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  1. #26
    Join Date
    Jan 2004
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    3,845
    Quote Originally Posted by drmark View Post
    To get the plantar fascia, or a tendon, to heal requires cells that have potential to morph into tendon or fascial cells which are tenocytes or fibrocytes respectively.

    The cells are the same stem cells that everyone has been talking about for years.
    And we have them in our blood stream. They just arent in a high enough concentration in any spot.

    The process of creating PRP, concentrates these cells from our blood. Usually about 20 ccs of blood is necessary.

    This is what is injected into the painful area.

    By contrast cortisone is a corrosive to these same tissues we are trying to get to heal.

    Any doc who injects cortisone into the plantar fascia in this day and age, needs some CME fast.
    Dr Mark is so on with this. Cortizone is a no go. It kills the tissues.

    I had Quad tendinitis for 6 months. Got an MRI and Tried everything, rehab, yoga, ect. Did two PRP shots a month apart and the injury is 95% better. was thinking of getting one more prior to ski season.

    Good luck.

  2. #27
    Join Date
    Jan 2009
    Location
    Squaw valley
    Posts
    2,567
    Yeah, don't even think of cortisone. Weakens tendons, and there is a life time limit of 3 injections in a given spot.

    Sent from my Moto G (5) Plus using TGR Forums mobile app

  3. #28
    Join Date
    Nov 2007
    Location
    Eburg
    Posts
    12,900
    A few years ago dry needling/cortisone shot 100% cured my chronic PF-itis. IME it was a miracle cure, stopped nearly a year of suffering. I know a half dozen other people (all ultrarunners) who were cured by the same treatment, same doc.

    But, yeah, best to ignore the experts and rely on advice from TGR mags with no training.

  4. #29
    Join Date
    Mar 2006
    Posts
    14,821
    Don't get up in the morning on bare feet and never go barefoot. Get a good shoe insert like Superfeet. Worked for me. You have to 100% quit anything that aggravates it too.

  5. #30
    Join Date
    Dec 2016
    Posts
    1,131
    Iím going through whatís probably a mild bout compared to others. Was prescribed diclofenac sodium and feel improvement. Was tripping it would impact ski season but after taking better care of the foot looks like itís coming around.

  6. #31
    Join Date
    Nov 2016
    Location
    SEA>DEN>Spokanistan
    Posts
    1,081
    Quote Originally Posted by CascadeLuke View Post
    I’m going through what’s probably a mild bout compared to others. Was prescribed diclofenac sodium and feel improvement. Was tripping it would impact ski season but after taking better care of the foot looks like it’s coming around.
    Glad that is helping out! Check out this site, it offers good information about the pathophysiology and treatment of it.

  7. #32
    Join Date
    Dec 2016
    Posts
    1,131
    Quote Originally Posted by SkiLyft View Post
    Glad that is helping out! Check out this site, it offers good information about the pathophysiology and treatment of it.
    Thanks! Iíll check it out

  8. #33
    Join Date
    Sep 2009
    Location
    not close enough
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    2,499
    Quote Originally Posted by GeezerSteve View Post
    A few years ago dry needling/cortisone shot 100% cured my chronic PF-itis. IME it was a miracle cure, stopped nearly a year of suffering. I know a half dozen other people (all ultrarunners) who were cured by the same treatment, same doc.

    But, yeah, best to ignore the experts and rely on advice from TGR mags with no training.
    There's mixed advice coming from the "experts". It remains "controversial".

    PRP to us/them, isn't yet proven by medical standards. Now, you and I can agree whole heartedly that PRP makes absolutely completely logical medical/physiological sense, but then refute it on a 'lack of evidence basis,' when the "evidence" is often leveraged by insurance reimbursement rates.

    Cortisone is not a healing remedy. It is a pain relief aid. I explain it, as the ortho who taught me, as packing a thousand NSAIDS (Ibuprofins) into a joint and letting that kill any inflammation. It really doesn't induce healing, and inhibits many of the molecular reactions that lead to tissue regeneration. That is exactly what it does. Inhibits the cellular/molecular response to injury. It is well known among the medical community that it isn't a fix, but the procedure makes patients temporarily and in some cases, permanently, happy. Insurance typically pays pretty well for this quick little go.

    On the other hand, PRP is a healing agent. It contains about 7 major growth factors which are derived from bone marrow stem cells. Now, if we want to get technical and really advanced with shit, we'd talk about stem cell therapy with bone marrow injections. But for those you have to tap your own pelvis to extract bone marrow and who really wants to go through all that. Centrifuged bone marrow to exact; the cell rich fluid is extracted and injected into joints. A similar but less invasive procedure is done with meniscus repairs. It was found over analysis of healing rates of meniscus repairs with ACL replacements vs isolated meniscus repairs, that those with the concomitant acl tear + repair showed higher rates of healing vs the isolated ones. It was extrapolated (not medically proven) that the difference was attributable to the leakage of bone marrow from the drilling of the ACL anchors leeching into the joint space and providing stem cells for the regeneration of otherwise metabolically slow/inactive tissue (meniscus). Now a meniscus repair with microfracture (tapping the femur to leak bone marrow into the joint space) is the standard of care for isolated meniscus tears.

    As a medical student up to date on all of this new shit, I'll take PRP prophylactically for wear joints before I'd take a steroid shot, anywhere. Steroid shot as last resort, yeah, give it to me. But not before prolo. Literal sugar water.

    Steroids however, are very useful in cases like acute respiratory distress syndrome, giant cell arteritis, sepsis and lupus. If you have those steroids are good. real good.

  9. #34
    Join Date
    Sep 2010
    Location
    Den/Baltimore
    Posts
    5,129
    ^^Great post.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

    photos

  10. #35
    Join Date
    Jan 2008
    Location
    Big Sky/Moonlight Basin
    Posts
    9,571
    Just got this shit 2 weeks ago. Hurts like hell ! Any advice ?



    Quote Originally Posted by 4matic View Post
    You have to 100% quit anything that aggravates it too.
    Great ! Now I can quit my job !


    Sent from my iPhone using TGR Forums
    "Zee damn fat skis are ruining zee piste !" -Oscar Schevlin

    "Hike up your skirt and grow a dick you fucking crybaby" -what Bunion said to Harry at the top of The Headwaters

  11. #36
    Join Date
    Jan 2008
    Location
    truckee
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    10,816
    Quote Originally Posted by QuikR12 View Post
    There's mixed advice coming from the "experts". It remains "controversial".

    PRP to us/them, isn't yet proven by medical standards. Now, you and I can agree whole heartedly that PRP makes absolutely completely logical medical/physiological sense, but then refute it on a 'lack of evidence basis,' when the "evidence" is often leveraged by insurance reimbursement rates.

    Cortisone is not a healing remedy. It is a pain relief aid. I explain it, as the ortho who taught me, as packing a thousand NSAIDS (Ibuprofins) into a joint and letting that kill any inflammation. It really doesn't induce healing, and inhibits many of the molecular reactions that lead to tissue regeneration. That is exactly what it does. Inhibits the cellular/molecular response to injury. It is well known among the medical community that it isn't a fix, but the procedure makes patients temporarily and in some cases, permanently, happy. Insurance typically pays pretty well for this quick little go.

    On the other hand, PRP is a healing agent. It contains about 7 major growth factors which are derived from bone marrow stem cells. Now, if we want to get technical and really advanced with shit, we'd talk about stem cell therapy with bone marrow injections. But for those you have to tap your own pelvis to extract bone marrow and who really wants to go through all that. Centrifuged bone marrow to exact; the cell rich fluid is extracted and injected into joints. A similar but less invasive procedure is done with meniscus repairs. It was found over analysis of healing rates of meniscus repairs with ACL replacements vs isolated meniscus repairs, that those with the concomitant acl tear + repair showed higher rates of healing vs the isolated ones. It was extrapolated (not medically proven) that the difference was attributable to the leakage of bone marrow from the drilling of the ACL anchors leeching into the joint space and providing stem cells for the regeneration of otherwise metabolically slow/inactive tissue (meniscus). Now a meniscus repair with microfracture (tapping the femur to leak bone marrow into the joint space) is the standard of care for isolated meniscus tears.

    As a medical student up to date on all of this new shit, I'll take PRP prophylactically for wear joints before I'd take a steroid shot, anywhere. Steroid shot as last resort, yeah, give it to me. But not before prolo. Literal sugar water.

    Steroids however, are very useful in cases like acute respiratory distress syndrome, giant cell arteritis, sepsis and lupus. If you have those steroids are good. real good.
    I won't comment on PRP specifically because I haven't done the reading. However, as a medical student you will learn, hopefully sooner rather than later, that lots of treatments that make "absolutely, completely, logical medical/physiological sense" turn out not to work.
    As far as the insurance companies go --there are few if any nonsurgical treatments more expensive than surgery. If PRP saves people from surgery the insurance companies will be all for it.

    I agree that healing is always best, just keep in mind that sometimes relieving symptoms is the best we can do and is the main thing people expect of us.
    Last edited by old goat; 09-03-2019 at 12:14 PM.

  12. #37
    Join Date
    Mar 2008
    Location
    northern BC
    Posts
    17,987
    I doubt strongly if any kind of shot/quick fix is gona help you, cortisone sounds like it might cause more problems than it fixes

    I seem to remember having to give up running for a year and then going to a motion control shoe ( probably sacrilege ) which helped me to become a forefoot striker and I have not had any problems since

    It did not hurt to skate ski, alpine ski, and telemark
    Lee Lau - xxx-er is the laziest Asian canuck I know

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