The central issue in most golf injuries is damage to ligaments and tendons. These connective tissues are highly innervated and when damaged, these ligament and tendon sprains and strains become very prominent pain generators. In fact, they are by far the most common underlying root cause of pain in the musculoskeletal system. Furthermore, the healing of these tissues tends to be problematic because their blood supply is poor; hence sprains and strains can persist and if not properly identified and treated, can often become chronic. Unfortunately, because MRI’s are not sensitive enough to pick up most of these stretched ligament and tendon attachments, the diagnosis is often missed and consequently, conventional treatment approaches may yield poor results.
The burgeoning field of Regenerative Medicine specializes in the diagnosis and regenerating of these damaged connective tissue structures by peppering small injections of proliferant at the precise points of injury. The goal of these injections is to enhance the blood flow to the damaged structures, stimulating the body to strengthen and tighten the ligament and tendon attachments, thereby solving the problem. What is truly exciting with Regenerative Medicine is we are now using PRP (Platelet Rich Plasma) as the proliferant in the injections. PRP is a concentrate of the patient’s own stem cells and growth factors (taken from a simple blood draw) and is proving highly effective to stimulate the healing of damaged ligament and tendon structures.
Regenerative Medicine with PRP can be used on almost any joint in the body and should be considered the treatment of choice for common golf injuries involving the back, rotator cuff, knee, elbow and wrist. The key is to find a properly trained and experienced Regenerative Medicine specialist who can correctly identify the proper ligament and tendon trigger points (i.e. elicit the “jump sign” on palpation) and inject them safely and effectively. This approach requires experience and a “hands-on” approach since damaged structures are properly identified through palpation and an indepth knowledge of anatomy. A skilled Regenerative Medicine specialist will usually have an 80%+ success rate for properly identified candidates.
The field of Regenerative Medicine is small and there are currently only about 200 specialists in the U.S. The forerunner of this specialty is a technique called Prolotherapy that used the exact same techniques of healing connective structures. The only difference is we now use PRP (which is a more powerful and effective proliferant) instead of dextrose or other proliferant. Some specialist are even using stem cells isolated and cultured from bone marrow. Whichever proliferant one uses (PRP, dextrose or bone marrow stem cells) the key is the expertise of the doctor in finding the precise “trigger” points and injecting them precisely and repetitively (usually takes 4 or 6 times over 8 to 12 weeks for complete resolution) to stimulate the body to properly heal itself. Patience is required on the patient’s side, but once healing is complete, it should be a permanent result.
The wonderful thing about Regenerative Medicine is that it is a highly effective treatment that is minimally invasive. If done properly there is little risk. It also requires no downtime during the treatment program and an active rehab is recommended. I consider it treatment of choice for many golf-related injuries (as well as many other musculoskeletal issues such as arthritis, disc and meniscus issues etc.). In my view, anyone with a persistent pain of more than three weeks should strongly consider a consultation with a Regenerative Medicine specialist before they embark on other courses of treatment. Using PRP and harnessing a patients own healing capacities is a rather elegant solution to many problematic injuries and may solve many persistent musculoskeletal pain syndromes. This truly is a better way to heal golf injuries!