LANDSTUHL, Germany — After nearly a decade of war, troops are increasingly battling chronic pain, from blast-related nerve damage to muscular and skeletal injuries caused by carrying heavy packs and body armor over mountainous and desert terrains.
What’s more, multiple deployments and more intense training bring minor aches and strains that can have cumulative effects when not given sufficient time to heal, said Dr. (Maj.) George Smolinski, a physiatrist at Landstuhl Regional Medical Center in Germany.
“These guys that are coming back, their bodies are worn out,” he said.
To help treat them, an $800,000 physical medicine clinic opened at Landstuhl this month. The clinic’s staff includes a chiropractor, a first for the hospital.
“I wanted to be as close to Iraq and Afghanistan as I could possibly get,” said Dr. Danny Walker, who served in the Marine Corps. “And as a chiropractor this is as close as I am going to get.”
With prescriptions for opiate painkillers increasing — and more troops admitting to abusing them — the military has been forced to look for novel methods to treat pain, and the physical therapy center at Landstuhl, the treatment hub for all U.S. troops injured in theater, is part of that effort.
Doctors at the clinic have access to innovative equipment and techniques to pinpoint and treat muscular and skeletal injuries including back, neck and shoulder pain, as well as pinched nerves.
“Studies show the earlier we address these problems, the better the long-term outcome is,” said Smolinski, the officer-in-charge of the clinic.
One of the tests to discern nerve damage is electromyography, which measures impulse and nerve patterns in muscles. It works by emitting short jolts of electricity into a tiny needle inserted into the muscles of the arm or leg. Using the machine, doctors follow the electric impulses as they run through the spinal cord and the brain to the hands or feet.
“If the impulse is slow,” Smolinski said, “or if the impulse does not get all the way through, that is a sign of a nerve problem.”
Another common injury for servicemembers is tendon damage in the knee or elbow. Tendons, the fibrous tissues that connect muscle to bone, heal slowly, and sometimes never at all.
To stimulate tendon healing, doctors at the clinic are using platelet-rich plasma injections, a therapy that, while not yet in the medical mainstream and subject to some debate over its effectiveness, is favored by professional athletes such as Tiger Woods and Pittsburgh Steelers football players Troy Polamalu and Hines Ward, according to news reports.
Platelets are a component of the blood containing proteins and other reparative substances. With platelet-rich plasma injections, a small amount of the patient’s blood is removed, placed into a centrifuge and spun to separate the blood cells from the platelets. By injecting high concentrations of platelets in areas where blood does not always reach, Smolinski said, the platelets stimulate the growth of soft tissue and bone cells without triggering a clotting response.
“Then we couple that with physical and occupational therapy,” he said, “to not only build the tissue but also make it strong again.”
On Thursday, Maj. Veronica Hansen, a legal liaison officer for U.S. Army Europe, had the platelets injected into her left elbow, which she injured about 10 months ago. Hansen, who had driven from Berlin to see the specialists at the clinic, grimaced while watching an ultrasound monitor as the needle was inserted and maneuvered within her arm.
“It feels like someone pinching your arm real hard,” she said.
Still she hoped that the minor pain would lead to the end of her discomfort.
Sgt. Jason Pack, an occupational therapist at Landstuhl, said he had already experienced firsthand the therapy’s benefits. Three weeks ago, he had the procedure performed on his left elbow, which he had injured lifting weights.
“It was a dull constant pain, with every once in a while a sharp shooting pain,” Pack said.
Now Pack said that the pain had eased greatly and that his arm was feeling 70 percent better.
“For the people that meet the criteria,” he said. “I would definitely recommend this.”