We are all familiar with the 80 – 10 – 10 Rule in clinical practice: 80% of our patients meet our recovery expectations, 10% of our patients may meet only a partial recovery, and the other 10% of our patients we may either have referred them out upon detecting a red flag on their examination, or they just did not respond to care. After decades of experience in providing clinical care to patients and talking to other colleagues, overall, these statistics bear out true.
Recovery Meets Performance with NovoPulse
So, the question becomes this: How do we help the 80% group of patients not only recover from their condition and but also improve their performance in life – and – how do we help the 10% of our "partial-recovery" patients reach a full recovery and hopefully move them more towards a higher level of performance as well?
Helping patients first achieve recovery is a massive step for them – this means they are mostly out of pain and have regained some of the lost functions in their life (i.e., walking, standing, sitting, etc.). But as we know, this doesn't necessarily translate into them achieving previous performance levels in how they may participate in life activities.
Whether you are treating an athlete for a sports injury or a grandparent for a chronic low back complaint, both need the same type of intense focus on striving to achieve recovery first and then optimize performance second to improve their level of participation in meaningful life activities.
How to asses the impact of pain and address recovery.
The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) considers the following concepts are relevant to defining the impact of chronic pain (i.e., pain extending longer than three months):
Impairments (physical or structural findings detected upon examination)
Activities and Activity limitations (lost function of activities of daily living)
Participation and Participation restrictions (inability to engage in participation of meaningful life activity)
Achieving pain reduction by addressing physical and structural findings is a key aspect of helping a patient move towards recovery – which begins with reducing inflammation in the joint and tissues identified as the patient's origin of pain. The patient's clinical diagnosis and degree of severity correlate with the functional and participatory impact on the patient's life and are essential considerations in the care planning process.
Goal setting with the patient enables both the clinician and the patient to re-engage key functions and meaningful activities that are currently limited but valued in the patient's life.
Recovery of the patient's condition is marked by making consistent improvements and progress towards these meaningful goals. However, in complex cases, achieving recovery may require more aggressively addressing the inflammatory status of the condition. When bringing the patient through the recovery process, we can often help them through the initial acute pain stage, but their progress stalls in the subacute or rehabilitative phase of recovery.
Reaching a state of maximum therapeutic improvement, which only represents a partial recovery that has fallen short of expectations, causes us as clinicians to consider seeking other treatment strategies for the patient. Although these patients improved from what they were when they first started treatment, they still may not be able to enjoy participating in meaningful activities like they were able to do before.
Transitioning from Recovery to Performance
For example, I am sure in your practice you have patients that love to play golf. Think of the patient who can only play nine holes when they are used to playing 18 – but cannot because of the pain returning by the time they have played nine holes. What can you do to help them "get over the hump?" In other words, how do we move our patients – who have achieved a maximum therapeutic benefit/recovery to go on from this level of healing to achieve a higher level of performance?
Improve function and then move towards improving participation in activities.
The clinical questions to ask ourselves are these: "What are some of the barriers our patients may face as they move towards improving their performance?" "Are there objective clinical findings that may be preventing the patient from moving forward to a higher level of performance?"
As mentioned, inflammation can be a key clinical finding as to why the patient cannot move forward with improving performance in activities, restricting them from participating and enjoying life. For example, osteoarthritis is a common underlying problem for patients.
As we know, osteoarthritis is a chronic disorder associated with damage to the articular cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Mediated by inflammation, the natural history of osteoarthritis is manifested by a steady decline of cartilage cellularity, degradation of cartilage matrix and surrounding tissues – leading to chronic pain. We also know that immune cells produce pro-inflammatory cytokines, creating a persistent state of inflammation in the joint. This inflammation modifies the operation of the chondrocytes by blocking mitosis, inhibiting the production of new cartilage, catabolizing extracellular cartilage matrix to produce a 4-5-fold increase in apoptosis.
And if that wasn't enough, this cascade of processes enhances the secretion of the Prostaglandin E2 pain mediator. As a result, this joint inflammation leads to pain and Osteoarthritis, preventing normal cartilage restoration and promoting the destruction of the joint architecture.
The physical limitations of the inflammation from OA inhibit proper range of motion to occur in a joint, making it difficult to move towards improving the affected region's balance, strength, conditioning, and function. Therein lies our clinical dilemma.
This is what led me to search for different solutions for pain management. I was introduced to a new technology, NovoPulse®, that provides an answer for long-term pain relief and promotes cartilage regeneration while improving function and performance. Two key studies caught my eye.
Studies Supporting PEMF and NovoPulse Technology
Study #1:
Clin Interv Aging. 2013; 8: 1289–1293. Published online 2013 Sep 26. DOI: 10.2147/CIA.S35926. Pulsed electromagnetic field therapy for the management of osteoarthritis-related pain, stiffness and physical function: clinical experience in the elderly Tommaso Iannitti, Gregorio Fistetto, Anna Esposito, Valentina Rottigni, and Beniamino Palmieri
The Iannitti study highlights pulsed electromagnetic field (PEMF) improvement in pain, stiffness, and function in patients with knee osteoarthritis. Clinically significant improvements were made in both pain and function. The VAS was used for pain assessment, and the WOMAC outcome assessment tool was used to provide objective evidence of functional improvement.
Study #2:
Lad D, Karnatzikos G, Gobbi A (2013) Is there any Role for Pulsed Electromagnetic Fields in the Treatment of Early Osteoarthritis of the Knee? J Osteopor Phys Act 1: 106. doi:10.4172/2329-9509.1000106
Clinically significant improvements were made in both pain and function. The VAS was used for pain assessment, and the Tegner outcome assessment tool was used to provide objective evidence of functional improvement at one year and two-year follow-up. At a 2-year follow-up, 80% of patients were satisfied with the results.
Considering the evidence behind this device, the real impact is on an actual patient's experience. Here are a few testimonials I think you will find interesting.
Real Recovery and Performance Stories from NovoPulse Users
Testimonial #1:
"I am a 57-year-old Plastic Surgeon. I sustained a torn rotator cuff (complete tear of the supraspinatus tendon) and underwent surgical repair in early February of 2021. The recovery was very painful, which is typical for this surgery. When I was eight weeks post-op, I still had significant amounts of pain and had minimal shoulder motion. I was doing my stretching exercises daily but was making minimal progress. My physical therapist was very concerned that I was developing a frozen shoulder. This was especially troubling, as I was scheduled to return to work in just another two weeks, including performing surgeries.
At this point, I had the opportunity to try the NovoPulse for my shoulder. I did not know very much about electromagnetic field treatments, but I was willing to try anything to help my shoulder recover function. I began using the NovoPulse for 30 minutes per day, combined with the stretching exercises recommended by my physical therapist. Within one week, I noted less pain in the shoulder and significant improvements in range of motion. These improvements continued steadily, and I was able to resume working and performing surgeries as scheduled. I continued to use the NovoPulse daily for about six weeks, noting steady improvements throughout this period. My Physical Therapist and Orthopedic Surgeon were very impressed with the improvements in function that I developed during this time. I am definitely a fan of the NovoPulse. I believe that this treatment was a major contributor to the successful rehab of my shoulder."
Testimonial #2:
"I'm 66 years old with arthritis in both knees, both hips, and left shoulder. I've had five torn ligaments and five arthroscopic surgeries, starting with my first skiing accident at age 12 in the days of bear-trap bindings.
About six years ago, my knees and hips began to suffer significantly higher levels of pain after strenuous physical activity. With physical activity, my body started protective reactions that caused sharp pain and swelling and made my joints less mobile. The orthopedic surgeon tried cortisone shots without effect and then recommended replacing both knees. The pain was so bad I could seldom sleep for more than an hour without the pain waking me up with painful, stiff, swollen, immobile knees.
I scheduled the knee replacement surgery, and while waiting, I tried a low-carb diet to reduce inflammation. Within about four weeks, the diet helped so much that I canceled the surgery since I could now sleep through the night. Nevertheless, my joints were still less agile than I would have liked, and I was generally in constant pain during the day and had a pronounced limp.
I tried the NovoPulse about nine months ago and got additional significant relief in pain and increased joint agility comparable to what I got from the anti-inflammation diet. I use the NovoPulse every day, generally on both knees, both hips, and sometimes on shoulders and back.
I still get sore after vigorous physical activity, but the NovoPulse soothes the nerve pain and restores mobility to my joints. Since I started using NovoPulse, people no longer comment that I am limping. The NovoPulse has been a miracle for me. It hasn't restored me to 16-year-old joints, but it has made it possible to reduce pain and recover joint mobility quickly after strenuous activity. I still feel the need to continue the anti-inflammation diet and my personal training for strength, but the NovoPulse is indispensable for me to continue the kind of activity levels I want to maintain."
Testimonial #3:
"As a 66-year-old male, I had an opportunity recently to use a NovoPulse for 2-3 treatments a week for about eight weeks. I have had lower back pain for twelve years due to degenerative disc disease, scoliosis, and arthritis, among other things. Routine daily activities were not so routine and were painful. I found the therapy very helpful in reducing my overall pain and lessening my reliance on over-the-counter pain medicine. Routine activities were more routine, and pain was minimized. A great outcome!"
Incorporating Research and NovoPulse Into Your Practice.
You may be wondering, "How does this device work?" NovoPulse is the first technology that has been learned through PEMF research to combine electric field with thermal stimulation. It penetrates to a depth of 7 cm, which allows the source of the inflammation to be directly targeted. In addition, it provides a full 360-degree joint coverage. This technology can be adapted to treat either the spine or the extremities.
Research has also guided the recommended treatment plan. This has been very effective in helping patients achieve the desired meaningful performance in their lives - enjoying their daily lives without the constant constraints of pain.