Rule 1: Set Yourself Up for Success

As of Today 6/14/2018 - after further review and many hours of research and many conversation with colleagues in stem cell research, I am convinced before your procedure date you should strongly consider a 24 - 48 hour fast .  This will induce autophagy and significantly decrease the pathogenic exosomes, microvesicles and extracellular vesicles being excreted by your resident cells as well as proliferation of stem cell and other progenitor cells.  This will create the best environment for regeneration to occur.  If you're interested in the science behind it, you can read more here.

Your new stem cells are fully able and capable of regeneration. They need special care if they are to promote growth and help heal your cartilage, systemic illness, injured or degenerated joints or vertebral discs. When in doubt be kind to them. You are your body’s best advocate. Congratulations on taking control of your health.

Rule 2: If It Hurts – Don’t Do It

Please use caution with activity. You may be sore from the procedure. Muscle spasms from the injection are not uncommon, and you should be prepared to have some pain or discomfort the first week. Use pain as your guideline and limit activity early in your recovery. Use heat for muscle spasms (deep ache, grabbing pain with transitions), and ice for inflammation (sharp, localized, burning, nerve pain). You may alternate hot and cold as needed. Deep diaphragmatic breathing and stretching with heat can help with the muscular pain. Get up and walk frequently. “Motion is lotion!” Even Hippocrates regularly prescribed walking regularly for health.

Rule 3: The Anti-Inflammatory Effect

The first week after injection, most people enjoy the anti-inflammatory benefit of the stem cells and related cells in the stromal vascular fraction, resulting in a dramatic decrease in pain. But a small minority people have increased pain from the procedure. You must not overdo it! Use caution with activity, no matter how good you feel. The old pain may return in a few days. Do not take anti-inflammatory medication. You need your body’s natural inflammatory process to start the healing process to create the matrix in your tissue/joint to gravitate the stem cells, use topical pain relieving ointments instead, i.e. BENGAY, Bio-freeze, etc.  Remember, those stem cells are healing cartilage and other connective tissues.  That’s a lot of work and requires a lot of time, approx. 3-4 months’ worth.  Rome wasn’t built in a day, right?

 

POST-PROCEDURE PROCESS

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Weeks 1 & 2 After Injections

Sugar, refined carbohydrates, breads, cereals, pastas, most grains are not your friend during this time and contribute to arthritis.  This is of course in excess; your body can only metabolize so many carbohydrates in a day.  The excess will go into your muscles and when they are full, they’ll go to your liver.  When your liver is full they’ll go to fat storage and will also cause “glycation” of proteins which is what destroys joints and contributes to diabetes and related illnesses.  Over weight individuals don’t have bad joint because of their weight (that’s a myth), they have bad joints because of glycation.  Just look at your hands, if your knuckles are starting to look a little gangly then you don’t metabolize sugar very well and need to avoid it.

Restrict yourself to light activity and the tasks of daily living. You will be sore, but it is better to move than to be completely sedentary. Use pain as your guideline. In the early weeks of regenerative healing, your body’s natural inflammatory process will use cytokines, leukocytes, proteins and inflammation to create a “scaffold” for the cells to bind to. The cells are just starting to form and divide, so you want to be very cautious and avoid overloading, shearing, or compression on the joint that was injected. Avoid too many frequent stairs, if possible (for hip, knee, ankle and foot injections), and limit lifting to 5-10 pounds on occasion.

No running or weight lifting the first two weeks! Minimize load, compressive forces, and torque on the joints and discs. Range-of-motion and gentle stretching exercises are appropriate. Light and easy walking can be very helpful to minimize soreness for spine patients. Manage muscle soreness and spasms with heat (hot shower, heating pad) and inflammation from procedure with ice.

No NSAIDs (ibuprofen, Aleve, anti-inflammatory medication)! You need your body’s inflammatory process to help with healing. Walking in the pool is a nice way to get some motion; it can unload your joints and be soothing. You can get in the pool once your injection sites are healed. Use a kick board, buoy, or noodle for support in the water. Kinesiology tape or additional medication may be needed to help you manage your pain. Analgesic creams or gel (Biofreeze, Traumeel) can help with pain. Trigger point dry needling can help with the muscle spasms.

It is not uncommon to have short-term increased soreness in your tissues and joints from the procedure. Mild to moderate pain is acceptable for a few days, but severe pain is not. If your pain becomes severe, or you cannot manage your pain with the above recommendations, contact us. We recommend our in-house Physical Therapy treatment to provide gentle exercise and manual release.

No chiropractic adjustments or traction in the first four weeks for spine patients. You want to minimize intradiscal pressure changes in the early stages of recovery. Cold laser, ultrasound, and electrical stimulation (TENS) are appropriate for pain management. You may wear a compressive brace for support during activity if it feels good, but don’t wear it when sedentary. Begin core stabilization exercises to minimize re-injury.

 

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Weeks 3 & 4 After Injections

Avoid repetitive loaded exercise, like stair steppers, running, or weight lifting. You may walk, use an exercise bike or elliptical machine or swim/walk in the pool. These exercises have minimal compressive loading or pounding to joints. Keep all workouts to less than 50 percent of normal/pre-injection distance/weight/reps. Give the new stem cells time to signal to the healing tissues. Proceed with caution; increase activity only within pain limits.

If it hurts, don’t do it! Maintain normal range of motion in injected areas with gentle exercise. Yoga, stretching, mat Pilates, tai chi, and easy walking are perfect. Continue to manage inflammation with ice and pain medications as directed if needed. If pain persists and doesn’t respond to other medications or treatments, you may start taking NSAIDs, but avoid them if you can. Contact us if you are still having pain or difficulty with your healing.

At this point physical therapy and massage therapy is a great idea. You may also resume chiropractic care at this time but avoid rough adjustments. A gentle chiropractor who is skilled at finessing chiropractic manipulations, drop table or activator is appropriate. Low-load spinal decompression can be initiated at week 4.

Weeks 5 & 6 After Injections

You may initiate light running exercise on even and soft terrain, a treadmill, or a track. Wear lumbar or joint support. Please be careful with jarring or compressive exercise and avoid shearing. No hiking on inclines or difficult, uneven terrain. Going up hills may feel fine but coming down is difficult for an unstable joint. Continue with core stabilization and joint stabilization exercises. You may start to increase resistance with weight lifting, but please still be cautious. Your stem cells are building new tissue and need oxygen/blood flow through gentle exercise but can’t tolerate being stressed by too much exercise. You may continue with stationary bike, elliptical, stretching, yoga, Pilates, and swimming exercise. Avoid compressive exercise such as overhead press, calf raises with weights on shoulders, squat rack, supine leg press, prone hamstring curls, twisting, repetitive flexion/extension, dead lifts, clean and jerks, kettle bells over shoulder level, box jumping, etc. If you still are experiencing pain, please back off on activity and continue to use ice. If you have concerns or questions, please don’t hesitate to call.

Weeks 7 & 8 After Injections

As long as you’re not having pain, you can slowly progress to your normal workout, but never to the point of pain in the injected area. Set yourself up for success by maintaining some aerobic capacity without injuring the new juvenile stem cells. Avoid or shearing or over compressive exercises. Continue to increase core and joint strengthening for optimal stabilization. Continue to use ice for pain and inflammation as needed.  If you are excessively sore in the injected area the next day, just know you need to back off a bit more the next time.

Months 3–6 After Injections

The stem cells are now at their peak of healing potential; help them heal you by not overdoing it. Walking, biking, yoga, stretching, and light weights are appropriate. Be careful with distance running. Get yourself strong to support your joints. Continue to use caution with compressive activity, twisting, planting and pivoting, overhead activity, and repetitive motion. Consider physical therapy if you need guidance on proper exercise to protect your joints and injection site(s) as you continue to heal.

Special Populations

Disc Patients
Avoid overhead work if possible for 4 months. This can put a lot of force on your new cells. You want to be careful and try to avoid compression with extension, repetitive flexion or twisting until your core is strong. Avoid compressive exercise such as overhead press, calf raises with weights on shoulders, squat rack, supine leg press, twisting, repetitive flexion/extension, dead lifts, clean and jerks, kettle bells over shoulder level, box jumping, etc. Highly recommended: core abdominal exercises; strengthen obliques, QLs, and gluteus medius, gentle spinal stabilization exercises; and stretching lower extremities and lower back for mobility. Pilates (mat and Reformer, chair), yoga and swimming are also appropriate. Get yourself strong before you challenge your spine. Remember what got you to the point of seeking stem cell therapy. Most likely, you were in pain and your spine was weak.

 

Shoulder Patients
Avoid overhead work if possible for two to three months. Don’t play tennis with the injected side for six to eight weeks. Set yourself up for success. A rotator cuff stabilization program (JOBES) and postural stabilization exercises are appropriate. Avoid shoulder/military press above head; no kettle bells over shoulder level during healing phase.  Neck problems are often associated or can even be a contributing factor in shoulder issues.  If you have a chiropractor, you may want to consult with them to re-adjust your neck as needed to help the nerves to your shoulders.

 

Hip, Knee, Ankle and Foot Patients
Avoid compression activities such as running, jumping, squatting, supine leg press, or pivoting for two to three months to allow the cells to settle. Pain is your guideline. Walking, elliptical, swimming, yoga, and Pilates are ideal exercises early in the recovery stage. You may resume light running and short distance running, ideally on soft terrain in weeks 6–8. Gradually increase your distance in weeks 8–12. You may start easy hiking in week 8 as long as there is no pain or swelling. Consider some physical therapy to strengthen knees and hips, and to support the joints we offer this on-site and it may be a recommended as a part of your treatment. Ideally, you should exercise to stabilize the entire lower extremity (hip, knee, ankle and foot).

 

Golfers
No golf (except chip and putt) for two months. Be very careful with rotational load on the spine. In the early stages of healing (weeks 1–8), you will want to work hard on increasing your core strength, especially abdominal obliques and QL muscles for spinal support with rotation. For months 2–3: minimal golf (no more than nine holes, once a week) and avoid over-rotation of neck and spine. Let the stem cells heal your discs/knee/shoulder/hip. During months 4–5, slowly work up to a few nine-hole games per week. After six months, take the next few months to slowly progress to 18 holes. Work on your swing to abbreviate over-rotation. Consider some lessons with a golf pro to change bad habits with your swing. Remember, almost everyone on the PGA senior tour has had lumbar surgery. Avoid surgery of your own with gentle, short swings. Strengthen abdominal obliques and spinal rotators to protect your spine during the forceful rotation activity of swinging a golf club.
Every case is unique and side effects differ for each person. Some patients may experience more pain and inflammation than others; please contact us if you have any questions or concerns. Certain joints and body areas can be more painful to inject, such as the spinal discs and the ankles. Expect varying degrees of pain in the first few days after the procedure and treat with ice and/or heat and medication if necessary. If your severe pain lasts for more than a few days, contact us for advice. Our physical therapy or massage therapy is recommended.
Treatments that can help with managing the pain and benefit the healing process include ultrasound, electrical stimulation, cold laser, gentle myofascial release, core and joint stabilization, stretching, trigger point dry needling, kinesiology tape, massage, ice and heat, and medication.

 

Post-Procedure Ancillary Care

Massage Therapy
We have massage therapy on-site.  You may have a massage the day before the procedure but keep it gentle (Swedish, Effleurage and Petrissage). You may have another massage once the injection sites are healed (after five to seven days). Massage lotions/oils are not sterile, and you don’t want to risk an infection. In the early recovery stages, gentle massage appropriate (like Swedish and effleurage) is appropriate. You may progress to deeper-tissue myofascial release after week 2, but gradually increase the pressure with the manual release. If the tissue around the injection site feels warm to the touch, is swollen or shows signs of infection, do not get a massage. Call us.

 

Physical Therapy
We have PT on-site.  In the early stages of recovery after injection (weeks 1–4), you may start with gentle myofascial release, kinesiology taping, TDN, ultrasound and TENS, gentle stretching, ROM, isometrics, and mat-based core stabilization exercises. Stationary bike, elliptical, and swimming are acceptable early in the recovery phase. Avoid traction, heavy load or resistance, compression to the spine, and NSAIDs the first few weeks of recovery. In weeks 4–8, you can progress to more activity and gradually add more resistive load to workouts. This is a great time to incorporate core yoga, Reformer Pilates, TRX, and light weights, with a gradual increase in resistance (50–75% of pre-injection workouts). Avoid any forceful rotation or manual manipulation. Remember that good healing during the first two months after injection will give you the best chance for success. The cells are fragile, and you need to be cautious that you don’t overload them or cause too much stress or shearing on them.

 

Chiropractic Care
We have chiropractic on-site.  Chiropractic care can work very synergistically for wellness care, prevention and pain management in weeks 1–2, including manual release, ultrasound, electrical stimulation, and cold laser treatments. Absolutely no rough rotational adjustments should be performed until after 2 months. The discs may be weakened by the injection, and the injection site needs to heal.

In weeks 2–4 weeks, adjustments need to be low load, gentle, and non-forceful. A drop table or activator is OK. Spinal decompression or traction after 2 months is probably also helpful. Once you start decompression, force must be low load, just to increase the flow of fluid and nutrients into the disc.
Ultrasound, electrical stimulation (TENS), cold laser, TDN or acupuncture, cupping, and gentle myofascial release are acceptable. Your chiropractor may call us with any questions.

 

Acupuncture
Acceptable any time before or after injection.

 

Personal Training
In the early stages of recovery (weeks 1–4), you may start with gentle stretching, ROM, isometrics, planks, and mat-based core stabilization exercises. Stationary bike, elliptical, and swimming are acceptable early in the recovery phase. Avoid heavy loads or resistance, compression to the spine and joints, and NSAIDs the first few weeks of recovery. In weeks 4–8, you can progress to more activity and gradually add more resistive load to workouts, up to 50%–75% of pre-injection workouts. Avoid any forceful rotation, flexion, or extension moves. Remember that good healing during the first two months after injection will give you the best chance for success. The cells are fragile, and you need to be cautious that you don’t overload them or cause too much stress or shearing on them. Avoid compressive exercises, such as overhead press, calf raises with weights on shoulders, squat rack, supine leg press, loaded twisting, repetitive flexion/extension, dead lifts, clean and jerks, kettle bells over-shoulder level, box jumping, etc. Highly recommended: core abdominal exercises; strengthen abdominal obliques; QL, and gluteus medius; gentle spinal stabilization exercises; and stretching lower extremities and lower back for mobility. Pilates (mat, Reformer, chair), yoga, and swimming are very appropriate. Please call with any questions.

 

Arthritis
Many factors or variables can lead to cartilage or disc degeneration and arthritis. Some you can control and some you cannot. These include genetics and family history, aging, autoimmune disease, microbiome deficiencies, connective tissue disease, poor diet or malabsorption of nutrients, obesity, lack of exercise, decreased strength around the joints and spine, diabetes, rheumatoid arthritis and chronic inflammation, gout, hormone disorders, smoking, consuming alcohol, repetitive trauma, or a low-energy trauma that progresses over time. Chronic inflammation and micro-motion instability can produce ongoing pain and tissue breakdown.
Spinal discs and joint cartilage have a little or no blood inside of them, but still have live cells in the disc or joint space. They get their nutrition from diffusion and osmosis with motion, not through blood supply. Once the disc or cartilage tissue is damaged, cell nutrition is compromised, and the body cannot naturally heal the degeneration on its own. Degenerative discs are diagnosed with MRI and are often but not always painful. A painful degenerative disc is frequently 50% or more collapsed and has cartilaginous endplate erosion. A healthy disc appears white or light grey, indicating fluid retention. A degenerated or desiccated disc will appear dark and have less volume or height. However, new regenerative cellular therapy uses your own mesenchymal stem cells to help your body repair these tissues and make your joints/spine healthier. It is imperative that you follow suggested guidelines during this repair phase to have the best outcome.
Arthritis and joint degeneration occur over time, and are often due to poor joint mechanics, poor body mechanics, bad posture, weakness, repetitive motion, high or compressive forces, and bad habits. Poor diet, weight gain, and other traumas can cause tissue and joint injury. Consider making lifestyle changes to eliminate factors that might put you at higher risk for joint/cartilage breakdown. You have come to Seattle Stem Cell for regenerative cellular therapy because you want to be healthy and get out of pain. Make the commitment to yourself and make the lifestyle changes that you can control, like diet and exercise, become familiar with intermittent fasting and get healthy!

 

Four goals to control arthritis:

1. Control pain and inflammation with nutrition, intermittent fasting and supplementation
2. Improve joint function with regular motion through activity
3. Maintain a healthy body weight
4. Achieve a healthy lifestyle with exercise and good nutrition

 

Tips to achieve these goals by changing your lifestyle:

Consider a clean diet: higher in healthy fats (avocado, olive oil, coconut, nuts/seeds), lean protein, fresh fruits and vegetables, whole grains in low amounts, low sugar/salt.
Stay hydrated! Dehydration dries out connective tissue and discs.
Get plenty of sleep and learn sleeping positions that can decrease stress on spine and joints.
Good ergonomics for work space and proper lifting techniques are important to reduce stress on your body.
Consult us for a weight loss program. Obesity is the No. 1 risk factor for degeneration and arthritis.
Quit smoking! Smoking dries out your discs and connective tissue.
Get strong! Build strength in the muscle that surrounds your painful joint. Strong muscles can absorb some of the shock that goes though the joint. Attend some physical therapy /chiropractic to learn proper exercises to support your joints.
Activity modification: Avoid repetitive lifting, twisting, rotation, and compressive exercise. Poor body mechanics and weakness on joints can accelerate degeneration.
Aerobic exercise boosts blood flow and increases nutrition to your joints. Inactivity can make your joints more stiff and painful.
Stretch every day! Stretching increases joint range of motion.
Manage diabetes and hormones!

The medical team and staff of Utah PR Institute and Seattle Stem Cell want you to have the highest success with your treatment. Someone from our offices will contact you from time to time to inquire about your recovery and answer your questions or concerns as you recover and resume activity. If you have unexpected pain or any questions, contact us.