Healing at the Highest Level

In the world of elite sports, the margin between greatness and retirement can be razor-thin. A single injury a torn tendon, an inflamed joint, a compressed nerve can derail a season or end a career. For decades, surgery was the default solution. But now, some of the most celebrated athletes in the world are turning to a new approach: regenerative medicine.

These advanced therapies, which include platelet-rich plasma (PRP) and autologous cell treatments, harness the body’s own healing potential to reduce pain, restore function, and avoid surgery. And while these treatments are helping professionals perform on the world stage, they’re just as effective for the rest of us.

Let’s explore how several internationally known athletes used regenerative medicine to recover, compete, and win and how this same science can help you, too.

Cristiano Ronaldo – Soccer Icon and Goal Machine

Cristiano Ronaldo is not only one of the greatest footballers of all time, with over 800 career goals, multiple Ballon d’Or awards, and Champions League titles, he’s also known for his commitment to physical excellence. In 2016, Ronaldo was battling persistent knee tendinopathy, a chronic inflammation of the patellar tendon that limited his explosiveness and stability on the pitch.

Rather than undergo surgery, he opted for PRP therapy, a form of regenerative treatment that concentrates healing growth factors from the patient’s own blood and injects them directly into the damaged tissue. The results were remarkable. Ronaldo recovered swiftly and went on to lead Portugal to victory in the European Championship that year.

Kobe Bryant – The Relentless Competitor

Kobe Bryant’s legendary career with the Los Angeles Lakers included five NBA championships and an ironclad reputation for pushing through pain. But chronic degeneration in his knees nearly sidelined him for good until he sought out Orthokine therapy in Germany.

This form of autologous conditioned serum (similar in concept to PRP) is designed to reduce joint inflammation and promote cellular repair. After treatment, Kobe not only returned to play, he extended his career by several years and continued to compete at a high level, proving that even wear-and-tear injuries can be managed without invasive surgery.

Rafael Nadal – The King of Clay

With 22 Grand Slam titles and an unmatched legacy on clay courts, Rafael Nadal has long battled the toll that elite tennis takes on the body. Over the years, he has faced both chronic knee tendinitis and lumbar spine pain conditions that could have forced retirement.

Instead, Nadal pursued a course of PRP followed by autologous cell therapy, leveraging the latest in biologic medicine to reduce inflammation and stimulate tissue healing. The treatments worked. He returned to top form and continued to compete at the highest levels, showing that regenerative techniques are not just band-aids, they’re solutions.

Bartolo Colón – The Ageless Wonder of Baseball

At an age when most pitchers have long since retired, Bartolo Colón was still delivering fastballs in the major leagues. But in 2010, with his elbow and shoulder failing, he faced what looked like the end of his career.

Instead of opting for a surgical overhaul, Colón underwent a therapy using cells derived from his own bone marrow and fat tissue. The procedure promoted natural tissue repair, restored function, and brought him back to professional baseball a remarkable comeback that gained national media attention.

Hines Ward – Super Bowl Champion

Known for his toughness and dependability, wide receiver Hines Ward played a crucial role in the Pittsburgh Steelers’ Super Bowl XLIII run. Just weeks before the big game, he suffered a sprained MCL, a ligament injury that typically sidelines players for weeks.

Ward turned to PRP injections and the results were almost immediate. He not only recovered in time to play, he led his team in receiving during the championship game. His case helped put PRP on the map in professional sports and inspired further exploration of non-surgical soft tissue treatments.

What This Means for You

You don’t have to be an Olympian or MVP to benefit from regenerative medicine. At OSSO HEALTH, we bring this same level of care to people from all walks of life — weekend warriors, active professionals, and anyone struggling with joint, tendon, or nerve pain.

Our regenerative medicine offerings include:
- Platelet-Rich Plasma (PRP) for tendon and joint injuries  
- Bone Marrow Aspirate Concentrate (BMAC) for more advanced tissue healing  
- Image-guided procedures to deliver treatment with precision  
- Non-surgical spine and nerve care for sciatica, disc injuries, and more

These therapies are minimally invasive, outpatient, and highly personalized, allowing you to avoid downtime and get back to the activities you love.

Ready to Heal Smarter?

If you’re dealing with pain, injury, or reduced mobility, whether from sports, aging, or everyday life, regenerative medicine may be the solution. Contact us at OSSO HEALTH to schedule a consultation and explore a treatment plan that works for you.

Live well. Move better. Heal naturally.

Musculoskeletal Care 3.0

Ultrasound is Changing the Game

At OSSO HEALTH, we believe in innovation rooted in experience — and there's perhaps no better example of this than the evolving role of ultrasound-guided, minimally invasive procedures in treating common musculoskeletal conditions.

Recently, Dr. Adam Pourcho at AOCPMR25, one of the leading experts in the field shared powerful data, techniques, and outcomes from over 20 years of clinical and procedural experience. Here's what you need to know about how this next generation of care is reducing pain, avoiding surgery, and helping patients get back to life — faster.

Why Ultrasound-Guided Procedures Matter

Many procedures once reserved for the operating room — like carpal tunnel release, trigger finger release, and treatment of chronic tendon injuries — can now be safely performed in-office using high-resolution ultrasound guidance. This precision minimizes risk and maximizes recovery.

Key Advantages:

• Smaller incisions

• Local anesthesia only

• Faster return to work and activity

• Fewer complications and lower infection risk

• Minimal post-procedure downtime

1. Ultrasound-Guided Carpal Tunnel Release

• Over 450,000 carpal tunnel surgeries are performed annually in the U.S., with high costs and downtime.

• With ultrasound, patients returned to activity in 3–5 days on average.

• Local anesthetic only. No tourniquet, no sutures.

• Pillar pain, a common post-surgical complication, was minimal or avoided entirely.

2. Trigger Finger and De Quervain’s Release

• Quick in-office procedure using a needle or device to release the affected tendon sheath.

• Performed under real-time imaging to avoid nerve injury.

• High satisfaction, even in postpartum moms and manual laborers. Most return to activity within 48 hours.

3. Ultrasound-Guided Tendon Debridement

• Ideal for chronic tendinopathies (tennis elbow, Achilles tendon, plantar fascia, hamstrings).

• Uses ultrasonic energy to precisely remove degenerated tissue without open surgery.

• Studies show a 90%+ improvement in function with fewer complications than traditional surgery.

• Common conditions treated:

  • Lateral epicondylitis

  • Patellar and Achilles tendinopathy

  • Plantar fasciitis

  • Rotator cuff partial tears

Understanding Tendon Failure

The speaker challenged an outdated term — "tendinitis" — highlighting how most tendon pain isn’t caused by inflammation, but by tissue breakdown and microtears. This helps explain why corticosteroids, while providing short-term relief, often lead to long-term tendon damage and rupture.

Instead, evidence supports orthobiologic therapies like:

• Platelet-Rich Plasma (PRP)

• A2M or IRAP protein injections

• Ultrasound-guided tendon scraping

When done precisely, these therapies stimulate healing, reduce pain, and avoid the long recovery times of surgery.

OSSO HEALTH’s Approach

At OSSO HEALTH, we’re proud to offer these leading-edge, minimally invasive options as part of our Spine | Sports | Pain | Wellness model. From elite athletes to active adults, our focus is on helping you move better with:

• Evidence-based techniques

• Ultrasound precision

• Personalized recovery plans

• Avoidance of unnecessary surgery

Final Takeaway

Whether you're struggling with carpal tunnel, chronic plantar fasciitis, or a nagging elbow or shoulder pain, there are safer, faster options than traditional surgery — and OSSO HEALTH is here to deliver them.

Schedule a consultation today with Dr. Amir Mahajer to see if ultrasound-guided treatment is right for you.

Let’s move better — together.

Adult Scoliosis

What Is Adult Scoliosis?

When we think of scoliosis, we often picture teenagers in braces. But scoliosis isn’t just a pediatric condition — it can appear or progress later in life, often bringing pain, dysfunction, and frustration for adults trying to stay active.

At OSSO HEALTH, we take a modern, whole-body approach to spine and musculoskeletal wellness. Adult scoliosis is no exception. Here’s what you need to know about this condition and how you can manage it — often without surgery.

Adult scoliosis is an abnormal sideways curvature of the spine in individuals who have reached skeletal maturity. It typically falls into two categories:

• Adult Idiopathic Scoliosis: A progression of adolescent scoliosis that becomes symptomatic or worsens with age.

• Adult Degenerative (De Novo) Scoliosis: Caused by age-related wear-and-tear, such as disc degeneration and facet joint arthritis, which leads to spinal imbalance over time.

Common Symptoms

Symptoms can vary from subtle to severe, depending on the curve’s magnitude and associated structural changes:

• Chronic low back pain

• Muscle fatigue or cramping

• Visible spinal curvature, rib hump, or uneven shoulders

• Difficulty standing upright or walking for extended periods

• Radiating leg pain (sciatica), if nerves are compressed

Diagnosis

Diagnosis is made through a combination of:

• Physical Examination

• Spinal X-rays (to assess the curve using the Cobb angle)

• MRI/CT scans when neurological symptoms or severe pain are present

A Modern, Non-Surgical Approach

Surgery is sometimes necessary for severe curves or progressive deformity, but many adults with scoliosis can be effectively managed with conservative care. At OSSO HEALTH, we focus on personalized non-operative strategies that aim to reduce pain, restore function, and prevent progression.

1. Physical Therapy & Postural Rehabilitation

A structured therapy program is key to long-term relief. We partner with specialists trained in scoliosis-specific techniques to provide:

• Core stabilization to reduce stress on the spinal column

• Flexibility training to relieve tight muscles and improve mobility

• Postural retraining and ergonomic coaching

• Scoliosis-specific protocols (e.g., Schroth Method)

2. Advanced Pain Management

Pain is one of the most common reasons adults seek help for scoliosis. Options include:

• NSAIDs for baseline pain control

• Muscle relaxants during flare-ups

• Neuropathic agents (e.g., gabapentin, duloxetine)

• Trigger point therapy for myofascial pain syndromes

3. Image-Guided Injections

Precision matters. We offer interventional procedures tailored to your pain generators:

• Epidural Steroid Injections for sciatica or spinal stenosis

• Facet Joint Blocks and Medial Branch Blocks

• Radiofrequency Ablation (RFA) for long-lasting joint pain relief

All performed under fluoroscopic guidance in our state-of-the-art facility.

4. Supportive Bracing (When Appropriate)

Bracing in adults is used selectively — not for curve correction, but to:

• Support unstable segments

• Improve posture and comfort

• Reduce fatigue during activity

We determine when a soft or rigid brace may help, without causing deconditioning.

5. Lifestyle & Functional Optimization

Spinal health is whole-body health. We promote:

• Weight management to reduce load

• Anti-inflammatory nutrition

• Daily walking or aquatic therapy

• Activity pacing to balance effort with recovery

6. Osteopathic Manipulative Medicine (OMT)

As part of our osteopathic foundation, we offer hands-on techniques to relieve musculoskeletal dysfunction:

• Myofascial release

• Muscle energy techniques

• Counterstrain

These techniques improve mobility and address soft tissue imbalances.

When to Consider Surgery

Surgical referral is appropriate if:

• The curve exceeds 50–60 degrees

• Pain is unrelenting despite conservative care

• Neurological symptoms or spinal instability worsen

We coordinate with fellowship-trained spine surgeons to ensure a seamless transition when surgical evaluation is needed.

Final Thoughts

Adult scoliosis can impact quality of life — but surgery is not always required. With the right multidisciplinary, patient-centered approach, many adults can live actively and comfortably.

If you or a loved one is dealing with scoliosis-related symptoms, contact OSSO HEALTH today to schedule a consultation with Dr. Amir Mahajer and our expert team.

Spine. Sports. Pain. Wellness. Let’s move better — together.

Ruling Out Serious Causes

Low back pain is one of the most common reasons patients seek medical attention, affecting up to 80% of people at some point in their lives. In most cases, the pain is benign and self-limited. However, in a small but critical subset of patients, low back pain can signal something much more serious—like infection, malignancy, fracture, or inflammatory disease. Identifying these red flags early is essential for timely diagnosis and effective treatment.

Let’s break down the major red flag categories and highlight a real-life case to illustrate the importance of clinical vigilance.

Red Flag Categories in Low Back Pain

1. Infection (0.01–0.7%)

Signs to watch for:

• Fever or recent infection

• Immunocompromised state

• IV drug use

• Severe, progressive pain not relieved by rest

• Night sweats, weight loss

2. Malignancy (0.7–1%)

Red flags:

• History of cancer

• Unexplained weight loss

• Age over 50

• Failure to improve with conservative therapy

• Pain at night or at rest

3. Fracture (4%)

Clues include:

• History of trauma (but not always required)

• Prolonged corticosteroid use

• Osteoporosis

• Age over 70

• Sudden onset pain with limited mobility

4. Inflammatory (0.3–5%)

Look for:

• Age <40, insidious onset

• Morning stiffness >30 minutes

• Improvement with activity, not rest

• Systemic symptoms 

• Family history of autoimmune disease

A Case to Remember: The Hidden Sacral Fracture

One of the most satisfying cases I’ve treated was an elderly woman—a mother and grandmother—who presented with severe lower back and pelvic pain. She had no history of trauma, falls, or recent weight loss. Yet her pain was so debilitating she required moderate to maximum assistance for transfers and ambulation. She was evaluated at multiple healthcare settings without relief.

Advanced imaging revealed the often-overlooked culprit: a sacral insufficiency fracture—a subtype of osteoporotic fracture that can occur spontaneously in older adults with fragile bones. It’s frequently missed or misdiagnosed due to vague symptoms and lack of an inciting event.

Fortunately, I performed a sacroplasty—a minimally invasive, image-guided procedure that stabilizes the sacrum using bone cement. The results were dramatic. Her pain diminished significantly, and she quickly returned to functional independence with activities of daily living (ADLs).

Takeaway: Don’t Miss the Red Flags

While most cases of low back pain will improve with conservative care, red flags are a critical part of the initial evaluation—especially in older adults, those with unexplained disability, or symptoms that don’t follow the typical pattern.

As clinicians, it’s our job to not just treat the symptoms, but to find the “why.” And sometimes, as in this case, the answer is hiding in plain sight.

If you or a loved one is struggling with severe or persistent back pain, don’t ignore it. Schedule a consultation with Dr. Amir Mahajer to determine the cause and explore targeted treatment options—including minimally invasive procedures like sacroplasty.

Blood & Bone Marrow

In today’s fast-paced world, high-performing professionals, athletes, and everyday movers are seeking smarter, safer, and more effective ways to recover, stay active, and maintain long-term function. If you're looking for a modern approach that supports healing rather than masking pain, regenerative medicine may be the answer—and it’s rapidly becoming the gold standard in musculoskeletal care.

What Is Regenerative Medicine?

Regenerative medicine leverages your body’s own healing potential to repair damaged tissue and reduce pain—without relying on surgery or long-term medications. Two of the most clinically validated treatments in this field are:

• Platelet-Rich Plasma (PRP): A treatment derived from your own blood, concentrated with platelets and growth factors that support healing in soft tissues like tendons, ligaments, and cartilage.

• Bone Marrow Aspirate Concentrate (BMAC): Also known as bone marrow concentrate (BMC), this therapy contains adult progenitor cells and bioactive proteins that stimulate regeneration in joints, discs, and chronic tendon injuries.

Unlike corticosteroid injections, which offer only temporary relief and can degrade joint or tendon structures over time, PRP and BMAC are designed to stimulate repair and optimize long-term function.

What Conditions Can Be Treated?

At our Miami Beach clinic, we use regenerative therapies to treat a wide range of musculoskeletal and spine conditions, including:

• Chronic low back pain (including disc-related and facet-mediated pain)

• Tendinopathies (tennis elbow, rotator cuff, patellar tendon, Achilles)

• Mild to moderate osteoarthritis (knees, hips, shoulders)

• SI joint dysfunction

• Labral and meniscal injuries

• Post-injury or post-surgical recovery

Why Diagnostic Precision Matters

Not all back pain or joint pain is created equal. Before treatment, we perform a comprehensive evaluation, including:

• Detailed physical examination

• Advanced imaging and diagnostic blocks

• Functional assessments to understand how your pain is affecting your life

This precision-first model ensures you receive the right therapy for your specific diagnosis, not just a generic injection.

A Word of Caution: Not All Clinics Are the Same

With the rise of regenerative medicine has come a wave of misinformation. In Florida, Senate Bill 1768 threatens to legitimize unproven and poorly regulated products—often made from umbilical cord blood, Wharton's jelly, or amniotic tissue.

Despite being heavily marketed, these products often contain no viable cells and lack scientific backing. A recent peer-reviewed study—Colony Forming Potential and Protein Composition of Commercial Umbilical Cord Allograft Products in Comparison With Autologous Orthobiologics—confirmed that these commercial allografts fall far short of true regenerative standards.

As a result, many patients are being misled by providers who do not follow FDA guidelines or evidence-based practices. That’s why choosing a trusted, board-certified physician with specialized training is critical.

Contact Dr. Amir Mahajer for a Consultation

If you're dealing with chronic pain, recovering from an injury, or simply want to explore whether regenerative medicine is right for you, Dr. Amir Mahajer is here to help. With specialized training in interventional spine and sports medicine, and a focus on nonoperative, regenerative care, you’ll receive a personalized treatment plan grounded in science and tailored to your lifestyle.

Don’t settle for masking pain—treat it at the source. Discover how regenerative medicine can help you move better, feel stronger, and return to the life you love.

Fail Diagnosis = Fail Treatment

The recent article, “What Works for Low Back Pain? New Study Suggests Not Much," draws attention to a critical flaw in the current approach to managing low back pain: the overreliance on nonspecific, generalized treatment strategies in the absence of a proper diagnosis.

If a clinician cannot identify the cause of low back pain, then it’s no surprise that nonspecific treatments would fail to outperform placebo. Pain management cannot be effectively standardized when the pain generator is unknown. This study doesn’t reflect the failure of all nonsurgical interventions—it reflects the limitations of treating back pain without diagnostic clarity.

Spine-trained professionals, including interventional pain, physiatrists and spine surgeons, are equipped with the tools and expertise to:
- Perform detailed physical exams
- Establish a differential diagnosis
- Use targeted diagnostic image-guided blocks, to localize the source of pain
- Develop individualized, evidence-based treatment plans tailored to the patient’s pathology

By contrast, non-spine specialists applying generalized protocols are likely missing the root of the issue entirely. This can result in ineffective treatment, prolonged disability, and escalating healthcare costs.

A better approach would be a physiatry-first model-leveraging the diagnostic and clinical strengths of physical medicine & rehabilitation physicians to assess musculoskeletal and spine pain at the front line. This model emphasizes:
- Functional assessment
- Nonoperative expertise
- Interventional diagnostics when needed
- Coordination of care between conservative and surgical pathways

Instead of viewing this study as proof that nothing works, we should interpret it as a call to elevate the standard of diagnostic care for back pain. When the diagnosis is wrong—or missing—the treatment is destined to fail.

Opioid Brain Injury

Understanding the Risks and Exploring Safer Alternatives

Chronic musculoskeletal (MSK) pain—such as persistent low back pain, osteoarthritis, or widespread myofascial discomfort—can significantly affect quality of life. While opioids have long been prescribed to manage pain, their use in chronic non-cancer MSK conditions has come under increased scrutiny. Leading health authorities, including the CDC and WHO, now advise against routine opioid therapy in these cases due to limited long-term benefit and significant harm.

Below, we break down why opioids are not recommended for chronic MSK pain, with a special focus on two major concerns: irreversible brain changes and opioid-induced hyperalgesia.

I. The Limited Effectiveness of Opioids in Chronic Pain

Opioids were originally intended for short-term, acute, or end-of-life pain. In chronic MSK conditions:

• Effectiveness is modest at best: Studies show only small improvements in pain and function, often outweighed by side effects.

• No improvement in long-term outcomes: After months or years of use, patients often report no greater pain relief than with non-opioid alternatives.

• Tolerance develops quickly, requiring escalating doses that increase risk without greater benefit.

“There is no evidence that opioids improve pain or function with long-term use in chronic musculoskeletal conditions.” — CDC Guidelines for Prescribing Opioids for Chronic Pain, 2022

II. Risk of Irreversible Brain Changes

Chronic opioid use has been associated with structural brain changes, particularly in regions involved in emotion regulation, cognition, and reward. Dr. Amir Mahajer has coined the term “Opioid Brain Injury” (OPI) to describe the neurological damage associated with opioid exposure. OPI encompasses what is medically known as toxic leukoencephalopathy, a condition characterized by white matter injury in the brain resulting from exposure to toxic substances, including opioids.

Neuroimaging studies show:

• Atrophy of gray matter in the prefrontal cortex, associated with decision-making and impulse control.

• Reduction in the amygdala and anterior cingulate cortex, areas involved in pain modulation and emotional response.

• Lowered brain volume, even in younger users, correlating with longer exposure and higher doses.

These changes may be partially irreversible and can contribute to:

• Cognitive dysfunction

• Mood disorders

• Increased risk of substance misuse

“Long-term opioid exposure can lead to persistent and potentially irreversible alterations in brain structure and function.” — Upadhyay et al., J Neurosci, 2010

III. Opioid-Induced Hyperalgesia (OIH)

A paradoxical effect of long-term opioid use is increased sensitivity to pain, a condition known as opioid-induced hyperalgesia (OIH).

What happens in OIH?

• The nervous system becomes amplified, over-responding to normal pain signals.

• Patients report increased pain, even as opioid doses are raised.

• The pain becomes diffuse, poorly localized, and more difficult to manage.

Mechanistically, OIH involves:

• Excitation of NMDA receptors

• Increased spinal dynorphin expression

• Altered descending pain inhibition

This creates a vicious cycle: more opioids → more pain → more opioids.

“Opioid-induced hyperalgesia is a recognized and serious clinical phenomenon that may worsen pain with prolonged opioid therapy.” — Lee et al., Lancet, 2011

IV. Other Serious Risks of Opioids

• Dependence and Addiction: Even at therapeutic doses, patients can develop physical dependence and addiction.

• Overdose and Death: Opioid overdoses remain a public health crisis in the U.S., with chronic pain patients at elevated risk.

• Hormonal Dysregulation: Long-term use can suppress testosterone and other sex hormones.

• Constipation, Nausea, Sedation: Common and often intolerable side effects.

• Falls and Fractures: Especially in older adults due to sedation and impaired motor control.

V. Safer and More Effective Alternatives

• Physical therapy and structured exercise: Improve mobility and reduce pain through strengthening, posture correction, and movement education.

• Cognitive-behavioral therapy (CBT): Addresses the emotional and psychological aspects of chronic pain.

• Non-opioid medications: NSAIDs, antidepressants (like duloxetine), and anticonvulsants (like gabapentin) may offer relief with fewer risks.

• Interventional procedures: Injections, nerve blocks, and minimally invasive techniques can reduce pain and inflammation.

• Osteopathic Manipulative Treatment (OMT): A hands-on approach to reduce pain and improve function through gentle manipulation of the musculoskeletal system.

VI. Final Thoughts

For people living with chronic MSK pain, opioids may seem like a quick solution—but they often fail to provide long-term relief and carry significant, sometimes irreversible risks. Brain atrophy and opioid-induced hyperalgesia are two particularly serious concerns that highlight the need for a more holistic, evidence-based approach.

As the medical community shifts toward comprehensive pain management strategies, patients and physicians are encouraged to work together to find safer, more effective paths toward relief and improved quality of life.

References

1. Upadhyay J, Maleki N, Potter J, et al. Alterations in brain structure and functional connectivity in prescription opioid-dependent patients. J Neurosci. 2010;30(18): 6109–6117. doi:10.1523/JNEUROSCI.0319-10.2010

2. Lee M, Silverman SM, Hansen H, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145-161.

3. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review. Ann Intern Med. 2015;162(4):276-286. doi:10.7326/M14-2559

4. Vowles KE, McEntee ML, Julnes PS, et al. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569–576. doi:10.1097/01.j.pain.0000460357.01998.f1

5. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95. doi:10.15585/mmwr.rr7103a1

Natural Pain Relief

Understanding the Science of Movement, Endorphins, and Natural Pain Relief

Chronic pain can significantly reduce quality of life, impacting everything from sleep and mood to mobility and productivity. While medications and interventions play important roles in treatment, exercise has consistently emerged as one of the most effective and sustainable tools to reduce pain, improve function, and support overall well-being.

But how exactly does exercise help relieve chronic pain? The answer lies in exercise-induced analgesia (EIA)—a natural pain-relief mechanism triggered by physical activity.

I. What Is Exercise-Induced Analgesia (EIA)?

EIA is the phenomenon where physical activity leads to a temporary reduction in pain sensitivity. This response can be seen in healthy individuals and in people living with chronic pain conditions such as fibromyalgia, osteoarthritis, and chronic low back pain.

Whether you're walking, lifting weights, practicing yoga, or swimming, your body undergoes complex neurochemical changes that inhibit pain signals and promote healing.

II. How Does Exercise Reduce Pain?

1. Activating Endogenous Analgesic Systems

During and after aerobic or resistance exercise, the body activates several biochemical pathways:

• Nitric Oxide (NO) / cyclic GMP / K⁺ ATP Channels: This cascade promotes hyperpolarization of pain-sensitive neurons, reducing their ability to transmit pain signals.

• Potassium Ion Efflux: This stabilizes neuronal membranes, making it harder for pain messages to reach the brain.

2. Release of Natural Pain Relievers

Exercise stimulates the release of key neurotransmitters and hormones known for their role in pain modulation:

• Endogenous Opioids (Endorphins): Bind to opioid receptors (μ and κ) to block pain.

• Serotonin (5-HT): Enhances mood and pain regulation.

• Norepinephrine (NE): Increases alertness and reduces pain sensitivity.

• Endocannabinoids (EC): Bind to CB1 and CB2 receptors, reducing inflammation and pain perception.

These substances mimic the effects of pain medications—without the side effects.

3. Engaging Pain-Modulating Receptors

These naturally released chemicals act on specific receptors in the nervous system:

• α2-Adrenergic Receptors: Mediate calming, anti-pain effects.

• Cannabinoid Receptors (CB1, CB2): Inhibit pain and inflammation.

• Serotonin Receptors (5-HT1, 2, 3): Help reduce central pain processing.

• Opioid Receptors (μ, κ): Major players in suppressing pain signals.

The result? A natural and powerful suppression of nociceptive (pain-transmitting) neurons.

III. Other Benefits of Exercise for Chronic Pain

✔ Reduces Inflammation

Regular movement helps lower systemic inflammation—one of the root causes of chronic pain.

✔ Enhances Sleep

Quality sleep is essential for pain recovery. Exercise has been shown to improve both sleep quantity and quality.

✔ Boosts Mood and Mental Health

Exercise reduces symptoms of anxiety and depression, both of which are common in people living with chronic pain.

✔ Increases Function and Mobility

Stronger muscles, better flexibility, and improved endurance lead to less joint stress and greater independence.

✔ Improves Body Awareness

Gentle movement practices like yoga, Pilates, and tai chi help patients develop better body mechanics and posture, preventing flare-ups and reinjury.

IV. Recommended Types of Exercise

Not every type of exercise is suitable for everyone, especially those in pain. However, the following are commonly effective:

• Aerobic Exercise: Walking, swimming, cycling (start light, build gradually)

• Resistance Training: Improves strength and pain tolerance

• Stretching & Mobility: Prevents stiffness and improves posture

• Mind-Body Movement: Tai chi, yoga, Qigong support both physical and mental health

Tip: Always consult your healthcare provider before starting a new exercise program, especially if you're recovering from injury or managing a complex pain condition.

V. Final Thoughts

Exercise is more than just movement—it’s medicine. By stimulating your body’s natural pain-relieving systems, improving function, and enhancing mental health, physical activity can be a transformative part of managing chronic pain.

The key is to start slow, stay consistent, and find what works for you. With guidance and persistence, exercise can help you reclaim comfort, strength, and vitality.

References

1. Mazzardo-Martins L, Martins DF, Marcon R, et al. High-intensity extended swimming exercise reduces pain-related behavior in mice: involvement of endogenous opioids and the serotonergic system. J Pain. 2010;11(12):1384-1393. doi:10.1016/j.jpain.2010.03.015

2. Koltyn KF. Analgesia following exercise: a review. Sports Med. 2000;29(2):85-98. doi:10.2165/00007256-200029020-00002

3. Nijs J, Kosek E, Van Oosterwijck J, et al. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician. 2012;15(3 Suppl):ES205-ES213.

4. Dietz J, Juhl C. Exercise-induced hypoalgesia in healthy individuals and people with chronic pain: a systematic review and meta-analysis. Pain. 2022;163(5):e633-e645. doi:10.1097/j.pain.0000000000002437

5. Stagg NJ, Mata HP, Ibrahim MM, et al. Regular exercise reverses sensory hypersensitivity in a rat neuropathic pain model: role of endogenous opioids. Anesthesiology. 2011;114(4):940-948. doi:10.1097/ALN.0b013e31820c7418

Sleep Science

Quality sleep is essential for physical and mental well-being, cognitive performance, emotional balance, and long-term health. Research shows that poor sleep increases the risk of chronic disease, impairs decision-making, and accelerates aging. The National Sleep Foundation recommends:

• Adults (18–64 years): 7–9 hours

• Older adults (65+): 7–8 hours

• Teenagers (14–17 years): 8–10 hours

• Infants and newborns: 12–17 hours

Below are evidence-based strategies to help optimize sleep and support long-term health and performance.

I. Sleep Hygiene Practices

• Follow the 3-2-1 Rule: Avoid caffeine and large meals 3 hours before bed, stop work-related tasks 2 hours before bed, and turn off screens 1 hour before bed to reduce blue light exposure.

• Maintain a consistent sleep schedule: Go to bed and wake up at the same time every day, including weekends.

• Create a restful environment: Keep your bedroom cool (65–68°F), dark, and quiet. Use blackout curtains and white noise if needed.

• Limit naps: Restrict daytime naps to 20–30 minutes in the early afternoon.

• Avoid alcohol and nicotine: Both interfere with the quality of sleep and should be avoided before bedtime.

II. Morning Light Exposure and Evening Blue Light Management

• Maximize natural light exposure in the morning: Sunlight within the first hour of waking helps reset your internal clock.

• Reduce evening blue light: Use night mode on devices or wear blue light-blocking glasses to prevent melatonin suppression.

III. Physical Activity and Sleep

• Exercise regularly: Resistance training has been shown to reduce insomnia more effectively than aerobic exercise.

• Avoid late workouts: Intense exercise within 2 hours of bedtime may delay sleep due to increased heart rate and body temperature.

• Incorporate relaxing movement: Tai Chi and Qigong have demonstrated benefits for improving sleep and reducing stress.

IV. Nutrition for Better Sleep

• Increase fiber and protein: These nutrients are associated with improved sleep duration and depth.

• Choose sleep-supportive foods: Almonds, turkey, bananas, and tart cherries provide melatonin, magnesium, and tryptophan.

• Avoid caffeine and heavy meals at night: Caffeine should be avoided at least 6 hours before bed.

• Include fermented foods: Probiotics from yogurt, kimchi, and miso may improve sleep by supporting gut-brain communication.

V. Stress Management and Mindfulness Techniques

• Practice meditation and deep breathing: Mindfulness-based stress reduction and progressive muscle relaxation improve sleep onset and quality.

• Consider Cognitive Behavioral Therapy for Insomnia (CBT-I): This is the most effective non-pharmacologic treatment for chronic insomnia.

VI. Use Technology Mindfully

• Sleep tracking tools: Use wearable devices to observe patterns but avoid over-reliance on data interpretation.

• Consult a medical professional: Persistent insomnia, snoring, or unrefreshing sleep may indicate a medical sleep disorder.

Wellness & Longevity Basics

Prioritizing quality sleep is fundamental to achieving optimal health, energy, and resilience. By integrating these evidence-based strategies into your lifestyle, you can improve your physical and cognitive performance, reduce disease risk, and enhance your quality of life. For ongoing concerns, consult a healthcare provider or sleep specialist.

Social Connections

Strong social connections are essential for whole-person wellness, influencing your mental, emotional, and physical health. Research shows that meaningful relationships can lower the risk of chronic disease, improve mental well-being, and even extend your lifespan. In contrast, chronic loneliness and social isolation have been linked to increased risks of depression, anxiety, cognitive decline, and heart disease.

Here are 7 practical ways to strengthen your social connections and boost long-term health:

I. Get Involved in Your Community

Join local clubs, community groups, or volunteer organizations to expand your social circle. Participating in cultural events, fitness classes, or hobby groups can enhance your sense of purpose and belonging.

II. Join a Support Group

Facing a life challenge? Support groups offer shared understanding, practical advice, and emotional comfort—whether for chronic illness, grief, parenting, or stress management.

III. Seek Out Peer Support

Connect with others who’ve experienced similar struggles. Peer support programs help you feel seen and understood, especially when facing health conditions or major life transitions.

IV. Improve Your Social Skills and Confidence

Start small: practice active listening, ask open-ended questions, and show empathy. Over time, building confidence in social situations can enhance both casual and meaningful interactions.

V. Prioritize Meaningful Relationships

Make time for the people who uplift and support you. A quick walk, a shared coffee, or a phone call can strengthen emotional bonds and help reduce stress.

VI. Use Technology to Stay in Touch

When face-to-face time isn’t possible, connect via video calls, social media, or messaging apps. While not a full substitute, virtual communication helps maintain vital connections.

VII. Be Open to New Relationships

Say yes to opportunities, smile at a neighbor, and initiate conversations. Positive connections often start with simple, intentional acts of outreach.

Wellness & Longevity Basics

Your relationships matter. Investing time and energy into building social support can profoundly enhance your quality of life—emotionally, physically, and spiritually.

Spine Medicine

Spine Health and Pain Management

Spine medicine is a multidisciplinary field that integrates cutting-edge medical technologies, holistic therapies, physical rehabilitation, and psychological support. Whether you are managing chronic back pain or recovering from a spine injury, this comprehensive guide outlines everything from conservative care to advanced interventions.

Understanding Spine Conditions

Degenerative Spine Disorders:

• Lumbar and Cervical Disc Herniation: Nerve root compression may cause radiculopathy. Treatments include physical therapy, epidural steroid injections, or surgery like microdiscectomy.

• Spinal Stenosis: Narrowing of spinal canal causing pain and weakness. May require decompression or laminoplasty.

• Facet-Mediated Pain: Often treated with medial branch blocks (MBB) and radiofrequency ablation (RFA).

• Spondylolisthesis: Forward slippage of vertebra; can be managed with therapy or fusion procedures.

Spinal Deformities and Instability:

• Adult and Pediatric Scoliosis: Options range from observation and physical therapy to long or short fusion surgeries.

• Schuermann's Kyphosis and DISH: Managed conservatively or surgically depending on severity.

Inflammatory and Infectious Conditions:

• Inflammatory Spine Disorders and Spine Infections: Require diagnostic imaging and often systemic treatment.

Neoplastic Spine Conditions:

• Spine Tumors and Cancer-Related Pain: May necessitate radiation, vertebral augmentation, or surgical stabilization.

Diagnostic Tools and Imaging Guidance

• Electrodiagnostics: To evaluate radiculopathy and neuropathy.

• Imaging: Use of X-ray, ultrasound, CT, MRI, and bone density scans.

Conservative Management

Rehabilitation Therapies:

• Physical Therapy (PT)

• Occupational Therapy (OT)

• Home Exercise Programs (HEP)

• Osteopathic Manipulative Treatment (OMT)

• Yoga and Pilates

Medications and Supplements:

• NSAIDs, Acetaminophen (APAP), Muscle Relaxants, Neuropathic Pain Agents

• Opioids - used cautiously in acute fractures and cancer pain.

Psychological Considerations:

• Addressing Anxiety, Depression, Fear Avoidance, and Chronic Pain Syndrome with integrated behavioral therapy.

Interventional Pain Procedures

• Epidural Steroid Injections (ESI) for acute radiculopathy

• Facet Joint Injections and MBB/RFA for chronic facet pain

• Trigger Point Injections, Peripheral Nerve Blocks, Sympathetic Blocks

• SI Joint Injections, Disc Injections, and Intravertebral RFA

Advanced Minimally Invasive Procedures:

• Vertebral Augmentation for osteoporotic fractures

• MILD Procedure for lumbar stenosis

• Disc Regenerative Therapies (PRP, Stem Cells)

• Spinal Cord Stimulation (SCS) for refractory neuropathic pain

• Endoscopic Procedures for disc pathology

Surgical Considerations

• Short vs. Long Fusion based on pathology severity

• Scoliosis Surgery: Traditional fusion vs. vertebral body tethering

• Sacroiliac Joint Fusion: For intractable SI joint pain

• Decompression Surgeries for stenosis and myelopathy

Patient Education & Safety

• Nonspecific Low Back Pain (LBP) Guidelines: Promote conservative management first

• Work-related and Traumatic Spine Injuries: Often treated with a combination of conservative and procedural interventions

• Spine Orthoses: May be prescribed for structural support

Conclusion

Spine medicine requires a comprehensive and integrative approach. From conservative modalities to complex surgeries, a personalized plan based on diagnosis, function, and goals leads to the best outcomes. Dr. Amir Mahajer has led the development of multiple Spine and Musculoskeletal Centers of Excellence and is committed to delivering individualized care rooted in the highest standards of clinical excellence.

To learn more, visit www.osso.health or schedule a consultation today.

What is OMT?

Osteopathic Manipulative Treatment (OMT) is a hands-on, evidence-based approach to healthcare used by Doctors of Osteopathic Medicine (DOs). Through skilled manual techniques, OMT helps diagnose, treat, and prevent a wide range of medical conditions, especially those related to the musculoskeletal system.

If you're dealing with chronic pain, restricted mobility, or even stress-related tension, OMT may be a gentle and effective way to restore balance and promote healing—without medications or surgery.

What Does OMT Treat?

OMT is commonly used for:

• Low back pain

• Neck and shoulder pain

• Joint or muscle stiffness

• Sports injuries

• Headaches and migraines

• Sciatica and nerve entrapment

• Poor posture and mobility issues

OMT may also complement treatment plans for respiratory conditions, digestive disorders, and chronic fatigue.

What Happens During an OMT Session?

Your osteopathic physician will begin with a general screening, which may include:

Postural Exam & Osteopathic Screening

The doctor evaluates your posture and body alignment, identifying imbalances that may contribute to pain or dysfunction. The comprehensive Osteopathic Screening checks for soft tissue and joint mobility. Once the evaluation is complete, the physician uses a variety of hands-on techniques tailored to your needs.

Common OMT Techniques

I. Lumbosacral Spine - HVLA (High Velocity, Low Amplitude), Myofascial Release

II. Cervical Spine- Counterstrain, Soft Tissue, Articulatory Techniques

III. Extremities - Joint Mobilization, Myofascial Release, Muscle Energy

IV. Ribs & Thoracics - Rib Raising, Muscle Energy, Lymphatic Techniques

V. Head & Face - Craniosacral Therapy (especially headaches), Myofascial Release (TMJ)

Each technique helps release restrictions, improve motion, and support your body’s natural healing process.

How Is OMT Different from Chiropractic or Massage?

While chiropractic care often focuses on spinal alignment, and massage therapy targets muscle tension, OMT is a medical treatment performed by licensed physicians. DOs have comprehensive training in anatomy, pathology, and internal medicine, enabling them to integrate OMT with other conventional medical treatments.

Benefits of OMT

• Reduces pain and inflammation

• Improves mobility and range of motion

• Enhances circulation and lymphatic flow

• Supports overall wellness and body balance

• May reduce reliance on medications

Is OMT Right for You?

If you’re searching for natural, holistic relief for chronic pain or movement issues, OMT may be the answer. It’s safe for patients of all ages—from newborns to seniors—and can be customized for your individual needs.

OMT at Osso Concierge Care

Dr. Amir Mahajer and the team at Osso Health offer expert Osteopathic Manipulative Treatment, combining clinical expertise with a personalized approach to care.

Schedule Your Consultation Today
www.osso.health
team@osso.health

Chronic Back Pain

Chronic low back pain is one of the most common reasons people seek medical attention and miss work. But despite how widespread it is, many people still don’t understand what causes it—or how to treat it effectively.

In this post, I’ll walk you through the core principles every patient should know about managing chronic low back pain and why taking a whole-body approach matters.

What is Chronic Low Back Pain?

Chronic low back pain is defined as pain that lasts for more than 12 weeks. Unlike acute injuries, chronic pain is often multifactorial and can involve muscular, joint, disc, nerve, and even psychological components.

Common Causes

• Disc degeneration or herniation

• Facet joint arthritis

• SI (sacroiliac) joint dysfunction

• Poor posture or biomechanics

• Muscle deconditioning or imbalance

• Old injuries that never healed properly

It's More Than Just Anatomy

One important thing I explain to my patients is that pain is both a physical and neurological experience. The brain interprets signals from your body and can amplify them if you’re dealing with stress, poor sleep, or anxiety.

That’s why it’s important to treat the whole person—not just the MRI scan.

What Are Your Treatment Options?

There’s no one-size-fits-all solution for chronic low back pain, but there are several evidence-based strategies I use in my practice:

I. Movement is Medicine

Gentle activity, walking, and physical therapy can restore function. Avoiding movement can actually make pain worse.

II. Osteopathic Manipulative Treatment (OMT)

As an osteopathic physician, I use OMT to improve alignment, reduce strain, and support healing. It’s a hands-on approach that works especially well for muscular and joint imbalances.

III. Injections and Abaltions

Targeted diagnostic / therapeutic procedures, like spinal joint or nerve blocks and even radiofrequency ablations (RFA), can reduce pain and improve mobility when used appropriately.

IV. Regenerative Medicine

Platelet-rich plasma (PRP) and bone marrow-derived cell therapies can support tissue healing and are showing great promise for disc and joint-related pain.

V. Mind-Body Optimization

Chronic pain can be worsened by poor sleep, anxiety, and depression. Mindfulness, breathing exercises, and optimizing hormonal health can play a crucial role in long-term outcomes.

Bottom Line

If you're dealing with chronic low back pain, the answer is not always surgery or pills. The best approach is a comprehensive one that looks at posture, movement, inflammation, and even your nervous system.

At Osso Health, we specialize in helping patients optimize their health from the inside out with non-surgical, regenerative, and osteopathic solutions.

Schedule a Consultation:
Visit www.osso.health or email us at team@osso.health to learn more about your personalized care options.

Watch Dr. Mahajer’s Video

Physiatry First

Revolutionizing Rehabilitation and Pain Management

Why Physiatry Should Be Your First Choice for Musculoskeletal and Neurological Care

When faced with pain, injury, or mobility limitations, many patients are directed to surgery or long-term medication use as a first-line solution. However, there’s an alternative that focuses on maximizing function, minimizing pain, and avoiding unnecessary interventions—and that’s Physiatry First.

Physiatry, or Physical Medicine and Rehabilitation (PM&R), is a patient-centered specialty that takes a holistic, non-surgical approach to treating a wide range of conditions, from sports injuries and spine disorders to stroke rehabilitation and chronic pain.

What is Physiatry First?

The Physiatry First movement promotes the idea that physiatrists should be the first point of contact for patients experiencing musculoskeletal, neurological, and pain-related conditions. Instead of jumping straight to surgery, opioid prescriptions, or passive treatments, physiatrists identify the root cause of dysfunction and create comprehensive rehabilitation plans tailored to the patient’s goals.

By emphasizing function, movement, and quality of life, Physiatry First offers a sustainable and evidence-based approach to care.

Conditions Best Treated by Physiatrists

Physiatrists specialize in diagnosing, managing, and rehabilitating a wide variety of conditions, including:

✔ Spine & Joint Pain – Chronic back pain, sciatica, arthritis, and degenerative disc disease
✔ Sports & Overuse Injuries – Tendinitis, ligament tears, muscle strains, and stress fractures
✔ Neurological Conditions – Stroke, multiple sclerosis, spinal cord injury, and traumatic brain injury
✔ Chronic Pain Syndromes – Fibromyalgia, complex regional pain syndrome (CRPS), and post-surgical pain
✔ Work-Related & Occupational Injuries – Carpal tunnel syndrome, repetitive stress injuries, and ergonomic dysfunction
✔ Post-Surgical Rehabilitation – Joint replacements, spinal surgery recovery, and soft tissue repair

How Physiatry First Improves Patient Outcomes

I. Reducing Unnecessary Surgeries

Many spinal conditions, joint disorders, and soft tissue injuries can be treated effectively without surgery using a combination of:

• Image-guided injections (PRP, corticosteroids, BMAC, etc.)

• Manual therapy & osteopathic manipulative treatment (OMT)

• Physical therapy & movement retraining

• Regenerative medicine & non-invasive pain management

Surgery should be the last resort, not the first option. Physiatry explores all conservative treatment avenues first, helping many patients avoid the risks and recovery time associated with invasive procedures.

II. A Functional Approach to Healing

Unlike other specialties that focus only on symptom relief, physiatrists address the underlying cause of dysfunction and create treatment plans to restore strength, mobility, and independence.

Instead of simply prescribing medications or recommending passive treatments, Physiatry First emphasizes:
✔ Active rehabilitation – Targeted exercises and movement strategies tailored to the patient’s needs
✔ Comprehensive diagnostics – Electrodiagnostic testing (EMG/NCS), musculoskeletal ultrasound, and motion analysis
✔ Integrative care – A multi-disciplinary approach that may involve physical therapists, occupational therapists, nutritionists, and mental health professionals

III. Whole-Person Wellness & Longevity

Physiatry First isn’t just about injury recovery—it’s also about enhancing long-term health and function. Many physiatrists integrate wellness, longevity, and lifestyle medicine into their treatment plans, helping patients:
✔ Optimize posture, movement, and biomechanics
✔ Improve nutrition and inflammation control
✔ Manage stress and mental well-being
✔ Enhance sleep quality and recovery

By taking a proactive approach, physiatrists help prevent future injuries and chronic conditions, allowing patients to stay active, mobile, and pain-free for life.

Physiatry First: The Future of Non-Surgical Care

As the demand for minimally invasive, patient-centered care grows, Physiatry First is becoming a leading philosophy in musculoskeletal, pain, and neurological rehabilitation.

Patients deserve more options than just surgery or medications—they deserve a customized, holistic plan that prioritizes function and long-term well-being. That’s what Physiatry First is all about.

If you or someone you know is experiencing pain, injury, or movement limitations, consider seeing a physiatrist first. Your body will thank you.

Would you like help finding a physiatrist near you or learning more about non-surgical treatment options? Contact us today!