Regenerative medicine is rapidly growing with more efficacy and safety data being reported, and more patient and physician interest. The increased visibility is great for the field, but patients need assistance navigating knowledgeable from novice providers in order to get the best quality treatments. I will discuss over time the ways for patients to differentiate a regenerative medicine pro versus an amateur. These criteria are based on clinically relevant patient centric concepts rather than vague and subjective concepts like reputation and political/economic hospital affiliations. In cases where subjective criteria are considered, they will be based on longer term experiential concepts.
An essential concept that must be understood to properly and expertly perform regenerative medicine procedures for arthritis and tendinitis is prolotherapy. Prolotherapy is the injection of low level irritants such as glucose into the ligaments, joint, and soft tissue structures of a painful area. The goal is to create a low level inflammatory response that leads to the normal and expected process of inflammation, remodeling, proliferation, and healing. By focusing treatment on supportive ligaments and other soft tissue structures, this improves stability, which in turns provides more support and pain relief in an arthritic joint.
Prolotherapy fits well with the classical Greek concept of hormesis where an inflammatory substance given in low concentrations actually results in strengthening and improvement. In addition the principle of biotensegrity is key in prolotherapy. Biotensegrity suggests that within a structural unit there is ongoing tension and cohesion between the individual components that provides form and feedback that ultimately creates strength and function within the structure.
Prolotherapy as a medical treatment has been practiced since the 1940s, so how does this fit with the newer regenerative medicine treatments such as platelet rich plasma and stem cells? Inserting a needle into a damaged tissue results in blood flow and inflammation. On its own this process results in a low level inflammatory response and fits with how Prolotherapy works. By injecting a high concentration of your own platelets, there is an influx of growth factors that elevates the normal initial inflammatory response to injury which helps to push forward the normal healing cascade. In addition, Stem cells have numerous functions in an injured area, one is to differentiate into damaged tissue, the other general function is to coordinate the other cells and growth factors in an injured area to work in a healing mode. Injecting a high concentration of your own bone marrow aspirate concentrate inserts more mesenchymal and hematopoietic stem cells into your injured tissue. This can accelerate a normal healing process or restart one that has failed.
The prolotherapy approach to regenerative medicine leads to using your own platelets and stem cells to improve stability in soft tissue structures, treat structural damage, reduce chronic bad inflammation in a joint, and address neurogenic aspects that drive pain. Combining the prolotherapy perspective with the newer platelet and stem cell treatments is the best non-surgical approach to your arthritis and tendinitis because it attempts to approach all aspects of what is driving your pain.
It’s surprising how many physicians entering the regenerative medicine space do not understand the basics of a prolotherapy approach. I’ve heard colleagues dismissively refer to it as the “sugar shot”. Clinically this results in an amateur treating a knee with a joint injection only. A regenerative medicine pro uses prolotherapy concepts to also inject your platelets and stem cells into the ligaments protecting the knee that are frequently loose and unstable because there is an understanding that improving stability will provide longer term pain relief. If your regenerative medicine physician scoffs at the Prolotherapy “sugar shot”, find a pro who knows how to handle your problems more expertly.