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Written by Joseph Christiano ND
I’ve had to struggle with chronic lower back pain for most of my life. Additionally, I had structural problems and complications that disrupted me from having my maximum quality of life. I knew there was more out there other than surgical procedures, so I sought to discover just what various types of treatment options were available to set me, and others, free from the prison of chronic pain. Unfortunately, most people with acute or chronic pain are not privy to some of the cutting-edge treatments that are available today. Most individuals who suffer from musculoskeletal distress become a prisoner of their own pain and are in desperate need of finding a ‘fix,’ so-to-speak, for relief! For these reasons and more, which included not only my personal search for treatment options but for that of others who are hurting, prompted me to write my new book “Living Beyond Your Chronic Pain.”
Of all the many conditions, symptoms, root causes, and treatment options I have listed in my book, I want to talk about my favorite cutting-edge type of treatments. I believe in the efficacious results of this technology, and treatment, for musculoskeletal pain and so much more. I can also attest to its effectiveness from firsthand experience. The following description of this technology and treatment will provide a closer look at what help is available today. It also introduces the wave of the future in regenerative orthopedics for individuals who are suffering with painful musculoskeletal conditions.
What is Regenerative Orthopedics?
Regenerative Orthopedics (or “RO”) is the 21st century stem cell technology that addresses orthopedic problems and musculoskeletal pain.
Regenerative Orthopedics is a non-surgical approach where small, precise, injections of PRP with, or without, stem cells to regenerate damaged joints, ligaments, and tendons are used. The PRP (platelet rich plasma) is rich in your body’s own growth factors and is spun down from a simple blood draw in a process that takes about 30 minutes.
Adult stem cells are typically harvested from your own abdominal fat which is lipo-aspirated in a simple office-based surgical procedure. The fat is then processed to yield the stem cell injectate in a process that takes a couple of hours. It should be noted that in all regenerative orthopedic procedures, only the patient’s own tissues are used (i.e. blood and fat, referred to as “autologous” tissues) so there is no foreign, unnatural tissues, or substances ever injected.
Once prepared, the PRP (with or without stem cells) is injected at the precise location of injury, or degeneration, and stimulates the body to “regenerate” the damaged structure. If done properly, these regenerative orthopedic injections are very safe and can yield impressive results with many orthopedic and musculoskeletal conditions.
The concept and art of regenerative injections to treat musculoskeletal conditions has been around for many years in a discipline called “Prolotherapy.” Prolo typically used injections of dextrose, and other natural proliferants, to stimulate healing. What is new are the advances in PRP and stem cell technology. They allow the physician to more adequately isolate, and concentrate growth factors and stem cells. They can then use these in properly targeted injections to help stimulate the natural healing of damaged structures.
What type of conditions can RO help?
Common conditions include Osteoarthritis of the knee or hip, rotator cuff tendonitis, as well as back and neck pain due to degenerative disc problems or other commonly treated causes. As for conditions such as sports injuries, wrist or ankle problems, plantar fasciitis, tennis elbow and whiplash injuries, the regenerative approach is by far the most effective treatment option. Interestingly, RO physicians often have a very different diagnosis as to what the “primary pain generator” is. Joint capsules, ligaments, and tendons are far bigger pain generators than bone, cartilage, or true nerve impingement. For example, an MRI might very well show disc abnormalities in a patient with back pain, but this does not mean that it is the primary cause of the pain. A very common scenario is the patient has a pelvic strain (that was not diagnosed!) causing the pain, and incidentally happens to have degenerated or damaged discs. Unfortunately, MRI (and x-rays of course) are often not the best diagnostic indicators when trying to find the “pain generators.” MRIs miss the subtle sprains and strains that are so often the true, root causes of the pain.
This begs the question...how, then, can we accurately diagnose the cause of a problem? Ultrasound can be useful in certain situations, but the most important diagnostic maneuver, by far, is a history and physical exam with an experienced regenerative orthopedic specialist. Dr. Walters, a pioneer in Regenerative Orthopedics, says, “When I examine a patient, I directly palpitate suspectedstructures to try and elicit the ‘Jump sign’. If I can reproduce the patient’s pain by directly palpitating a specific structure (ligament compression test) I am confident that I have identified the correct pain generator. This is where the patient requires the regenerative injections.”
In most cases, it may take several treatment sessions, usually spaced two to four weeks apart, to achieve optimal results. Dr. Walters concludes, “Overall, after I have examined the patient where the particular structures that are damaged are identified with a positive ‘jump sign,’ my personal success rate is in the range of 80%.”
Do you start with just PRP or PRP and stem cells?
Platelet Rich Plasma (PRP) is a therapy that utilizes a patient’s own blood to stimulate a healing response within a damaged tissue or joint. This form of therapy takes cutting edge technology and combines it with the body’s natural ability to heal itself.
PRP is made by taking a small sample of a patient’s blood and spinning the sample in a centrifuge for fifteen minutes. This process concentrates platelets and white blood cells in what is called a “buffy coat.” This is extracted and delivered to the injured area. Growth factors in the platelets recruit and produce cells necessary for healing. This choice depends on several factors such as: how severe the damage is, how much time it will take, the age and overall health of the patient, if the patient is a good candidate for the fat harvesting lipo-aspirate procedure, financial considerations, etc. In general, PRP can be used successfully when it is a joint capsule, a ligament, or a tendon that is the primary problem. Stem cells should be considered to give the best chance at successful joint regeneration if dealing with lots of cartilage loss and severe degeneration. In this case, PRP is also added as a “fertilizer” to help the stem cells grow, proliferate, and repair the damaged structures. If the patient receives a stem cell treatment and still has significant symptoms four weeks afterwards, a “PRP-Booster” is recommended to reignite the stem cell healing.
A Regenerative Orthopedic doctor should be a specialist!
The beauty of the RO approach is that it is safe, minimally invasive, and can yield some spectacular results. However, the safety and effectiveness of the procedure is totally dependent on two factors: the expertise of the specialist you choose as well as the quality of the PRP and stem cells used. It is recommended that you seek out a medical doctor who is well trained and experienced in regenerative injections and is also advanced in PRP and stem cell preparation. When considering diagnostic and injection skills make sure and look for a doctor who has been performing regenerative injections/Prolotherapy for a long time and has had specific training in regenerative injections. Regenerative Orthopedics is a specialty unto itself. For optimal results, choose a doctor who is fully dedicated to the specialty.