Spine and Sport Physical Therapy - South West Health Center

If you suspect that you have a concussion, pull yourself from the competition, seek medical attention and get evaluated. If it is determined that you have suffered a concussion, you should immediately practice cognitive rest. That means no cell phone, limit all screen time and no exercise for the first 48 hours. What is a concussion? A concussion is a brain injury altering brain functions typically for a temporary amount of time.  How does a concussion occur? A concussion can occur from any hit to the body or head. A concussion typically occurs when a forceful blow results in rapid head movement leading to brain function alterations. Signs and Symptoms of a concussion can include (can occur immediately or hours later): - Headache - Dizziness, lightheaded - Nausea, vomiting - Dazed, glazed appearance - Lack of coordination or balance - Feeling of being in a fog - Emotional changes (e.g., both happy and sad) - Amnesia (memory loss either after the event and/or prior to the     event) - Slowed response time (verbal or physical) - Disorientation, confusion - Altered vision (e.g., blurry vision or double vision) - Dilated or unequal pupils - Sensitivity to light - Auditory changes (e.g., sensitivity to sound, ringing in the ears) - Difficulty concentrating, recalling information What should I do if I suspect I, or someone else, have sustained a concussion? Stop activity, tell someone, and seek further medical attention. When can I return to competition? You may return to competition once you have provided a note from a physician clearing you for full participation.  It is your responsibility to provide this physician note from a MD, DO, or sports medicine chiropractor. Your Athletic Trainer cannot clear you for participation. If any symptoms return, it is important that you notify a health care professional for further care.

We are able to image the body in either the upright position using a wall mounted bucky or in the recumbent position via a 4-way float table, usually found in hospitals. This enables us to image extremities and to perform non-weight bearing radio graphs accurately, comfortably and most importantly safely. We utilize a hospital grade CR digital imaging system manufactured by Konica Minolta. Our images are displayed in high definition on 40 inch plasma monitors to give our patients the information that they need in order to make informed healthcare decisions. This technology will enable our doctors to save your radiographs indefinitely. This unique technology also allows us to provide your images to any other physicians that you see with a couple mouse clicks. Your physicians can arrange to have direct access to our server to be able to window and level the images for you at their office remotely.  We also have the capability to burn a CD of your images for easy transportability. In addition we have off-site tele-radioligists that are able to read our images in real-timeand help quickly diagnose your condition. 

What makes a sports medicine chiropractor different from a regular chiropractor, Newport Beach? A sports medicine chiropractor or sports chiropractor has specialized training in the diagnosis and treatment of any injury that an athlete may sustain in their respective sport.  Sports chiropractors are highly sought after and are on the sports medicine staff of every professional sports team in Major League Baseball, the National Basketball Association, the National Hockey League, and the PGA Tour. In addition, sports medicine chiropractors are on-site at all AVP Beach Volleyball events and work with every governing body within Team USA for the Olympics. Sports medicine chiropractors work all Pan Am Games and any other large international competitions.  South West Health Spine and Sport is home to Southern California's best sports chiropractic team. Our Costa Mesa sports chiropractors include Dr. Dobbs, the team sports chiropractor for the Los Angeles Angels, as well as Dr. Zappala, who works closely with USA Swimming. Two of the sports chiropractors hold the highest certification achievable in sports chiropractic, a diplomate in sports medicine. Each Costa Mesa chiropractor specializes in sports injuries and uses manual manipulation of the spine and extremities, as well as rehabilitation and strength and conditioning techniques, to treat our patients. Sports medicine chiropractors have advanced training in areas of sports medicine not covered in the traditional chiropractic curriculum. These areas include, but are not limited to, concussion management, both at the athletic event and in the office. Some topics on which a chiropractor, Costa Mesa has expertise include heat, acclimatization, and hydration management; emergency medicine; airway management; and CPR. Fracture management, bracing strapping taping, and many others. Sports chiropractors are specialists within the field of chiropractic, much like an orthopedist is a specialist in the medical field. There are two levels of sports medicine specialists in the field of sports chiropractic. The first is a CCSP, which stands for certified chiropractic sports physician and requires: Completion a minimum of 100 hours of postgraduate education in the Certified Chiropractic Sports Physicians® program from an accredited chiropractic college. Possess a current Athletic Trainer (ATC) Certification Completed a Masters of Science (MS) program in exercise and sport science or equivalent program from an accredited college Completed the first year of a sports medicine residency program with an accredited college All candidates must have completed a post-graduate level hands-on emergency procedures course and a healthcare-provider level CPR certification course with a hands-on component as part of their program or study or in addition to their program.  The highest level of sports medicine specialty in the field of sports chiropractic is referred to as a diplomate in sports medicine, or a DACBSP. The requirements for this level are first completing the aforementioned CCSP® program and the following: The CCSP certification is a prerequisite to earning the DACBSP® certification. Earning the DACBSP certification requires successful completion of a written exam, a six-station practical exam, a written project, and 100 hours of practical experience in the field. Licensed doctors of chiropractic who satisfy one of the following, and are able to provide official documentation demonstrating such, are eligible to sit for the DACBSP® examination: Active Certified Chiropractic Sports Physician/Practitioner® (CCSP®) with completion of a minimum of 200 hours of postgraduate education in the DACBSP® Program, from an accredited chiropractic college. Active Certified Chiropractic Sports Physician/Practitioner® (CCSP®) with completion of a Master of Science (MS) degree in an equivalent program in the domain of sports medicine. Completion of a sports medicine residency program in its entirety. DACBSP® candidates must maintain their CCSP® certification in current and active status with the ACBSP. Injuries Treated ankle injuries, e.g., ankle sprains knee injuries, e.g., infrapatellar tendonitis hip injuries, e.g., hip impingement shoulder problems, e.g., rotator cuff injuries elbow problems, e.g., tennis or golfers elbow wrist injuries, e.g., sprains, strains spine injuries, e.g., disc bulges, herniations, facet injuries neck injuries, e.g., torticollis, whiplash back injuries, e.g., stress fractures, strains, sprains head injuries, e.g., concussions, MTBI How often should I visit a sports chiropractor near me? A Newport Beach chiropractor determines the frequency of visits based on the severity and nature of your condition. For example, if a patient presents with a sore shoulder, the type of injury to the shoulder will help determine how often that patient will need to be seen. If a patient comes to us with neck stiffness and soreness without referred pain down their arms, their treatment plan may call for treatment twice per week for 2-3 weeks. If a patient presents with lower back pain complicated by pain, numbness, and tingling in their leg, the treatment may be 3 times per week for 6-8 weeks. No two patients respond the same; that is why we custom-tailor our treatment to the individual. When you have recovered from the condition that brought you to our office, you are released from care for that condition. We find that this type of treatment empowers our patients to help themselves and provides great education to the community of Costa Mesa. Too many chiropractic offices focus on keeping patients coming back week after week for the same treatments. At South West Health Spine & Sport, the treatment evolves as patients improve. As an example, a patient may present to our Costa Mesa facility complaining of knee pain, and once that is resolved, we may start dealing with weight management, which may evolve into sports performance. Maintenance Care Maintenance care is a misunderstood term in the chiropractic profession. At our Costa Mesa office, care is based on need. In other words, when is the body ready to be re-evaluated? The frequency of care for our patients is based on several key criteria, including but not limited to: a) fitness level;b) age;c) diagnosis. This type of care is proactive as opposed to reactive and is an integral part of a healthy lifestyle. (i.e., 8 hours of sleep per night, eating 4-6 small meals per day, exercising daily)Each patient's concerns are addressed initially to determine whether there are injuries to be addressed or simply a desire to enjoy a healthier lifestyle.Treatments Used We use a variety of methods in-house to assess each patient's current health and fitness levels, including: Functional movement evaluation Muscle Activation Techniques Evaluation Orthopedic Testing Neurological Testing X-rays MRI review Our treatments are vast and include: non-surgical spinal decompression, extremity manipulation, M.A.T. (Muscle Activation Techniques), Shockwave therapy, myofascial release techniques, Instrument Assisted Soft Tissue work (IAST), Foundation Training, sports performance, and many others. In the event that a patient needs care that cannot be delivered here at our office, we work directly with a network of like-minded orthopedic surgeons, neurosurgeons, and integrative medicine doctors to ensure that your needs are met. We refer out for other diagnostic testing that is not available at our Costa Mesa facility, such as MRI, CT scans, etc.Our philosophy is to provide custom tailoring services because no two people have the same needs. Once we identify the root cause of the problem, we can deliver care more effectively. Find a Sports Injury Chiropractor Near Me Today Our sports chiropractic team treats many common athletic injuries. Medical issues like pulled muscles in your hamstring or shin splints from overtraining are very common. We also see foot problems like plantar fasciitis a lot. Other injuries we see include sports hernias, groin strains, and tendinitis in the shoulders, knees, or Achilles tendon. Our treatments  like Shockwave Therapy, taping, soft tissue work, and corrective exercises work great for muscle and tendon issues. Overuse injuries are handled with stretches and strength routines designed just for you. Sports chiropractors can also check your running style and suggest shoe inserts when needed. Our goal is to find and fix the root cause, not just treat pain. We take time to fully assess how you move, where you're weak or tight, and where your body compensates. Manual therapies combined with exercise plans fix issues best. We send patients home with their own exercises to keep improving between visits too. If surgery is needed, our team partners with trusted surgeons for before and after care. Most of all, we want to maximize how you function, feel, and play sports safely long-term. Give us a call at (949) 631 5226 or email us at swhconcierges@gmail.com to schedule an appointment. We're ready to help you perform and feel great again through custom sports chiropractic care!

The problem is that most everyone sits too much, which tends to “turn off” the glutes and hamstrings. Sitting places these muscles in a static elongated position which means that they are largely responsible for hip extension and when you sit, your body is in hip flexion. These foundation videos here are meant to be an introduction into Foundation training in that these videos are step by step instructions on specific moves to help get your hamstrings and glutes firing on all cylinders. As with any exercise, precision is critical and if you feel pain or discomfort with any of these moves, stop and contact your sports medicine professional for further advise on how to proceed. Foundation training is part of our lumbar rehabilitation protocol here at South West Health Spine & Sport. We incorporate Muscle Activation Techniques, Basi Pilates, and Foundation Training into our programs to help get patients back on their feet and back in the game, regardless of their sport. For more information on Foundation Training click here:  https://www.foundationtraining.com/ or to consult with Dr. Zappala regarding your individual situation, contact him at swhprofessionalcenter@gmail.com

Preventing injuries in the world of sport is a hot topic, especially in the young athlete. Kids tend to play one sport year round and this leads to over training and prevents the natural cross training that occurred in the past when kids played the sport of the season. If your child plays soccer, for example, and plays on a club team and a high school team, he or she plays soccer year round. This requires that the athlete learn to listen to their body and inform their coaches parents and sports medicine personal of any persistent pain that does not resolve with rest and ice. Young female athletes in particular tend to have an imbalance between flexibility and strength, often lacking the strength to support their flexibility. An ACL injury prevention program is critical for all youth soccer athletes to participate in and our team of expert sports medicine personnel can custom tailor one for your young athlete.

ROCKTAPE is a brand of Kinesio tape that we use in here at South West Health Professional Center. It is a high performance brand of traditional kinesio tape. It is fantastic for treating common sports injuries like shin splints, plantar fasciitis and "runner's knee". Rocktape also can increase endurance by promoting blood flow during an athletic event. When applied properly, ROCKTAPE lifts the skin away from the muscle, which promotes blood flow. Faster blood flow means more oxygen and more lymph drainage, which helps remove lactic acid. ROCKTAPE can be worn up to 5 days. It is 100% organic cotton and can be worn while swimming or in the shower. Kinesio tape will help promote tissue healing and facilitate movement to get you back in the game. You now see athletes from around the world sporting the brightly colored tape on national television, from Lance Armstrong, to Venus Williams, and even Kerri Walsh.

DEEP TISSUE MASSAGE Deep Tissue massage releases chronic patterns of tension in the body by targeting the deeper layers of muscle and connective tissue through focused slower strokes and firm pressure. Increased hydration is always recommended in order to help the body eliminate debris often released from deep tissue massage. PREGNANCY MASSAGE Pregnancy massage is designed to give relief to the special needs of the mother to be. Enjoy a comforting and soothing experience during this period of change, Relieve weight-bearing tension, increase circulation and reduce swelling while relaxing yourself and your baby too. SPORTS MASSAGE Sports massage therapy benefits all enthusiasts from week-end warriors to professional athletes. Designed to speed recovery and help prevent soft tissue damage, sports massage therapy helps to obtain maximum performance and physical conditioning with less chance of injury or pain by increasing flexibility. This massage is tailored to the athlete's needs and is recommended pre and post competition. SWEDISH MASSAGE A classic massage style using firm but gentle pressure, long strokes, kneading, and circular movements on superficial layers of soft tissue. Swedish massage improves circulation, eases muscle aches and tension, improves flexibility and can bring a sense of overall well-being to the patient. TRIGGER  POINT THERAPY Trigger points are hyperirritable fibers in muscle tissue and are often the cause of chronic muscular pain. Our expertly trained Neuromuscular Therapist will identify trigger points and address them individually. Static, deep pressure is used to reset the neuromuscular junction and increase range of motion. Therapist will educate the client regarding activities that may perpetuate the dysfunction (mechanical, nutritional and metabolic insufficiencies).

MSK (musculoskeletal) ultrasound imaging uses sound waves to produce pictures of muscles, tendons, ligaments, nerves, and joints throughout the body. It is used to help diagnose sprains, strains, tears, trapped nerves, arthritis, and other sports injuries. We are actually able to image your injury while you are moving it to confirm the location and sometimes even the cause of the injury. This information allows us to make precise a precise diagnosis and give you better rehab protocols and speed the healing of injuries. MSK ultrasound is the best way to make sure that tendon repair procedures are performed in precisely the exact location. It is also used to chart the progress of your healing and recovery to make sure you are on track to get back in the game as soon as possible. This technology is a game-changer for a sports medicine specialist and we are excited to be able to offer this service to you.

Muscle Activation Techniques (MAT)® is a powerful muscular assessment tool that analyzes and corrects muscular imbalances. At MAT we focus on the cause of the imblance by testing, correcting, and maintaining muscle contractile efficiency. We believe that flexibility is a derivative of strength, and that muscle tightness is secondary to muscle weakness.  Muscle Activation Techniques is for anyone who wants their muscular system optimized. You don't need be a world class athlete to know how life takes a toll on our bodies.  Patients with chronic pain and restricted movement as well as practitioners have been using MAT in clinics for over 20 years.

 Non-surgical spinal decompression explained ↑↑↑↑↑↑↑↑↑Click the link for video↑↑↑↑↑↑↑↑↑ Spinal decompression is often misunderstood. It gets confused with traction. The two words are not interchangeable. Spinal traction is an outdated technique to treat disc injuries. Modern technology uses an innovative process to achieve much better treatment outcomes for spinal disc injuries than traction used to. This technology is called IDD therapy which we will explain here. Intervertebral Differential Dynamics Therapy is a highly precise computer applied regimen which utilizes treatment forces to manipulate specific spinal segments. IDD Therapy is administered through the Accu-SPINA, a state-of-the-art computer directed spinal rehab system. When properly administrated, the treatment is able to achieve several objectives. First, unloading compressed spinal segments helps reduce built-up pressure on the affected disc. This is primary in relieving and resolving the pain. The nature of the cyclical graduating waveform also creates a spinal pumping effect inducing a vacuum within the disc and oxygen flow essential to the disc health. Finally, a secondary modality called oscillation is delivered to the surrounding muscle tissue working to release and re-educate guarded muscle spasms. All this is performed while you rest comfortably in a soothing glow of light, listening to relaxing music. A heated massage bed feature assures that you will complete your treatment session feeling refreshed. Patients often ask if spinal decompression hurts. The treatment actually is relaxing and is not painful, but treating a disc injury requires patience. The decompression process is a gradual one. The intensity of the pull on the spine has to ramp up slowly to allow the guarded tight muscles to relax. Prior to beginning decompression, the muscles around the injured disc are very tight and stiff. They are tight for a reason...to protect the injured disc. As the disc starts to improve, the muscles gradually start to relax since they do not need to protect the disc as much. As the back or neck starts to relax, the intensity of the pull increases until eventually the disc bulge has been reduced to a point where it is not contacting the nerve root or spinal cord anymore. At this point, patients' are out of pain and ready to start the rehabilitative phase of spinal decompression. This is where you are prescribed a specific set of exercises to strengthen the core muscles if you have a lower back disc injury or neck and postural exercises if you have a disc injury in your neck.  For more information on spinal decompression, how it works and how it can help you, please contact Dr. Zappala.

When conservative care fails to provide a solution for spine pain, then we use pain management techniques like epidural injections and facet blocks to modulate pain. This allows us to move faster into rehabilitation techniques to restore function and work on eliminating the cause of the original condition. Many pain managment physicians use pain manegement as their only tool. We use it as a bridge to rehab as we dont want to just manage your pain, we want to solve it. Many times poor hip mobility is the cause of lumbar spine overload leading to disc injuries like herniated discs and facet cysts. Likewise, poor shoulder mobility can be the root cause of cervical spine overload leading to cervical disc injuries.

South West Health Professional Center has an entire floor (3500 square feet) dedicated to our fitness center where patients are seen for training sessions to improve fitness, prevent injuries and improve their overall health. South West Health & Fitness is staffed by board certified chiropractors, and certified personal trainers. Upon completion of a thorough functional assessment, the fitness program is then tailored to meet your individual goals and assure that you will be exercising safely and effectively. South West Health and Fitness is run by Leciana Zappala. Leciana is a personal trainer and specializes in women's fitness. She is also a certified golf fitness trainer and a member of the Professional Golf Fitness Association (PGFA). A fitness buff herself, Leciana offers her clients personal training, golf fitness training, dietary management and lifestyle modification. She is very involved with each and every client to ensure that they achieve their fitness goals. Schedule NOW 949-631-4656

Pilates is essential work for good posture. Leciana Zappala teaches Basi Pilates as part of her rehabilitation protocols.She has years of experience working with spine injured patients and is supervised by the sports medicine team at South West Health Spine & Sport. Pilates is an integral part of spine rehabilitation at South West Health Spine & Sport where we blend Pilates, and Foundation Training to stabilize the spine. Pilates is something that requires one on one training and is difficult to do in a class setting as every individual patient's needs are unique. Leciana only teaches Pilates on a one on one basis so that you can get the most out of your sessions.   

Shockwave Therapy is an acoustic wave therapy that is targeted to treat chronic tendon injuries like tendinosis that can occur in your extremities. The therapy is very effective for Rotator cuff tendons, Achilles tendon injuries, hamstring injuries, as well as knee and elbow injuries. Treatments only take a few minutes and usually are complete after 6-8 sessions. Once complete, targeted physical therapy will complete the healing of the tendon and prevent it from re-occurring.  Tendons by nature, have very poor blood supply, so when they get injured during your life they don't heal very well. That is where Shockwave technology can help by stimulating blood flow to the damaged tendon tissue, the tendon can then repair itself. If significant tears are present in the tendons, then a more aggressive approach with PRP is usually appropriate to facilitate healing. The good news for you, is that we offer shockwave and have a specialist who performs PRP injections.

Sports acupuncture focuses on the specific presenting injury vs. traditional acupuncture which focuses on overall wellness. COMMONLY TREATED CONDITIONS: rotator cuff injuries hip injuries ankle injuries elbow injuries wrist injuries back pain knee injuries neck pain sciatica tendonitis

So how does cupping work? Either heat or air is used to create a suction in special cups that are placed on the body. The vacuum that’s created pulls the skin and blood vessels in toward the cup, which is why they can leave marks on the skin. Cupping is thought to pull blood to a certain area, improve circulation, and loosen up muscles and joints.  In addition, the fascia that lies below the skin is given more room from the tenting effect of the cup which in turn improves blood flow to that layer. There’s also some suggestion that it has anti-inflammatory effects. Cupping Therapy is not simply a “hickey” meant to “bruise” the person and magically “heal” someone. In the United States, it is most often associated with Traditional Chinese Medicine, however, it has deep roots throughout Asia and Eastern Europe. At South West Health, we also employ a cupping technique where we gently move and slide the cups over the skin during the therapy. This helps facilitate blood flow and often prevents the “hickey” effect. This would also be considered another form of soft tissue manipulation.It is difficult to fully recover from an injury when the muscle, tendons, and connective tissue are “vacuum packed” to your bone? Cupping helps to loosen it up so we can activate, strengthen, or stretch it.Cupping Therapy has helped lead Sports Medicine into another generation of managing injury for Elite Athletes and everyday people.

Dr. Zappala uses the latest information from the world of sports medicine when he performs his assessments on athletes. The information comes in the from of new studies, position papers, and twenty five years of experience. The world of sports medicine is constantly evolving and this is nowhere more apparent than in the management of concussions. Each year athletes die from injuries associated with concussions right here in our backyard. These injuries are preventable with proper medical care and early intervention. If you suspect that your child has sustained a concussion, assume that he or she has one, pull them from their sport and seek immediate medical attention. There are very specific criteria that are used to return an athlete to sport following a concussion and the licensed athletic trainer as well as the team physician are well versed in this process. It is critical that the steps are followed properly or serious consequences cab occur including death. This is why parents need to insist that wherever their child is competing, including practice, that there is a properly licensed athletic trainer on site to watch for these types of injuries. Treating sports injuries continues to evolve as well. Modalities such as cold laser have been shown to be very effective at treating injuries to soft tissue and bone. Recently, South West Health has added Whole Body Cryotherapy (WBC) to its treatment regimens as well. This amazing tool allows us to treat multiple areas simultaneously by creating a systemic anti-inflammatory response to assist in removing damaged and inflamed tissue from the injured areas. In addition, the ancient art of acupuncture is also used extensively to treat acute sports injuries like ankle sprains, infrapatellar tendinitis as well as more chronic sports injuries like tennis elbow and shin splints. We also use instrument assisted soft tissue techniques to treat these injuries. Injuries to ligaments and tendons require great blood supply to heal properly and these soft tissue techniques assist in getting blood to these frequently injured connective tissues.

Dr. Zappala has been a sports chiropractor and sports medicine specialist for the last 36 years. He holds the highest level of sports medicine training offered in his field.  He is a member of the national concussion registry and sits on the ATC board for the C.I.F. southern section. He preaches injury prevention with all. of his athletes and uses his knowledge of strength and conditioning to help athletes perform at their best and reduce their chances of injury. If your child is suffering from an injury, it is important to figure out why they became injured in the first place. This will help prevent the injury from returning once it has healed. Dr. Zappala and the staff at South West Health Professional Center have all the 21st-century tools necessary to both evaluate and treat sports injuries to the spine and or extremities. Let's get you back in the game. Local/National Athletes & Teams we work with Regularly   Costa Mesa H.S. Football Charlotte Drury   Erica Owen Rachel Bryant

A team physician has the leadership role in the organization, management and provision of medical care for individual, team and mass participation sporting events. The most important responsibility of the team physician is the medical care of athletes at all ages and all levels of participation. A team physician has the leadership role in the organization, management and provision of medical care for individual, team and mass participation sporting events. The most important responsibility of the team physician is the medical care of athletes at all ages and all levels of participation.The team physician should possess special proficiency in the prevention and care of musculoskeletal injuries and medical conditions encountered in sports. The team physician integrates medical expertise with certified and/or licensed athletic trainers, and other allied health care professionals (athletic care network). Aided by the athletic care network, the team physician also educates athletes, coaches, parents/guardians, and administrators. The team physician is ultimately responsible for the clearance to participate and the return to play (RTP) decision. Dr. Zappala has received the training mentioned above that uniquely qualifies him to be a team physician. The training has expanded his knowledge of emergency medicine as well to prepare him for any emergency situation that he may see in the field of sport. As a team physician, you actually see the trauma take place as opposed to having the athlete relate it to you when they present in your office. The ability to observe the trauma take place allows Dr. Zappala to make a more accurate diagnosis of the athletes injury. This early diagnosis ensures that the athlete is started on the proper treatment right out of the gate which means better recovery from their injuries and less time away from their sport. The team physician is as stated part of the team and part of a medical team that cares for the athletes. As team physician, Dr. Zappala is also responsible to coordinate the medical care with the other members of his team, primarily the athletic trainers who see the athletes on a daily basis. This communication allows for a good relationship to be established between athlete, physician, trainer and coaching staff. If all parties work together for the better of the athlete, we can help keep our young athletes healthy and avoid some of the real dangers of sports participation.

Tendon injuries are difficult to deal with and are best evaluated with MRI or MSK ultrasound. For tendons that are not badly torn (less than 20%), Shockwave Therapy is very effective at restoring the blood flow to the tendon to facilitate healing during the rehab process. For patients with more severe tendon injuries or are diabetic, we offer regenerative medicine procedures like PRP through our partners. PRP stands for protein-rich plasma and is a procedure where we perform a blood draw and then put the blood into a centrifuge and spin it. This allows us to separate out the cells and then we use the pro-inflammatory plasma and re-inject it into the tendon to facilitate healing.