Aftercare Instructions for Regenerative Injections
RULE 1: SET YOURSELF UP FOR SUCCESS
Your new Regenerative cells are tender and delicate. They need special care if they are to grow and help heal your injured or degenerated joint or disc. When in doubt, be kind to them. You are your body’s best advocate.
RULE 2: IF IT HURTS – DON’T CONTINUE DOING IT. TRY MODIFYING HOW YOU ARE STANDING, SITTING OR MOVING THEN TRY AGAIN!
Please use caution with activity. You can 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 moderate heat for muscle spasms (deep ache, grabbing pain with transitions), and ice for inflammation (sharp, localized, burning, nerve pain). Each in 10-minute sessions 3-4 times each day, especially before bedtime to optimize the healing time during sleep. Deep diaphragmatic breathing and gentle movement, gentle stretching with heat can help with the muscular pain.
RULE 3: THE ANTI-INFLAMMATORY EFFECT
The first week after the injection, some people enjoy the anti-inflammatory benefit of regenerative cells, resulting in a dramatic decrease in pain; however, many 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 for at least 2 weeks. You need your body’s natural inflammatory process to start the healing process to create the matrix in your tissue/join to gravitate the regenerative cells.
IMMEDIATELY AFTER INJECTIONS:
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 (no anti-inflammatory medication). If your severe pain lasts longer for more than a few days, contact us for advice.
- Treatments that can help with managing the pain and benefit the healing process include gentle myofascial release, core and joint stabilization, stretching, trigger point dry needling, kinesiology tape, massage, ice and heat, and medication (no anti-inflammatory medication).
WEEKS 1 & 2 AFTER INJECTIONS:
- Restrict yourself to light activity and the tasks of daily living. You may 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 and knee injections), and limit lifting to 5-10 pounds on occasion.
- No running or weight lifting the first 6-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 moderate heat (hot shower, heating pad) and inflammation from the procedure with ice.
- Avoid NSAIDs (Ibuprofen, Aleve, and other anti-inflammatory medications). 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. Use a kick board, buoy, or noodle for support in the water.
- Kinesiology tape (K Tape) or additional medication may be needed to help you manage your pain.
- Analgesic creams or gel (Bio Freeze, Traumeel) can help with pain.
- Trigger point dry needling can help with muscle spasms. It is not uncommon to have 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 Physical Therapy starting 2 weeks after the procedure to provide gentle exercise and manual release.
- 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.
WEEKS 3 & 4 AFTER INJECTIONS:
- Avoid repetitive loaded exercise, like stair steppers, running, or weightlifting. 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 less than 50 percent of normal/pre-injection distance/weight/reps. Give the new regenerative cells time to implant themselves in 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.
WEEKS 5 & 6 AFTER INJECTIONS:
- You may initiate light running exercise on even and soft terrain, a treadmill, or a track only if coordinated with your doctor or physical therapist. 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, 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 weightlifting, but please still be cautious. Your regenerative cells are building new tissue 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 exercises 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:
- If 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. Void 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.
MONTHS 3-6 AFTER INJECTIONS:
The regenerative 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.
- Attain and maintain best alignment postures 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.
Additional Specific Body Area and Activity Instructions
- Avoid overhead work if possible, for several months. This can put a lot of force on your new cells
- 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 regenerative therapy. Most likely, you were in pain and your spine muscles were deconditioned.
- Avoid overhead work if possible, for two to three months.
- Don’t play tennis with the injected side for six to eight weeks.
- Rotator cuff stabilization program and postural stabilization exercises are appropriate.
- Avoid shoulder/military press above head; no kettle bells over shoulder level during healing phase.
HIP, KNEE, AND ANKLE 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. Never increase your pain rating more than 2 levels during an activity, stop and reset positions or postures to stop increase in pain.
- If there is sharp pain, STOP and rethink what might be causing the issue, recognize what it is, then modify and continue IF the sharp pain ends.
- Expect that you will return to the pre activity pain level in the same amount of time it took to perform the activity or exercise. REMEMBER: anything you are doing IS an exercise/activity.
- Walking, elliptical, swimming, yoga, and Pilates are ideal exercises early in the recovery stage.
- 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 if there is no pain or swelling.
- Consider some physical therapy to strengthen knees and hips, and to support the joints. Ideally, you should exercise to stabilize the entire lower extremity (hip, knee, ankle).
- No golf (except chip and putt) for two months. You have the rest of your life to play!
- 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 regenerative cells heal your joint.
- 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.
Post-Procedure Additional Care Options
- You may have a massage the day before the procedure, but keep it gentle (Swedish).
- 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.
- 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, instead call you doctor.
- 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.
Acceptable any time before or after injection.
- In the early stages of recovery (weeks 2-4), 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 health 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; strengthening 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 have your trainer call with any questions 443.808.1808.
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, connective tissue disease, poor diet or malabsorption or 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 discs or joint space. They get their nutrition from diffusion and osmosis with motion, not through blood supply. Once the disc cartilage tissue is damaged, cell nutrition is compromised, and the body cannot naturally health the degeneration on its own. Degenerative discs are diagnosed with MRI and are often but not always painful. A painful degenerative 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 All Star Pain Management and Regenerative Medicine 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, and get healthy!
FOUR GOALS TO CONTROL ARTHRITIS:
- Minimize pain and avoid inflammation
- Improve joint function with appropriate postures and movements with best alignment and minimizing loads
- Maintain a healthy body weight
- Achieve a healthy lifestyle with exercise and good nutrition
TIPS TO ACHIEVE THESE GOALS BY CHANGING YOUR LIFESTYLE:
- Consider a clean diet: low fats, lean protein, fresh fruits and vegetables, whole grains, 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 workspace and proper lifting techniques are important to reduce stress on your body.
- Consult a nutritionist or registered dietician for a weight loss program. Obesity is the No. 1 cause 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. Learn to attain and maintain the best postures and movement for efficient joint movement with functional control and endurance with Physical Therapy
- Activity modification: Avoid repetitive lifting, twisting, rotation, and compressive exercise.
- Reset your body mechanics. 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. “Motion is lotion” by increasing restorative fluid s moving through your joints to bring healing materials and help eliminate toxins and destructive chemicals.
- Stretch every day! Stretching increases joint range of motion. Learn to know how much motion each joint needs, attain then maintain it.
The medical team and staff at All Star Pain Management and Regenerative Medicine want you to have the highest success with your treatment. Someone from our office 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 at 443.808.1808.