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By Craig Chappell, DO
Whether you are a professional athlete, a sports minded student, a tri-athlete or an active adult, Dr. Chappell specializes in activity related injuries and nonsurgical orthopedics.
Dr. Chappell provides treatment for the following conditions:
• Sports Injuries
• Chronic Pain
• Overuse injuries (tendonitis, plantar fasciitis, tendonosis and stress fractures)
• Acute injuries (sprains, muscle strains, joint injuries, and fractures)
• Trigger point injections for pain control
• Arthritis treatment and bracing
• Nerve blocks for pain control
• Unstable and loose joints
• Headache treatments
• Back and Neck pain
• Concussion care
By looking at the x-rays below, can you tell which patient has more pain and dysfunction?
Give yourself a point if you determined that the x-ray is of a knee and the knee on the right has a significant amount of degeneration, as seen by narrowing of the joint space. Logically you may assume that the bad looking knee is also the one with more pain.
In recent studies the conclusion is that knee pain, stiffness, and duration of disease are more predictive of dysfunction than x-ray. Therefore, it is better to consider a person’s functional status in addition to radiological findings while planning the treatment of knee pain.
This same process is also carried over to all other joints in the body. The trick is in determining the Main Pain Generator. So if the bony changes seen on x-ray are not the cause of pain, what is? Theoretically, if I were to make a small incision on the inside of your knee there are several structures that I would pass through on the way to the bone. These may include, skin, subcutaneous tissue (fat), muscle, tendon ligament, capsule, cartilage and finally bone. So when one points to the inside of their knee to describe their pain, it could be a number of anatomical structures that they are pointing at and only one or two of them possibly could be helped by surgery. This is why determining the main pain generator is key. Using this as an example there are several non-surgical options we offer to locate and address the pain.
Non-surgical options offered by Dr. Chappell include the following treatments:
Regenerative Injections
Regenerative injections are a rapidly emerging technique and are showing exciting potential where surgery was once the only option. Painful conditions frequently treated with regenerative injections include osteoarthritis, knee, shoulder, hip and spine, rotator cuff tears, plantar fasciitis, anterior cruciate ligament (ACL) injuries, hip/pelvic pain and instability, back and neck injuries, tennis elbow, golfers elbow, ankle sprains, tendonitis, and ligament sprains/laxity.
The basic intent of Regenerative Injections is to intentionally create a small injury to initiate a healing response. This can be accomplished in several ways, from aggressive physical therapy techniques to injections. Substances used in injections can include Prolotherapy (hypertonic dextrose), Platelet Rich Plasma (PRP) and Stem Cells.
Prolotherapy
Prolotherapy is a regenerative injection treatment used to stimulate the healing mechanism to repair damaged or injured areas by injection of a hypertonic dextrose solution which in turn stimulates an inflammatory response and leads to healing. Prolotherapy is a viable alternative to surgery and an alternative option to pain medications and anti-inflammatory injections such as cortisone. Prolotherapy is a safe and affordable option that allows the patient to keep working and/or training during treatment.
Platelet-Rich Plasma Therapy (PRP)
Most people associate platelets with clot formation. While that certainly is an important function of platelets, they are also very much involved in injury healing. Platelets are extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments, tendons, and joints stimulates a natural repair process. But in order to benefit from these natural healing proteins, the platelets must first be concentrated.
PRP works by recreating and stimulating the body’s natural healing process. Several conditions that benefit from PRP include:
• Shoulder pain and instability, including rotator
cuff injuries
• Tennis and golfer’s elbow
• Quadricep/Hamstring strains
• Knee sprains and instablility
• Patellofemoral syndrome and patellar tendinosis
• Ankle sprains
• Back, Neck & Hip Pain
Stem Cell Injections
An exciting addition in the field of regenerative medicine is the introduction of Stem Cell Therapy. This is the use of a person’s own cells from bone marrow, fat, and blood (alone or in various combinations) which is then injected into the area which has a cellular deficiency. These immature cells have the ability to become tissues like cartilage, bone, and ligaments. Like Prolotherapy and PRP, the goal of stem cell injections are the same: to stimulate the repair of injured tissues.
Dr. Chappell has been performing regenerative injections with the use of ultrasound guidance for the past 5 years and has taught regenerative injection technique nationally and internationally.
Dr. Chappell specializes in understanding and identifying your pain generator. This is accomplished by performing a thorough history and physical exam. Frequently diagnostic ultrasound is used to pinpoint the dysfunctional or injured area. Ultrasound allows for dynamic visualization and comparison without the side effect of ionizing radiation or uncomfortable positions. Ultrasound is also used to guide injections which allows absolute accuracy with the first stick and virtually eliminates the need to reposition the needle which happens with other forms of guidance. Less needle sticks and repositioning also results in less pain.
Please feel free to call our office and we will be happy to review your medical problems and assist you in making a decision for an appointment.
Dr. Chappell’s office is located in Ocala at:
1720 SE 16th Ave Suite 303 Ocala, Fl 34471
352-512-0907 . www.fhmllc.net
Craig Chappell, DO
Board Certified Sports Medicine,
Neuromuscularskeletal Medicine,
Osteopathic Manipulative Medicine,
and Family Medicine
