Physical Medicine and Rehabilitation

Dr. John E. Stavrakos, M.S., M.D.
Board Certified in Physical Medicine & Rehabilitation

Fellowship Trained in Women’s Sports Medicine

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A doctor of Physical Medicine and Rehabilitation (PM&R), or “Physiatrist”, is an expert on nerve, muscle, and bone issues who treats injuries or illnesses that affect your quality of life. Things that a physiatrist does include:

  • Diagnosing and treating painful conditions
  • Restoring maximum function that has been lost through injury, illness or a disabling condition
  • Treating the whole person, not just the “problem” area(s)
  • Working with a team of medical professionals
  • Providing non-surgical treatment options, or when appropriate, facilitating a referral for a surgical condition
  • Providing explanations for your medical issues along with a treatment/prevention plan.

 

Dr. Stavrakos’ job is to treat any disability resulting from disease or injury, from various causes – anything from sore knees and achy necks, to numbness and tingling in the hands to recovery from a stroke or other long or short term illness. The idea is to create an individualized plan, often with the help of other health care providers (e.g. physical therapists, neurosurgeons, neurologists, orthopedic surgeons) and/or modalities at his disposal (e.g. injections, medications, etc.) to put the pieces of a person’s life back together after injury or disease. By taking the time needed to pinpoint the source of an ailment and designing a treatment plan that a patient can carry out his/herself or with the help of his medical colleagues, the goal is to help patients stay as active as possible at any age. PM&R is ultimately about improving the quality of people’s lives.

As a fellowship trained Sports Medicine physician, Dr. Stavrakos has worked with athletes from the grade school through the collegiate and professional level. His specialty is identifying and treating conditions unique to the female athlete, such as the Female Athlete Triad (disordered eating, amenorrhea, low bone mineral density), but he is trained to work with active individuals of both genders, from childhood to senior citizens.

 

 

 

SOME OF THE PROCEDURES DR. STAVRAKOS OFFERS INCLUDE:


1. Electrodiagnostic studies, or EMG’s: EMG’s are an in-office procedure that involve the stimulating and recording of a patient’s peripheral nerves (e.g. those outside the brain or spinal cord) to evaluate and then treat conditions such as carpal tunnel syndrome, cervical/lumbar radiculopathy (aka “pinched nerve” in the neck/back leading to pain and/or numbness and weakness), sports injuries such as “stingers,” diabetic nerve pain/dysfunction, etc. This can involve short (1/10 of a second) low current electrical pulses to nerves in the arms/legs (not very different from testing an electrical wire), and/or insertion of a recording electrode (a probe roughly the size of an acupuncture needle) under the skin to test the electrical activity of muscles and look for nerve or muscle abnormalities that may explain a patient’s symptoms.

2. Regenerative injection therapy (RIT) – Prolotherapy, Platelet Rich Plasma (PRP) injection therapy, and Neural Prolotherapy:

-Prolotherapy has been in use since the 1940’s and has improved the quality of life of countless individuals, from professional athletes to ‘weekend warriors’ to those who simply want a relief from chronic joint or neck/back pain. One of the biggest advocates of prolotherapy was C. Everett Coop, former Surgeon General of the United States, who had chronic low back pain and stated that prolotherapy saved him from back surgery. It involves a series of injections of dextrose (a 10 chain sugar) and other natural compounds spaced out over several weeks that cause localized irritation of damaged tissue that stimulate the body to regenerate damaged ligaments, tendons and cartilage. 

– Platelet Rich Plasma (PRP) injection therapy made its debut into the musculoskeletal world in the 1990’s and is now used by nearly every college and professional sports team in America. It involves drawing a few milliliters of blood from the patient, spinning it in a centrifuge it to remove most the “solid” elements and concentrate the platelets (the clotting element of the blood, which are rich in growth factors) to 4-5 times their normal amount, and then re-injecting them into the damaged area. The growth factors released by the platelets stimulate a regenerative (healing) response to the tissues, which can improve or resolve issues that would otherwise require surgery or lead to permanent loss of function. PRP is often used in lieu of prolotherapy in cases where the damage is more extensive, previous treatment plans have failed, or there is a time sensitive element (e.g. a soccer player getting hurt in mid-season and needs to be ready to play for the upcoming state finals).

– Neural Prolotherapy (aka Neurofascial Prolotherapy or Lyftogt technique) is a safe, exciting new advance in Regenerative Medicine that can be used to treat nerve related pain in many musculoskeletal injuries. It involves subcutaneous (i.e. just under the skin) injections of a medical grade sugar (5% dextrose or mannitol) that promotes the healing of damaged nerves and leads to restoration of injured tissue. Neural Prolotherapy is the brainchild of Dr. John Lyftogt, a physician from New Zealand who used it to treat himself of a painful chronic condition, and then shared his knowledge with the world to help doctors treat a bevy of various pain syndromes and musculoskeletal injuries. Neural Prolotherapy is safe, quick and easy to administer and has resolved pain in many of Dr. Stavrakos’ patients when nothing else worked adequately.

 3. Ultrasound guided joint injections and nerve blocks: The use of ultrasound guidance to accurately visualize structures under the skin is a safe and fast way to diagnose some conditions and may in many cases avoid the need for further imaging studies such as an MRI. The ultrasound machine allows for pinpoint accuracy of needle placement for the injection of medication such as PRP, steroid solution to multiple joints (hips, knees, shoulders, wrists, et. al), or hyaluronic acid to knees and hips (see below). This can be used both for joint/soft tissue injections as well as localizing nerves in the arms and legs (e.g. carpal tunnel injection, where the goal is to get the injecting needle next to – but not into – the nerve).

 4. Botox injections for spasticity, neck pain and migraine headaches: Botulinum toxin A, more commonly known as Botox, is a natural compound that blocks nerve impulse transmission to muscles. When used properly in the hands of a trained physician, it has several amazing medical benefits, including decreasing excess muscle tone (known as spasticity) often seen in patients suffering from stroke, head injuries or conditions such as cerebral palsy, chronic neck pain and migraine headaches.

– Decreasing spasticity can lead to reduction in pain, a decreased risk of contracture (i.e. “frozen” joints), skin breakdown, and sometimes restoration of limb function when combined with splinting and a therapy program.

– Chronic neck pain and tightness with loss of range of motion, also called cervical dystonia, can usually be successfully treated with Botox injections to the “problem” muscles and combined with an appropriate therapy program.

– Botox injections to specific muscles of the face and neck have been found to typically be extremely successful in the treatment of chronic migraine headaches, even those that do not respond well to medications and lifestyle changes. Many patients dissatisfied with the lack of success with their migraine medicines and/or tired of the expense and side effects of these medicines have opted for this treatment, often with amazing results. Please inquire for details.

 5. Viscosupplementation to hips and knees: With the assistance of ultrasound guidance, injection of Hyaluronan, a naturally occurring substance that lubricates the joints, can markedly decrease knee and/or hip pain in arthritic joints for several months or longer. This is especially true when combined with other treatment plans such as weight loss and progressive strengthening of the muscles that move the knee joint. Please inquire for details.

  6. Trigger Point Injections (tpi’s): these are subcutaneous injections over sore, painful areas of the body of a small amount of anesthetic and an anti-inflammatory medication to provide pain relief. Care is taken to avoid any underlying structures such as large nerves or blood vessels. The “typical” response from a tpi is pain improvement/relief within a few minutes of injection (the effect of the anesthetic), a return of discomfort the next day when the anesthetic wears off, and then pain relief of much longer duration in approximately 2-7 days (3 days is an average) when the anti-inflammatory medicine kicks in. Tpi’s  are often done in conjunction with other treatment plans, such as physical therapy, massage therapy, oral medication and/or a home exercise program.