Stenosis?

Spinal stenosis is a bone condition that affects vertebrae running from the top of the neck to the base of the spine. In most cases, spinal stenosis is a secondary condition caused by osteoarthritis. Many people will go through life with stenosis and not have a single symptom, whereas others will experience a sliding scale of intensity in symptoms.

The centers of the vertebrae are hollow, allowing the branches of the nervous system to connect to the brain to the rest of the body. The wear and tear that comes with aging can cause spaces within the vertebrae to narrow. When this happens, ligaments and other vertebral tissue can press against the nerves. The two most common areas of the spine that are affected by spinal stenosis are the neck and lower back.

Causes of Stenosis of the Spine 

Spinal stenosis is most commonly associated with osteoarthritis, but other medical conditions, injuries, and diseases can cause it, too. These can include:

  • Herniated spinal discs
  • Bone spurs forming on the spine
  • Being born with a smaller than average spinal canal
  • Overgrowth of Bone
  • Thickened spinal
  • Tumors
  • Injury to the Spine
  • Swelling of nearby tissues after back surgery

Cervical Spinal Stenosis vs. Lumbar Spinal Stenosis 

There are two primary kinds of spinal stenosis: cervical and lumbar. Cervical stenosis is the narrowing of the spinal canal in the neck. Lumbar stenosis involves the narrowing of the spinal canal in the lower back, usually happens when bone or tissue growth in the openings of the spinal bones. This growth can squeeze and irritate the nerves that branch out from the spinal cord.

Symptoms of Cervical Spinal Stenos 

  • Numbness or tingling (usually in one hand, arm, foot or leg)
  • Muscle weakness
  • Difficulty in walking and balancing
  • Neck Pain
  • Bowel or Bladder Problems

Symptoms of Lumbar Spinal Stenosis 

  • Numbness or tingling (usually in one foot or leg)
  • Weakness
  • Leg pain and/or cramping when standing for long durations or when walking
  • Lower Back Pain

Spinal stenosis usually doesn’t develop until later in age, however, some degenerative diseases and conditions that affect younger people can cause spinal stenosis. Certain conditions can also cause spinal stenosis in those under 50 including physical trauma, congenital spine deformity, or genetic disease that affect bone and muscle development.

To learn more about spinal stenosis or treatment options available to you, contact us at (317)794-2759 to book a consultation with Dr. Robert Silbert.

K-Lasers – What They Have Been Used To Successfully Treat

K-Lasers – What They Have Been Used To Successfully Treat

K-laser therapy has been around for some time now. In Europe, doctors started using laser therapy for treatment as early as the 1970s. However, the adoption of this medical technology has been slow, and plenty of research had to be done. Today, K-Laser therapy is one of the leading medical technologies that is used in the treatment of various ailments.

Here in Indianapolis, we have the latest in K-Laser therapy, so you need not go too far to seek this technology.

How Does K-Laser Therapy Work?

A high energy laser beam is directed to specific soft tissue cells. The photonic energy increases the amount of ATP (Adenosine triphosphate) production, which is responsible for the cell energy production. The production of ATP enhances the general metabolism of specific cells, and hence a faster recovery process for damaged tissues.

The K-laser mode has a unique pulse that delivers the photonic energy to deeper tissues without providing a warming effect, as opposed to other laser procedures.

What Can K-Lasers Be Used For?

The K-laser therapy is a process that helps in the recovery of wounded cells. It has many medical uses which mainly include internal injuries.

K-Lasers have been used in the treatment of:

  • Sports Injuries
  • Neck Pain
  • Knee Pain
  • Elbow Pain
  • Muscle Strain
  • Diabetic neuropathy
  • Carpal tunnel syndrome
  • Joint pain
  • Injuries to ligaments and tendons of hands and feet
  • Arthritis of the neck joints
  • Plantar fasciitis
  • Various pain conditions and/or injuries to tissues


What Are The Benefits?

  • Painless
  • No physical operation/or surgery needed
  • The method creates an environment for quick recovery of cells by drawing water, oxygen, and nutrients to the damaged cells.
  • Short treatment time; the entire process lasts between 3 and 9 minutes depending on the extent of the injury.
  • The healing process is much faster than most other types of treatment.
  • It improves circulation of blood in the body and reduces inflammation of cells.
  • The effects of the treatment can be felt immediately after the therapy.

Are There Side Effects?

There are no major reported side effects from the use of K-Laser technology. In some cases, old injuries may feel aggravated, but the healing process is much faster.

If you are interested in learning more about K-Lasers and managing chronic pain from injuries or tears you need to come in and see us as soon as possible. Dr. Silbert, sees patients with various conditions at his clinic in Indianapolis.

To see if this is a good option for you, or if another treatment is better suited, contact PM&R Associates to set-up a free consultation. Have Dr. Silbert provide his expertise on the best course of action on your specific injury.


Pros and Cons of Joint Injections

Pros and Cons of Joint Injections

Here at PM&R Associates, we combine new and traditional medicines.  We offer a variety of different injections for the treatment of joint pain. All joint injections are done with either X-ray or ultrasound guidance. We prefer ultrasound because it is safer for the patient, since there is none of the ionizing radiation associated with X-ray. We also use a specially formulated “no sting” local anesthetic to numb the skin before all injections. Below you will find different joint injection treatments and the pros and cons of each.


Pros: Steroid injections will reduce inflammation, if inflammation is present, and will reduce pain, swelling, and fluid in the joint.

Cons: Steroid injections have a limited use with osteoarthritis (OA) or degenerative joint disease as those are typically not associated with inflammation. It is a pharmaceutical treatment, which means it has a peak action and the effect tapers. Both local and systemic side effects increase with the dose injected and frequency of injections. Side effects of steroid injections may include weakening of the joint, increased blood pressure, elevation of blood sugar, and decreased ability to fight infection. Patients are usually limited to no more than 3 injections per year for any particular joint.


Pros: Non-steroid injections work best in degenerative joint disease or osteoarthritis (OA).It is a biologic treatment, which means it gets better with time and lasts longer than pharmaceutical treatments. Since no cortisone is used, this can be repeated as often as needed and is typically covered by insurance.

Cons: Non-steroid injections do not work for everyone. May be safely repeated more often than every three months.


Pros: This injection s made of hyaluronic acid from rooster combs, which works like an artificial joint fluid given by injection. It is expensive, but it is usually covered for some joints by most insurances.

Cons: Usually requires multiple injections with limits on how many times it can be repeated. Not all joints are covered by all insurances and it required prior authorization. Given its cost, it’s worth noting that it may be no more effective than cortisone injections. Some experts feel risks are not worth the benefits and can have allergic reactions.


Pros: PRP injection is a biologic treatment, which means the patient gets better with time and the effect lasts longer than pharmaceutical treatments. Taken from the patient’s own blood and given back the same day, PRP injections are now regularly performed across the country and can last 6 months to a year or longer. Sometimes it lasts longer, but not everyone gets better.

Cons: PRP injections are not covered by insurance, so there is a surcharge above what insurance pays. It may only prevent additional deterioration and even in those studies with symptomatic improvement, there were no MRI changes.


Pros: Stem cell therapy delivers decreased pain scores 75-78% at 6 months. It is able to treat avascular necrosis, which is a condition in which the bone of the joint actually dies. MRI will detect an increase in both cartilage and menisci. Stem cell therapy is not as painful as other options. It typically shows an increase in lifestyle scores by 75% at 6 months. This injection is dissolved in PRP, so the patient gets the benefits of both at one price.

Cons: Stem cell therapy is often expensive and is not yet covered by insurance.

To learn more about our injection treatment options, give us a call today.


Common Causes of Shoulder Injuries

Common Causes of Shoulder Injuries

The shoulder is a highly mobile joint composed of tendons, ligaments, cartilage, and bones, all of which are prone to injury with activity and sports. People experiencing shoulder pain may be suffering from a variety of conditions such as bursitis, tendinitis, osteoarthritis, or degenerative arthritis. Shoulder pain can also be caused by sports injuries or other accidents, and those over the age of 50 are especially susceptible to developing rotator cuff tendon tears.

Symptoms of shoulder pain can range from mild to severe and may disturb physical activity and sleep. Pain, weakness, and a loss of range of motion are all symptoms of a shoulder injury. Those who participate in high-risk sports, those whose jobs involve physical labor or older adults are all at a higher risk for a painful shoulder injury. For more details, check out the below list of common causes of shoulder injuries.

Sports Injuries

Sports that involve repetitive overhead motion can be detrimental to your shoulders. The tendons that connect muscles to bones can partially or completely overstretch. Overhead arm movements can cause tendons to rub or scrape against part of the shoulder blade. Examples of sports with repetitive overhead motion include swimming, tennis, pitching and weightlifting.

Work Injuries

Similar to the above-mentioned sports injuries, repetitive lifting at work can also be a cause of shoulder injuries. Those who work in manual labor are susceptible to shoulder injuries. This includes painters and carpenters.


Suffering from a fall, car accident, or another sudden injury can result in a rotator cuff strain or tear. Typically, these injuries cause intense and immediate pain. Rotator cuff tears often occur with other shoulder injuries, such as a broken collarbone or a dislocated shoulder.

Everyday Activities

It’s important to consider your shoulder health, not only when at work or while paying sports, but also during your everyday activities. Overuse injuries can occur when too much stress is placed on a joint or other tissue, typically by overdoing an activity or through repetition of an activity. Hanging curtains, gardening and washing walls can also be causes of shoulder injuries. Performing these activities with poor posture or with insufficient joint mobility and strength may predispose you to shoulder pain.

If you are experiencing shoulder pain that won’t go away, give us a call at PM&R Associates.

How Can Stem Cell Therapy Help Degenerative Disc Disease?

How Can Stem Cell Therapy Help Degenerative Disc Disease?

Degenerative disc disease is a degenerative process affecting the intervertebral discs. Pain is experienced due to loss of cushioning, fragmentation and herniation related to aging. There are more than 3 million cases of regenerative disc disease in the US every year. At PM&R Associates, we offer stem cell injection treatments for disc pain.

What is a stem cell injection?

The injection of stem cells is a biologic treatment, which means the patient gets better with time and the effect lasts longer than pharmaceutical treatments. Stem cells are suspended in platelet-rich plasma (PRP), so the patient gets the benefits of both at one price: The patient gets stem cells, platelets, fibrin, and growth factors.

For disc pain, stem cells are first obtained, usually from fat, and then injected into one or more degenerated spinal discs. The injection is always done with x-ray guidance. This is a procedure to reduce pain and increase function in a patient with a degenerated painful spinal disc.

Am I a candidate?

Anyone with a painful spinal disc is a candidate for stem cell therapy. Usually, it is done in patients that have not gotten relief from less invasive procedures such as epidural steroid injections (ESI) or selective nerve injections or blocks, TENS units, physical therapy, facet joint injections and similar treatments. The only surgical procedure that treats the degenerated discs is a surgical fusion and it may be no more successful.

What should you expect from the treatment process?

In order to obtain the stem cells, fat must be taken from your abdomen by a needle and syringe aspiration. Fluid with numbing medication is injected before the fat is removed with a syringe. The fat is dissolved and the stem cells are obtained and then mixed with platelet rich plasma, which is obtained from you blood. After the stem cells have been processed and mixed, they are injected into the degenerated discs.

Discomfort at the site where the fat was obtained is mild and goes away in a few days. There is usually significant pain and pressure in the back or neck after the procedure, which goes away on its own after a few days, but in some individuals, the discomfort can last longer.

After the procedure, you will be asked not to take a bath or use a hot tub until all the injection sites have healed. You may take a shower the day of the procedure. We ask you not to increase your activity too quickly as you get better to avoid any setbacks.

Patients are seen back in the office two months after the procedure, and by then patients usually have started to get better. Patients can continue to see results for many months afterward.

What are the risks and side effects?

Infection is one of the more serious side effects. If an infection of the disc occurs, you will usually be very sick and require antibiotics. Hospitalization and I.V. antibiotics may be necessary. You will be given I.V. antibiotics before the procedure and the procedure is done under a full surgical scrub and drape to minimize the risk of infection.

The most serious side effects from intravenous sedation is sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose. These risks can be avoided by not getting sedation.

You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.

Are you suffering from degenerative disc disease? Stem cell injections may be a treatment option for you. Call PM&R Associates for more information today!