Bespoke MSK Medicine is medicine that recognizes your unique & individual needs, tailored and customized interventions using the below services in combinations tailored to your needs.

Question 1

Prolotherapy

Answer

Prolotherapy is a non-surgical injection procedure used to treat connective tissue injuries of the musculoskeletal system that have not healed by rest or conservative therapy. Prolotherapy is treatment method for loose or injured ligaments. It uses the body’s natural ability to heal ligaments and muscles to reform healthy tissue without scar tissue. A dextrose solution is injected directly into the ligament and causes a mild inflammatory reaction. This signals the body to lay down thicker and stronger tissue which helps to relieve chronic pain. This therapy is best suited for chronic myofascial pain seen commonly in dancers, musicians, and repetitive motion. Dr. Wang is trained in prolotherapy through her residency training and through the Hacket Hemwall Patterson foundation. There is good and strong evidence for the use of prolotherapy: Dr. Robago's landmark randomized control study for knee osteoarthritis - efficacy and effectiveness Systematic Review for the use of prolotherapy in knee osteoarthritis Evidence of disease modifying effect and improvement in quality of life in knee osteoarthritis Evidence of regenerative effects of prolotherapy in the knee Evidence for prolotherapy in the treatment of tennis elbow Systematic Review on the effectiveness of prolotherapy in knee osteoarthritis: Hassan F, Trebinjac S, Murrell WD, Maffulli N. The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review. Br Med Bull. 2017 Jun 1;122(1):91-108.

Question 2

Platelet Rich Plasma (PRP)

Answer

PRP is the plasma portion of blood consisting of platelets and related growth factors. PRP is injected into sites of injuries, particularly tendons. PRP is injected directly into the injured tissue, stimulating a healing response. PRP is prepared from your own blood. A simple blood sample is taken and then transferred into a high power centrifuge and concentrating device. A PRP injection can be done in 45 minutes or less. We use proprietary EmCyte technology to ensure pure PRP product and higher cell counts. Emcyte's PurePRP® II provide upwards of 9.5 billion platelets in a 7mL treatment sample (approximately 1.4 million platelets per microliter). High volumes of deliverable platelets enhances the volumetric activity of platelet growth factors and cytokines in active tissue repair. Platelet alpha granules contain various platelet growth factors that promote tissue repair through cell proliferation, chemotaxis, differentiation, and angiogenesis. Platelet cytokines provide the chemical stimulus needed to mediate cell signaling and migration. The amount of deliverable platelets are clinically significant if you are to attain active tissue repair. It is imperative that your deliverable platelet count be more than 1 million platelets per microliter. PurePRP® II is unique in that it greatly enhances monocyte concentrations, while giving the end user control over the amount of neutrophils they would like to add to their PRP preparation. PurePRP® II takes advantage of the long term phagocytic and protective properties of the monocytes while avoiding the potential harmful inflammation incurred by large concentrations of neutrophils that go through cellular necrosis. This is another differentiating factor that help to explain the natural success of PurePRP® II in patient outcomes.

Question 3

Fascia Layer Specific Hydromanipulation

Answer

Fascia Layer Specific Hydromanipulation (FLuSH) is a novel technique developed by Dr. Wang using invasive needle techniques to remove fascial adhesions/densificiation. Normal saline is injected into areas of fascial densification to release these areas of restrictions. This includes scar tissue from trauma or simply from exercise and overuse. This technique builds upon current interventions like Fascial Manipulation, Acupuncture, Dry needling technique, and Trigger Point Injections into areas of densification when used in combination of movement are also effective for release of restricted areas.

Question 4

Fascial Manipulation - Stecco Method

Answer

Fascial Manipulation was developed by Luigi Stecco to address fascial chain dysfuction from densifications in the deep fascia. The technique is characterized by treating specific centers of coordination and fusion using specific and tailored diagnostic and treatment sequences.

Question 5

Functional/Intergrative Medicine

Functional medicine is an individualized and tailored approach that addresses the underlying causes of disease using a systems-oriented approach to engage both patient and practitioner through a therapeutic partnership. It uses lifestyle interventions and dietary supplementation to address the causes of a person's symptoms. Functional Medicine shift away from the traditional disease-centered focus of medical practice to a more patient-centered approach that address the root causes rather than merely treating symptoms.

Commonly ordered laboratory values are : Hemoglobin A1c, High Sensitivity C-Reactive Protein, Homocysteine, IgG Food Spot Test, Vitamin D, Omega 3:6 EFA Ratio, Hormone levels.

Functional Medicine heavily utilizes neuroketotherapeutics is a type of medal therapy that uses bioenergetics through various dietary and exercise methods to induce ketosis. These therapies include medium-chain triglyceride supplements, ketone esters supplementation, fasting, strenuous exercise, modified Atkins diet, and classic ketogenic diet.

Answer

Yoga is an ancient meditation practice using the influence of movement and body to influence the mind and spirit. Spiritual wellbeing is crucial to healing and is integral to optimal health.

Question 6

Dynamic Musculoskeletal Ultrasound Imaging

Ultrasound is a noninvasive medical imaging that helps to diagnose and treat medical conditions. Ultrasound is safe and painless, and uses sound waves to show in the inside of the body. Sound waves are transmitted from a probe into the body and collects the sounds that bounce back to create an image.

Ultrasound examinations do not use ionizing radiation (like x-rays or CT scans). Because ultrasound images are captured in real-time, they can show the structure and movement of the body’s connective tissue like muscles, ligaments, bones.

Question 7

Fascia

Fascia is the connective tissue that connects our entire body. The fascial system is a complex network of connective tissues that run the entire length of the body and connect all of its parts together. Fascia is mobile, three-dimensional, intertwined, and a continuous web.

Fascial manipulation is a system of evaluating and treating myofascial dysfunction throughout the body. Many problems from back pain to headaches can be caused from the fascia not working properly.

There are different approaches to working with fascia including skin rolling, Stecco Fascial Manipulation, fascial dissection, visceral manipulation, osteopathic fascial unwinding.

Question 8

Performing Arts Medicine

Performing arts medicine is a unique specialized field that treats the injuries associated in the performing arts as seen in dancers, musicians, vocalists, etc. Performance related musculoskeletal conditions and disability are remarkably high, but artists often ignore symptoms. Performing arts medicine specialist help correct mechanical technique issues that are the root cause of performance related injury.

There is a deep emphasis on the biopsychomechanical etiology. Performing artists are subject to specific conditions- early exposure to high expectations of excellence, incessant demands for perfection, long periods of intense practicing, fierce competition, high levels of anxiety associated with performance, and uncertain careers.

Performing arts medicine uses an interdisciplinary approach to treating the artist patient. Dr. Wang uses novel interventions like IASTM, kinesiotaping, and regenerative treatments to help musicians with performing arts related pain. The prevention of injury, conservative management, collaboration with teachers, and a psychotherapeutic approach are used.

Question 9

Instrument Assisted Soft Tissue Manipulation

IASTM is an approach to fascial work that reduces friction in the body. Using IASTM instruments allows for precision, sensitivity and depth in the treatment of fascial dysfunction that cannot be accomplished with the hands. Using an instrument focuses the distribution of forces to specific and targeted tissue layers allowing for a more efficient treatment.

IASTM is a regenerative treatment. The goal of IASTM is to trigger an inflammatory and healing response. The inflammatory response stimulates the production of new collagen and healing in tissue that did not heal correctly.

IASTM alters the biotensegrity system of the body. The biotensegrity system of the body is composed of neurocentric synergism, myofascial continuity, and mechanotransductive homeostasis. By altering the myofascia, we can alter the neurologic and mechanical systems of the body work.

IASTM is the use of any instrument to achieve these tasks including cupping technique that lifts and seperates the fascial layers.

Question 10

Kinesiotaping

Kinesiotape is elastic tape that has the ability to re-educate the neuromuscular system, reduce pain and inflammation, optimize performance, prevent injury and promote good circulation and healing, and assist in returning the body to homeostasis.

Question 11