As many of you know, I’m a big proponent of stem cell therapy and platelet-rich plasma (PRP) treatments. These regenerative injections harness the power of a person’s very own cells to stimulate healing and repair for all sorts of conditions. The range of conditions stem cell and PRP therapies can help heal is impressive, from debilitating back pain and osteoarthritis to torn ligaments and other common injuries. Still, there are a lot of PRP and stem cell myths out there — and a huge range in the quality of treatments.
To sort through the hype and learn how people can find the highest quality treatments, I recently caught up with Dr. James Leiber, founder and medical director of New reGeneration Orthopedics of Florida. He’s an associate professor at the Lake Erie College of Osteopathic Medicine and a former officer, physician, and educator for the Air Force, including personal physician to the president and vice president. He is triple board certified in neuromusculoskeletal medicine, pain medicine and Family Medicine.
Dr. Leiber’s seen his share of injuries. And he and I are happy to report that for many people dealing with orthopedic problems, surgery can often be avoided. But first, a little bit background on these treatments.
What’s the Difference Between Stems Cells & PRP?
To understand these two treatments and their roles in repairing the body, we have to take a step back and look at prolotherapy. In essence, prolotherapy is an injection procedure that injects a benign, irritating substance into the tissue that stimulates healing in that area.
Today, using stem cell and/or PRP injections is a more advanced way of doing that. The prolotherapy concept arose in the 1930s as orthopedic doctors sought ways of strengthening ligaments without putting patients under the knife. Back then, it involved both joint and vein injections.
Originally called sclerotherapy — the term still used today for vein injections that treat spider veins, hemorrhoids and varicose veins — the term prolotherapy today refers specifically to joint, ligament and tendon injections. Prolotherapy injections contain natural substances that trigger healing in the body. Localized anesthetics are also used to minimize injection site pain. And while original prolotherapy injections consisted of ingredients like dextrose, saline, sarapin, and procaine or lidocaine, today’s formulations can now include platelet rich plasma (PRP) and stem cells taken from the same person they’re used to treat. These stem cells are often taken from a patient’s bone marrow or fat tissue.
Depending on the candidate, prolotherapy methods like PRP and stem cell injections may be more effective at repairing injured joints and stretched or torn ligaments or tendons and permanently stabilizing weak, damaged, painful joints than surgery or pain-killing drugs. (1)
PRP Platelet-rich plasma (PRP) is technically autologous blood with concentrations of platelets above baseline levels, which contains at least seven growth factors. Because PRP contains growth factors that heal damaged tissues, it works by naturally triggering localized inflammation, collagen production and other regenerative processes.
As a form of prolotherapy, PRP treatment is performed through a series of injection procedures that help resolve tears or injuries to connective tissue located throughout the musculoskeletal system. These can include injured or damaged ligaments, tendons, muscle fibers, fascia, cartilage and joint capsules.
Most patients receive multiple injections at each session. Repeat injections may be needed in four or more weeks. In many instances, the condition can be cured (ligament or tendon injuries), but in other instances, injections may need to be repeated periodically to maintain the clinical benefit (for example, moderate arthritis). The goal of PRP treatment is to strengthen and improve the quality of the targeted tissue and to reduce chronic inflammation resulting in more stable and functional joints or other tissue, and, of course, less pain.
So how does it work? Platelets from the blood are known for their repairing abilities: The released growth factors are key in a three-phase process during an injury that includes inflammation, proliferation and remodeling. These growth factors send a signal to the body that it’s go-time in terms of fixing up a damaged area of the body.
In PRP treatment, doctors can use concentrated platelets and growth factors from the patient and precisely guide them by ultrasound and or live X-ray (fluoroscopy) to the targeted tissues, delivering a potent dose of these compounds to enhance the healing process in many musculoskeletal injuries that include: bones, joints, ligaments, tendons, discs, labrum, meniscus and nerves.
In the last 12 years, stem cell injections for orthopedic conditions are becoming more common. Driven by clinical and basic science research (largely by the pioneering company Regenexx), stem cell availability and successful outcomes are growing tremendously. This highlights what is most promising about stem cell and PRP therapy. The procedures offer relief for patients with chronic pain and difficult-to-heal injuries, all without medications or risky surgeries. Today researchers are also uncovering ways to apply stem cell treatments for common chronic conditions such as heart disease, neurodegenerative diseases, and diabetes, though much more research is needed.
Managing pain ranks among the most common uses for stem cell treatments. From this, a new medical field has emerged — Interventional Regenerative Orthopedic Medicine. These non-surgical, minimally invasive techniques are administered by physicians in specialties that focus on musculoskeletal health such as: physical medicine and rehabilitation, interventional pain, sports medicine and neuromusculoskeletal medicine. Treatment involves injecting stem cells (along with an anesthetic and sometimes other substances) around painful and damaged nerves, tendons, joints, ligaments, discs, labrum, meniscus or muscle tissue.
Still, there are a lot of stem cell myths circulating, so we wanted to clear them up.
Top PRP & Stem Cell Myths
Stem cell and PRP therapy can work wonders. But it’s also important to understand the top stem cell myths to get a full understanding of these procedures.
Stem Cell Myth #1. All treatments are equal.
Lots of doctors are advertising use of PRP and stem cell treatments. It’s important to note that the quality of these procedures varies greatly. In fact, some injections are nothing more than liquified dead cells, as seen with injections of aminiotic fluid. That’s not going to help you heal. Dr. Leiber offers Regenexx procedures because the organization has a rich history in research, quality control and keeps close tabs on all of its patients in the world’s largest database registry of its kind — tracking safety and outcomes. In fact, Regenexx pioneered the concept of using stem cell injections for orthopedic tissue repair in 2005.
As of Spring 2017, Regenexx was responsible for publishing more than 50 percent of the world’s orthopedic stem cell literature, with more than 44,000 procedures administered. Affiliated doctors adhere to strict protocols to make sure treatments are standardized.
Stem Cell Myth#2. Treatments are magic bullets.
While Dr. Leiber says many people can avoid chronic use of narcotic drugs and even surgery through PRP/stem cell treatments, the patient needs to make lifestyle adjustments, too. These include eating anti-inflammatory foods, exercising and taking certain supplements.
Stem Cell Myth #3: Using stem cells in medicine is considered unethical by certain religions.
I hear this a lot, but what we’re talking about here is not use of fetal stem cells, which is a cause of major controversy. But rather, this process involves using a person’s own stem cells to create a solution with potent healing power. In addition, using one’s own stem cells is the safest way to go, as well.
Interested in Stem Cell/PRP Treatment? These Are 5 Must-Ask Questions
1. Do you use a centrifuge kit?
Many doctors administrating stem cell treatments don’t have an extensive background in prolotherapy, PRP or stem cell injections and are more used to injecting single targets with cortisone. Most simply use a centrifuge kit that a rep sells them. The problem with this process is that the cellular product results in a 1-size-fits-all approach. There’s no customization.
Regenexx, on the other hand, uses a sterile-hood biosafety cabinet where a full-time lab processor works to separate tissue and customize the concentration and the components based on the patient’s needs.
2. How are the cells injected?
It’s crucial to place the stem cells and the PRP directly into the target tissue that’s injured or weak. Many doctors will tell you that they can feel the tissue and inject accurately. Unfortunately, research studies show us this is incorrect. Precise placement requires highly advanced techniques using ultrasound and X-ray guidance.
Many of these techniques have never been taught before and require specialized training through organizations such as The Interventional Orthopedic Foundation to gain the appropriate level of skill.
3. What percentage of cells in the injection are alive?
You want to make sure your doctor has a way of measuring the level of living cells in your injected solution. Most doctors don’t have the capability of measuring this. Since the injectable solution is essentially coming from you, it’s important to know what’s in the final product. Some patients only have 75 percent living cells injected, while others may have 98 percent living cells. This matters, since having more living cells likely increases your healing capability. Lifestyle factors such as diet, exercise, tobacco and alcohol use and stress may influence this number, too.
4. Where do the stem cells come from?
As discussed earlier, doctors can remove stem cells from the patient’s bone marrow or fat tissue. Although fat tissue removal sounds like an appealing stem cell treatment bonus, regrettably, that’s not the case. Dr. Leiber says taking stem cells from fat is less effective at turning into orthopedic tissue and comes with a higher risk of infection and pain. Aside from that, the process of getting stem cells from the fat tissue is actually against FDA regulations — requiring a lengthy and expensive drug approval process. Therefore, it’s actually considered illegal to use it in this way.
5. What’s the pre-game plan?
Dr. Leiber says he sees a huge shift in the right direction when patients take the six weeks leading up to injections to start an anti-inflammatory lifestyle routine that involves a primarily plant-based, low-glycemic diet with a moderate amount of healthy protein, primarily from plants or some fish. This also includes healthy fats like avocados, coconut, and nuts.
Stem Cells Therapy: Who Can It Help?
The type of stem cell/PRP therapy discussed in this article can help treat:
- Chronic back pain or neck pain related to degenerated discs and joints
- Joint pain caused by osteoarthritis or instability (such as knee, hip, shoulder, ankle, and so on)
- Frozen shoulder and rotator cuff tears
- Chronic ligament and tendon injuries — sprains or strains such as plantar fasciitis, achilles tendinosis, patella tendinopathy, and chronic elbow injuries like tennis and golfer’s elbow
- Additionally, the following people can benefit, including those who:
- Take pain-reducing medications frequently (including Advil, aspirin, ibuprofen, oral steroids) but don’t feel their condition is getting better
- Fail to feel better after having surgery
- Have tried physical therapy but still experience pain and stiffness
Have trouble exercising, sleeping or moving normally without experiencing joint pain and limitations
Final Thoughts on PRP & Stem Cell Myths
- There are a lot of stem cell myths circulating, but once you understand the treatment and the science behind it, it can be a powerful way to deal with a range of painful conditions, including herniated and bulging disc symptoms, osteoarthritis, torn or stretched ligaments or tendons, sports injuries and many other conditions.
- Not all stem cell/PRP therapies are equal. Regenexx produces the majority of theworld’s research in this field and is able to customize the processing of the stem cells and PRP to maximize the number of live cells in the injection. They also have standardized the procedures and trained doctor’s to perform these procedures at the highest level . •
- Be wary of doctors who won’t tell you the percentage of live cells in a formula, or who don’t put you on a several-week lifestyle adaptation plan to improve your diet before getting injections.
- Make sure your doctor is highly skilled at using an ultrasound to help evaluate the problem and later to precisely guide the injections. X-ray guidance skills are also necessary for certain injections. Both skills are important.
- Remember, bone marrow is a better option than fat derived stem cells.
- In many cases, PRP/stem cell therapy is able to prevent orthopedic surgery and the chronic use of pain medications.