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Treatment Areas

Nerve & Muscle Pain

Back pain, it's the most common type of musculoskeletal pain out there. It's debilitating, it prevents people from working, and it prevents them from participating in exercise, as well as all the activities of daily living. I'm here to tell you that it's treatable. In many cases, it's very easily treatable, and this is not just PT and acupuncture, or chiropractic. It's in addition to all these things. 
 
Hi, my name is Dr Jennifer Stebbing and I would like to talk to you about other alternatives to treating back pain. This includes prolotherapy and sometimes PRP. If your back pain is related to disk disease, or facet arthritis, or issues with the nerves coming out from the spaces between the bones. These are all potentially treatable. 
 
Some people do better, and some people don't do well at all. But I'm here to tell you, that I can assess these type of things and give you a reasonable way to maneuver through the medical system, so that you could get treated as best you can. 
 
I'm Dr Jennifer Stebbing. I'm border certified in Family practice and Sports Medicine. If you'd like to look at my website, it's drstebbing.com and I can be reached at info@drstebbing.com. Please reach out to me, I'd like to help you. Hi, I'm here to talk to you a bit more about back pain. There are reasons for back pain and the reasons behind the back pain can be anything from, for example, that you're out of alignment, or that you have trigger points, or that you have early arthritis, or you have scoliosis, or a leg length discrepancy that's causing a scoliosis. It's really important to evaluate all these things with x-rays, possibly MRI's and an ultrasound that I can do in the office. This helps us determine a more complete idea of why you're having pain. Sometimes the x-ray findings, if you just rely on them, will lead you astray, because they may not be the cause of your pain. 
 
I'm Dr. Jennifer Stebbing. I'm an Osteopathic Family Physician with a Board Certification in Sports Medicine and I use all different types of modalities to evaluate and treat back pain. I'm here to tell you that you can get back to work, you can get back to exercise, as we evaluate you more thoroughly with some diagnostic imaging that's available. If you'd like some more information, you can look at my website, drstebbing.com, or email me info@drstebbing.com 
 Hi. I'm here to talk to you a little bit more about back pain. There are reasons for back pain. And the reasons behind the back pain can be anything from for example that you're out of alignment, or that you have trigger points, or that you have early arthritis, or you have the scoliosis, or a leg length discrepancy that's calling a scoliosis. 
 
It's really important to evaluate all these things with X-rays, possibly MRIs, and an ultrasound that I can do in the office. This helps us determine a more complete idea of why you're having pain. And sometimes the X-ray findings, if you just rely on them, will lead you astray, as they may not be the cause of your pain. 
 
I'm Dr. Jennifer Stebbing, I'm an osteopathic family physician with board certification in sports medicine. And I use all different types of modalities to evaluate and treat back pain. I'm here to tell you that you can get back to work, you can get back to exercise, as we evaluate you more thoroughly with some of the diagnostic imaging that's available. 
 
If you'd like some more information, you can look at my website, drstebbing.com, or email me at info@drstebbing.com, and I will send you two more videos, from which you can get more information to help you feel comfortable about coming in to see me. Hi. Do you have pain going down your legs that you think is coming from your back? Sometimes this is a sign of nerve damage, or nerve compression, or an issue where the nerves exit at the spinal column. But it can also be indicative of a ligamentous referral pattern. There's other referral patterns like sclero patterns and trigger points have referral patterns, as well. Referral patterns are simply where you receive pain, but the pain may be coming from something else. It's really nice to have a doctor that can evaluate you in terms of these different pain patterns because it can change your pain drastically if the reason behind it is evaluated and treated appropriately. 
 
I'm Dr. Jennifer Stebbing. I'm Board Certified in Family Practice and Sports Medicine. I'm here to tell you that, although, back pain is difficult to treat, it is treatable, in many cases. And I'd be happy to evaluate for those. I can be reached at info@drstebbing.com,  
where I'll send you two additional videos that give you more information on back pain. I hope this makes you feel a little bit more comfortable about coming in and seeing me. Thank you. Hi. This is Dr. Jennifer Stebbing. I'm so happy that you're looking at this video. This is a further informative video on back pain, and I'd like to talk to you about causes. There are many different causes for back pain. The most common cause is probably called mechanical back pain, and there is no x-ray changes with mechanical back pain. It's pain that's caused by movement, and for this reason we usually treat people with physical therapy, chiropractic, acupuncture, and other different types of modalities that are aimed at strengthening the core, which includes your abdominal muscles, part of your psoas, your multifidi in your back, and some of the other smaller muscles that help support it. 
 
Because the back has so many different bones in it, there's a lot of room for something to go wrong. On one hand it allows us to have the flexibility, so that we can bend over and bend backwards, side bend and rotate in a whole bunch of directions in the low back. This is an incredible advantage that we have. However, because each of those areas moves, there's a potential injury at each attachment from one vertebrae to the next. The attachments, our joints are called facets and the facets can develop arthritis. When arthritis occurs, it is actually indication that the ligamentous structures that hold the spine together are a little bit lax. So what happens is you have additional movement from one vertebrae to the next, and this can cause the facets to widen as your body tries to stabilize it. 
 
Your body's very smart, it says, how can I make this a more stable joint? What I'm going to do is lay down calcium, make the joint wider. And when this happens, what can occur next is that it can make the space between the bones where the nerves exit the spine smaller, and this is called a foraminal stenosis. And when this happens, you can get pain that goes down into your butt or into your leg that is a result of the nerve being compressed. 
 
Additionally, if the disc is affected, meaning that the  ligamentous structures or these capsular structures that hold it in place are injured. For example, a whiplash injury or if your bio mechanics are such that over time you get an overuse injury that creates the disc to slide forward or backwards or partially to the side, the disc can cause compression near or onto the spinal column. And when that happens, you get a condition called spinal stenosis. 
 
All the literature suggests that if we wait, your body does a good job of trying to fix itself over the course of a year. But sometimes people in their haste to get out of pain, and in some cases, this may not be unwarranted, they pursue surgical options. And when this happens, depending on the type of surgery, you can get further decompensation of the spine over time. So understanding that there are different causes of pain in the spine is important and can be evaluated by MRI. 
 
When we talk about the different causes, then we direct treatment accordingly. For example, we know if the spine is stiff or tender with rotation one way or the other, we may have to use a little bit of manipulation to get that the facets so they're moving better. On the other hand, there may be some soft tissue injury. For example, an injury to the muscle that may cause pain right there, because the muscle then can't do its job properly. Under ultrasound we can sometimes see these defects or these areas where there's tears in the muscle or tears in the fascia, and we're able to treat those simultaneously. 
 
What do we treat these things with? And that's a great question, because sometimes the trigger points can easily be treated with an acupuncture dry needling. On the other hand, if the trigger point comes back again, it really suggests that the spine is hyper mobile and the muscle tightness that is occurring and the trigger points that are occurring are in direct response to try to stabilize that spine. In that case, prolotherapy or PRP can be used to help repair or heal the ligamentous structures or the capsular structures that surround the spine. And there are quite a few of them. For example, the supraspinous ligament can be injured with whiplash. Interspinous ligaments can also be injured with whiplash or any flexion or extension injury. The facet has a capsule around it. The capsules have pain fibers. The muscle itself can be injured, and there's ligamentous structures that we can treat on the backside of the spine. 
 
In addition, there's a huge role for physical therapy which is geared towards getting the back strong. I like massage. I love acupuncture. I like chiropractic. I'm an osteopath. I do manipulations, and we know that there is also probably a psychological cause of pain that can be treated at the same time. 
 
The thing about mechanical back pain is that if we don't treat it, the injury gets worse. So many times people will come in and say, oh yeah, I've had days where I'd lie on the ground for 24 hours and after that it gets better. What happens over time is that there are more days involved, it takes longer to recover, and you get more days lost from work. This is an ideal time to treat with prolotherapy. Once the disease has progressed more, then you start to get arthritic changes in the joint, and you may end up having more larger muscle tears and other things, in which case the PRP becomes really important in terms of treatment. 
 
If there's disc disease or if there's bone marrow changes and things like that, that's when stem cells and other higher level of options exist. And although I don't treat these specifically, I have colleagues across the country that I know that do a great job with treating disc disease. And I can help refer you to that if that's what you need. 
 
In the meantime, a very nutritious diet with lots of fruits and vegetables is important. Supplements such as vitamin D, lots of minerals, fish oil, and probably there's a role for glucosamine in there as well. It can help improve your healing. Obviously avoiding smoking and drinking alcohol plays a benefit in terms of your overall health. And exercise every day is really, really important. You don't have to run. You can do non weight bearing exercises if that's all you can tolerate, which includes pool work or exercise bicycle or an elliptical machine. You don't have to do weights. There are other ways to get your abdomen strong. 
 
The side effects to prolotherapy and PRP have to do with the anaesthetic and also where you are injected. You have to make sure that your needle is in the right place. And for that reason ultrasound is very important in terms of guiding treatment along the way. The following video is going to be about prolotherapy. And if you want additional information about PRP, there's a video on my website that you can look and get general information about that. Thank you for listening to the video. My website:  https://drstebbing.com Please email me at info@drstebbing.com if you have any further questions. Thank you.

Upper Body
– Greater Occipital Nerve
– Cervical Plexus
– Brachial Plexus
– Axillary Nerve Pain/Injury
– Suprascapular Nerve Pain/Injury
– Ulnar Nerve Entrapment or Injury
– Radial Nerve Entrapment or Injury
– Median Nerve Entrapment or Injury

Lower Body
– Superior Cluneal Nerve
– Iliohypogastric Nerve
– Ilioinguinal Nerve
– Lateral Femoral Cutaneous Nerve
– Femoral Nerve
– Sciatica
– Genital Femoral Nerve
– Saphaneous Nerve Injury
– Obturator Nerve Injury
– Peroneal Nerve Entrapment or Injury
– Tibial Nerve Entrapment or Injury

Pelvic Pain or Dysfunction

– Superior Cluneal Nerve
– Iliohypogastric Nerve
– Ilioinguinal Nerve
– Lateral Femoral Cutaneous Nerve
– Femoral Nerve
– Genital Femoral Nerve

Spine


Neck Pain
– Whiplash
– TMJ Pain or Bite Issues
– Degeneration
– Facet Issues or Arthritis
– Headaches referred from Neck
– Cracking, Tightness
– Cervical Plexus Pain-from nerves in the neck that radiate into head, ear, face
– Brachial Plexus Pain- nerves in the neck that lead to pain, numbness, tingling into the arm
– Mid Back Pain
– Rib Pain
– Low Back Pain
– Facet Issues or Arthritis
– Spondylolithesis
– Tightness
– Recurrent Back Pain, especially with a relatively normal MRI
– Stenosis- treated closely with another like minded physician
– Sciatica
– Whiplash
– Scoliosis

Sacroiliac or Pelvic Pain
– Instability
– Leg  Length Discrepancy that doesn’t hold with repeatd adjustments
– Pain after pregnancy
– Night time pain
– Trouble standing up straight
– Nerve Pain
– Abdominal Wall Pain
– Scar Pain

Knee, Ankle, & Foot


Arthritis
– Knee Cap Pain or Patellar Femoral Tracking issues
– Meniscus Injuries
– Medial Collateral Ligament Injuries
– Lateral Collateral Ligament Injuries
– Pes anserine Pain- pain under the joint at the top of the tibia
– Joint Effusion (Fluid on the Knee)
– Tibia-Fibula Joint Pain or movement (outside of the knee)
– Saphaneous Nerve Injury
– Obturator Nerve Injury
– Knee hypermobility
– Dislocations after the joint has been re– placed in correct position
– Scar and Pain after Surgery 

Foot & Ankle
– Ankle & Toes Arthritis
– Bunions
– Chronic Ankle Sprains & Instability
– Peroneal Tendinitis or Tendinopathy
– Plantar Fasciitis
– Tibia Nerve Entrapment
– Peroneal Nerve Entrapment
– Plantar Fasciitis or other foot pain
– Scar pain
– Continued pain after surgery


Shoulder

 I'd like to talk to you about shoulder pain. In this case, we're going to be talking about the rotator cuff. What is the rotator cuff, people ask. The rotator cuff consists of four tendons and muscles that attach right to the humerus, which is the arm bone. There's two on the back side, there's one that comes and travels underneath this bone, and there's a fourth that comes along the front side.  
 
All of them attach to the top of the humerus and are responsible for the small movements in the arm, the little movements. If they get injured, the shoulder does not work quite right, and you end up using larger muscles like the trapezius to help move your arm. That's a coordination pattern that we don't really want and can further injure the rotator cuff. 
 
The rotator cuff, when it gets injured, the most common muscle that is injured in muscle tendon complex is the supraspinatus, and that's because it comes under this bone. So as you move your arm up into space, what happens is if your arm movement isn't correct, this happens. This is called impingement, and if you get impingement and motion, you get this grinding sensation that happens onto the muscle, and it tears. 
 
Now the question is, what do you do if it tears? Many of us have small tears, and do they heal? The answer is yes. They do heal. The question then becomes, well when do you pursue treatment, and is surgery necessary? The answer is says is depends. I suspect that when you have an injury, my thought is that you should be a little bit more aggressive about treating it. Go ahead and at least see a physical therapist who can help correct some of the movement problems that can occur when you have an injury and prevent further injury from happening. 
 
There's a role for massage. There's a role for acupuncture, and there's some chiropractors who can help with that muscle tension. I'm an osteopath. I use OMT, or osteopathic manipulation to treat these areas and try to get them to calm down. However, if the discomfort or the pain persists, and the pain usually happens right where the tendon attaches, and it can radiate down the arm. Sometimes it's found right here, and it occurs with small movements. You know, lifting that arm, or reaching, lifting your arm that way, and in which case, some regenerative treatments may be beneficial, and by that I mean prolotherapy or PRP.  
 
So if you have a rotator cuff injury, I suggest that you get it evaluated, at least by a physical therapist, and if not by a physician, on the earlier side so that you know what you're dealing with
I'd like to talk to you about labral tears today. 
Labral tears are cartilage. They occur on the most inside portion of the shoulder. This is the humerus, or the arm bone, and this is called the glenoid. 
 
The glenoid is the bone that's right inside, and it has a layer of cartilage that helps make the joint a little bit wider so that the humerus, which is a ball on a plate, which is called the glenoid, has a little bit of a curvature to help guide the motion inside it. 
 
The labrum, at least the upper portion, is where part of the capsule in the biceps tendon attaches to.The injury there can be kind of debilitating and can give you a sense of weakness in the arm with lifting things. 
 
What I can tell you is that this is not necessarily a surgical treatment. 
 
We can use  prolotherapy. Sometimes we can use PRP to help strengthen the capsule.And you can recover much quicker, and without a scar, or any surgical complications. 
 
Contact me at info@drstebbing.com, or at drstebbing.com and I'd be happy to give you more information about this.
You know those people that are double jointed. They can take their thumb and bring it down to their forearm or when they straighten their arm it goes past 180 degrees. Or they used to be able to do party tricks where they could bring their leg behind their neck. Those people are hyper mobile. They are great gymnast. It sets them up for being quite a good dancer, ice skater. But they are also more prone to ligamentous injuries. And one of the ligamentous injuries that can happen is at the shoulder. It can become loose. 
 
And what can occur after that is they can get rotator cuff injuries or they can get bicep injuries. They can get other injuries in the shoulder. But the underlying background behind the injury is a loose capsule. And the capsule is something that attaches around the whole shoulder. It's loose on the underside, back down here. So that allows you to bring that shoulder all the way above your head.  
 
There's a redundancy down below, and on occasion that area gets stretched out. This also happens in throwing athletes, for example, tennis players and volleyball players and anybody who uses their arm above their head. 
 
What I can tell you is that even if you have a rotator cuff injury, something right here, and it gets treated with surgery, you haven't treated the underlying cause. And this can be treated before surgery, after surgery and maybe depending on the other injury, instead of surgery. Prolotherapy or PRP can both be used to treat ligamentous laxity or capsular laxity in hyper mobile people. 
 
My name is Dr. Jennifer Stebbing, and I'd love to be able to have a conversation with you and talk to you more about your injury. I can be reached at info@drstebbing.com, you can contact me through my website at drstebbing.com. I'm here to help you. Thank you.

– Arthritis
– Rotator Cuff Tears
– Labral Tears
– Bicep Tendinitis or Tendinopathy
– SLAP Tears
– Acromial Clavicular Joint Arthritis (AC Joint)
– Glenohumeral Instability
– Frozen Shoulder
– Axillary Nerve Pain/Injury (pain or weakness in the upper arm)
– Suprascapular Nerve Pain/Injury (scapula or wing bone pain or weakness)
Hypermobile or Unstable Joints (shoulder clicks or pops)
– Sternal-clavicular instability or pain
– Tightness
– Scar pain
– Posture related injury (shoulder forward)
– Muscle imbalance (common with weight lifters who concentrate on pecs and forget about lats)
– Rib – Shoulder Blade pain or tightness
– Shoulder Dislocations after shoulder has been put back into place.
– Continued pain after surgery

Hip


– Arthritis
– Labral Tears
– Greater Trochanter Pain-pain on the widest part of the hip, noted with laying on it
– Leg Length Discrepancy
– Cam & Pincer Deformity (congenital, from birth)
– Piriformis
– Psoas Tendinopathy
– Quadriceps Tendinopathy
– Gluteus medius, Gluteus minimus – Tendinopathy- weakness with standing on one leg
– Adductor Tendinosis
– Quadricep Tears, Tendinosis
– Hamstring Tears, Tendinosis
– Lateral Femoral Nerve Entrapment/ Injury
– Femoral Nerve
– Groin Pain or Numbness
– Numbness & Tingling of the Thigh or Groin
– Joint Hypermobility (gymnasts, dancers, performance ice skaters)

Elbow, Wrist & Hand


Elbow & Wrist
– Arthritis of Elbow, Wrist, Hand, Thumb, & Fingers
– Medial Epicodylitis or Epicondylosis (Golfer’s Elbow)
– Lateral Epicondylitis or Epicondylosis (Tennis Elbow)
– Ulnar Collateral Ligament Injury (Little League Elbow)
– Triceps tendinitis or tendinopathy
– Ulnar Nerve Entrapment or Injury
– Radial Nerve Entrapment or Injury
– Median Nerve Entrapment or Injury
– Joint Hypermobility

Wrist & Hand
– DeQuervain’s Tenosynovitis
– Trigger Finger
– Finger Joint Pain
– Dupytren’s Contracture
– Carpal Tunnel Syndrome
– Radial Tunnel Syndrome
– Ulnar Collateral Ligament Injury (Game Keeper’s or Skier’s Thumb)
– Joint Hypermobility or Instability

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