Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Te | JPR – Dove Medical Press

Tsung-Ju Wu,1,2 Chen-Yu Hung,3 Chih-Wei Lee,4 Stanley Lam,5 Thomas B Clark,6 Ke-Vin Chang3

1Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan; 2Department of Physical Medicine and Rehabilitation, Yuanlin Christian Hospital, Changhua, Taiwan; 3Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; 4Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan; 5Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; 6Private Practice Ultrasonographic Training, Vista, CA, USA

Correspondence: Chen-Yu HungDepartment of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, TaiwanEmail chenyu810@gmail.com

Abstract: We described two cases and the techniques for using the ultrasound (US) to guide lumbar intradiscal injection with platelet-rich plasma (PRP). The two cases suffered from chronic low back pain. Magnetic resonance imaging revealed posterior annular tear of the L5/S1 intervertebral disc (IVD) in the first case and L4/5 and L5/S1 IVDs in the second case. For the US-guided lumbar intradiscal injection, the patient was placed in a prone position. By placing the transducer in the axial plane at the interlaminar space, the needle was directed toward the center of the aimed IVD. The needle tip was ensured inside the IVD by using the end-feel of sudden reduction of resistance and the poking technique with the transducer oriented in the paramedian sagittal oblique plane. At the follow-up, both patients had significant improvement after the intradiscal PRP injections (visual analogue scale from 7.5 to 1.5 on average). The report indicated US-guided lumbar intradiscal PRP injection to be a feasible approach for treatments of low back pain. Familiarization of the anatomy and sonoanatomy of the lumbar spine is fundamental to achieve the success of intradiscal injection.

Keywords: low back pain, lumbar spine, ultrasound, platelet-rich plasma, intervertebral disc

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Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Te | JPR - Dove Medical Press

Platelet-rich plasma: Does the cure for hair loss lie within our blood? – Harvard Health Blog – Harvard Health

Platelet-rich plasma, or PRP, is derived from the bloodstream and has been used for years to treat musculoskeletal conditions, and more recently, skin conditions. Colloquially termed vampire treatments, PRP injected into the skin or used after microneedling (a technique that uses small needles to create microscopic skin wounds) may help to improve skin texture and appearance. Recently, PRP has garnered attention as a promising solution for one of the most challenging problems in dermatology: hair loss.

Platelets are one of four primary components of blood (the other three are red blood cells, white blood cells, and plasma). Platelets promote cell growth and regeneration. As the term platelet-rich plasma suggests, platelets are generally about five times more concentrated in PRP than in regular blood. This concentration of platelets is useful, because platelets secrete growth factors than are thought to assist in wound healing and tissue regrowth.

When it comes to hair loss, the theory is that platelets, injected deep into the scalp to reach the bottom of the hair follicle, may stimulate a specialized population of cells named dermal papilla cells, which play a critical role in hair growth.

The process of obtaining PRP involves a blood draw and a centrifuge. To yield PRP, blood is drawn from your arm, then spun down in a centrifuge (a machine that spins at high speeds to help separate blood components). After centrifuging, the plasma rises to the top, and the lower part of the plasma is the PRP. Sometimes, a second spin is performed to increase the platelet concentration of the plasma.

Your own PRP is collected, then injected into multiple areas of hair loss across your scalp. The usual treatment plan involves three sessions, approximately one month apart, followed by maintenance sessions every three to six months to keep up the results.

Most research on PRP for hair loss has focused on its use to treat androgenetic alopecia (AGA). Also known as hormone-related baldness, this is a condition that can affect both men and women. In men with AGA, hair loss typically occurs on the top and front of the head. In women, thinning occurs on the top and crown of the head and often begins with the center hair part growing wider. The evidence suggests that PRP may work best when it is combined with other treatments for AGA, such as topical minoxidil (Rogaine) or oral finasteride (Propecia), which is an anti-androgenic drug.

There is not enough evidence to make conclusions about the effectiveness of PRP for other types of hair loss, like telogen effluvium (stress-related hair loss), alopecia areata (autoimmune-related non-scarring hair loss), or forms of scarring hair loss.

PRP injections are not suitable for everyone. These injections can be painful, for both your scalp and your wallet. One session can cost around $1,000, with a series of three treatments needed before improvement may be seen. These treatments are generally not covered by insurance.

PRP injections are considered safe when performed by a trained medical provider. Mild risks include pain, redness, headaches, and temporary hair shedding. PRP may not be appropriate for those with a history of bleeding disorders or autoimmune disease.

Providers currently use a variety of PRP harvesting and administration techniques. More research is needed to understand the best process for obtaining and injecting PRP. Further, more information is needed to understand how PRP helps regrow hair, and how useful it may be for less common types of hair loss.

Follow us on Twitter @NeeraNathanMD and @hairwithdrmare

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Don’t feel bad about your neck a dermatologist urges the importance of protecting ‘the forgotten skin’ – image.ie

According to my dermatologist, the neck starts to go at forty-three, and that's that..." writes Nora Ephron in I Feel Bad About My Neck. "The neck is a dead giveaway. Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn't have to if it had a neck. Here, Dr Rosemary Coleman, consultant dermatologist at Centre for Restorative Dermatology in Blackrock Clinic, Dublin, writes about the importance of protecting what she calls 'the forgotten skin'

From a very early age, we become conscious of our face yet neglect important other regions of skin until many decades later. If we paid them the same attention as our face, theyd remain in far better and more youthful condition. We can get away with it in the winter but not in the spring or summer, or in evening wear when theres a lovely, clear, plump-skinned face and pigmented, crinkly chest and neck to go with it.

Around mid-forties, we suddenly realise we have a neck and that its becoming somewhat crepey, pigmented or blotchy red. It takes another decade to suddenly observe, usually when trying on a summer or evening dress, that the chest skin has now become thinner, more translucent, has mottled pigmentation and broken blood vessels or developed crusty pre-cancerous lesions (actinic keratoses), soon to be skin cancers if not treated.

As for the hands, they are steadily losing their volume from our mid-40s, becoming crepey, developing liver spots and again pre-cancerous crusty areas. As we age further, they show the bruising of very thin old skin, Batemans purpura. Theres a reason why Madonna, Karl Largerfeld and many other celebrities never reveal their hands in public!

Finally, the lower legs are amongst the most common sites for skin cancers as we age. The skin here is very prone to drying out, getting crusty and pigmented and even developing leg ulcers if not cared for. People often forget SPF all the way down there, especially women wearing skirts.

Fret not, help is at hand using appropriate preventative/corrective skincare and restorative skin treatments. Heres how you can protect the forgotten skin.

The skin on these forgotten areas are highly environmentally exposed sites which get significantly sun-damaged and aged.

As with all anti-ageing approaches, prevention is better than cure. There is nothing cheaper and more effective than sun avoidance and protection from as early an age as possible. Society has become very aware of the importance of applying SPF to our face on a daily basis (and remember it should be 365 days a year) but it amazes me why people stop the application at their jawline! I believe that the face begins at the hairline and ends at the cleavage as far as SPF and skincare products are concerned. Even mens necks benefit from daily SPF rather than developing the blotchy red or brown discolouration we so frequently see.

To prevent pigment change and ageing on the neck, avoiding directly applying perfumes and aftershaves here. They interact with daylight and cause unsightly red-brown pigmentation, which can be extremely difficult to remove, so-called Berloque Dermatitis. Im amazed how many women have never heard of this and end up with discolouration on the sides of their necks below their ears.

Remember that 80% of ageing is photo-ageing and not just the passage of time. Clothes offer the best photoprotection for the forgotten skin, complemented of course by SPF underneath. Try wearing light summer scarves for the neck and chest, long skirts and sun protection gloves for driving and rash vests like the ones we put on our children to stop them burning in the swimming pool to protect the upper body while in the pool/sporting activities.

I often ask women if they put rash vests on their children on holidays in the sun and of course, they all do. However, when I ask if they wear them themselves they invariably say no, so I question at what age they decided they didnt need to protect their chest and shoulder skin anymore! Women also forget that if they are wearing a light, wispy fabric that they can see sun rays through, it can penetrate it and damage their skin.

Surprisingly, the skin of the neck and chest can be far less tolerant to stronger anti-ageing ingredients such as retinol and glycolic acid, than the face. However, it can usually tolerate vitamin C, peptides and resveratrol without a problem. If the skin here is pigmented, consider skincare products containing anti-pigment agents such as Skinceuticals Discolouration Defense, Skinceuticals Advanced Pigment Corrector and CE Ferulic Serum, Biologique Recherche Crme PIGM 400 and Lotion P50 PIGM 400, and products containing ingredients such as Kojic acid, Azelaic acid, Tranexamic acid and vitamin C.

Severe pigmentation disorders such as melasma will require prescription-grade products from your dermatologist.

For the hands, SPF is very hard to keep in place because of exposure and frequent hand washing, so consider protective gloves for activities such as golf, or if you do a lot of driving, flesh-coloured fingerless gloves are unnoticeable and easy to buy online. When applying retinol to the face, rub into the backs of the hands also. For lower legs, rich moisturisers containing urea and ceramides are particularly hydrating here, like Eucerin with urea and Cerave.

The face can tolerate stronger, active treatments than the neck or chest which are far more prone to keloid scarring and must be treated very cautiously when it comes to invasive treatments.

For the neck, combination treatments work best.In the early days when the jawline is softening, tightening treatments such as Ulthera will work well and tone everything back up for a few more years. If there is a pronounced double chin, CoolSculpt fat reduction by cryolipolysis might be beneficial in selected patients.

Fat-dissolving injections, not yet licensed in Ireland, can also tweak small fat bulges under the chin. Botulinum toxin injections can dramatically improve longitudinal platysmal bands, soften horizontal Venus lines, sharpen a slightly soft jawline and even improve the crepey appearance of the skin. For severe laxity, all of the above will be a complete waste of money and a little neck lift can be amazing, once you have thoroughly researched your surgeon.

With the hands, volume loss is a major issue for ageing hands. Radiesse, calcium hydroxyapatite, is the ideal volumiser here and results can last up to 2 years, after two 30 minute treatments a month apart.

For the chest, I often find that I cant convince women to mind the skin of their chests until they get their first skin cancer and then it takes a lot of work to try to restore it. Avoid filler injections here as volume loss is not the problem and lumps are almost inevitable.

With tone and texture, having firmer skin in all of these areas will still not look much better unless the tone and texture are also improved. They are all suitable for treatments such as Fractionated lasers, Intense Pulsed Light therapy, Yag laser, Platelet Rich Plasma injections, Sunekos, Profhilo, mesotherapy, micro-needling and skin peels.

These treatments stimulate collagen and elastic tissue production to thicken skin and many can also improve pigmentation and redness. The specific treatment needed must be chosen for the particular needs of the skin of the individual and be bespoke.

Finally, keratoses pre-cancerous lesions need to be treated by liquid nitrogen or chemotherapy creams from your dermatologist.

Dr Rosemary Coleman is a consultant dermatologist at Centre for Restorative Dermatology in Blackrock Clinic, Dublin.

Photography by Jason Lloyd Evans.

Read more:'Everyone should use a topical retinol' Dr Rosemary Coleman on the essential skincare routine

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Don't feel bad about your neck a dermatologist urges the importance of protecting 'the forgotten skin' - image.ie

The Dermatologist Whos Obsessed With Sun Damage – The Cut

Photo: Courtesy of the Laser & Skin Surgery Center of New York

Dermatologist Robert Anolik treats some of New Yorks most discerning faces his clients include Stephanie Seymour and Kelly Ripa but that doesnt stop him from worrying about fictional characters, too. Over the past few weeks, he, his wife, and their 7- and 5-year-old kids have been watching The Singing Detective, an 80s-era BBC show about a hospitalized mystery writer.

It has great music in it, but my kids keep asking me all these questions about the main character, whos covered in psoriasis and has psoriatic arthritis, says Anolik, a dermatologist at the Laser & Skin Surgery Center of New York. All I can think about is how that patient could be helped dramatically today with the approach of medical dermatology.

Anolik was a protege of the late Dr. Fredric Brandt, who was well-known in the beauty world for popularizing Botox. But what initially drew him to cosmetic dermatology wasnt injections or chemical peels, but DNA, RNA, and proteins. As a molecular biology major at Princeton, he spent one summer at the Institute for Genomic Research, studying the science of sequencing the human genome. In medical school, I saw how protein sequence analysis touched every field in medicine, but particularly skin and aging, he says. I approach skin with that kind of molecular framework to make it healthy and beautiful.

During his dermatological training at NYU, Anolik landed a fellowship with famed dermatologist Roy Geronemus, director of the Laser & Skin Surgery Center. Brandt was also part of the practice, and when he wanted to divide his time more evenly between his Miami and New York practices, Anolik became his official associate.

He wanted someone who also had laser expertise, which he knew I had, says Anolik. Even though we looked like total opposites, our personalities clicked.

Five years later, tragedy struck and Brandt took his own life. Anolik seamlessly took over, with high-profile clients now trusting their complexions to him.

These days, until he can see those patients again, hes been volunteering at Bellevue Medical Center, tending to patients with post-op wounds and other surgery-related issues. Stuff that needs attention by a physician, he says. Theyre all so overwhelmed, so hopefully I can help decrease the burden.

Anolik spoke with the Cut about the calming presence of Angela Lansbury, his complicated relationship with fruit, and why now is the perfect time to exfoliate.

Whats your definition of beauty? The Keats line beauty is truth; truth beauty is a chestnut for a reason. When I look at a face, my goal is to reveal its truth, that is to let its beauty become manifest, which is why I work very hard to eliminate distortions, both external (e.g., sun damage) and internal (e.g., psychological negativity).

What do you think of when you hear the term clean beauty? I get wary when I hear it. I believe in the sentiment that drives the clean beauty concept. As a scientist, however, I also believe in rigorous study over intuition and guesswork. Just because something grows on a tree doesnt mean its safe and/or effective. And even the cleanest ingredients in too high a quantity can be dangerous. For example, drinking too much water will kill us. And, conversely, an ingredient that sounds strange or worrisomely artificial can, in fact, be beneficial. A word of caution for those experimenting with only clean or alternative therapies: If you believe something is strong enough to help you, its likely strong enough to hurt you as well. So dont overdo it! And be sure to consult with a board-certified dermatologist about safe strategies.

Where, if anywhere, in your beauty (or life) routine are you not quitethat clean, green, or sustainable? I drink diet soda. Its dumb and I know better, but I do it anyway.

Please fill in the blank as it pertains to beauty or wellness: I think about ______a lot. SUN DAMAGE.

What is the opposite of beautiful? An artificial appearance. Lips that are too big or faces that are frozen are not beautiful. And believe me, I cringe more than you do when its obvious someone has had work done. Just because we can do something in cosmetic dermatology, doesnt mean we should.

What is your morning skin-care routine? Alastin Gentle Cleanser or Neutrogena Ultra Gentle Cleanser, shave, sulfacetamide wash to reduce shave irritation, LaRoche-Posay Anthelios Melt-In Sunscreen Milk SPF 60, SkinMedica HA5 Rejuvenating Hydrator.

Whats the last product you use every night? A prescription retinoid, then moisturizer. Usually Alastin Ultra-Nourishing Moisturizer or Cerave Cream.

Who cuts your hair? Garren. Asking Garren to cut my hair is like asking van Gogh to paint on a milk carton. But hes my friend; he pretends not to mind.

Toothbrush of choice: My wife bought me a Sonicare but I still use the freebie from the dentist.

Razor of choice: Gilette Fusion 5.

Shaving cream of choice: Gillette Fusion Hydra Shave Gel Ultra-Sensitive.

Hand wash of choice: Dove Foaming Hand Wash.

Hand sanitizer of choice: Purell.

Fragrance of choice: Hermes Eau dorange verte Eau de cologne.

Bath or shower: Shower, with Olay Ultra Moisture Body Wash with Shea Butter, R&Co. Television Shampoo, Television Conditioner, and Acid Wash.

What was your first grooming product obsession? In third grade, I discovered mousse. Id blow-dry my hair with it. Maybe I watched St. Elmos Fire a few too many times.

Daily carry-all of choice: Prada nylon shoulder bag. A gift from Dr. Brandt. Prada was a favorite brand of his.

What do you splurge on? My wifes very particular about our sons footwear. Lots of tiny pairs of Air Jordans, Converse, Vans, and Adidas Gazelles by our front door.

What is your classic uniform (under your lab coat)? Black or navy Brooks Brothers pants and black or navy Ralph Lauren crew neck sweater.

Whose shoes are you usually wearing? Greats Royale sneakers.

What do you own too many of? Medical journals. I know at this point that the past issues are all online where I read the new ones, but theres something enjoyable about referencing them with your handwritten notes. At some point, theyll find their way to the recycling bin.

Any secret talent or skill you possess? I can juggle.

What is your own personal definition of misery? Fruit of any kind in my desserts. I love cake but Im crushed when it turns out to be carrot, and I cannot get enough ice cream but I pout when the flavor turns out to be strawberry.

What is your own personal definition of glee? Getting my cholesterol tested. I dont eat all that well, and Im not great about exercising, but my cholesterol is always low. I find that so gratifying.

Favorite way or place to spend a weekend? Nantucket. My wifes family has a house there, and they make fun of me when I wear my aqua socks to the beach.

What do you most often disagree with others about? People who insist they need to get a base tan before a tropical vacation. This is nuts. You should avoid getting a tan before your tropical vacation and during your tropical vacation and after your tropical vacation. Heres what you should get instead: sunscreen and sun-protective clothing.

What must you adjust or fix when you see it done incorrectly? Bad Botox on someone who comes in for a first-time consultation.

Favorite CBD product: Ridgway Hemp Love Balms.

What calms you down? Seinfeld reruns on Netflix. And when Im really feeling stressed: Murder, She Wrote reruns on Amazon Prime (dont judge).

Comfort food: Oreos and milk.

Vice snack: Chili-roasted pistachios and Empire Bakery house-made Twinkies.

What do you foresee as the top beauty and wellness trends for 2020? Combination therapy, specifically more one-day treatments that combine multiple lasers and injections. We have been developing this for years and are now presenting safety data on the subject.Also, laser-assisted drug therapy, such as resurfacing lasers followed by topical applications of skin-brightener serums and platelet-rich plasma. Heres what I hope is the top beauty/wellness trend in 2020: a public repudiation of non-board-certified dermatologists performing cosmetic dermatology procedures on people.

What treatment at your practice is misunderstood and should be morepopular? Laser resurfacing. Granted, this is already a very popular treatment in our office, but I believe it should be even more popular. Somepatients come in with misinformation that laser resurfacing thins theskin. Nothing could be further from the truth. In fact, it does theopposite. It targets collagen-producing cells in the dermis andgenerates a stronger, more resilient skin.

What treatment is currently your favorite (understanding that thiscould change all the time)? Botox. And it has been for years. Precise treatment avoids artificial outcomes and allows for a refined, rejuvenated, lifted, rested appearance.

What activity do you do when the stress becomes too much these days?Cook. Ive been spending a lot of time with my cast-iron skillet. My cast-iron pizza is a favorite.

What have you been binge-watching? Ozark season three for suspense how good is Tom Pelphrey as Laura Linneys brother? And Cheers for laughs.

What has been an upside to this crazy time for you? My time with my wife and young sons, except during the screaming. And the homeschooling. And the cleaning.

Whats a good beauty treatment for someone whos stuck at home? Exfoliation. A downside of exfoliation is it can sometimes leave the skin dry and flaky, but if youre staying home, thats okay!

Conversely, what in your own grooming routine are you less on top of these days?Shaving, although my wife prefers a cleaner look, so early signs of a beard appear only now and then.

When this is all over, what are the first three to five things youll do or places youll go? The office will be my first stop! I miss my amazing patients! I expect Ill be there in overtime mode for a while getting everyone in. Id love a flat white at Laughing Man in Tribeca, maybe a burger at Odeon. Also we watched King Kong with the kids during quarantine, so my oldest wants me to take him to the top of the Empire State Building. He thinks King Kongs going to be there. I havent had the heart to set him straight.

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The Dermatologist Whos Obsessed With Sun Damage - The Cut

Baby Hair or Breakage: How to Tell the Difference – Allure

Christine Shaver, a dermatologist at Bernstein Medical Center for Hair Loss in New York City reminds us that "it's important to differentiate genetic 'baby hair' from broken hair and miniaturized hair as they all can look similar. If hair is broken, then styling practices need to be reassessed as heat, chemical, and over-styling can cause more brittleness and cracking," she says. "Miniaturization is the shrinking of hair in genetic hair loss and can occur in both men and women." Thankfully, this can be reversed to some extent with medications liketopical 5 percent minoxidil ( a.k.a Rogaine). In contrast to baby hairs, which are stable, the amount of miniaturized hair on a persons head will tend to increase over time.

Additionally, Shaver adds that platelet-rich plasma (PRP) scalp injections can help women reverse miniaturizing hairs. "Both these therapies need to be maintained for their benefit to continue as the hair is always growing and cycling," she shares. "While Rogaine can be applied at home, PRP injections require periodic in-office treatments with your dermatologist."

Also watch for changes in texture, Hill notes. "The changes in the texture around the hairline are individual and impacted by your genetic makeup, hair type, texture, and hairstyling habits. Extensive tension, overuse of heat and styling tools, as well styling products can impact the texture as well as cause those finer hairs to grow in coarser and thicker."

Pregnancy can create baby (-looking) hairs temporarily. "Following pregnancy, there is often a large shed period of hair as the plentiful pregnancy hormones decrease in the body," explains Shaver. "Following this shed, hair initially grows back more wispy and fine and then over time strengthens, darkens, and returns to normal."

Ah, the golden question: Do you actually have baby hair or just breakage? Emmanuel weighs in: "If it is breakage, the hair along the edge of your hairline will feel dry, it will also be uneven in length and brittle. You will also notice split, frayed hairs," she says.

"If it is hair loss, you may notice a smooth, shiny surface with little or no hair this may be due to traction, pulling your hair too tight, or overusing hot tools really close to the scalp. The scalp may look red and inflamed as well," Emmanuel clarifies.

So what to do if your baby hairs are really breakage hairs? First, cut back on heat styling. "These hair-care practices weaken the strength of bonding among hairs and can create brittle nodes which lead to premature cracking and breakage," Shaver explains. But if you absolutely cannot help yourself, "You should always try to use the lowest temperature possible when styling hair to avoid additional trauma."

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Baby Hair or Breakage: How to Tell the Difference - Allure

The Best Face and Body Skin-Care Products for 2020 – Shape Magazine

When our panelists were asked which innovation showed the best results, scalp injections of platelet-rich plasma (PRP) for hair growth was at the top of many lists. You get significant benefits with very little downside, Dr. Schultz says. First, your blood is drawn and spun in a centrifuge to separate the PRP, which is then injected all over your scalp. Using your bloods growth factors to stimulate collagen and follicles lets your own body work its magic, says dermatologist Mona Gohara, M.D.

Another new option is a laser called Lutronic KeraLase ($750 to $1,000 per treatment), which is paired with a synthetic growth factor serum. The device stamps across your scalp, stimulating the area and creating tiny channels in the follicles, where the serum is then applied. It delivers active ingredients where theyre needed, says dermatologist Jeanine Downie, M.D. The serum can contain even more growth factors than a persons own PRP, plus stem cells to help hair growth, she says. Nutrafol for Women (Buy It, $79 $88 for 1 month, nutrafol.com), a supplement brand for hair loss, also garnered multiple mentions from our panel. Ive seen promising results, especially in conjunction with the above treatments, Dr. Downie says.

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The Best Face and Body Skin-Care Products for 2020 - Shape Magazine

Twins Daily: How would a shortened season impact MLB injuries? – Bring Me The News

Andy Witchger / Bring Me The News

When major league baseball will resume is anybodys guess. But assuming baseball does have some semblance of a season during the 2020 calendar year, how will it impact the health of MLBers, however stunted it may be?

When major league baseball will resume is anybodys guess. But assuming baseball does have some semblance of a season during the 2020 calendar year, how will it impact the health of MLBers, however stunted it may be?

In many ways this is an impossible question to answer with any sort of confidence at this time. For instance, we dont know when the season will begin, when it will end, the amount of doubleheaders it will contain, if roster sizes will extend and for how long, nor to what extent will there be an extended Spring Training, among other factors that may be in play during the upcoming season.

It seems intuitive that injury rates may increase during the upcoming season as athletes and teams will assuredly have less time to prepare physically compared to a typical season with a typical Spring Training; during the strike-shortened 1995 season, MLB had a three-week Spring Training prior to beginning the regular season on April 25th, which may serve as precedent for how MLB will handle the upcoming season.

While athletes around the league are doing their best to remain in game-shape, each week without access to live pitching and batting practice at game speed decreases the likelihood that the athletes will remain ready for action.

There is some debate, however, regarding the role that Spring Training plays in athlete injury prevention. Spring Training likely decreases injury rates as many musculoskeletal injuries - among athletes as well as the lay population - occur after a sharp increase in activity which was preceded by relatively less activity, however, to what extent is unknown and likely impossible to study with a high-degree of accuracy.

Injury rates are usually highest among MLB athletes during the early portions of the season. A study conducted in 2011 found that injury rates during the 2002-2008 seasons were highest during April (5.73 injuries per 1,000 athlete exposures) and steadily decreased throughout the rest of the season, bottoming out at an injury rate of 0.54 during September.

Later studies published in 2019 and 2020 found that lower body and upper body injuries, respectively, suffered during the 2010-2016 seasons had the highest occurrence during the month of April (24% of all upper extremity and 21% of all lower extremity injuries suffered over the six year timeframe); these same studies found, perhaps unsurprisingly, that pitchers were more likely to suffer upper extremity injuries, whereas position players were more likely to suffer lower extremity injuries.

This is a guess, but it would not surprise me to see an increase in the rate of lower extremity soft tissue injuries - i.e. muscle strains - during the first month or two of the 2020 regular season compared to other seasons, particularly among position players, due in large part to the likely shortened Spring Training interval.

However, as long as pitchers are stretched out and brought along at an appropriate pace - such as capping pitch counts and limiting innings - I could see upper extremity injuries maintaining similar rates compared to previous seasons.

In all reality, it will be impossible to know how the shortened season impacts MLB athlete injury occurrence until after the 2020 season has been completed, and even then how late the season extends into the calendar year as well as the percentage of games that are played as doubleheaders will likely influence the overall rates of injury. We may never truly know the answer as to how MLB athlete health was impacted during the 2020 season.

Blaine Hardy Undergoes Tommy John SurgeryPhil Miller of the Star Tribune dropped a surprising nugget Saturday afternoon when he reported that reliever Blaine Hardy underwent Tommy John surgery recently to address a torn UCL and damaged flexor-pronator mass in his left elbow. Hardy was signed to a minor league contract by the Twins during the offseason.

Hardy dealt with left elbow pain during his 2019 campaign with the Detroit Tigers - spending time on the injured list twice, including a 60-day stint - and received a PRP injection in August to address his pain under the recommendation of famed orthopedic surgeon Dr. James Andrews.

PRP injections involve removing blood from the athlete, separating the plasma from the red blood cells, and injecting the plasma into the injured tissue; PRP is shorthand for platelet-rich plasma as the injected plasma is composed primarily of platelets and water. Platelets, which are small cells primarily involved with clotting, also release healing factors such as hormones.

The increased density of platelets within the injected plasma theoretically spurs the tissue to recover at an higher-rate, however, the true efficacy of PRP injections is debated.

The typical timeframe of return-to-play after Tommy John surgery is 12-18 months.

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This story first appeared at Twins Daily and was re-shared through a collaboration with Bring Me The News.

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Twins Daily: How would a shortened season impact MLB injuries? - Bring Me The News

Stifle injuries and treatments – Tri-State Livestock News

In the past, an injury to the stifle joint of a horse may have certainly ended his or her career or usefulness. Now, with the ever-evolving science of veterinary medicine, afflictions to the joint have a much higher chance of being treated or even healed.

One of the reasons a stifle injury gives apprehension to horse owners is the complicated nature of the joint said Scott Cammack, D.V.M. He practices at Northern Hills Veterinary Clinic in Sturgis, South Dakota, with several other specialists.

Cammack explains that its treatment is much more involved than similar injuries. For example, an injury to the hock can often be resolved by fusing the bottom two joints (the hock consists of four total). Because it is a low-motion joint, the horse will still be sound and function after fusion.

The stifle, on the other hand, is a high-motion joint. Its got a lot of things going on in there. It doesnt have the capacity to be fused and still be sound. I would consider that they are more serious. They are more prone to long-term issues than a hock is, in my mind, he said.

According to Dr. Cammack, the stifle is anatomically similar to a human knee. All the parts are similar to your knee. Just as athletes injure their knees, they injure themselves. They have a patella, theyve got meniscuses, theyve got anterior and posterior cruciate ligaments, theyve got collateral ligaments. One major difference is that humans have one patellar ligament coming off the kneecap, while horses have three. Therefore, horses can have very unique issues.

One condition, often found in younger horses (aged 2-6) is the intermittent upward fixation of the patella or simply a catchy stifle. Dr. Cammack describes this condition: The locking mechanism of the stifle is inappropriately keeping the leg in the locked, extended position. They cant bend their leg and it only bends at the fetlock. That one is one that we treat in different ways. Sometimes, well do a procedure where we put a needle in the medial patellar ligament and we split it a little bit and cause it to thicken up and tighten up a little bit to help correct that. So thats a pretty simple procedure.

Another condition found in younger horses is OCD (osteochondrosis) lesions, a developmental issue. According to Dr. Cammack, they are cyst-like lesions on the bone. Some of them fill in and some require surgery. We saw one just the other day. A four year old had large cysts up in the bone. All they did was turn the horse out and waited. That one filled in on its own, but thats not common. Usually youre injecting the cyst or putting a screw across it or various treatments for something like that.

On the other hand, older horses may have very different afflictions in the joint. He said, In my mind, youre going to see more of the soft tissue injuries in your younger horses and more of the osteoarthritis in the older horses.

Older horses are going to be more prone to seeing arthritis in their stifle, which might be secondary to an injury it had had way back when. They injured a collateral ligament and it wasnt diagnosed, or they have some instability from ligament damage and then it healed some and they got by with it. Years down the road, youre seeing the arthritis, the osteoarthritis in there.

Stifle injuries are often seen in performance horses in various disciplines. When you start getting into any disciplines where theyre having to run hard, turn hard, stop hard, spin. We see it more in the reined cow horses and the reiners and the barrel horses, Dr. Cammack said. However, injuries can occur on the ranch or in other disciplines, as well. Certainly any horse can catch some bad ground or find a hole in the ground or something that can cause them injury.

Interestingly, younger horses may be more prone to injuries that occur in the arena. We are doing our futurities and so much heavy training on them when theyre young and they dont have the muscle memory and the skillset to have their leg in the right place at the right time with that amount of force on it.

Dr. Cammacks procedure for examining horses includes a flex test, where the joint is stressed momentarily to determine the location of any potential weaknesses in the joints. The end goal is to determine how to optimize the horses performance without masking any problems. If the horse deals with chronic issues, the typical injection of HA (hyaluronic acid), a type of steroid, may be administered, costing around $175.

For other injuries, different types of injections may do the trick. Theres certainly a lot more going on with regenerative medicine than there used to be, Dr. Cammack said. Using PRP (platelet-rich plasma) can help the joint heal itself. Youre taking the blood and processing it and pulling out platelet-rich plasma. Its going to have healing factors and certain proteins that can help the joint get better. This may cost around $250.

Theres another one called pro-stride, which is another form of PRP, but its a more concentrated form of PRP. Its more like $450. If youre getting into stem cells, that goes right up. We just pull the bone marrow or the fat, depending on which form were doing and we send it in. With that sample that we send in, we have to send $2,300 to the laboratory. That one can be in excess of $2,500 to do stem cells, Dr. Cammack said. Its an exciting area.

Cammack has devoted his professional career to the study of equines and particularly their joints and movement.

When I was in college, I started working at this clinic with Dr. Margie Jones. I developed a strong affinity for equine work and did a year internship with an equine surgeon in California, but he did a sports medicine practice and then I got in the deep pool of sports medicine and developed a deep love for it, he said.

More severe injuries to the stifle may involve surgeries, which range vastly in involvement and price.

This article serves as a brief overview of a very large field of veterinary study. Dr. Cammack devotes much of his practice and time to learning more about the equine, attending the yearly American Association of Equine Practitioners conferences, and expanding into regenerative medicine.

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Stifle injuries and treatments - Tri-State Livestock News

Platelet-Rich Plasma (PRP) Therapy for Arthritis

Platelet-rich plasma therapy, sometimes called PRP therapy or autologous conditioned plasma (ACP) therapy, attempts to take advantage of the blood's natural healing properties to repair damaged cartilage, tendons, ligaments, muscles, or even bone.

See What Are Stem Cells?

Although not considered standard practice, a growing number of people are turning to PRP injections to treat an expanding list of orthopedic conditions, including osteoarthritis. It is most commonly used for knee osteoarthritis, but may be used on other joints as well.

This article describes how experts think PRP works, who might consider PRP injections for osteoarthritis, how to choose a doctor, and the injection procedure. Also discussed is the available research examining whether PRP is an effective treatment for osteoarthritis.

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When treating osteoarthritis with platelet-rich plasma, a doctor injects PRP directly into the affected joint. The goal is to:

Platelet-rich plasma is derived from a sample of the patient's own blood. The therapeutic injections contain plasma with a higher concentration of platelets than is found in normal blood.

What is plasma? Plasma refers to the liquid component of blood; it is the medium for red and white blood cells and other material traveling in the blood stream. Plasma is mostly water but also includes proteins, nutrients, glucose, and antibodies, among other components.

What are platelets? Like red and white blood cells, platelets are a normal component of blood. Platelets alone do not have any restorative or healing properties; rather, they secrete substances called growth factors and other proteins that regulate cell division, stimulate tissue regeneration, and promote healing. Platelets also help the blood to clot; a person with defective platelets or too few platelets will bleed excessively from a cut.

There is no universally accepted medical definition for platelet-rich plasma, so a PRP injection that one patient receives can be very different than that of another. Variations occur for many reasons, including:

How PRP production and composition affects the therapy's effectiveness is not well understood. Until more research is done, patients considering platelet-rich plasma therapy should take time to learn what is known about PRP.

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Experts are unsure exactly how PRP therapy may alleviate symptoms for certain orthopedic conditions. Doctors who use PRP therapy to treat osteoarthritis theorize that the platelet-rich plasma might:

It could be that platelet-rich plasma does all of these things, or none.5 More large-scale, high-quality clinical studies are needed before scientists can know.

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Platelet-Rich Plasma (PRP) Therapy for Arthritis

Losing Your Hair? This Is Why You Need A Scalp Analysis – Essence

In my journey to regrow my edges, I have been doing a number of things that are supposed to aid in restoring my hairline, including getting PRP (plasma-rich platelet) injections, applying Rogaine 5% topical foam minoxidil daily, washing my hair once a week, steaming and spritzing my hair with a nourishing mist every other day. But I realized that Id skipped one of the most important steps in the process; the one that I should have started with. It was time to get a scalp analysis.

I went to see scalp therapist, stylist and certified trichologist Bridgette Hill at Paul Labrecque Salon and Skincare Spa in Midtown Manhattan. Trichologists specialize in the science of the structure and function of the hair and scalp. They look at elements like fibers, possible scalp disease, and diagnose the cause of hair loss (note: dermatologists can be trichologists but not all trichologists are dermatologists).

My visit was eye opening for a number of reasons, but mainly because Hill did a scope to take a closer look at my scalp in order to better understand the condition of it, my follicles and my hair fibers.

Hair care is really scalp care, she said as she moved the scope around my scalp. Its not sexy. And the beauty industry wants sexy. They didnt make money dealing with the hair care part or the scalp care. So there were many different levels that forced the industry to ignore it because there was really no benefit. That has changed because [hair loss] is becoming more of an epidemic across race, gender, economic [background] and lifestyle.

Seeing my hair fibers and scalp through a scope brought some perspective to my treatment process. For one, I found out that my hairline was inflamed, which is bad for blood flow and can affect your scalp analysis. When I went to see Hill I was wearing a headband wig combination that was creating pressure along the hairline.

Hill was able to show me what the scalp looks like when its inflamed from pressure versus when its allowed to breathe and let blood flow. My constant wig wearing is not helping with growth. I also found out that I have wispy little hairs trying to push through follicles that I couldnt see with my naked eye. Its called miniaturization. The bad news is that miniaturization is a negative and typically means future hair loss. The good news is that my follicles are still active, and if I treat them right, we can reverse the damage and further loss.

Miniaturization is when we know that that follicle is being compromised. It can be compromised because of inflammation. It could be compromised if youre ill. It could be compromised because of genetics, whatever that is, Hill told me.

But the good thing is, they exist. Meaning that thats a hair follicle, nothings coming out of it, but I still see that little speck. I probably can get a hair or something out of it. Every time you see these little brown specks, those are follicles that just may need to be revved up.

Most people have anywhere from two to five hair fibers coming from each follicle, depending on how thick or thin the hair is. I had on average two; my hair being on the thinner side. But my fears that my edges wouldnt grow back at all were quelled. I was worried about keratinization, which happens when the hair is completely gone and it does not come back after miniaturization. It turns into scaly, baby soft skin just like Whitney Eaddy, the growth guru, told me months ago. I was relieved.

As someone who has suffered severe blood loss from fibroids, Hill also advised that I get my ferritin levels checked. Ferritin is a blood protein that contains iron, so low ferritin levels may mean iron deficiency. She noticed that my hair was very brittle even in areas of the scalp that were very healthy, which indicated to her that there was in internal issue causing hair damage. It could also be a catalyst for the hairline loss (in addition to my traction alopecia).

I didnt need to get a ferritin check to tell her that my iron levels were low (my Gyne had put me on iron supplements almost a year ago because of my abnormally low blood levels). But just mentioning this opened my eyes to the fact that my fibroids could essentially be affecting my hair health in ways that I never considered.

As a beauty editor Im exploring topicslike this all of the time. And I have access to experts that the average womanmight not. So I asked Hill, what should a woman do when she starts noticinghair loss and shes unsure of the cause or shes started treatment and itsgoing slowly. These are her three tips:

At the end of the day, seeing my scalp close up and having a professional explain what I was seeing was a big part of understanding how to treat my particular hair loss. Hill was able to show me things I was never able to see at home in my bathroom mirror. I found out things I didnt know, and corrected misconceptions that I had about my own hair.

But the biggest thing I took away from the scalp analysis was that theres hope. Im one step closer to treating my particular hair loss properly because I now know what Im working with. Whether you have follicles that can be reenergized, or your follicles are completely closed, it will help inform how you proceed with your treatment process.

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Losing Your Hair? This Is Why You Need A Scalp Analysis - Essence