Podcast 28 - SLAP Lesions


Automated voice: This is Dr. Chad Edwards. You are listening to podcast 28 of Against the Grain.

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We offer prolotherapy, PRP or platelet-rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy and functional medicine to get you back on track to optimal health.

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Automated voice: Welcome to Against the Grain podcast with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle.

Get ready because we’re about to go Against the Grain.

Marshall Morrison: Welcome, my name is Marshall Morrison. Today I am joined by Dr. Chad Edwards who believes that 80% of the medical recommendations are crap, technically speaking there.

He is the author of Revolutionize Your Health With Customized Supplements and he served in the US Army for 23 years as both an enlisted soldier and as an officer as a physician. He graduated from medical school at Oklahoma State University. He is the founder of revolutionhealth.org and Against the Grain podcast.

Welcome Dr Chad Edwards, thanks for joining us.

Chad Edwards: Thank you so much. You know sometimes you read that stuff and I’m like, “Who are you talking about?”

Marshall: [laughs] I want to become sort of like your hype man when we go out and do some of these speaking events or maybe educational seminars. I feel like you need a hype man.

Chad: Yes, I feel like that too [laughs].

Marshall: Okay, okay. So we are here today, and I know the listeners are pumped, because we have an awesome topic. Dr. Edwards, what are we talking about today?

Chad: Today we are talking about an issue that affects a lot of athletes and I’ve certainly seen it in non-athletes but mostly in athletes and it is a real problem and we’re talking about SLAP lesions. So SLAP lesions are a shoulder injury that we see in a lot of athletes, a lot of baseball players. I’ve seen it in a lot of crossfit athletes, weightlifters, those kinds of things. See it, pretty common.

Marshall: Okay, so we’re talking about a SLAP lesion. Is that like you get slapped and you know a lesion appears on the skin or what’s the deal, what is this?

Chad: [laughs] Yes, we could probably make that little jump but specifically what we’re talking about here is a tear of the superior labrum. The SLAP is an acronym and the S and the L stands for superior labrum tear. In the shoulder in, what’s called the glenoid cavity in the shoulder joint itself, you have a small rim of cartilage. It’s pretty much an analogus to the meniscus in the knee. So this rim of cartilage inside that shoulder joint and the long head of the biceps tendon attaches to that thing. And for a number of reasons you can have a tear in that thing. The S and the L is the superior labrum, A and the P stands for anterior to posterior. So we have a tear, anterior to posterior in that superior labrum. So the labrum is torn.

Marshall: Okay, so the labrum is torn and what happens when you tear the labrum? Do you just lose complete function of your shoulder or is it excruciating pain? How bad is an injury like this?

Chad: Well I would say it depends on the extent of the injury. You can have a relatively minor injury or you could have a, like a bomb went off inside the joint, you can have the long head of the bicep completely torn off and a chunk of the labrum is also pulled off and all of those kinds of things.

Now, usually the extent is determined, I would argue about by physical exam as well as MRI findings and we have to be very very careful about MRI findings and I’m going to reference our podcast on MRI. I don’t remember the number but it was early 7, 6, somewhere in there on MRI. And the interesting thing is there was a study done by an orthopedic surgeon out of Florida. He was seeing so many shoulder problems and seeing so many MRI’s abnormal, he’s a sports medicine orthopedic surgeon, and he saw so many abnormal MRI’s he decided to do a study on baseball players without pain.

So these were actually pitchers and they did a MRI on them, none of them had pain, none of them had previous injury. And the MRI came back with, I want to say it was like 80% had abnormal findings on their MRI. So again, with no pain, with no symptoms. So I would caution the listeners getting some of these tests, specifically an MRI, it’s kind of like picking your nose in public. What are you going to do with the results. You know if you think about somebody holding a bugger in public.

Marshall: [laughs]

Chad: Anyway, so what are you going to do with the MRI results? If someone comes to me and they say, “I want an MRI on my shoulder” and they say, “I’m not getting surgery” then why are we getting an MRI? And in fact that orthopedic surgeon at the end of his discussion, he said, in fact he described MRI as a roadmap to surgery, “If you want surgery, the best way to get surgery is to get an MRI.

It’s not a bad tool, in fact it’s a fantastic tool but you have to be very careful about how you interpret the results and what does this mean for the patient and how is it going to change your management? If we’re just looking to do surgery, if we’re looking for a reason to do that, you’ll often find it and that may or may not be the cause of that person’s pain.

So as far as the extent of the injury or how bad is this, I think it varies from person to person. It can be relatively minor or it could be severe and if you find a SLAP lesion on an MRI I would argue that it doesn’t necessarily mean that that is the cause of their pain.

Marshall: Okay and so it’s manifesting as pain when they’re moving their shoulder, that’s a symptom of it and the way to specifically identify that you have, in fact, torn your labrum is an MRI. Are there other ways to determine that or is it typical or?

Chad: Well there are some suggestions based on certain physical exam testing, you know. We test the biceps tendon and there’s things like, and I don’t mean this is specific to the SLAP lesion, but like the Yergason test and the empty can and the full can and there’s all kinds of these different physical exam tests that we can do to evaluate the integrity of the shoulder and those are all important. And I think it’s important to be able to correlate those findings with what we see on the MRI. When you get those two overlapped, a lot of times that can tell us a lot about the patient’s injury.

Marshall: And so the thing that an athlete goes in, gets an MRI and immediately most doctors will say, “You need surgery”. It sounds like a pretty significant surgery to repair that.

Chad: Right, I remember having a, this was back in 2000– In fact I think it was February of 2012. I had a high school softball player that had a full ride scholarship to a division 1 university. And she was playing on a, in an all-star team and the school team, if I remember right. And she had significant shoulder pain, went to see an orthopedic surgeon. They asked him actually about PRP and he said, “Well, you know, I don’t think so, you need surgery.”

The problem was that she had a full scholarship and if she has an injury requiring surgery, she’s going to lose her scholarship. She’s not going to get to go play, she’s not going to get to go to school, at least not with the scholarship. I mean this was a real problem And so they came to me saying, “Can you help us?” And I said, “Well there’s only one way to find out you know. We’ll treat this and see what we get”.

So we started standard prolotherapy, not PRP or platelet-rich plasma therapy, which is also a fantastic procedure. Now that procedure, the difference between that and standard  Tulsa prolotherapy and the way I perform it, is merely the type of solution that we use. PRP is probably a little bit more effective, however a little more intense at stimulating the healing process but I mean plain dextrose Tulsa prolotherapy is amazing at helping to heal these injuries.

Marshall: So basically what you’re saying is, there’s other alternatives while most doctors might say, hey the way to fix this is surgery going in and repairing it. There’s other options as well.

Chad: That’s correct. And you know, that girl, she didn’t take a single day off. She didn’t take a single practice off. She was– Actually when she was practicing, before she started prolotherapy, she had to be very careful and was trying to hide her injury because she couldn’t let her coach know. So she was doing different things and trying to hide the fact that her shoulder was hurting, didn’t take a single day off, started getting Tulsa prolotherapy and she went and played full level division 1 competitive sports without pain.

Marshall: And so do you see that frequently with athletes maybe? Just kind of as a broad comment here where maybe they have some kind of injury and they’ll want to hide it from their coach, they’ll keep playing on it and actually make it worse because the implications of fixing it is surgery. Do you see that frequently?

Chad: To that extent, no. That was fairly exceptional. But yes, I mean, certainly when I was in the military I it saw all the time. I worked with special operations and these guys, they might have a deployment coming up and their team is going to deploy and they don’t want to miss out on something, so they will keep their mouths shut. Especially, I saw a lot, you know, of flight surgeons, so I worked with the pilots. And, you know, the pilots, if they get what’s called grounded, so they can’t fly, then they will lose their flight pay for that. If they go over certain period of time they’ll lose their flight pay. Well that’s– It could be over $1,000 a month. That makes for that, for that soldiers. So yes, we see people hide injuries to avoid consequences understandably.

Marshall: Okay. Something that your clinic and other functional medicine clinics do is provide these alternatives which can heal these different injuries over a course of time without you having to take a day off.

Chad: That’s correct. Now let’s be careful about using the word heal, words cure, those kinds of things. So, to be clear, that, what we are doing is not healing or curing anything. We are stimulating the body to heal itself, the body heals through inflammation. So, that’s how it works. You have an injury, you have some inflammation. That’s appropriate. Chronic long term inflammation is not appropriate. Acute inflammation after an injury is appropriate.

Certainly we have some pain associated with that. Some people will take anti-inflammatory medications which I recommend against, for something like this because we heal through inflammation. We want maximum healing. So, I recommend against those medications. Tulsa Prolotherapy merely stimulates that healing mechanism that’s standard, normal inflammation response in your body. And we often– I mean, it’s rare, extremely rare, that I recommend them taking time off. It’s very rare.

Marshall: We’re going to take a quick break because I feel like this is kind of the tip of the iceberg, how Tulsa prolotherapy can actually affect an injury like this. When we come back we’ll get more into it.

Chad: Yes sounds good.

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Marshall: Okay. We are back and we were just getting into the specifics of how Tulsa prolotherapy can help. Why don’t you break down for all the listeners that maybe missed one of the previous podcast episodes on how prolotherapy works and how you use it.

Chad: Yes. So basically, we are supposed to heal through inflammation. The problem is ligaments and tendons. You know, your muscles are very metabolically active, if you go run a mile, the muscles are churning away, they’re the furnace. They require a lot of energy. In order to get a lot of energy and there you have– And fuel and oxygen all those things, you have to have a good blood supply. Ligaments and tendons, which hold, ligaments hold bones to bones, tendons hold muscles to bones, are really more like a steel cable and there’s no metabolic activity. There’s next to no activity whatsoever in those structures independent of the level of activity.

So, you go run that same mile and the ligaments and tendons don’t need more oxygen because they’re not requiring energy to do what they do. Most of the tissue is just a protein in the form of collagen, which is very strong, and hold these muscles to the bones so that we can exert the change. You don’t need a blood supply to it because of that. You don’t need the blood supply all the way up until you injure it. Now all of a sudden we’ve got to get a superhighway in there to get all of the inflammation in there, to get the healing things and the white blood cells and all that. We need all that stuff in there yesterday so we can heal that.

Because of that poor blood supply, we often see very poor or incomplete healing of ligaments and tendons. For the most part you’re only going to see this kind of stuff or hear this kind of stuff from a prolotherapist because of the training in ligaments and tendons. I wasn’t– I mean when you understand the physiology it makes absolute sense, but I wasn’t taught this way in medical school. We weren’t taught to think about almost a subclinical, you know– Most of the issues that I deal with, you can’t detect on M.R.I. It’s a damaged ligament, but it’s not torn. Now we can certainly work with a lot of torn ligaments. But most of what we see you would never see on an M.R.I. So, we just say, “Well you have pain but we don’t know why on M.R.I”.

Actually had that happen when I was on active duty. One of my special operators had done everything under the sun and deployed multiple times and he had limiting back pain and he said, “If you can’t fix my back pain then send me home”. His M.R.I. was normal and I remember sitting around talking, this was before I did prolotherapy. I remember sitting around talking with our group surgeon and our other docs and we were like, “Is this guy making it up”, because we can’t see anything on M.R.I. The reality is I didn’t understand ligament and tendon issues at the time and now in retrospect that guy had something that, more than likely, prolotherapy would have been able to address.

Marshall: What would you say to the athlete that maybe has one of these SLAP lesions, that one alternative is surgery, the other alternative is something like prolotherapy. And they say, well, you know, there’s risks associated with both I would imagine. How would you maybe advocate for prolotherapy in terms of the risks that are associated with that.

Chad: Well, I think it’s pretty easy. First of all, the risks associated with surgery are like death, extremely rarely, but that can happen. I almost hesitate even bring that one up but it’s possible. You can have a complication from anesthesia and that’s a major complication. The last people to die from prolotherapy were in 1956 and these papers were published. They were using a solution that we no longer use and they had an injection into the spinal canal and it resulted in an infection and that’s how they died.

So, you’re talking about something that we haven’t seen a fatality really ever because those were not for shoulder injuries. We’ve never seen any serious complication from dextrose prolotherapy from an appropriately trained prolotherapist versus something that there’s potentially significant complications or risks. The second thing is, we don’t generally require a significant part of down time. Look at the recovery time on surgery. You’re going to be down for weeks, if not months. There’s always a chance that surgery can make your shoulder pain worse. I’ve never seen shoulder prolotherapy make anyone worse. I’ve never seen prolotherapy on any area in the body make anyone worse, ever.

Marshall: And so when you talk about, you know, shoulder prolotherapy, what is that? Is that a couple injections around the shoulder area by a trained professional?

Chad: Sure, it depends on the exam and where I think the damages. It might be several injections in one procedure but generally very well tolerated and you walk out with your shoulder basically numbed up and anesthetized and you can kind of go about your normal way. You still want to be careful and don’t overdo it. But the body will often heal some of these damaged tissues when appropriately stimulated with the appropriate amount of inflammation. So I have multiple patients and if you go to reevolutionhealth.org on the far left hand side of the top you’ll see a section for testimonials and there are several on there with athletes getting prolotherapy on SLAP lesions that didn’t take any time off, that had complete resolution of their symptoms. And, you know, I’ve had competitive crossfit the athletes. I’ve had, in fact, multiple crossfit athletes but several of them competitive. I’ve had football players, and wrestlers, and MMA fighters and with M.R.I. diagnosed SLAP lesions that had complete resolution of their symptoms, without really even taking a day off, so to me it’s a no brainer.

Marshall: I see a ton of benefit to prolotherapy, very little downside, because at the end of the day, if you still need surgery, you can still go get surgery to get it repaired.

Chad: That’s exactly right and it doesn’t mess anything up for the surgeon. It’s just, you know, if prolotherapy doesn’t work– Our success rate with shoulders across the board, shoulders is in excess of 95%. It is extremely effective. And I’m talking full function, full weights the whole bit.

Marshall: That’s awesome. Well, thank you so much for sharing about the SLAP lesion resolution and I know that a lot of our listeners now around the country are wanting to learn more about that. So, where would you tell them to go if they want to learn more about this topic?

Chad: Well obviously I’m going to recommend our clinic because I know our numbers. Anytime you’re looking for a prolotherapist any physician can hang up their shingle and say I do prolotherapy. That does not mean that they’ve had appropriate and adequate training. So I recommend going to Hackett Hemwall website and hacketthemwall.org maybe hacketthemwallfoundation.org but either way. And on that site there’s a list of prolotherapists that have been appropriately trained and are recommended by the Hackett Hemwall Foundation. So, we are the only one in Oklahama and we’re the only one in several hundred miles radius around the Tulsa area.

So, come see us we love seeing patients from out of town. We’d be happy to see you, I don’t care where you come from and it’s one of those things that we can do. You know, you come in, it doesn’t take long in the clinic and come see us a month later, three to six rounds is what it usually takes but you’re welcome to come see us or go to the Hackett Hemwall website.

Marshall: And then for more information, about prolotherapy in general, you can visit us at revolutionhealth.org. Dr. Edwards, thank you so much.

Chad: Thanks Marshall, appreciate your time.

Automated voice: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week when we’ll be going Against the Grain.

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