To learn more about how we can offer comfort and well-being, follow our blogs. 


DISCLAIMER: Like all medical procedures, all the procedures that we perform have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else. 

Sunday, July 15, 2018
By Edward Dieguez Jr. MD PA
Pin It

Where are the sacroiliac joints? 

 They are located in the lowermost part of your back. There is one on the right and one on the left side. These joints as the name implies are formed by the sacrum in the middle sore of as a wedge in between the right and left iliac bone. On top of the sacrum sits the lumbar spine.  Strong ligaments in front and in the back hold the bones together. The actual articular surface of each joint is very irregular. 


What is SI joint dysfunction? 

It is improper movement of the joints that connect the sacrum to the iliac bones. 


What can cause it?

*Pregnancy or recent childbirth 

*Lower lumbar fusion

*Leg length disparity


*Contact sports

*Regular heavy lifting, or labor-intensive jobs

*Pelvic or low back muscles unconditioned combined with prolong sitting 

*Direct result of injury or trauma, such as the jolt from a fall


What are the symptoms?  

Lower back pain usually unilateral dull and aching. Pain usually spread to the hips, buttocks and groin. Sciatic-like pain from sacroiliac joint dysfunction rarely extends below the knee and may include numbness and tingling. Reduced range-of-motion in the lower back, hips, pelvis, and groin, which may cause difficulty with movements such as walking up stairs or bending at the waist.


How to diagnose SI joint dysfunction?

There is no single test to diagnose it. Among the test used we have the sacral thrust test, the distraction test and the Faber test.  However an injection of the SI joint in question is the gold standard for diagnosing that the SI joint is the source of the pain. 


What are the treatment options? 

After a good diagnosis is made, basically the treatment  will depends on the severity and on how long you have been suffering from it. Conservative therapy is always better than surgery and much less risky. Initially and if not too severe or prolonged, prescription NSAID along with prescription muscle relaxants ice or heat and physical therapy including manual manipulation may be best.  A pelvic brace or support may be useful for a hypermobile joint. 


If all of the above fails, the most successful treatment by far with minimal risk is Prolotherapy injections using hypertonic glucose or PRP. On each Prolotherapy session, the ligaments that hold the joints together are injected precisile where they attach to the bone. This points are called Enthesis. Injection these point with the proliferant solution, stimulates the local stem cells to grow and strengthen the ligaments. These in turn strengthens the joint.  The goal here is to strengthen the ligaments that hold the joint together. Usually  four or five sessions  separated three to four weeks apart wil do the trick. 

Thursday, June 21, 2018
By Edward Dieguez Jr. MD PA
Pin It

What is Metatarsalgia? It is a common overuse injury in which there is DISCOMFORT and inflammation of the ball of the foot (first metatarsal head) and may include other metatarsals heads also. It is common in those that participate in high impact sports such as jumping, track and field, baseball, soccer and tennis.


Factors that may influence its appearance.The following factors can contribute to excessive localized pressure over the forefoot:

  • High level of activity
  • Prominent metatarsal heads
  • Tight toe extensors (muscles)
  • Weak toe flexors (muscles)
  • Hammertoe deformity
  • Hypermobile first foot bone
  • Tight Achilles tendon
  • Excessive pronation (side-to-side movement of the foot when walking or running)
  • Ill-fitting footwear

Some anatomical conditions may predispose individuals to forefoot problems. They include:

  • A high arch
  • A short first metatarsal bone or a long second metatarsal bone is often seen in people with a Morton toe; the normal forefoot balance is disturbed, resulting in the shift of an increased amount of weight to the second metatarsal.
  • Hammertoe deformity

Any or all of the above musculoskeletal problems may contribute to forefoot trauma in athletes.


What are the symptoms? Discomfort in the ball of the foot (first metatarsal) or other metatarsals aggravated by walking or running. Patient may also describe the feeling of like walking on marbles or pebbles. 


What treatment work best? After the correct diagnosis is made and after you have tried all the common modalities of treatments such as ice, rest, physical therapy, orthotics etc., and before any surgery is considered, you owe it to yourself to try Prolotherapy. This modality of therapy is very benign and the results are very good.  In a retrospective study done by Dr. Hauser, of 19 patients treated with Hackett-Hemwall hypertonic dextrose prolotherapy, all 100% had improvements of their pain and stiffness. Eighty-four percent experienced 50% or more pain relief. Dextrose Prolotherapy helped the patients make large improvements in walking and exercise ability, as well as produced decreased levels of anxiety and depression. One-hundred percent of patients said Prolotherapy changed their lives for the better. This article was published in the Journal of Prolotherapy.

Monday, June 18, 2018
By Edward Dieguez Jr. MD PA
Pin It

What is the ilio-tibial band?  

          The iliotibial tract or iliotibial band (also known as Maissiat's band or IT Band) is a longitudinal fibrous reinforcement of the fascia lata. The action of the ITB and its associated muscles is to extend, abduct, and laterally rotate the hip. In addition, the ITB contributes to lateral knee stabilization.The iliotibial band is an important stabilizer structure of the lateral part of the kneeas the joint flexes and extends. The iliotibial band runs along the lateral or outside aspect of the thigh, from the pelvis to the tibia, crossing both the hip and knee joints.

What is iliotibial band syndrome? 

           It is an inflammation and irritation of the iliotibial band basically from overuse. It can occur as it travels back and forth, crossing the bony prominence of the femoral epicondyle on the lateral aspect of the knee, as the knee flexes and extends. Iliotibial band syndrome is an overuse injury. It causes pain on the outer part of the knee when running as the heel strikes the ground.


Standard treatment of Iliotibial band syndrome.

           It consists of rest, ice, compression and elevation (RICE). Physical therapy helps with stretching exercises and other therapy modalities.


What to do if the problem keeps coming back? 

           As we mentioned above in the description of what the iliotibial band consist of, this structure is an important stabilizer of the lateral aspect of the knee joint. If there is an instability of the knee joint because of laxity of other joint ligaments, then more stress is placed on the iliotibial band and it is irritated from overuse. 

           When the iliotibial band syndrome persist or keeps recurring, it may signals an instability of the knee due mainly to lateral collateral ligament laxity. In this chronic cases an excellent treatment modality is Prolotherapy or Platelet Rich Plasma (PRP) therapy. These are advanced Regenerative medicine technique that work regenerating the weaken tissues of old injuries

Monday, March 12, 2018
By Edward Dieguez Jr. MD PA
Pin It

1. What is it? 

Is an inflammation of the fluid-filled sac, or bursa, that lies between the ischial tuberosity and the tendon that attaches the hamstring muscle to the bone.


2. What is the cause?

Injury or overuse can irritate the bursa causing the bursa to become inflamed, swollen, and painful. It is also caused by inflammation or injury to a nearby tendon, the hamstring that insert on the ischial tuberosity. This injury can be from direct trauma to the area, or from injury to the hamstring muscle or tendon through activities such as running or bicycling. Ischial bursitis can also result from sitting for long periods on a hard surface,


3. Symptoms

This may include pain when sitting and pain at the center of the butt that can radiate going down the back of the leg that mimic sciatica. This can be felt during walking or even when flexing the hip at rest.


4. Treatment

      a) Concervative Treatment.-  These are the  simplest and most commonly use. They include of rest, ice, compression and elevation is done for managing the ischial tuberosity pain. These techniques are not always effective, and are   not helpful in restoring the tissue injury. They only in alleviating the pain for short term, but it is not quite effective in chronic cases of ischial tuberosity pain. Additionally if the patient takes prolonged rest or ice application, there is decrease in the blood supply which delays in the healing process.   

     b) Physical therapy: This also help in controlling and reducing the ischial tuberosity pain. However it does not provide a permanent solution, as it does not repair the damage in the muscular tissues and ligaments.

    c) Analgesic Medicines: A variety of analgesic are also used for treating the ischial tuberosity pain. They will only relieve the pain and will not heal the damaged tissues. Analgesic should only be used for short term duration, as using them long term produces significant side effects and may affect the kidney function. Steroid such as hydrocortisone are also used sometimes and will relieve the pain but weaken the tissue even more.


The therapy modalities that fallow are very advance therapy modalities and there are not many physician familiar with them. These treatment methods require very skilled and experienced physicians and health care staffs to conduct them.


     d) Prolotherapy: This is a favorable and very advanced treatment method for pain in the ischial tuberosity. A hypertonic dextrose solution is injected in the areas of the damaged tissues to produces inflammation, which stimulate the local stem cells to repair the damaged area. This treatment helps in depositing new collagen and repairing the injured ligaments. It promotes strengthening of the soft tissues, which leads to gradual improvement of hamstring tearing. This process helps in resolving the ischial tuberosity pain.


     e) Stem Cell Therapy: This treatment is an innovative method for treating ischial tuberosity pain. Stem cells obtained from the bone marrow of the patient are injected into the area. This leads to self-restoration of the affected tissues alleviating the associated ischial tuberosity pain. Stem cell procedure is a a natural treatment process.


     f) Platelet Rich Plasma Technique: This therapy is used in conjuction or as a booster, after stem cell therapy. There is large amount of cytokinin present in the Platelet Rich Plasma, which reinforces and helps in coordinating the physical involvement required for healing of the bones and soft tissues.








Friday, March 02, 2018
By Edward Dieguez Jr. MD PA
Pin It

Check this out! We couldn’t have grown without you!


We are sponsoring the Health and Wellness Expo to be held on Saturday, April 28, 2018 from 10:00AM to 4:00 PM (EDT) at the World Golf Village Renaissance St. Augustine Resort 500 South Legacy Trail St. Augustine, FL 32092.


There are over fifty companies attending already. Dr. Dieguez will be in attendance to answer questions about all our modalities of treatment offered at our office.