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Episode 22: Tissues, Issues, Platelet Rich Plasma (PRP) & More with Dr. Musnick, MD

Updated: Jan 15

Podcast Drop Date: 10/11/23

In this conversation, Dr. Musnick focuses on tendinopathy, osteoarthritis, and regenerative orthobiologics like platelet-rich plasma (PRP) and bone marrow aspirate (BMA) injections, explaining the differences, ideal candidates, and potential benefits for various conditions!


Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper.

Amber Warren, PA-C: Hey, welcome back to all our listeners. I'm back here with Dr. Musnick. Dr. Musnick is a highly accomplished clinician and diagnostician, specializing in orthopedic sports, medicine and functional medicine, with board certifications in both sports medicine and internal medicine. He brings an impressive 33 year background in both sports medicine, internal medicine and internal medicine. And he has 26 years of experience in functional medicine. His extensive experience has led to the development of his unique assessment and treatment approach showcased through countless cases. Not only has his work been published in numerous books, but he's also a sought after speaker on various conditions, most notably osteoarthritis and concussion management. Originating from Boston and spending much of his career in Seattle, Dr. Musnick now calls Idaho his home, Idaho, bringing his expertise and passion for athletics, outdoor activities and specialized treatments in the community. I wanted to point out that he's been doing orthopedic injections, which we'll be discussing today for 27 years. His first PRP injection he did was ten years ago, and he actually has written a chapter in an orthopedic textbook on Tendinopathy, which we'll be discussing today. And he's got that book to show us all. For those of you watching on our YouTube channel and we want metabolic therapies.

Dr. David Musnick, MD: In orthopedics, I have two chapters in that book, too.

Amber Warren, PA-C: Oh, my goodness.

Dr. David Musnick, MD: Yes. And you know, for our listeners, if they have any idea how much time it takes in research to create a chapter.

Amber Warren, PA-C: Oh, I can only.

Dr. David Musnick, MD: But I was honored to be chosen as the doc in the world to write the osteoarthritis chapter and the tendon chapter.

Amber Warren, PA-C: That's amazing. So I know we spent kind of part one really digging into osteoarthritis, what it is mechanistically and our approaches and how you treat osteoarthritis. So today we want to dig into more of the regenerative orthobiologics and touch on tendinopathy, which I think is just as important to educate our listeners on as osteoarthritis. So maybe we start there. What is Tendinopathy? What should our listeners be aware of?

Amber Warren, PA-C: So you got the stage.

Dr. David Musnick, MD: First thing is, there's a difference between tendonitis and tendinopathy. Okay? And it's really important that people understand this. Most clinicians, primary care docs, they don't understand it, so they think everything's tendonitis. So Tendinopathy is a degenerative condition of a tendon. One of the risks of tendinopathy is that the tendon could tear either partial or total. And so what's really interesting about this, we're going to be talking about platelet rich plasma. If a tenant has a partial tear platelet, rich plasma is a very good treatment for a partial tendon tear. But if a person has pain in a tendon that's lasting for more than two months and it hurts when they move it, it hurts when they use it or it hurts when they sleep or whatever, they really got to get it checked out to see if it is tendinopathy So one of the issues is like, how do you know something's in a tendon? Well, the tendon is at the end of a muscle and a tendon attaches a muscle to a bone. And so there's a lot of tendons in the body. And if you want, at some point I could talk about which tendons are affected the most by Tendinopathy.

Amber Warren, PA-C: Yeah.

Dr. David Musnick, MD: And then and then tendon tears.

Amber Warren, PA-C: Let's, let's, let's talk about it. Yeah. Which ones do we see most affected by this. Okay.

Dr. David Musnick, MD: So you start out in the hand with thumb tendons and even on the forearm, people could see if they're looking at the video, which is on our YouTube channel that I'm pointing to, this part of the forearm that that really regulates regulates the what's called the extensor compartments of the thumb so people can get this tendonitis or inflammatory tendonitis here. And then did you know that this stuff called golfer's elbow and and tennis elbow a lot of people that get that they're not golfers or tennis players so it is a tendon degeneration Tendinopathy yet and the medial elbow in her elbow or lateral elbow that will go on and on and on and cause a lot of pain and and people have trouble doing things with it. So those are those are tendon problems. The shoulder is a classic place for this. The long head of the biceps, if anybody can see on the video that I'm pointing to my shoulder here and right in the middle of it, but also the other place is the rotator cuff. So there's four rotator cuff muscles and there's three of them that act up. But the most common one is called the supraspinatus, which is like the front anterior of the shoulder. But then there's the infraspinatus, which is on the back of the shoulder, and those years can develop tendinopathy, but the subscapularis can do it too.

Dr. David Musnick, MD: And here's an interesting thing. It's like when someone comes in with one of these problems, we the better clinicians are going to find all of it, not just, okay, you have that, let's just stick a needle in that and treat it with PRP. Let's find all of the issues here so we can make a complete diagnosis of what's going on with the tissues in that painful area. And then you go down from there and believe it or not, a lot of what people call hip bursitis is tendinopathy of the glutes of the glute muscles. Yeah. So, yeah, so most of the time people don't have swollen verses or inflamed verses at the side of their hip. You know, this hip pain. They say, Oh, it hurts when I lie on my side. It's a tendinopathy. It's a tendon problem. Usually if the glute medius, but it could be other gluteal muscles and that needs to be treated as a tendon problem there because if a doctor injects cortisone and the Bursa, yeah, it usually doesn't work. It doesn't work very long, or it could lead to rupture of one of those tendons or a tear of one of those tendons.

Amber Warren, PA-C: And then the steroids weaken, right?

Dr. David Musnick, MD: Very classic places for tendon problems are the quad tendon, which is the top of the kneecap and the patella tendon, which is attaches the kneecap to the tibial tuberosity. So there's two tendons in the knee classically involved with this. And then a big one in the ankle is the Achilles. And then there's something that's similar to a tendinopathy in the bottom of the foot called plantar fasciitis. And it's actually very similar to a tendinopathy, but there's some different aspects of it, but it can be treated somewhat similarly.

Amber Warren, PA-C: So we talked about in our osteoarthritis conversation, what is what are some predisposing factors, right? We've got age and immobility and inflammation. Is it similar with these tendinopathies? Well, who are the people getting these tendinopathies and how are they presenting?

Dr. David Musnick, MD: As we get older, even after 3540 people will get these. But I've seen them in people in their 20s. So overuse I've been amazed by. By this, seeing this in people in their 20s. Yeah, it's definitely overuse, but it's not intentional overuse necessarily. Like the person isn't intending to overuse something. But another thing that can lead to it is injuries. So like someone gets into a car accident, believe it or not, they're frequently going to have a rotator cuff or biceps tendinopathy because the neck and the shoulder get involved with this. So sprains or strain strains can lead to tendinopathy so the tendon gets overstretched from an injury or a fall or something running can lead to Achilles tendinopathy where the tendons just can't repair. So it's a problem of repair, use and repair. But the other interesting thing is you can get a person can get a tendinopathy because there's a spasm or a trigger point ropelike spasm in the muscle, pulling up on the tendon, causing a shortening and a tendinopathy or the muscle just isn't strong enough. And then they get. So there's many different factors why they're getting it. So we don't just want to treat it, we want to figure out why it's going on. I mean, I see a lot of people with Achilles Tendinopathy and their shoe wear is is not supportive enough.

Amber Warren, PA-C: Yeah. Or their their their stance when they're weightlifting, their mechanics when they're weightlifting.

Dr. David Musnick, MD: Or people with this hip tendinopathy or the hip bursitis, there sure is not supportive enough and it's going all the way up into the hip. Yeah. And the side of the hip. So remember, pain at the side of the hip is often not a hip joint problem. It's often a tendon problem.

Amber Warren, PA-C: So what are you doing when you evaluate these patients that they might not get if they go to? I don't know, local orthopedic office or sports medicine office.

Dr. David Musnick, MD: I think any good evaluation has to be really complete. So one thing I said before, we want to we want to identify all the structures that are involved. So we want to identify the tendons that have tendinopathy. The best way to do that is with musculoskeletal ultrasound, because that will show a change in the tendon and that's definitive. Definitive either it's there or it's not. But also relative weakness could be there on physical exam. These tendons are very tender to touch often, so we want to do like a physical exam and actually palpate them. We want to check all the muscles around the area to see if anything is shortened. So we want to check muscle lengths, muscle strength, the gait in the shoulder. We want to check range of motion, all kinds of things. I want to know how someone sleeps because oftentimes they're decreasing the blood flow to the tendons at night with hip issues. I want to know how they sleep. So a lot of things go on in an evaluation, including the ultrasound of the tendon itself. I also want to check the ligaments because if you have, say, a loose shoulder, because the ligament, the joint capsule, the shoulder, then you have a tendinopathy. But if you treat the tendinopathy, it's going to come back. If the shoulder ligaments are not snugged up or.

Amber Warren, PA-C: All about.

Dr. David Musnick, MD: Mechanics, yeah, there's a lot of issues.

Amber Warren, PA-C: So how would I, as a 38 year old female that tries to stay active and every once in a while deals with aches and pains or ailments? How would I know if it's a tendinopathy versus an osteoarthritis or like a muscle issue?

Dr. David Musnick, MD: So you'd have to you'd have to say, okay, the place where I'm hurting is in a tendon location. Okay. So I have to say this. This seems to be at the end of a muscle. Yeah. Okay. It seems to be near a bone.

Amber Warren, PA-C: So you need to know anatomy to kind of know.

Dr. David Musnick, MD: Well, you know, you don't have to know anatomy, but you'd have to say, okay, you know what? I don't think this is just a muscle. Okay? Or maybe you went to a massage therapist and they say, you know, this is a tendon, right? So, I mean, someone could go to a massage therapist and say, will you let me know if any tendons are acting up? And the way to treat tendinopathy is not necessarily with massage, but maybe they could tell someone that the tendons are acting up. Um, so, you know, these days there's all these apps where somebody could say where they hurt and what it might be. But, but I know that we're going to soon have on our website pictures of the human body and where these tendons are. We don't have that yet, but we're going to have that.

Amber Warren, PA-C: Yeah. Okay.

Amber Warren, PA-C: So treatment modalities for these tendinopathies, I know PRP, plasma rich platelets is one of your favorites. Yeah, and something we're set up to do here in the clinic. Now tell us a little bit more about that. What is it? Why does it help so much?

Dr. David Musnick, MD: So PRP is especially important for Tendinopathy because it can help regenerate the tendon. So so if you say, okay, what is tendinopathy? Well, one term that describes it's degenerative. It is a change in the tissues. These tissues are not strong enough. They don't have enough fibroblasts content, they don't have enough tenocytes, they're not structurally strong and they could tear or they could already have a partial tear. They could have both tendinopathy partial tear. If there's a tendinopathy and it tears in half, well, that's a surgical issue. So PRP or platelet rich plasma is concentrated the concentrated platelet fraction of the blood. So what's interesting, and I use this analogy is like if you get a CBC done, a complete like a complete blood count, so you're going to get a count of red blood cells or you're going to get a count of platelets to and this is fascinating to me because if I'm going to evaluate someone and say, okay, is PRP appropriate for you, I'm going to do a platelet count. I mean, I'm going to do a total evaluation with an ultrasound, but we're going to order a platelet count because if someone is low in like their platelet counts, like 90,000, that's less favorable than their platelet count is 180,000. Because if we're talking about PRP is like a minimum of five times concentration, better, six times really good, 16 times if you can get it with the equipment that you have. And so it's so people might be listening to this or watching this.

Dr. David Musnick, MD: They say, what do my platelets have to do with the tendon? You know, because platelets are in the blood, right? So what most people know or they may not know is one of the amazing things about these little platelets because they're little and they're smaller than red blood cells is one of their biggest jobs is to coagulate so someone doesn't bleed to death when they get a cut. Right? So we have two systems in our body. We have the we have the coagulation factors and we have the platelets. But the other thing is these platelets do other things. They're like a storehouse for growth factors, which is really interesting. And it's amazing that it was discovered because these growth factors can be concentrated through kits and a centrifuge to bring not not only, you know, because it doesn't make sense to draw someone's blood and inject that into ten and it won't really do much, okay. Because they're not getting anything than one time. It's called one time or one time. The amount of platelets they have, it's not enough. It's so happens that in order for PRP to be really useful, it has to be a concentration of at least six times. And that also has to do with what the platelet count is. Because if I get someone with a platelet count of 100. I might want to do a concentration of 12 or higher times than if I have someone who has a much higher platelet count.

Amber Warren, PA-C: You don't try and increase the platelet count before you would proceed with.

Amber Warren, PA-C: It's hard to do that. Yeah, I can imagine. It's very hard.

Amber Warren, PA-C: I was going to ask how you do it.

Amber Warren, PA-C: That's my.

Dr. David Musnick, MD: There's another issue. So if someone had thrombocytopenia, which means they have an immune problem, that's a whole nother issue where we have to then work on the immunology of that to get the platelet count up right. But with the average person that doesn't have that disorder, then we want to do the platelet count. We want to determine, okay, what do we need regarding the PRP? What concentration do we need? How much do we need to put in, Where are we going to put it in? Because that's another thing. It's like not only is it going to be need to be highly concentrated because there's some systems out there that only concentrate at two times, you know, and there's some people getting, you know, they don't even know what they're getting when they sign up for these programs and they're getting plasma.

Amber Warren, PA-C: Yeah, well.

Dr. David Musnick, MD: They're just getting a draw of plasma. And that put it doesn't do much.

Amber Warren, PA-C: So they're not actually.

Amber Warren, PA-C: Getting therapy.

Amber Warren, PA-C: Even though they're not getting PRP because in.

Dr. David Musnick, MD: Order to get PRP, it has to be at least 5 to 6 times concentrated. So that's why someone has to have a really good plan for this and have the right product, right? It's from their own body, but the right kits and the right centrifuge to accomplish it and have their platelet count done. And then there has to be a plan. Where is it going to go? Now, the other interesting thing is. If someone is going to get this done, they better ask, is this ultrasound guided or is it fluoroscopy guided? What is it guided? Because if it's not guided, then the doctor is guessing where it needs to go. And I was talking to a.

Amber Warren, PA-C: Physician, even in like the.

Amber Warren, PA-C: Knees, those with pretty accessible joints. You still like to do ultrasound guided.

Dr. David Musnick, MD: There have been some studies done where they had some some solution and contrast medium and all these orthopedic surgeons. It's in the knee. And they did imaging studies and it wasn't in the knee. It was in the fat pad. It was someplace else. And if you put PRP or something else in and it doesn't go in the joint space, but it goes in the fat pad or someplace, it can be incredibly painful and make the person worse. So I would say when people are looking for this to be done, there's many questions you got to ask. But one is, is it image guided? Is it guided by imaging?

Amber Warren, PA-C: Great point. And I know you use PRP combined with other modalities. So it's not.

Amber Warren, PA-C: Just. Yes, it's.

Amber Warren, PA-C: Not just PRP. You're offering these patients.

Dr. David Musnick, MD: Yeah, I am. One of the only persons that is could combine it with frequency specific microcurrent or pulse magnetic field. I think it makes it even more effective to do it that way. But I want to give I'll give my patients the options and I'm not saying it has to be done that way because there's many docs in the country that don't use those modalities have good effects. But I think we can have even longer term effects if we do that.

Amber Warren, PA-C: And it's not covered by insurance, we.

Amber Warren, PA-C: Don't see PRP.

Dr. David Musnick, MD: Is not covered by insurance. And there are a number of a lot of different procedures that aren't covered by insurance. Um, so that's, that's, that is true. Although I say like, say someone gets PRP in the sacral iliac joint, then there is a way to give them a coding sheet for the standard joint codes for these things for them to get something back.

Amber Warren, PA-C: Okay.

Dr. David Musnick, MD: But the PRP part of it, they don't get back, but they can get back for the coded joint or the ligament or the tendon or maybe.

Amber Warren, PA-C: There are ways to code.

Dr. David Musnick, MD: So that they might get something back. Okay.

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Amber Warren, PA-C: Um, anything else you want to speak on with regards to PRP injections that you're offering?

Dr. David Musnick, MD: Well, I want to say where it can go.

Amber Warren, PA-C: Okay. Because the only.

Dr. David Musnick, MD: Thing I've talked about right now is it can go into tendons that have tendinopathy. It can also go into tendons that have partial tears.

Amber Warren, PA-C: Great.

Dr. David Musnick, MD: So the most common place for partial tears are in the shoulder. But PRP is incredible in arthritic joints. It can go in the knee, it can go in the hip. It can give people a lot of inflammatory relief, pain relief, growth factors that support the cartilage. It can give them a lot of relief in osteoarthritis of the knee, the hip. It can even go in the shoulder. It can go in the joint, so it can go in joints, it can go in ligaments to to strengthen the ligaments around the joint. Um. So there are a lot of benefits from it in all those different tissues. It can even go in the spine.

Amber Warren, PA-C: Yeah.

Amber Warren, PA-C: Amazing. Yeah. I mean, I'm, I'm somebody that has done the PRP facial. They call it like the vampire facial because all those growth factors. And how.

Amber Warren, PA-C: Did you like.

Amber Warren, PA-C: It? Yeah, I loved it. They just do Microneedling And then you do? Yeah, PRP and they apply it to your skin so that it can get into the dermis.

Amber Warren, PA-C: That's pretty cool. Okay. I should look into that.

Amber Warren, PA-C: Yeah, it's fabulous. I mean, it's kind of one of the newer things and I don't know how new it is, but, you know, talked about things with for anti-aging.

Amber Warren, PA-C: I can't.

Dr. David Musnick, MD: Stick needles in myself, so I will not do that procedure on myself, but I'm going to.

Amber Warren, PA-C: Look for it. You should.

Amber Warren, PA-C: You should. Well, it's microneedling it's not like the same gauge size is what you're using to put in a hip. But so I'm really intrigued. I know a lot more about PRP than I do this bone marrow aspirate that you're offering. Okay, so I really want to talk about that. So how does that differ from PRP?

Dr. David Musnick, MD: Okay. So b, m, A or B, it's also called bone marrow. Concentrate. Okay. Okay. So it's so happens that in certain places, in our body. We have in bone marrow. We have these things called mesenchymal stem cells. And they can promote growth. And they and also there's growth factors in there, too. So but the interesting thing is it has to get harvested. So it means that we have to put something in comfortable prone position beans on their belly, give them anesthetic, numb them up and get the bone marrow from mainly the what's called the iliac crest and get enough of it. And then it has to be concentrated. So, you know, what I think is interesting about this is that. Many times. I think that it's that that product is most helpful for osteoarthritic joints, but PRP is too. So PRP is less expensive than bone marrow aspirate. So I usually suggest to people that they try PRP first.

Amber Warren, PA-C: How much better is bone marrow aspirate?

Dr. David Musnick, MD: Somewhat better, but not as much better as some. So so there's some there's some clinics that only offer it. And I'm from Seattle, and I can tell you that patients used to come in to see me and say, Oh, I just got this procedure for $8,000. I said, What was it? Well, it was a bone marrow, and that's all they did.

Amber Warren, PA-C: Eight grand. Yeah.

Dr. David Musnick, MD: And that's all they did. They didn't they didn't do the supplements. They didn't do the homoeopathy. They didn't do the they didn't, they weren't offered anything else except that. Yeah. And so my theory well, my experience with it is everything works better if you have a complete, comprehensive, integrative approach to supporting the joints. But I do think that because it's the person's own bone marrow and mesenchymal stem cells, it has a lot of potential. It so happens, even as we age, that we still can have some good product. Even if you're harvesting it out of someone 60, we can still have some good product. It's it's they've it's even been done in 80 year olds and had efficacy so I think it's a really good option. Um but because it's a little bit more uncomfortable than PRP, I would always probably start with PRP.

Amber Warren, PA-C: Okay.

Amber Warren, PA-C: That's fair. That's fair. Um, how long does it last compared to PRP? I guess, How long does each of them last? Prp versus bone marrow aspirate?

Dr. David Musnick, MD: It really depends because this is a really interesting thing because if you just talk to doctors that do these injections and they don't do the supplements and they don't do the homeopathy or or the modalities. Prp can give relief for about a year and a half or more.

Amber Warren, PA-C: Wow.

Dr. David Musnick, MD: Um, same thing with bone marrow aspirate. And then so it just depends on the person. Um, when they might need another treatment, you know, and it depends how severe the osteoarthritis is because I'm not going to offer PRP or bone marrow with someone who's completely bone on bone and doesn't have anything left and can barely move. It's it's just not fair. Unless they said, Look, I want to try this because I can have surgery for a year and then I've done this on people and giving them a lot of relief. So I want to always be realistic with my patients, say, this is what you can expect, right? Um, because one would say that it's for, you know, mild to moderate osteoarthritis, not so severe that there's not much cartilage left.

Amber Warren, PA-C: Who do you think is the most ideal candidate for PRP or bone marrow aspirate?

Dr. David Musnick, MD: Well, for PRP, anybody with chronic tendonitis or tendinopathy, you know, especially shoulders, elbows, I mean, people with, you know, this chronic elbow pain, lateral epicondylitis that's really affecting their life. They like they can't even use their arms very much. Um, people with biceps, tendinitis, rotator cuff tendonitis because they say most things that are called tendonitis are not tendonitis. Right? Like I always say, okay, look, you know, like I finally decided three months ago to hire a trainer. And it just so happens in this part of Idaho, there's a gym called Axiom Gym. And I just okay. And I know that there's other people in this organization that have bigger biceps than I do, and I can deal with that. But I'm trying to enlarge my biceps as part of a image thing. But anyway, I hired a trainer and and so I will get some tendonitis occasionally. Okay. I mean, I will I'll get it in the biceps tendon. I'll get it in the rotator cuffs. I'll get it in the knees because I'm really like. Like a trainer will take you to fatigue and like, it's not just so it's tendonitis is different than delayed muscle soreness, delayed onset muscle soreness. Like oh yeah, my muscles ache the day after I did something. This is the tendons. Yeah.

Amber Warren, PA-C: Okay you can you can tell.

Dr. David Musnick, MD: But it doesn't go on for more than three four days a week. Okay so but what I'm talking about this chronic tendinitis of the shoulder, um, the elbows, um, and then um, the Achilles tendon tendonitis, the tendinopathy, which is inhibiting people's function, the patella or the quad tendonitis around around the knee, those are all great. Good idea. Great areas for PRP. Um, partial tears, partial tears at the elbow. Okay. Like for instance, ligament tears. Recently I had a, I had a patient that was a pitcher for high school and he had a partial tear of the ulnar collateral ligament of the elbow. And he couldn't pitch a whole game without having pain shoot. So that's a totally appropriate procedure. Um, so there are ligament problems that are totally appropriate, like the medial collateral ligament is overstretched or partially torn lateral collateral of the knee, um, the anterior tib fib ligament of the ankle, you know, people with these bad ankle sprains that are now a bit loose, um, shoulder looseness, totally appropriate for PRP on the capsule. So that brings up the issue of identifying every tissue that has an issue and making a plan for it, because incomplete PRP is where you just put it in the joint. But if the ligament needed it or the tendon needed it, you didn't. So you want to identify all the tissues. That's a really complete plan for PRP besides having a high concentration of it and have it image guided and sterile procedure, all of it.

Amber Warren, PA-C: And then have the patient.

Dr. David Musnick, MD: Take and a good rehab program afterwards.

Amber Warren, PA-C: And have them take good care of themselves.

Amber Warren, PA-C: Sleep stress management, right.

Dr. David Musnick, MD: Toxic and prepare them for it.

Amber Warren, PA-C: Yeah.

Dr. David Musnick, MD: Don't just bring them in with, you know, diabetes under control or all this inflammation out of control and just get started with it. That's not I don't think that's a good idea.

Amber Warren, PA-C: I think I'm going to buy you a t shirt. I evaluate tissues with issues. Yeah, well.

Amber Warren, PA-C: I don't know if.

Dr. David Musnick, MD: You know that I developed a system that I was teaching docs at the Institute of Functional Medicine in 2009 and then again in 2019, ten years later on the whole model of identify the tissues, the issues with the tissues and what is going on in the pain processing system so that you can totally treat these.

Amber Warren, PA-C: Things. Yeah.

Amber Warren, PA-C: Does a really good job. You do a really good job of teaching that. Yeah it's great that.

Amber Warren, PA-C: Processes but.

Dr. David Musnick, MD: Wouldn't mind the t shirt.

Amber Warren, PA-C: Dun dun.

Dr. David Musnick, MD: Actually probably be good to have a tie then I could wear it to work.

Amber Warren, PA-C: There you go. Black tie with.

Dr. David Musnick, MD: The tissues.

Amber Warren, PA-C: Tissue with.

Amber Warren, PA-C: With issues, with issues.

Amber Warren, PA-C: It has to rhyme. It's the whole.

Dr. David Musnick, MD: Issues with issues.

Amber Warren, PA-C: Identify and evaluate tissues like that.

Amber Warren, PA-C: I really like that.

Amber Warren, PA-C: It's your new thing, you know, And every one of my interviews with if there's one piece of advice you could offer our community of listeners based on the topic that we we discussed today, what would that piece of advice be?

Dr. David Musnick, MD: Well, number one, don't just go find a place that does PRP unless you do your research. And I talked about what to look for if you have a tendon that's been hurting for more than a month, get it checked out and and don't just go with a program of ibuprofen or something like that. That's that's really and definitely don't get a steroid injection in your tendon. Get it thoroughly checked out. Yeah. And including ultrasound.

Amber Warren, PA-C: We didn't get.

Dr. David Musnick, MD: Out what is going on with your tendons so that you don't the last thing that you want is for a tendon tear. Right. Tear in half. But you want to have full function of your tendons, so you don't want them to continue degenerating either.

Amber Warren, PA-C: And we didn't get to touch on why throwing NSAIDs non-steroidal anti-inflammatories at these issues is not a good thing because it doesn't actually take care of these inflammatory molecules we discussed. It doesn't actually reach those ones that.

Dr. David Musnick, MD: So here's a did you know.

Amber Warren, PA-C: Did.

Dr. David Musnick, MD: You know. But Amber you're one of my favorite clinicians.

Amber Warren, PA-C: Oh, you're so so I.

Dr. David Musnick, MD: Know that you know a lot. But did you know that Tendinopathy has very little inflammation? So this is fascinating. There's biopsy studies of these of tendinopathy. There's almost very little inflammatory molecules in there. So it's not an inflammatory issue. It's a degenerative issue with sensitization of the pain receptors and often the pain processing system and weakness and other things going on. But it's not an inflammatory issue. Whereas, say the use of PRP in the joints, that is an inflammatory issue and an enzyme issue and all these other things. So that's very interesting because a lot of people donating. So if we throw an Nsaid at the Tendinopathy like ibuprofen, the anti-inflammatory, first of all, people don't usually take enough Nsaid for it to be anti-inflammatory. Second of all, it can damage the kidneys and the liver and the gut. But third, it doesn't regenerate the tendon, but it will decrease pain because it has an analgesic effect. But then a person is more likely to overuse it and damage it even more.

Amber Warren, PA-C: Right? Yeah, it's definitely a double edged sword, that's for sure.

Amber Warren, PA-C: Well, thank you so much for your time. Always an honor discussing these fascinating topics, topics with you. Thank you, everyone, for listening in.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations Podcast. For more information on topics covered today, programs offered at FMI Center for Optimal Health and the highest quality of supplements and more go to

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