Revolutionary Non-Surgical Technology to Heal Joint, Back and Neck Pain.
Welcome to the exciting new field of Regenerative Medicine! A lot of people (and many doctors) don’t realize it but over 80% of musculoskeletal pain actually comes from ligaments and tendons, collectively known as the connective tissues. Ligaments, which hold bone to bone, form a dense, fibrous capsule around every joint and tendons tie every muscle to bone. These extremely strong, whitish structures hold much of the skeleton together and gives it form and strength.
The attachments of these connective tissue structures are also highly innervated, giving us joint feedback (called proprioception). When damaged, these structures become very prominent pain generators. In fact, collectively, they are a far more common and bigger pain generator than bone, cartilage or nerves in the body. Hence, if you have some kind of joint or pain of musculoskeletal origin, this should be the first thing you consider, not the last.
The reason why it is so important to identify ligaments, tendons and joint capsules as the root cause of the pain is that there is a fairly simple and effective way to fix it. Prolotherapy and PRP is a little known but highly effective treatment to regenerate these vital structures. The technique of Prolotherapy has actually been around for over 50 years and is the forerunner of the fledgling specialty of Regenerative Medicine.
Although many substances have been used to inject and regenerate joints, the most common, simplest and safest has been dextrose. By creating an osmotic shock to the injected areas, it creates a focal area of healing and tissue proliferation that brings new blood flow to the area and stimulates the body to heal itself. The body can heal what it can get blood flow to.
PRP or Platelet Rich Plasma has been a major advance in the field of Regenerative Medicine. Here we take a patient’s blood , spin it down, and use the platelet-rich portion (which is rich in stem cells and growth factors) and inject that as the proliferant. The technique is exactly the same as Prolotherapy but the results are better because the proliferant (in this case the PRP) is a more powerful stimulant to healing. Because the PRP comes from the patients own blood, it is also extremely safe. PRP is like a super Prolo. I believe it will revolutionize the field of Orthopedics.
What problems can Prolo/PRP fix? A lot. Almost any joint in the body can be injected. Common problems that are quite amenable to Regenerative Medicine include whiplash, sports-related injuries, rotator cuff problems, knee and hip osteoarthritis, lumbar and cervical disc problems, wrist sprain, elbow tendonitis, plantar fasciitis and Achilles tendonitis
How can you tell if you’re a candidate?
Regenerative medicine is a “hands-on” specialty. Unfortunately, conventional modalities such as x-ray and MRI are of limited value in the field of connective tissues. Ultrasound has more potential but is dependant on the doctors skill at doing the ultrasound properly and interpreting the results correctly. By far the most important diagnostic skill in Regenerative is palpation. Based on the practitioners experience and knowledge of anatomy, various structures are explored to see if they elicit the so-called “jump” sign.
Weakened structures herald themselves by becoming pressure sensitive. If a practitioner presses on a certain structure and elicits the jump sign i.e. reproduces the pain syndrome that they have, you have identified the pain generator(s). It is these structures that must then be peppered with small injections to increase the local blood flow and begin the healing process.
It usually takes six to 10 sessions of regular Prolotherapy (spaced one or two weeks apart) and four to six PRP sessions (spaced 2 to 4 weeks apart) to complete the healing of a given joint or region. For a good and experienced Prolotherapist, the success rate is over 80%. I make this point because the effectiveness (and safety) of Regenerative Medicine techniques is totally dependent on the doctors experience and skill in finding the right spots (the so-called “epicenter”) and injecting them properly. An in-depth knowledge of anatomy is required and just like a surgeon, the practitioner has to develop a feel and expertise for their procedures. When seeking a doctor to do Regenerative Medicine, you want to make sure that they have adequate training and experience.
I believe that Prolotherapy /PRP should take its’ rightful place as primary care Orthopedics. In the absence of a broken bone or obvious muscle weakness (which would herald nerve damage) and persistent pain of more than a few weeks, the first doctor you should see is a physician knowledgeable in the field of connective tissues/Regenerative Medicine. Unfortunately there are currently only about 200 doctors in the U.S. who make Regenerative Medicine their full time specialty. I think with time, the numbers will grow. The concept and effectiveness of PRP will bring it into the lime light and revolutionize how Orthopedics is practiced. This is the medicine of the future!
