MEMBER LOGIN

Filter posts by category

Clinic Operations

Clinic Operations, Lower Extremity, Spine, Upper Extremity

Sharpening Ultrasound Skills for Spinal Injections: A Practical How-To for Providers

By /

Sharpening Ultrasound Skills for Spinal Injections: A Practical How-To for Providers

Before you start scanning, clarify your goals. Identify the target anatomy for your planned injection—whether you’re aiming for the spinous process, lamina, facet joints, or transverse processes. Mapping out your needle trajectory and entry angles ahead of time helps you select the most appropriate transducer and scanning window. Establishing these parameters upfront sets the stage for a smoother, more precise procedure.

Transducer selection is central to this process. The curvilinear transducer, typically lower in frequency with a larger footprint, excels when target depth is a factor. For structures around five centimeters or deeper, it provides better penetration and a broader field of view, enabling you to visualize deep bony landmarks and the needle path with greater confidence. A key advantage of the curvilinear probe is its multi-angle sound-wave emission, which can improve visualization when you plan multiple needle angles during the injection.

By contrast, the linear transducer offers higher near-field resolution and is superb for superficial structures—roughly zero to four centimeters deep. It provides detailed visualization of the superficial bone cortex and soft tissue, which can be crucial for precise needle localization once the trajectory is established and the target lies within the near field. A practical approach is to start with curvilinear for depth and broad overview, then switch to linear for final needle advancement and fine-tuning in the near field.

Imaging the spinal cortex and landmarks benefits from understanding how the angle of insonation affects reflection. Perpendicular insonation yields the brightest reflections from cortical bone, so position the transducer to maximize perpendicular impact on the spinous processes, lamina, and facet joints. With a curvilinear probe, you can take advantage of multiple incident angles to enhance visualization of complex anatomy and to track the needle when approaching from multiple directions. If you encounter artifact or shadowing, a small adjustment in angle or a gentle rock of the probe can optimize reflections from the cortical bone.

Transducer selection is more than a procedural backdrop; it’s a lever that can meaningfully improve accuracy, safety, and efficiency. By understanding the trade-offs between curvilinear and linear probes and applying deliberate imaging strategies, clinicians can elevate their ultrasound-guided spinal injections and deliver better patient care.

 

Sharpening Ultrasound Skills for Spinal Injections: A Practical How-To for Providers Read Post »

Clinic Operations

Maximizing Regenerative Injectables: Why Post-Procedure Physical Therapy Matters

By /

Maximizing Regenerative Injectables: Why Post-Procedure Physical Therapy Matters

I’m Dr. Eric Phillips of RPI, and I want to share a practical, patient-focused approach to regenerative medicine. In my view, the success of regenerative injections—whether prolotherapy, PRP, or stem cell treatments—depends as much on what happens after the procedure as on the procedure itself.

My core message is simple: after a regenerative injection, I aim to place patients into a structured physical therapy program within about a week. The rehab protocol I use is tailored to the specific area we’re treating—whether it’s a spine injection, a shoulder, a peripheral joint, or another region. The goal is to guide the body’s remodeling process through targeted therapy that complements the regenerative work we’ve done.

I don’t have in-house physical therapists in my practice, but I’ve built a strong network of skilled PT partners throughout the community. I educate these therapists about my protocols and frequently refer patients to them, while collaborating closely with their teams. This network creates a seamless continuum of care and ensures patients receive consistent, high-quality guidance throughout their rehab journey.

I talk to patients about the synergy of regenerative injections with physical therapy, describing it as a “one plus one equals three” dynamic. When rehab reinforces tissue remodeling and functional recovery, we’re more likely to achieve optimal outcomes. I also frame the rehab plan in terms of what patients have already invested—time, money, and discomfort—so I encourage them to stack the deck in their favor by committing to comprehensive post-procedural care.

Practically speaking, I advise clinicians to build relationships with local physical therapists, invite them into the practice ecosystem, and even host meetings or joint visits. A well-established PT network can reliably support patients before and after injections, which translates into stronger patient confidence, measurable progress, and higher satisfaction at follow-up visits.

If you’re considering regenerative treatments, I hope this approach helps you see why post-procedural rehabilitation is a critical component of success. A thoughtful rehab plan, backed by a trusted PT network, can significantly enhance outcomes.

Maximizing Regenerative Injectables: Why Post-Procedure Physical Therapy Matters Read Post »

Business, Clinic Operations

Consultation to Recovery: Setting Clear Expectations for PRP and Regenerative Therapies

By /

Consultation to Recovery: Setting Clear Expectations for PRP and Regenerative Therapies

Setting realistic expectations for regenerative injections is a practical, patient-centered approach that can significantly improve satisfaction and outcomes. I’ve found that the way we frame conversations with patients before a PRP or stem cell procedure sets the tone for the entire recovery journey. 

A simple, honest framework makes a big difference: I share the average worst-case scenario during the consultation so patients aren’t surprised by what’s typical. In my practice at RPI, I often see patients experience four to seven days of discomfort after a procedure—soreness, stiffness, and limited mobility. By acknowledging this up front, I help patients understand that initial post-procedure discomfort is common and not a sign that the treatment has failed. I also discuss the possible need for nighttime pain medications to sleep, while clarifying that the pain is usually related to the recovery process rather than the underlying condition being treated. This transparency helps reduce anxiety and builds trust, which is crucial for adherence to post-procedure care.

Equally vital is outlining a clear post-procedure plan. After the regenerative injection, I guide patients into a structured rehabilitation protocol, with physical therapy typically starting within a week and a dedicated rehab coach to walk them through the process. I explain the availability of supportive modalities—peri-neural injection therapy, shockwave therapy, and red light therapy—to give patients a tangible sense of the tools that will aid their recovery. The overarching goal remains improved function and reduced pain in the long term, even if the early days feel worse. To minimize disruption and optimize outcomes, I advise patients to limit travel, strenuous activity, and other demanding tasks during the initial weeks, and to plan recovery around lighter schedules. Building a network of trusted physical therapy providers not only supports each patient’s rehab but also strengthens referrals and collaboration within the care team.

I recognize that patient experiences vary; some may notice rapid improvement, while others progress more gradually. However, providing a consistent, evidence-informed framework reduces uncertainty and improves adherence to the rehabilitation plan. A practical takeaway is to offer a one-page handout that outlines what to expect before and after the procedure and to schedule a brief follow-up within a week post-procedure to address questions and adjust the rehab plan as needed. By centering conversations on transparent expectations, clear timelines, and coordinated care, we can help patients achieve the best possible outcomes from regenerative injections.

Consultation to Recovery: Setting Clear Expectations for PRP and Regenerative Therapies Read Post »

Clinic Operations

The Surprisingly Perfect Skin-Marking Pen for Prolo & PRP (Yes, It’s an Eyeliner)

By /

The Surprisingly Perfect Skin-Marking Pen for Prolo & PRP (Yes, It’s an Eyeliner)

Hey—it’s Dr. Phillippi with RPI. Quick, practical tip you can use on your very next injection day: the humble skin-marking pen. When I’m planning prolotherapy or PRP, I always start with palpation. I mark bony landmarks and key reference points directly on the skin, then confirm and refine with ultrasound. That simple step does two things: it sharpens my targeting on screen and it improves the patient’s experience—because they can see the plan before we ever pick up a needle.

After trying a dozen options (I literally visited a beauty supplier and sampled every eyeliner they’d let me test), one pen rose to the top: CoverGirl Ink It! Eyeliner, Black #230. Here’s why it’s become my go-to.

1) High-contrast, stays visible
Black ink reads clearly against most skin tones and pops on camera if you’re teaching. Clarity matters when you’re triangulating your palpation line with your probe orientation and needle path. With this pen, the mark is unmistakable.

2) Survives skin prep
I don’t inject through the inked spot—ever—but I do prep the field with chlorhexidine and alcohol. Many markers disappear the moment you prep; this one doesn’t. The line holds through aseptic prep so your reference stays intact while you work around it.

3) Durable, clinic-friendly design
It’s a gel-style mechanical eyeliner. That means no sharpening, less mess, and fewer broken tips. Keep the extension short and it’s surprisingly tough. There’s plenty of product in the barrel, so a pen lasts far longer than you’d think (even in a busy clinic).

4) Patient expectations are easy to manage
Because it’s designed to stay, I give patients a quick heads-up: some marks may linger for several days. A standard makeup remover will take it off faster. If you’re seeing them the next week, don’t be surprised if a faint line is still present—it’s a feature, not a bug.

5) It complements palpation-first technique
For me, palpation is the foundation: PSIS to iliac crest, fibular head to Gerdy’s tubercle, patellar and tibial landmarks—mapped before the probe comes out. The mark anchors my mental model, the ultrasound refines the target, and the needle path gets executed with confidence. That sequence keeps the work precise and repeatable.

Practical pointers

  • Mark your bony landmarks first; keep your injection target adjacent to, not through, the ink.
  • Prep as usual—your marks should remain readable.
  • Reconfirm depth and trajectory with ultrasound before you start.
  • Document your landmarks in the note; patients appreciate the extra clarity.

A quick note on skin sensitivity
This is a beauty-industry product, used here in a medical workflow. Test on a small area first if your patient has sensitive skin or known reactions to cosmetics. As always, follow your clinic’s protocols and scope of practice.

Bottom line: if you want crisp, reliable skin marks that survive prep and make both ultrasound and patient communication easier, CoverGirl Ink It! Black #230 is a small upgrade that pays off big. I’ve tried them all—this is the one I keep going back to. Give it a shot on your next clinic day and see if it tightens up your process as much as it did mine.

The Surprisingly Perfect Skin-Marking Pen for Prolo & PRP (Yes, It’s an Eyeliner) Read Post »

Spine, Clinic Operations, Lower Extremity, Nerves, Upper Extremity

Ultrasound-Guided Needling: A Stepwise Technique You Can Trust

By /

Ultrasound-Guided Needling: A Stepwise Technique You Can Trust

Access Full Lesson

Ultrasound guidance can take injections from “good enough” to precise, safe, and reproducible—especially near small targets like nerves. This quick guide distills a stepwise approach you can apply immediately in clinic.

1) Set up before you scan

  • Ergonomics first: Adjust table/chair height so a shallow in-plane angle feels natural. If the table is too low, you’ll default to a steep, hard-to-control trajectory.
  • De-gel for control: Diagnostic scans love extra gel; injections do not. Wipe probe, hands, and syringe so you can make micro-movements without slipping.
  • Right tools: Prefer the shortest needle that reaches the target. Use smaller gauges (e.g., 25G) for patient comfort as your skill grows. Match syringe size to control—smaller barrels are easier to finesse; learn alternate grips for stability and continuous injection.

2) Master the probe hold (micro-moves matter)

Use a three-finger wrap high on the probe with the 4th/5th fingers resting on the patient. This balances stability with mobility, enabling all five motion families (slide long/short axis, rotate, tilt, heel-toe) in tiny increments. Flex the wrist—this “intentional discomfort” increases leverage and fine control.

3) Line up like a pool cue

Before inserting the needle, align patient → target → probe → injecting hand → eyes → screen. Keep the second monitor low enough that you glance with your eyes, not your neck. Minimize skin-to-target distance: position the probe so your path is short and your needle can stay shallow.

4) Geometry beats guesswork

  • Depth decides angle. Estimate target depth and pick an initial angle (e.g., ~30–45°) relative to the probe, not the room. If you tilt the probe (to fight anisotropy), adjust needle angle to match.
  • Stand off the footprint. Avoid inserting right against the probe—maintain room to pivot and protect the transducer.

5) Keep the needle in view (and prove it’s the tip)

Three visualization boosters:

  1. Heel-toe toward the needle to make the beam more perpendicular—needle brightens dramatically.
  2. Oscillate the needle (tiny in-out “sewing” motion) while keeping net depth unchanged.
  3. Lateral sweep the probe ~5 mm each way—like radar—to pass over the true tip.
    Safety check: the on-screen motion of the tip must match your hand movement; if not, you’re probably seeing shaft, not tip.

6) Correct deliberately—don’t “fish”

If you’re off target, retract almost to skin, adjust angle, then re-advance. Don’t bend the needle by steering while deep. Frequently look at your hands to ensure the probe is centered over the needle path (dominant-hand drift is common). Break contact points if needed—another moment of intentional discomfort that prevents hidden angle changes.

7) Progress thoughtfully

Skill progression runs: safe → effective → minimal pain → efficient → effortless. Smaller needles, fewer redirects, and consistent visualization take thousands of iterations—but they spare patients bruising and you frustration.

Access Full Lesson

Ultrasound-Guided Needling: A Stepwise Technique You Can Trust Read Post »

Clinic Operations, Nerves

Ultrasound Depth Settings for Safer, Cleaner Injections

By /

Ultrasound Depth Settings for Safer, Cleaner Injections

Depth is one of the first—and most important—settings to optimize when performing ultrasound-guided injections. Set it too shallow and you’ll lose critical lateral information; too deep and you sacrifice resolution. Here’s a simple, repeatable approach using the medial ankle (posterior tibial nerve at the medial malleolus) to get your depth right before you ever pick up a needle.

Why Depth Matters

On many machines, changing depth doesn’t just alter how far you see—it also changes how much of the probe footprint is represented on screen. With overly shallow depth, the image can stop reflecting the full lateral edges of the transducer. That creates a dangerous mismatch: you think the screen shows “everything under the probe,” but the true footprint extends beyond what’s visible. Result: a needle can travel off-screen (e.g., toward the Achilles) even though it’s still beneath the probe.

The Setup: Medial Malleolus Window

Short-axis view between the medial malleolus (bone/cortical shadow) and Achilles tendon:

     

      • Identify posterior tibial artery and paired veins (veins collapse with gentle compression; artery stays patent/pulsatile).

      • Find the posterior tibial nerve (oval/round, honeycomb fascicles with hyperechoic epineurium).

      • If there’s an air gap between malleolus and Achilles, flood the space with gel (standoff) rather than pressing harder.

    The Depth Drill (Before You Inject)

       

        1. Start shallow, then watch the left/right edges of the image as you step the depth deeper one click at a time.

        1. Confirm full footprint capture: As you increase depth, there’s a point where the image gets wider (more of the probe footprint is now represented). Keep stepping deeper until additional depth no longer widens the image—then back off one click so you maintain resolution while still visualizing the entire footprint.

        1. Landmarks visible: At your working depth, you should see the medial malleolus cortex, Achilles margin, artery/veins, and the tibial nerve—all within the on-screen field.

        1. Angle of approach: If your injection is in-plane from posterior → anterior, confirm that the entry corner of the probe corresponds to on-screen edge. With full-footprint visualization, your needle should appear as soon as it passes the skin and remain visible to the tip.

      Safety Pearls

         

          • Never chase a missing needle by advancing blindly. If the tip disappears, stop, re-optimize depth/angle, and re-approach.

          • Use anisotropy to brighten the nerve (tilt the transducer a few degrees in either direction).

          • Hydrodissect with a small test bolus to confirm perineural spread; avoid intraneural resistance or swelling.

          • Machine-specific sweet spot: On some systems, that “full-footprint” depth might be ~2.5–3.0 cm for this ankle window. Test on your unit (and each probe) so you know the threshold before procedures.

        Common Pitfalls

           

            • Too shallow: Great nerve detail but truncated lateral field—needle can go off-screen under the same probe.

            • Too deep: Entire footprint visible, but resolution suffers and small targets are harder to see.

            • Over-compression: Distorts tissue, collapses veins, and hides the plane you intend to inject.

          Bottom Line

          Pick a depth that captures the full probe footprint while preserving enough resolution to track the needle tip. Do this first, every time, and your injections will be safer, cleaner, and more predictable.

          Ultrasound Depth Settings for Safer, Cleaner Injections Read Post »

          Clinic Operations, Marketing

          The 5-Minute Consult: Patient Education That Drives Outcomes

          By /

          The 5-Minute Consult: Patient Education That Drives Outcomes

          Access The Full Lesson

          Great procedures start with great conversations. When knee pain patients arrive already “pre-sold” by a friend’s success, your job is to connect clear diagnostics with an ethical, evidence-based plan they understand—and can act on. Here’s a fast, reproducible flow you can use at the end of your visit to align expectations, reduce fear, and map next steps.

          1) Make the invisible visible

          Use a whiteboard, tablet, or smart board. Sketch the hinge joint, label medial and lateral compartments, and mark the patient’s pain zone. Briefly show how cartilage loss, a partially resected/extruded medial meniscus, patellar maltracking, and MCL laxity create abnormal loading. Patients remember pictures.

          2) Synthesize the findings

          Tie history, exam, ultrasound, and X-ray into three or four clear diagnoses:

          • Knee osteoarthritis (cartilage thinning + risk factors)
          • Medial meniscal pathology (tears/extrusion; not currently locking → likely nonsurgical)
          • Patellofemoral maltracking (lateral tracking, anterior knee pain)
          • Neuropathic contributors (periarticular genicular/saphenous branches can amplify pain)

          Explain that nerves modulate pain and healing; if you ignore them, you may undertreat.

          3) Set treatment goals (pain now vs healing later)

          Patients want to move, travel, and sleep. State two parallel aims:

          • Reduce pain now to enable activity and PT
          • Improve tissue environment for longer-term function

          4) Present the ladder of options

          Avoid rushing to surgery or high-dose steroids (discuss risks and cartilage effects).

          A. Low-risk relief

          • Dextrose (D5W) perineural “nerve reset” around symptomatic branches
          • Intra-articular dextrose for joint pain modulation

          B. Insurance-covered adjuncts

          • Viscosupplementation (“lube job”) when criteria met (often requires ~4 PT sessions)
          • Targeted PT for tracking and strength (VMO, hip abductors/ERs)
          • Unloader brace to open the medial compartment during activity and during post-procedure protection

          C. Regenerative options (orthobiologics)

          • PRP (platelet concentrate as the “fertilizer” for healing signals)
          • Bone marrow–derived cell therapy (the “seed”); often combined with PRP for synergy
            Set expectations, discuss indications/contraindications, and review evidence you provide in take-home materials.

          5) Optimize the terrain

          Address modifiable risks that blunt outcomes:

          • Hormonal status (e.g., menopause): consider functional medicine consult and labs
          • Supplements with supportive evidence (e.g., omega-3, turmeric, vitamin D/C) and dosing sheet
          • Load management (brace use, graded activity)

          6) Close with a clear plan + follow-through

          Number your handouts (1–4), summarize in one minute, and schedule:

          • Today: nerve/joint pain modulation; brace fitting; PT referral
          • Next 1–2 weeks: insurance steps, functional medicine consult, supplements
          • 5–6 weeks: reassess; consider PRP/BMAC based on response and goals

          Reinforce via automated email/SMS (testimonials, steroid education, procedure FAQs). Use an AI scribe to capture your narrative as you teach—the same words educate the patient and build a clean chart.

          Bottom line

          Show the problem, name the drivers (joint + nerve + mechanics), and offer a stepped plan that relieves pain now while creating the conditions for healing. Patients feel heard, you set realistic expectations, and your procedures work better.

          Access The Full Lesson

          The 5-Minute Consult: Patient Education That Drives Outcomes Read Post »

          Scroll to Top