As an M.D. who has specialized in Non-Surgical Regenerative Orthopedics for over a dozen years, one of the most common presenting complaints I encounter is back pain. In my experience the true underlying cause of back pain is often misunderstood and misdiagnosed by the medical profession and of course the resultant treatments, which are often invasive, commonly fail to relieve the patient’s pain.
Mark Walter M.D.
Unfortunately, MRI’s are often misleading and for two reasons. One, they fail to pick up the subtle sprains and strains that are so often the cause of back pain. Two, they often pick up abnormalities that are then incorrectly assumed to be the cause of the pain, resulting in inappropriate and often heavy handed treatments that may in fact compound the problem.
The non-surgical Regenerative Orthopedic approach can be highly effective and, in my opinion, the treatment of choice for many types of back pain. The approach of using injections to treat back pain and rebuild commonly damaged structures has been used for many years and is known as Prolotherapy (“prolo” stands for proliferation of joint tissue as well as supportive ligaments and tendons). What is new and very exciting for the field is the capacity to “harvest” and inject a person’s own stem cells in the office setting, which greatly enhances the stimulus to healing.
By far the most common cause of low back pain is a sprain or strain of the pelvic tendons. This commonly gives a “sciatica” like presentation and mimics nerve pain quite closely. Since this problem will not show up on MRI or x-ray, by far the best way (and perhaps the only way!) to properly diagnose it is with a detailed physical exam by an experienced Regenerative Orthopedic specialist. This is a “hands-on” specialty. The doctor needs to palpate specific structures to see if he/she can elicit the so-called “jump sign”. If the doctor can in fact reproduce the symptoms by palpating certain structures with his/her thumb, to my mind, this is virtually diagnostic of the root-cause of the problem.
Once the diagnosis is made, the next decision is what strength of solution should be injected to stimulate the body to heal the damaged structures. This depends on the complexity and severity of the case as well as the healing capacity and desires of the patient. Level one is the tried and true dextrose Prolotherapy (which has been used successfully for many years) where a concentrated sugar solution stimulates new blood flow to a region. Level two is high density PRP (platelet rich plasma) prepared from a simple blood draw from the patient and brings a few stem cells and a lot of growth factors to bear on the damaged region. Level three uses stem cells, known as adult mesenchymal stem cells, which are harvested from a person’s own body fat, usually around the abdomen, in a simple office procedure. The stem cells are then joined with PRP and injected in and around the damaged joint or region, often with the help of ultrasound guidance.
For most cases and depending on the strength of solution it takes three to eight sessions of regenerative injections to heal the damaged structures (usually spaced from two to eight weeks apart) to achieve the desired results. For patients who have back pain and are candidates for Regenerative Orthopedics we have better than an 85% success rate. The advantages of this approach is minimal risk and little down time. There is often some soreness with the injections but the vast majority of patients tolerate the injections well once they understand that this may well be the most effective solution to fix their problem.
Regenerative Orthopedics with stem cells represents an elegant and powerful non-surgical approach to heal back pain. Due to the minimal risk and downtime, I believe that this approach may eventually become the treatment of choice for many orthopedic problems. This truly is the medicine of the future!