DH 46 | Treating Chronic Pain

 

Living with chronic pain can interfere with your daily life and keep you from doing things you need to do. It can also take a toll on your emotions, making you feel irritated, angry, anxious, frustrated, and depressed. In this podcast episode, Dr. Trish Murray is joined by Dr. Gloria Tucker to discuss the benefits of Proliferative/Regenerative Therapy and how it can help treat chronic pain. Dr. Tucker is an instructor of Proliferative Medicine to other physicians and also a published author in the field of proliferative/regenerative medicine.

Listen to the podcast here:

Proliferative Or Regenerative Therapy

A Missing Link to Treating Chronic Pain With Dr. Gloria Tucker

I’m here with Dr. Gloria Tucker. Welcome, I’m so glad to have you.

Thank you. It’s my pleasure.

Dr. Gloria Tucker did her undergraduate studies at the University of Southern California, graduating Phi Beta Kappa in 1983. She then attended the University of Southern California Medical School and did her residency in Internal Medicine in San Francisco and became board-certified in Internal Medicine in 1990. She went then on to practice in that discipline for ten years at the Kaiser Medical Center in Petaluma, California. In 1999, she became board certified in sports medicine and in 2000 joined the Orthopedic Department at Kaiser in Santa Rosa where she practiced until 2013. Dr. Tucker is also a certified yoga instructor. She also has taught musculoskeletal anatomy on a regular basis along the way in her career. She had a personal experience and along with that, she learned about prolotherapy and learned how to do this as a treatment. She actually had this treatment done for herself and helped her with her chronic pain. It led her down the path to become trained in prolotherapy or proliferative or regenerative therapy in 2009.

She then went on and became an instructor of Proliferative Medicine for other physicians and has done that since 2011. She was in Kaiser Permanente in an institutional setting in the traditional medical model. Insurance started telling her what she could do and what she couldn’t do, which happens to many of us. She decided, “I believe in what I’m doing so much that I’m out of here.” She left the institutional setting and has been out on her own since. Dr. Tucker, how long have you been out now doing your own thing with prolotherapy and regenerative therapy?

Since 2013 and it was the best decision I ever made.

Give us a bit of your background and what led you down the path of learning this regenerative and proliferative therapy called prolotherapy. How did it personally change your life and what led you to believe in it so much?

I used to be very athletic. I was a long-distance runner. I used to mountain bike and ski downhill. I was having a lot of trouble with my back. I didn’t know what it was. Here I was a sports medicine doctor. My X-ray and MRI are normal. I am in a lot of pain. I’m working at Kaiser and I remember sitting at my desk thinking, “I’ve got to go see a patient. I’ve got to go to the nurse’s station and I’m going to go to the bathroom all in one go because it’s so painful standing up to do this.” It was a problem and nothing helps. Physical therapy, epidural injection, massage, nothing helped. Finally, I went and saw an amazing osteopath who realigned my spine. She said, “Your pelvis is out of place. Your SI is problematic. Let me put it in place.” I walked out of there and the pain is gone. It was incredible. We did that a number of times. However, as much as I would try to strengthen, I wouldn’t hold her adjustments. Eventually, she said, “You need proliferative therapy. You need prolotherapy.” I said, “Sign me up,” and we did. It took a while.

It took about three treatments before I could see that it was helping. After switching to PRP after about a year, I was terrific. I was so strong. It was a different ballgame. I thought, “I have to bring this to Kaiser. How can I be the nonsurgical orthopedic doctor and knows about osteopathy and what to do if they don’t hold?” I would sneakily tell them about osteopaths and refer them to private practice osteopaths in our area. I would try to treat with prolo. I would treat at lunchtime and at the end of the day. I would only use my own time. I had a three and a half month waiting list.

Was that because the institutional setting told you, you could not do it in your regular hours?

They said, “It’s not covered by this insurance, so if you want to do it in your own time, you can do it.” I said, “Fine, I will,” and I did.

DH 46 | Treating Chronic Pain

Treating Chronic Pain: Injecting very precisely in the joints with something that acutely inflames it actually induces the body to heal itself.

 

Did patients pay out of pocket for them?

No, I never put it in the records that I was doing this. They didn’t pay out of pocket for it. We did it under the radar.

You would see them for their lumbar degenerative disc disease or whatever their pain was or whatever diagnosis you were using that they would have been seeing you for anyhow and spending that time. You would bill out that time you spent with them, but then on your dime, you would do this procedure that was benefiting them. Is that what you mean?

That’s exactly right. For example, a meniscal tear. I would record it, “Just meniscal tear follow up in six weeks.” There was nothing in the record that showed what I did.

Which isn’t beneficial for the patient nor for you and the institution you’re working for because you’re not getting paid for it. The patients are receiving it, but the records don’t show it. You’re not benefiting profitably for your business from this. How long did that go on for?

That went on for about three years. My chief came to me and he said, “Gloria, it’s not covered. You can’t do this.” I thought about it. Ethically, how could I not? It’s like knowing one and one is two. How could I not know that? I thought, “I’m not going to do this. I’m going to start my own practice and teach people about what’s going on and do proliferative medicine on them.” The next day, I went to my chief and told them, “I quit.”

You jumped ship as some of us do. I myself jumped ship many years ago and opened my own practice. Dr. Tucker and I have known each other for a little while. She has come to the University of New England, College of Osteopathic Medicine where I teach osteopathic manipulative therapy or treatment to other physicians from all over the world at times, but mostly in the United States. I know Gloria has been doing prolotherapy as a specialist in it and I’ve been doing prolotherapy since the early 2000s myself. That’s why I invited her here because this is such a wonderful topic. More and more people know about it. I remember asking when I was teaching physicians, how many people in the audience are familiar with prolotherapy? If you go back to mid-2000s, 2008, 2009, you wouldn’t see very many hands go up. Now you ask that question and the majority of the hands in the room go up. I’m hearing more and more patients have heard of it. You still don’t see a lot that have had it though and a lot that still don’t know about it. That’s why we need to have this conversation. Gloria, what exactly is proliferative therapy or regenerative therapy?

It’s the injection of the supporting structures of the joints very precisely with an agent that stimulates those structures to heal. When I talk about supporting structures, I’m talking about generally tendons, ligaments, sometimes into the joint itself. Injection very precisely in those joints with something that acutely inflames it and then the body heals itself.

How does that happen? How does the body heal itself?

How does it ever heal itself? First we create an inflammation. The question is what do we use to create that inflammation? We, as physicians, want to use the mildest substance possible. In the old days we used to use sodium morrhuate or phenol, but we want to use something more natural. What we’re using now is 25% dextrose, which is 25% sugar water. The body normally has 5% sugar water in its system. The body recognizes that it’s something different and becomes inflamed. After the inflammatory phase, it undergoes the repair phase and then the remodeling phase. The process takes about four to six weeks to take effect and even continues changing for up to two years.

Never give up. Do not accept misery. Keep looking for ways. Click To Tweet

The typical story similar where I say to someone, “I’m going to inject this now,” and I wouldn’t see them back for at least a month. For me, in the essence of seeing how they’ve been responding. Because at first, they’re going to have an acute inflammatory reaction and that can get a little more sore focally and a little swollen maybe. I tell them, “If you need anything, you’re going to only want to take things like Tylenol or maybe Arnica,” something that’s not an anti-inflammatory because you don’t want to block what we’re trying to do. You may not even need anything like that. Within a week or so, that is done. It goes into the second phase, which you called the repair phase. What’s going on with the inflammatory process at that point is that fibroblasts come in and lay down new fiber into the tendon or into the ligament. Therefore it’s going to start rebuilding it or making it denser. Is that correct, doctor?

It makes it stronger. If you think of the ligaments as a rope, and when you’ve had an injury chronically, it’s like a frayed rope. We’re stimulating that rope to heal itself and it takes time. Essentially, it’s the body doing the work. We’re just stimulating it to do the work.

You go into that third and final phase because we’re still not done and we’re a couple of weeks out. It goes into that remodeling phase and what happens there?

That’s where the tissues change to become stronger. People say scar tissue, but it’s very similar to tendon tissue itself. It’s now got some integrity as opposed to just holding itself together.

The one thing I’ve read in research studies is they have shown that the tendons do get denser and it is tending on ligament tissue. It is not scar tissue. The other thing is I like to try and explain to my patients that when the fibroblasts come in and lay down new fiber, it’s as if they’re laying down a pile. It’s like when you rake your leaves in the fall and you have a pile, but that doesn’t mean it has the correct fibrous structural tensile alignment that you’re looking for. It’s a pile of cells. You move around and you are able to do things. It’s like if you’re knitting and you see a very specific pattern, then that pattern starts to develop to give it the right strength that you’re talking about.

I haven’t heard such homey explanations, but it’s exactly right. It’s perfect.

That’s why I do this because I was a high school teacher before I ever became a doctor. I liked to take complex information and simplify it for people so they can say, “I get that. Is that what’s happening?” I was pretty close to describing that. The other thing I want to make sure we talk about is we’ve brought up this idea that inflammation is healing. A lot of people out there hear that inflammation and chronic inflammation is bad, especially in the functional medicine world. Dr. Tucker, what would you say about differentiating those two types of inflammation?

This is a precise inflammation. The physicians who do this have to do a lot of training because we are very precisely inflaming just that ligament or that tendon. The whole body’s not going to get inflamed at all and you’ll know it. If someone treats your arm, it will be inflamed just at that elbow. It will be sore there. When it’s precise like that, the treatment can result in healing there. If you have chronic diffuse inflammation in your whole body, it’s overwhelming to the system. That’s why healing is difficult. This is small and controlled.

You brought up the elbow and let’s talk about a tennis elbow, what’s called in the science and medical world lateral epicondylitis. Any word in the medical profession that ends in “itis” means inflammation. If someone comes to me and says, “I have tennis elbow,” if they have itis and they’ve had it for a couple months, then that’s still acute or subacute. Maybe it’s like a tattered towel. The tendon has become tattered. If you buy a towel and you bought it now, you can’t see through it. It looks great, it’s dense and it’s got a lot of fibers. If you wait a couple of years and you’ve had it in your kitchen forever, when you hold it up, you can see through it. You’re noticing that it’s like a tattered towel. From repetitive use, our elbows and the tendons that help us move our hands and our forearms and attached to our elbows, like playing tennis for 30 to 40 years or other things can make our tendon like a tattered towel. When you first injure it though, maybe you hit the ball wrong four to six weeks ago, it might be an itis. If it’s been there for a year, it’s no longer what’s called an itis. It’s called an “osis,” which means it’s a condition of a tattered towel that sometimes is inflamed, but other times it’s just weak and not working right. Would you agree with that description, doctor?

DH 46 | Treating Chronic Pain

Treating Chronic Pain: Platelet Rich Plasma is better is because it creates a stronger inflammatory response and it has growth factors that help you heal even better.

 

We’re now calling these things tendinosis. The old name would be the lateral epicondylitis and we still use that name, but if we looked at it under the microscope, it’s degenerated. It’s worn out like your towel. We’re stimulating that to get strong.

What we’re actually doing is taking a needle and going down right where that tendon is attaching to the bone and peppering it with the needle, which is one form of re-injuring it, and then injecting that sugar solution, which the body sees as a toxin. It causes that very focal inflammatory reaction for healing purpose. You brought up PRP. You jumped out at that with the sugar solution, but there’s also a PRP. What does that mean?

PRP is short for Platelet Rich Plasma, which is essentially a component of your blood. If you’re a sports fan, you’ll see that all the athletes are using this. In our area, Steph Curry, Tiger Woods, Kobe Bryant, Fred Couples, Alex Rodriguez, everybody’s using it because it’s stronger. If somebody has bad tendinosis for many years, we may choose to try phenol dextrose first. If that doesn’t work, we’ll go with PRP. If it’s bad, we’ll go straight to PRP. PRP is about three to five times stronger. We’ll draw the patient’s blood, then spin it down and take out the platelet-rich components of it. The reason that’s better is because it creates a stronger inflammatory response and it has growth factors that help you heal even better.

Are there other compounds that you might use?

Some people use stem cells, but I would only recommend those into the joint. I don’t use them on tendons. I don’t recommend them on tendons or ligaments at all.

Is that a newer modality, the stem cells? I’m seeing that a lot more from email marketing that I’ve seen.

I’ve done training in the stem cell area, but I don’t use them. My take on it is I would definitely use them for end-stage osteoarthritis. It’s better and just stronger. It’s outrageously expensive and sometimes PRP will work and sometimes even dextrose works for that. You have to balance it out and how you want to try it. If you’re not getting anywhere in a bad significant joint, it’s worth a try.

What do you find yourself using the most and how do you process that with the client or patient?

I take a look at three factors. One, how old the patient is. Two, how long they’ve had the problem? Three, how severe the problem is? If they’re on the older side and they’ve had the problem a long time and it’s bad. For instance, I have a lady who only got out of bed for two minutes every hour for years because of SI instability. She couldn’t stay stable. For her, I went straight to PRP. As I get older, I don’t know what old is anymore. She’s in her 60s, I would call that middle age, but maybe late middle age. We went straight to PRP and she’s done beautifully. Now she walks three miles a day. She’s up washing dishes and cooking meals. She’s back in her life.

Something that you brought up and I also wanted to highlight was the idea that if someone is having these chronic pains and they can’t function as well, they come to someone like myself as an osteopathic specialist doing manipulative or manual medicine and we manipulate. They leave and come back to follow up and say, “I walked out of your office feeling great, but within hours to one day, I was right back where I started.” To me, that is a sign that there is probable ligament laxity or tendinosis particularly down in the pelvis and the low back around all the ligaments that support the sacrum, for example. If someone’s out there reading and you’re like, “I’ve been going to the chiropractor, the manual medicine person, the doctor of osteopathic medicine, whoever it might be. They do help me, but within a day or two, I’m already back hurting again.” That is a sure sign that possibly you have some laxity going on. Would you like to comment on that piece, Dr. Tucker?

DH 46 | Treating Chronic Pain

Treating Chronic Pain: Most of us use our bodies pretty hard, whether it’s in sports, our jobs, or raising a family.

 

This particular lady, she was seeing a chiropractor but she couldn’t stay. On that note, there are people who have injuries and these things don’t get better and they see their osteopath and they can get better. There are also people who have chronic instability everywhere. They move their wrist or they play tennis and their wrist and elbow go out of place. They’re universally loose-jointed. Another name for that is hypermobility. There’s a spectrum of that from a real disease called EDS to people who move out of place easily. It’s important to get yourself straightened out before doing prolotherapy and important to see an osteopath or a chiropractor. You very well may not hold.

That’s the other thing for me as an osteopath and doing osteopathic manipulative treatment as a specialty and then also adding prolotherapy. I always, with my patient with osteopathic manipulative treatment, make sure things are imbalanced first and then do the injection. I’ve found that that’s very important and very helpful. It just may not heal as well and they’re not going to function as well. Add on the functional piece to it all. It sounds like you send out to someone who’s doing the osteopathic manipulation on a regular basis.

I do, although I haven’t taken your courses. I can treat some things, but me taking your courses, as fabulous as they are, it’s very different than going to a real osteopath.

You’ve been taking them for a while and I’m sure you’re doing the treatment yourself because many of the people that come to my classes are either MDs or DOs. It doesn’t matter your background, everybody learns. As far as I’m concerned, as long as more people are doing it to help people get better, the more the merrier. What kinds of things can proliferative and regenerative medicine address? What would be the top issues that you have found you’re treating on a regular basis?

I want to begin with chronic hip pain on the side because most allopathic doctors will call that trochanteric bursitis. What that frequently is instability of the pelvis. When the pelvis is unstable, the hip tendons will hold on for dear life to try to stabilize you. There’s a pattern of pain on the side of the hip and in the front of the hip. You do an X-ray and it’s normal. The doctor wants to help you, but everything looks good. He doesn’t know that what’s going on is your SI is off and if we stabilize the SI, we may have to treat those tendons around the hip as well and your life will change. That’s the big one that I see very often that people are so frustrated with. Secondly is ankle sprains. It’s so common. They sprain all the time and they go on and on. They keep re-spraining. Everybody tries to strengthen them and they just can’t get strong. The flattening of the arch, the plantar fasciitis or that pain you get in the inside of your foot. Not in the bottom of the foot, but are inside where the posterior tibial tendon gets frayed and worn out. It’s so treatable. Meniscal tears, chronic elbow pain, wrist pain, base of the thumb, early arthritis, these are treatable.

TMJ is treatable so that when you’re biting down and you’re getting some pain, it’s very treatable. We haven’t even begun talking about the net. Most of us use our bodies pretty hard, whether it’s in sports, our jobs or raising a family. First of all, we should probably all be seeing a manual doctor regularly, but who does? They’ve got a lot of work to do. When you finally see them, there can be significant changes at the base of the neck, the mid-back and the base of the spine. Sometimes it can be hard to keep that from going in and out or keep that from hurting. What’s your experience?

I have used prolotherapy predominantly of the sacroiliac joints, right down around the tailbone, because the tailbone sits in this humongous ligamentous sling. Typically, it’s very stable but if someone has a history of some abrupt trauma, people fall off a ladder or fell off a horse or their bike or something like that. That’s not the only stories but those are some examples. That is where a light bulb may go on and especially if I treat them, they go home and then they come back and say over and over two or three times, “I was better for a short time, but I’m still not better,” then I’m definitely thinking about that. I’ve also found absolutely that instability in the tailbone can radiate and cause problems out into that hip.

The other probably most common place I’ve used prolotherapy is the shoulder for the rotator cuff especially the superspinatus. It’s not a difficult injection. It’s right where the superspinatus, which is one of the rotator cuff muscles, comes out and attaches on the side of the humerus, basically the side of the shoulder. It’s a very straightforward injection. The long head of the bicep muscle is not one of the rotator cuff muscles, but it comes in and attaches up at the top of the shoulder. If those two are lax, it can cause a great deal of shoulder instability and shoulder pain. That’s probably the other second place I’ve used it the most. Finally, the third most common place for me is absolutely the elbows. It’s either the middle or the outer side of the elbow for either tennis elbow or golfer’s elbow.

It’s a good point about the shoulder. That’s the number one place of tear, it’s that superspinatus region. You can get little small tears. It’s so great that you’re treating it and take care of it before we have to wait until it’s completely torn and separated and have surgery. This treatment has probably prevented so many surgeries in the shoulder.

Doing something that will keep contributing to life will make you have a happy and healthy life. Click To Tweet

I’ve also had people that are older who do not wish to have surgery and said, “I want to try prolotherapy and see how beneficial it will be for me.” It’s brought them to literally zero pain and more function. That’s another avenue in which you see people seeking it out. Let’s talk about insurance and non-insurance. What is going on there? You’ve got a therapy that works and people benefit. Is it covered by insurance and why not? How do we deal with payment and cost?

It’s such a shame. It is not covered by insurance. I think the difficulty is it’s very hard to do placebo-controlled trials because we’re injecting. How can you not notice that you’re getting injected? Secondly, there is no drug benefit. Who’s going to fund these studies since the drug companies won’t make any money doing this? Nevertheless, there have been some doctor-funded studies and some university-funded studies at the University of Wisconsin published in the Annals of Family Practice. There was a good study on knee osteoarthritis using dextrose prolotherapy found significant benefit. There was a great study in the well-respected journal Spine for sacroiliac pain. There’s been a good study for sacrococcygeal ligament laxity and a good study about lateral epicondylitis. These are all out there, but still most allopathic doctors don’t even know. If you extrapolate those studies, we know it works with a shoulder. We know it works for the neck. We know it treats a lot of migraine pain. Unfortunately, the insurance companies aren’t accepting that. I do think it will be accepted. I don’t know when, just the way acupuncture is now being steadily covered more and more, but not quite yet.

What do you charge? How do you work with patients? First of all, when a patient comes to you and they’ve heard you do prolotherapy and you’re evaluating them, what do you explain as the process? Is it just onetime injection and then they’re done and bye-bye? How does this work?

Suppose we’re going to do an area, for instance, the elbow. There are a number of places in the elbow to inject. Right around the annular ligament, two places where the extensor tendons and insert, also the insertion of the biceps on the radius. When I treat a joint, I treat that area. I don’t charge per injection. I’m treating that elbow. The truth be told, I don’t know how many times I’m going to need to do it. I treat once the whole area or every area that’s problematic. We call them in six weeks and we say, “How are you?” They’ll say one of three things. “I feel great,” or “It didn’t work,” or “I’m much better but not completely better.” We’ll say, “Would you like to try it again?” We’ll do it again. I know there are some doctors and I even see some patients where I feel this is going to be a lot of treatments. I give them the option if they would like to be treated every three weeks, we could do that, but they may be responding. We can just wait for six weeks. I’ll leave it up to them.

I usually see people back because I utilize the insurance model for the visit with me. I’m doing some osteopathic manipulative treatment, which typically is covered by insurance and then I can check in with them, “How’s it going now?” If we choose to do the injection, then that is an out of pocket excess cost to the patient. Are you pretty much outside the insurance model completely at this point?

I am, although we can give them the ICD codes and they’re welcome to bill their insurance, but the patients, they reimburse us at the time of the visit.

You’ve brought up what I’ve read through your materials is Perineural Injection Therapy. We haven’t talked about that. What is that?

It turns out that there is a 5% dextrose solution, which when you inject not into the nerve, just near the nerve, it diffuses down and blocks what’s called the TRPV1 receptors, which are the pain receptors of that nerve. For instance, I have a lady who has a below the knee amputation, so she has phantom limb pain. I treat her around her lateral femoral cutaneous nerve or antifemoral cutaneous nerve, way up around the hip. It knocks off her nerve pain. It’s not something I use when the nerve problem is treatable. For instance, if there is a disc that they could do the treatment on, removing the disc or treating the disc. If they can’t, I can treat the pain.

How long will that last?

DH 46 | Treating Chronic Pain

Treating Chronic Pain: The shoulder is the number one place of tear. Prolotherapy has prevented so many surgeries in the shoulder.

 

We treat very superficially. We don’t go deep at all. It’s a very benign treatment and it will last the first time only four hours to four days. It’s a cumulative effect. Let’s say we see it back in a week and it lasted eight hours. The next time, it won’t come back with as much pain, but now it’s going to last sixteen hours. The next time it lasts twenty hours. The next time it lasts three days. It goes like that until we’re seeing them every week, then every two weeks and once a month. If you’ve had chronic unrelenting pain, that’s fine. It’s going to take maybe a year to get this under control, but it’s going to be under control.

We brought up stem cells. Is that being looked at more to be covered by insurance or no?

I think in this arena, no. Not that I know of.

It is too bad. There’s got to be research studies showing the stem cells when you get into that level of cost and everything. Aren’t there research studies that insurance is going to have to pay attention to?

I think it’s coming.

Dr. Tucker, how do people find you if they’re interested in looking into prolotherapy further? How do they get in touch with you?

My name is Gloria Tucker and they can always call me. I’m in Nevada, California. You can look up Dr. Tucker prolotherapy for the website. Our number is (415) 506-4907. More and more natural paths are referring to us, chiropractors, osteopaths. What I’m finding is it’s word of mouth. Patients get amazing relief and their life changes so they tell their friends. It’s amazing. I’m sure that’s happening with you.

When I first opened my practice, I would send letters to the local doctors and to the different institutions. I put ads in the paper and this and that. I’ve done a lot of marketing over my life. To be honest, the number one thing that brings people in is word of mouth. They tell their neighbors, their kids, their husband, their wife, “You’ve got to go see this lady because my life has been changed for the better.” I’m sure the same thing’s been happening for you. Gloria, thank you so much for coming. This has been great. I hope it’s educating people about proliferative or regenerative therapy it’s being called now. If you’ve also heard prolotherapy, these are all terms that are exactly what we’re talking about in this discussion. Gloria, one question I always love to ask all my people, what is your secret to living a healthy life?

It’s never give up. Do not accept misery. Keep looking for ways. Think about swimming or Tai Chi. Most of all, if there’s any way you can keep contributing to life, it will make you have a happy and healthy life.

Thank you, Dr. Gloria Tucker. We appreciate you coming. Thanks, everyone.

Thank you, Trish.

Important Links:

About Dr. Gloria Tucker

DH 46 | Treating Chronic PainI am a Medical Doctor. I did my undergraduate studies at the University of Southern California graduating Phi Beta Kappa in 1983. I attended the University of Southern California Medical School from 1983 to 1987. I did my residency in Internal Medicine in San Francisco and became Board Certified in Internal Medicine in 1990. I practiced that discipline for 10 years at the Kaiser Medical Center in Petaluma, California. In 1999, I became Board Certified in Sports Medicine and in 2000, I joined the Orthopedic Department at Kaiser in Santa Rosa where I practiced until 2013. I am also a Certified Yoga Instructor and a former instructor of Musculoskeletal anatomy.

I am hypermobile, that is, I have always had loose-limbed joints. Yoga was easy for me and I loved gymnastics as a child. In Medical School, I became a long distance runner and did lots of mountain biking. However, I began having chronic low back and hip problems which I didn’t understand. I spent a great deal of time at the Medical Library at UCSF reading all about low back and hip problems, going to medical conferences and although I was board certified in Internal Medicine, I went back and got my boards in Sports Medicine.

I stopped running, and biking and started swimming and doing yoga which helped in some ways but my back still hurt. I saw many doctors and tried strengthening exercises which made it hurt more and cortisone into my back and hip, which helped for a very short while, but the pain returned. Every morning, I would lay in bed, not wanting to get up because it hurt my back, and I used to wonder what would become of me. It was a very hard time. Although I did continue to swim in order to stay strong, I couldn’t walk for more than a half a mile without pain. I was gaining weight.Finally, saw a Chiropractor who really helped me. The pain was relieved when he manipulated my back, but in a few hours, it returned. I did this for a year or so and tried to strengthen my core, but many of the exercises exacerbated the pain. Then I saw an Osteopath who did a manipulative treatment which put my back in, and when the pain recurred, she said, “You need prolotherapy”. We did it, and it was life changing! Now I can go to a Pilates class, ride my bike again, go on long walks and most important get out of bed every morning without pain!

I felt so hopeful again, that I had to offer this to my patients.

I was glad that I had learned musculoskeletal anatomy when I became a sports medicine doctor and had been teaching anatomy and physiology for many years, but the training to become a good prolotherapist required intensive study. I went to many many courses and did very serious training through the Hackett Hemwall Foundation where the most respected prolotherapists in the world come together to teach and learn. I am now an instructor for other doctors to learn Prolotherapy through the Hackett Hemwall Patterson Foundation.

For the last 7 years, Dr. Tucker has gone to Honduras every year to treat pain in underserved people by using prolotherapy. She has been an instructor of Proliferative Medicine to other physicians since 2011.
Once I learned the technique, I offered it to my patients at Kaiser where I was only able to give prolotherapy to two patients per day. Very quickly, I had a 3 1/2 month waiting list. Unfortunately, this is not covered by Kaiser Insurance and I had to stop. But I saw how many people were helped by this, and I decided to start my own practice specializing in Prolotherapy, PRP and Peri-Neural Injection Therapy.

PRP (Platelet Rich Plasma) is another way to treat ligamentous instability and osteoarthritis using plasma from the patient’s own body. In those patients with more severe ligamentous problems or even tears, this is an effective treatment, since not only collagen is layed down, but growth factors are part of the plasma which strongly aide in tissue repair. This procedure is the very one that got Steph Curry back in action with his torn meniscus!

Not everyone has pain due to ligamentous instability, so I researched and learned another effective treatment for pain called Peri-Neural Injection Therapy, and I now offer this treatment to those people who have unusual pain syndromes. It is elegant and simple and works.

 

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