This is an exciting time for treating pain and injuries. When I was a resident, the hallmarks of sports medicine were steroids and surgery. Unfortunately, that model still dominates conventional sports medicine, but times they are a changin’. If you suffer from any tendinitis or other soft tissue injury, or if you are hampered by an arthritic joint, the key word to think about is regeneration.
Regeneration is the process of growing healthy tissue. For tendon injuries, this means laying down collagen and growing a stronger tendon. For joint arthritis, this means growing stronger ligaments so the joint capsule is strengthened. When the tissue is strengthened, the pain diminishes, and this results in long-term healing. When you are treated with a regenerative method, you get pain relief in the short-term and the long-term.
Regenerative treatments can be used for a wide range of musculoskeletal injuries and almost any joint arthritis. Most injuries involve tendons and ligaments. Common tendon injuries include tennis elbow, rotator cuff tendinitis, DeQuervain’s tendinitis and runner’s knee. Common ligament injuries include ankle sprains, wrist strains and knee ligament injuries. Arthritic joints also respond beautifully to regenerative treatments, even when the arthritis is advanced such as bone-on-bone.
I would like to contrast for you the concept of regeneration versus the conventional treatments. With steroids, usually injected, pain relief is often achieved but is usually a short-term fix. The pain tends to recur when the effects of the steroid wear off. Furthermore, steroids have a side effect of eating away at tissue. That is why, for most conditions, we limit the number of steroid injections to three. As a Yankees fan, it always bothers me when one of the Yankees gets a steroid injection. It is not good for their career in the long-term. It would make sense to avoid, if possible, a treatment that can potentially eat away at tissue.
Another common conventional treatment is arthroscopic surgery. An example of this is knee arthroscopy for a meniscus tear. The surgery involves the removal of damaged tissue to “clean up” the joint. I would suggest that before undergoing a surgical treatment that removes tissue, one should try a regenerative treatment that helps build tissue.
The injuries that heal the slowest are those that affect ligaments and tendons. This is because ligaments and tendons do not get much blood flow, which is why they appear either white or whitish yellow. Muscles, on the other hand, appear red, partly because they get profuse blood flow. With minimal blood flow to deliver nutrients and healing growth factors, tendons and ligaments heal slowly, if at all. That is why some tendinitis conditions are among the most difficult injuries to treat.
Regeneration is holistic. The regenerative techniques stimulate the body to heal itself. These techniques stimulate increased blood flow and the migration of growth factors. These growth factors lead to the deposition of collagen fibers, which are the building blocks of tendons and ligaments. The tendons and ligaments are then stronger. When the tissue is healthier, it will be less painful and more functional.
The most long standing regenerative technique is prolotherapy. This involves the use of dextrose placed in the tendon or ligament, usually near its insertion at bone. The dextrose creates a mild irritation, which stimulates the blood flow and migration of growth factors. When that occurs, the tendon or ligament gets stronger, healthier, less painful and more functional. This leads to long-term healing.
There have been multiple studies that have demonstrated the efficacy of prolotherapy. For lateral epicondylitis (tennis elbow) and for knee arthritis, there is level 1A evidence that establishes the effectiveness of prolotherapy. This is the highest level of evidence with multiple randomized placebo-controlled studies. For many other conditions such as back pain, there is level 1B evidence. That means that there are very good studies but just not enough of them yet to give it the 1A designation.
Platelets are another powerful stimulant of regeneration. The platelets are obtained from our own blood. With taking 120 mL of blood, and spinning that blood in a high-speed centrifuge, we are left with 10 – 15 mL of platelet rich plasma, commonly known as PRP. The PRP is then placed along the injured tendon or ligament or into the arthritic joint to stimulate the migration of growth factors for healing.
Compared to prolotherapy, the advantage of PRP is that it is a more powerful stimulant of growth factor migration so usually requires fewer treatments to achieve full healing. The disadvantage is that because it requires more time and effort, PRP is more costly. Also, for more diffuse conditions that require more volume for a treatment, it is easier to get the increased volume with prolotherapy. With a flexible approach, PRP can be combined with prolotherapy to achieve the desired result.
Another emerging regenerative treatment is stem cell therapy. Stem cells can be derived from placental tissue or extracted from your bone marrow or fatty tissue. Your bone marrow or fatty tissue is spun in a high-speed centrifuge, thereby separating the stem cells. Stem cells from placental tissue, bone marrow or fatty tissue can signal enough growth factors into an area to repair a tear of the tendon or ligament. Third generation PRP (which is used in my office) extracts cells that express CD34, which is a form of stem cell. With this advanced PRP, patients benefit from stem cells in addition to PRP.
Whether you are experiencing tendinitis, joint arthritis or other musculoskeletal condition, you have the potential to achieve regeneration of injured tissue. This is a new way of thinking and I believe will become the standard of care for treating musculoskeletal injuries and arthritis in the not-too-distant future. Regenerative treatments address the cause of the injury by strengthening weakened or torn tissue. I strongly recommend that you take the opportunity to explore these treatments and work with a physician specially trained in regenerative medicine to regenerate your own tissue, thereby achieving long-term healing.
Dr. Slaten is a pain wellness physician in Ridgewood. For more than 20 years, he has been practicing regenerative techniques with great skill and an open mind. You can learn more at www.njprp.com or call his office with any questions or to schedule an appointment at (201) 882-1500.
