Southern Oregon Sports and Spine has offered the highest level of care for over 35 years in Ashland. Doctors Marc Heller, DC and Matt Terreri, DC, CCSP®, have been recently joined by Ann Michael, DC, CC and Valerie Breiten, ND. The clinic specializes in chronic and acute musculoskeletal problems of the neck, back, and extremities, as well as focusing on sports medicine & rehabilitation. The clinic’s mission is to assist those in our care to maximize physical function, resolve pain & discomfort, and quickly return to activities or goals.
They partner with patients to provide education, evidence-based treatment, and supportive therapies to assist the body’s innate healing process. In today’s interview, I speak with Dr. Matt Terreri about the growing office and an exciting technology he is introducing to chiropractic patients here in Southern Oregon.
Thanks Shields, I’m excited to be here and chat with you!
To begin with, please introduce us to Southern Oregon Sports and Spine. I know you will be a familiar face to many in the community.
Southern Oregon Sports & Spine is predominantly a chiropractic clinic that focuses on musculoskeletal conditions ranging from acute to chronic. We treat the neck, mid and low back as well as all extremities. Dr. Heller has a large focus on “difficult to figure out” cases, while I head up the sports medicine division. I am the official chiropractor for the SOU Athletic Department and volunteer medical provider for the U.S. Olympics. But… we are expanding!
Sure. We have recently introduced Ann Michael, DC, CC and Valeria Breiten, ND to our office. Annie is a seasoned chiropractor of 24 years, and is internationally certified in Sacral Occipital Technique (SOT) and is also certified in Craniopathy. She also likes to study nutrition and diet. Dr. Ann is also fluent in Spanish.
Dr. Breiten is a naturopath with 20 years of experience, specializing in homeopathy, diet, and nutrition. She also treats musculoskeletal conditions using a high-tech biofeedback device called SCENAR.
For the past 35 or so years, you and Dr. Marc Heller have worked tirelessly to offer the best care to your patients. Please talk more about your personal goals and achievements.
Our mission is to help people heal, while having them actually understand their own problem. Many people get temporary relief, but continue to re-injure themselves because they are lacking education on WHY they hurt and how to prevent future injuries. Our team works hard, researching the latest technologies, science, and treatment approaches.
As a result, we are always taking a lot more continuing education than required. For example, Marc has been studying with Stuart McGill, PhD, one of the most recognized authorities on low back pain and dysfunction. Dr. McGill teaches the most current research regarding spine function, injury prevention, and rehabilitation.
Another example of our commitment to quality care involved myself and another sports chiropractor meeting with former Senator DeBoer last year, as part of a team helping the Oregon State Legislature develop consensus on concussion identification and treatment standards in athletics. Sports chiropractors retained their role in diagnosing and treating concussions as it relates to athletes.
More recently, I have been focused on bringing Pulsewave technology to our patients here in Southern Oregon. It has been a lengthy process, but I’m excited to announce that the wait is over!
So, what is this cutting-edge technology called Pulsewave and how does it work?
Pulsewave is an advanced medical device that is officially called EPAT® or “Extracorporeal Pulse Activation Treatment.” It is sometimes generically referred to as ESWT.
This FDA-approved device generates an acoustic pressure wave that travels through a person’s body until the soundwave hits damaged tissue. That damaged tissue can be muscle, fascia, ligaments, tendons, calcium deposits, or even bone.
Not all devices are created equal, but the Storz® EPAT® machine drastically reduces or eliminates pain, increases vascularization, stimulates tissue and bone growth, and dissolves calcium deposits. It falls under the category of “regenerative medicine.”
What’s regenerative medicine?
Regenerative medicine includes treatment modalities that stimulate the body to heal itself. This includes Pulsewave (EPAT®), as well as various injections such as prolo, PRP, and stem cells. The key here is that these modalities don’t just block pain, like steroids, NSAIDS, or opiates do. They stimulate the body to regenerate its own tissue. Additionally, the right rehab exercises can also stimulate tissues to regenerate.
So how is Pulsewave different?
First, there are no injections and the effects can be felt immediately. Secondly, since there are no injections it is now within the scope of our practice. It is also much cheaper for the patient when compared to biological injections. For years Marc and I used to say that we wished we could do prolotherapy, but it wasn’t in our scope. Well, this is the answer!
What are the key benefits of using this device for your patients?
Being able to walk without your knee or foot hurting anymore, being able to throw a ball, or even picking up your children pain-free are some real-life benefits. The machine’s effects can be felt almost immediately, and healing continues for 12 weeks after the last treatment has been applied. Published data studies show the technology is between 80 to 90% effective, and outcomes are equal to or greater than traditional treatment methods including surgery. And there are virtually no side effects or down time for the patient!
What types of conditions is this therapy used for?
The list is long, but currently, EPAT® is being used for plantar fasciitis, heel pain, jumper’s knee, shin splints, Achilles tendinopathy, Morton’s neuroma, Osgood-Schlater, calcific tendinopathy, tennis elbow, back pain, scar tissue treatment, ankle sprains, and even non-union fractures. There are many more uses, and new ones are being added all the time. It is even being used to treat horses! There are a lot of other “off label” uses in Europe (Google it) which I’m sure in time will make their way to the United States.
Matt, please tell us more about the history of this machine.
In the 1950’s, scientists started systematically studying the relationship of human tissue and sound pressure waves being generated in water. In the 1980’s this eventually led to the treatment of kidney and gallbladder stones (called lithotripsy). This is still the first choice for most kidney and gallstones that require treatment. The technology was then applied successfully to non-union fractures in 1985. In the 1990’s the device was applied to dissolve calcium deposits in tendons, which eventually gave way to the broad applications we see today.
Please talk about how Pulsewave therapy works in conjunction with the many other aspects of your clinic.
EPAT® must be utilized in conjunction with other therapies. If you sprain your ankle or injure your rotator cuff, you still need to do your prescribed therapy exercises or whatever other treatment is deemed necessary. The machine decreases your healing time and increases your success, but is not meant to be used in a vacuum.
You told me earlier that you are able to work in conjunction with other physicians or providers. Please say more.
Since Pulsewave therapy is meant to be done in conjunction with other modalities, an outside physician or provider could refer their patients to our clinic just to have this treatment performed as long as they are currently being treated appropriately by that provider. We are used to working with all types of quality health care providers in the valley, and are always seeking to partner with new ones.
So, what is the proper selection of the patient? How does a patient qualify for care?
Good question! Patients are typically between the ages of 18 and 70. We usually offer the modality to patients who are not responding to first line treatments such as therapeutic exercise, rest, ice, bracing and orthotics. The patient should not be taking NSAIDS while having treatment, and they must not have had a cortisone injection for about 45 days prior. Other contraindications include pregnancy, pacemaker and cancer. Taking blood thinners is not a problem, and having previous surgical hardware is okay.
How do you generate realistic expectations and goals for your clients?
Four to five treatments are applied at 4- to 7-day intervals. This must be done in order for treatment to be effective. The patient must be able to commit to this and also be willing to do other standard types of treatment in conjunction. The effects of the treatment continue for 12 weeks, so it is important to maintain regular therapy through the whole process. It is going to take some work on the patient’s behalf, and as I always say, “There are no magic silver bullets.”
Are there any side effects?
Occasional mild bruising, swelling or mild pain that quickly subsides.
What are some unusual uses for this healing modality?
I would say using it for non-union fractures or stress fractures is something you don’t see every day. This technology is also used to treat horses, which I find intriguing!
Matt, you are very passionate about this new modality and are solely responsible for bringing this technology to the chiropractors in Oregon. Please say more.
I found out about the technology because I’m involved with sports medicine. The more I learned about EPAT®, I was convinced it was a powerful tool that could help my patients. Curiously, I could not find many medical offices that offered the technology in Oregon. I asked the Oregon Board of Chiropractic Examiners if the treatment was within our scope. Even though it is popular within the sports medicine world, most people are unfamiliar with this technology. Consequently, no rule was written one way or another, but I was invited to apply to have it officially approved. This ended up taking 6 months and countless hours of research & effort. I had to answer pages and pages of questions regarding the machine’s published research, efficacy, safety, contraindications and proposed applications. Once I provided all the answers, the board met on the subject, then provided me with MORE questions to answer, but I just kept persevering, convinced that I could get it approved. I just took it one day at a time and one small step at a time. The board met again and finally approved the device in July 2019.
What are the most interesting aspects of this treatment for you?
What fascinates me is that a soundwave can induce healing in tissue with virtually no complications. There is a whole complex cascade of biochemical changes that occur which boggles my mind!
Moreover, because it is a sound or pressure wave it has the ability to travel deep inside the body (around 2.5 inches) and get to places that our hands or tools (like Graston®, Gua Sha or cupping) just cannot reach. Plus, the healing time is relatively fast!
What are the transformations that patients experience after having this treatment?
The most immediate and obvious difference is pain reduction. I mean within the treatment session pain is almost always reduced or completely gone. This also allows the patient to further their therapy exercises, because their pain is reduced. So, one gain builds on the other. Consequently, patients are able to heal very stubborn problems that they were not able to heal before.
This is a science-based solution. Please tell me more.
The technology has been heavily researched, with countless peer reviews and double blind studies. Each condition requires specific analysis & testing, so this can take years to accomplish.
Popular journals that have published on this are:
American Journal of Sports Medicine, American Journal of Bone and Joint Surgery, International Journal of Surgery, Journal of American Medical Association, International Journal of Prevention Medicine and Techniques in Foot & Ankle Surgery. I think you get the point!
Where else have you seen it being used?
Paul, my sale representative, mentioned the other day just how many sports teams are using this. He was just delivering a second unit to the Golden State Warriors basketball team. Other teams include baseball like the LA Dodgers; football like the Eagles, the Saints, Notre Dame, the University of Florida and the University of Nebraska; hockey teams like the Red Wings and in the Olympics. It is also being used at the Cleveland Clinic, Mount Sinai, Johns Hopkins University, Queen’s University, the Mayo Clinic, and Duke University.
Matt, this sounds like a great addition to your clinic and something you and your team put a lot of time and intention into acquiring.
Yes, it took a long time, expense and training to bring this together, but we are doing this to provide the absolute best and most current care we can to our patients. If there is something out there that substantially will help patients, then I want to know about it! And this certainly fills an important niche.
Matt, thanks so much for taking the time to speak with me today. Do you have any last thoughts or comments you would like to share?
Yes, thank you to the readers for their time. If anyone has any questions I would be happy to speak with them. I am also happy to provide literature or links if they wish.
Southern Oregon Sports & Spine
987 Siskiyou Blvd