Dr. Leonard Kaplan and fellow doctors at Buffalo Spine and Sports Medicine use ultrasound and Botox in a variety of ways, including to relieve joint pain and muscle damage from stroke. (Harry Scull Jr./Buffalo News)
By Scott Scanlon – Refresh Editor
If it’s been a few years – or decades – since you’ve seen a physical therapist or sports medicine doctor, you might be surprised to get a feel for new techniques and equipment designed to keep people active, even after a substantial health setback, including a stroke.
Three weeks ago, when I wrote a cover story on getting prepared for the outdoor running season, Drs. Jason Matuszak and Todd Lorenc, of Excelsior Sports Medicine in Amherst, told me the meniscus I blew out on the inside of my left knee a few years back shouldn’t prevent me from running (It hasn’t, though I do most of my cardio work on a spinning bike and save the running for a few races each year, including the Corporate Challenge and Turkey Trot).
The latest optimistic news came during an interview I had recently with Dr. Leonard Kaplan, of Buffalo Spine and Sports Medicine, for today’s “In the Field” feature in WNY Refresh.
Kaplan, an osteopathic doctor with the practice that has offices in Batavia, Lockport, Orchard Park and Williamsville, and others in the practice look to help patients return to a full range of motion without pain medication, if possible.
They do so with the help of physical therapists, chiropractors, a yoga instructor and a mental health and wellness counselor. They also use Botox and ultrasound technology.
Combined, the possibilities allow folks to chase after treatment in a variety of ways before having to make the painful choice of controlled substance prescription medication, and the uncertainty that can come with it.
Here are excerpts of my interview with Kaplan when it comes to some of those treatment options:
You treat refractory painful conditions such as chronic daily headaches, cervical dystonia and neurological spasticity with Botulinum Toxin Injections. Why? How does the process work?
It’s a protein that was extracted from a botulinum toxin, which used to cause botulism. It’s purified in the lab, so it’s really a lab-made product, it’s not a natural product. This is why there’s a little misconception, even in some of the primary care offices where some people think we’re injecting the person with a toxin that causes people get to get sick. It’s a protein designed to do its job, which is to block some of the excess transmission of nerve signal to muscle ... which causes the muscle to contract and relax...
In a headache, I don’t know if it’s as well understood but the concept is similar. It’s blocking the release of pain producing chemicals from the nerves and it allows reductions in headaches. ... People would get Botox for wrinkles and they’d find that when they used it, their headaches would go away.
Do these shots last for a particular period?
They last three months. They get better with each application. For a lot of people, they do so well, it’s really just a 10- or 15-minute investment. Dystonia, spacity, migraine headaches, those are all covered by insurance.
Upper limb is the other one that’s very important, people who have strokes. Once they get released from nursing homes, they often end up in primary care offices and people don’t realize that the patient has ended up with a spasm of an arm, and recognize that there’s something that can be done for it.
We’re trying to spread the word that you can use this Botox and relax the muscles and it helps bathing and dressing, and reduces pain in the arm.
These really are mainstream treatments, but they’re off the radar. It’s not something doctors get trained on in residency.
How are you using ultrasound?
The ultrasound allows us to view the body in motion. This is why it’s so revolutionary. Up to this point, everything we ever had to view the body in motion was always a still picture. If you get an X-ray, you’re standing or laying down. If you get an MRI, you’re laying down. A lot of times the injured body parts don’t start bothering somone until they’re moving. The ultrasound gives you the incredible ability to see a knee or an elbow or a hip while it’s moving. See what the tendon is doing, what the muscle is doing, so something won’t get missed. It’s also an incredible tool for guiding procedures. If we’re going to put a cortisol steroid into an area to help decrease inflammation, we want to make sure it’s going into the right location, a safe location. It’s done live, so under ultrasound we can guide this medicine into an area, and be absolutely sure it’s getting where it’s supposed to go.
How long have you been doing this?
About six years. It’s become more common but there’s still just a few practices that use it. It takes a lot of work to learn.
Talk about your new tendon treatment procedure, TENEX Health TX.
That’s an exciting renovation driven by the ultrasound technology in two ways. It can only be done if you visualize a tendon with ultrasound, so you use an ultrasound to guide this procedure. This is a needle that was invented that uses ultrasound pulse waves that breaks down unhealthy tissue. Chronic tendon problems are an epidemic in this country. Because of obesity and deconditioning, people ultimately fall into problems with their tendons because their tendons cannot frequently withstand the weight. The weaker the muscles become, the more weight is transferred to the tendon, where the tendon inserts in bone, whether it’s your hip, your knee, your ankle. These tendons become thick. They scar. They lose their elasticity. They become very painful. And it’s a chronic condition. They can be hard to treat. They don’t (always) respond well to physical therapy, so what the equipment allows us to do ... we can see the tendon, we can see where it’s unhealthy, and we take the needle – it’s power operated – we have a pedal, a vibrating tip, and the vibration releases ultrasound waves and the vibration literally, as it goes through the tendon, breaks up unhealthy tissue, rinses it and takes it out. It’s incredible. ... It gets sucked into a bag, so sometimes we’ll show people what got sucked out. To get anything like that done in the past, you would need an open surgery.
We started doing this in December and had some really, really good results. It only takes two or three minutes. We always tell people if they have a lot of issues, they may need another one, but it’s meant to definitive. We’ll follow up with therapy and try to strengthen the area, as well.
Would the pain go away fairly quickly after one of these procedures?
More often than not, the pain will go away very quickly. I’ve have some patients come in on the third day after the procedure and feel better already.
After a treatment like this, what would happen?
There’s a reason why that elbow got in trouble. There’s a reason why that shoulder got in trouble. ... We go beyond treating the problem. We go to ‘Why did that happen?’ Did you have some trouble with your posture? Did you have some weakness in your muscles somewhere else, so you compensated for it? We look at the entire body, because if you fix that body part, but don’t figure out why it got in trouble, guess what? In another year or two, you’re going to get in trouble again.
What are some of the best forms of exercise to prevent back, neck and other nerve and joint injuries?
Functional exercises place the body into positions a person finds themselves in throughout the day – they’re standing, they’re sitting at work, they’re walking. Non-functional exercise places people in a position where they don’t often find themselves, like laying on their back – unless they’re sleeping or doing other things we’re not going to talk about today. Unless you’re a wrestler who needs power to push somebody off yourself to prevent from getting pinned, most exercises you should do should not be on your back. If you’re a gardener, you want to do exercises that look like gardening. Whatever the body part, whether it’s spine or limb, the exercise needs to look, feel and smell like the activity you want to go back to and have a problem doing, because you’re doing it to go back to that activity. This is what I call functional.
People ask me about pool therapy all the time. I love the pool, but you’re about 50 percent lighter in the pool. How do you feel when you go up the stairs in the pool? In the pool, you’re training your legs to carry 50 percent, but when you go up the stairs, you’re asking the legs to carry 100 percent of you. So where’s the training?
Can you throw some pool therapy into the mix? Sure, but you’ve got to do some land therapy to get the benefit of strength against the full weight of gravity.
What about some of the best foods?
We cover that. We try to partner with nutritionists, but we talk about the inflammatory load. We’re students like other folks are, and we’re starting to understand more about, let’s say, the role of gluten and how it can be very pro-inflammatory. Today, I think I advised three people to cut out gluten. My daughter is gluten insensitive, so we’ve learned a few things about it. Red meats are pro-inflammatory, so we talk about cutting out red meats. Lamb, actually, and chicken are good. Obviously fish. Fruits, nuts, salad.
And, of course, supplements. When the person comes to us, there have been some very specific recommendations for osteoarthritis. We’ve taken those recommendations and put ‘em in our handouts. At the end of that handout, there is a list of doses that have been shown to be effective: fish oil, primrose oil, glucosamine chondroitin – it’s a little controversial but it’s still advocated for arthritic joints. Those are the big ones. Krill oil. The omega-3s used to be believed to be antioxidants, so the role was believed to be anti-aging, anti-cancer. But now, it’s understood that they’re very much anti-inflammatory.