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Many of us are excited about stem cell orthopedics and its’ potential. After all, who wouldn’t be interested in a very safe, minimally invasive treatment that uses your own stem cells and growth factors (from your fat and blood) to heal many painful and troublesome orthopedic problems? Yes, this treatment can help many avoid the risks of invasive surgery and in fact, for certain types of problems, may be much more successful. And yes, the benefits can be long-lasting. Stem cells regenerate structures and if done properly, can sometimes actually heal the root-cause of the pain.

Once you appreciate the broad application and effectiveness of regenerative orthopedics, I think it is self-evident that this really should become primary care orthopedics. If you have some persistent orthopedic problem, stem cell orthopedics should be the first thing you try, not the last. Can it fix everything? Of course not, but it can fix at least 80% of orthopedic ailments. No, it is not yet standard of care for orthopedics and yes, there is resistance to it by the establishment as it it does not fit into the current business model of surgery and pharmaceuticals. Nevertheless, there is unprecedented interest by the scientific community worldwide and people who have a problem are doing their own research online. There is no doubt that stem cells is the medicine of the future. It is just a matter of learning how to use them properly!

As a physician, I have specialized in regenerative orthopedics for over 20 years and sub-specialized in stem cell orthopedics for over a decade. We have had more experience applying stem cell technology to orthopedics than any other specialty. At my own practice, my protocol is as follows. The treatment is minimally invasive and done in a few hours as an outpatient procedure. You walk in, we take a little blood and about 60-100ccs of fat in a painless harvesting procedure (with only local anesthesia). You take a break and relax while we prepare the stem cells. Then we inject the stem cells and PRP in and around the specific area involved. And you walk out. The whole thing takes 3-4 hours, start to finish. Yes, you’ll be a little sore for a day but downtime is minimal and you can return to activities of daily living within 24 hours. It depends on the severity of the problem but sports and more demanding activities can generally be reintroduced incrementally within a few weeks.

Sound too good to be true? Actually, it’s not, but there is a big caveat. Results can be truly amazing, but are only possible if you do the treatment properly. Stem cells are powerful modifiers of degenerated and damaged tissue but they can only work if they are prepared properly and delivered to the right spot. With the right doctor and the right type of stem cells your chances for long-term success are 80-85%. In many cases and with many types of orthopedic conditions, stem cells may even have a better result than surgery, with much less risk. In fact, the main risk of this therapy is you may pay your money (insurance does not cover it as of yet!) and the results may fall short of your hopes and expectations.

OK, what’s the downside? The field of stem cell orthopedics has grown rapidly over the last decade and unfortunately, as with any new field, there is no standardization and much misconception and misinformation. It is also true that many doctors who are attempting to do these treatments do not have the right training or background to do it correctly. I call them dabblers!. They may mean well but their lack of knowledge, training and experience in regenerative orthopedics can greatly jeopardize the outcome. If someone has had a stem cell procedure and if the outcome of the treatment was poor, the first question is: who did it? and what type of stem cells did they use? Certainly, when it comes to healing, there can be poor biologic outcomes, but far more common is poor diagnostic and injection technique, improper selection or preparation of the stem cells or regenerative solution and failure to educate the patient properly for follow-up and rehab.

The obvious question is how does one go about finding the right doctor and program so you have the best chance of success? Let’s review the basics. There are three major determinants of the outcome of any stem cell orthopedic procedure. First, you need to make the right diagnosis of the precise pain generators and inject them properly. Good medicine starts with the right diagnosis! For this, you need the right doctor with the right background and skill set. Make no mistake, regenerative orthopedics (of which stem cell orthopedics is a subset) is a highly specialized field that is a totally different specialty than traditional surgical orthopedics. The outcome, as with any skilled procedure, will totally depend on the training, skill and knowledge of the practitioner.

The best regenerative doctors will have had training in a technology called Prolotherapy. The diagnostic methodology of Prolo is crucial to identify and prioritize the pain generators in any given patient. It is a little known fact that the majority of pain actually comes from micro tears in the attachments of ligaments, tendons and joint capsules. These loose attachments and the resultant joint instability are crucial concepts to understanding the pain picture and represents a totally different understanding and approach to musculoskeletal pain. Unfortunately MRI and ultrasound often miss these microtears and are often misleading. The only reliable way to make a precise diagnosis is with a technique called palpation interrogation. If I palpate a specific site on a specific structure it reproduces the pain, we call this the “jump sign”. The bigger the jump sign the more important that specific structure and site is in the pain picture. As simple as this technique sounds, it is in fact the only reliable way to identify and prioritize the true root-cause of the pain.

Second, you need to use the right kind of stem cells, prepare them properly and mix them correctly with good quality PRP. For orthopedic purposes autologous tissue (from your own body) is far safer and more effective than any other type of stem cells. Freshly prepared, DNA-matched stem cells work much better than umbilical tissue from a donor. There are two sources of autologous stem cells- fat and bone marrow. I prefer fat since its is easier to get and fat has a higher concentration of mesenchymal stem cells, which are the precursors of ligaments, tendons, cartilage and bone.

Finally you need the right follow-up and rehab program to give the stem cells the right healing environment to work optimally. After the stem cells are placed they will continue to work for at least 4-5 months. If, for any reason, a patient is slow to respond and has no progress after 6-8 weeks, we may suggest a one or two PRP boosters over a month or two to reignite the stem cells. PRP is the fertilizer and stem cells are the seed. In some cases, if there is severe instability we may even recommend one or two dextrose primers before the actual stem cell treatment. The individual treatment plan for any given patient needs to be adjusted depending on desired timeline, severity of problem, ability and willingness to come for several visits etc. If the problem is long-standing and severe, I usually recommend to start with stem cells. The combination of stem cells and PRP is by far the most potent regenerative solution we have, and gives the best chance for a rapid and substantial improvement. After all, I only get one chance to make a first impression. I want to turn every patient into a huge success case- and as quickly as possible!

Proper rehab is also important for optimal healing. The patient needs to use and move the area involved without over-loading the attachments. Painkillers such as tylenol and tramadol are fine but pharmaceutical anti-inflammatories are to be avoided as they interfere with healing. Reducing stress wherever possible and good nutrition and sleep hygiene also helps the healing process. If you optimize all the above factors, your chances of success are 80-85% of a long-lasting great result. The goal of stem cell orthopedics is to relieve pain and restore functionality. In the end it’s all about quality of life. This is the medicine of the future!

About Dr. Walter

Mark Walter MD has pioneered the field of regenerative orthopedics for the last 22 years and is considered one of the top stem cell orthopedic specialists in Florida. Dr. Walter completed his MD degree at McGill University (1980) and went on to do five years of post-doc work in regenerative orthopedics with the world famous Hackett-Hemwall foundation (in association with the University of Wisconsin). Dr. Walter has collaborated with the top teachers in the world and is a leading expert in using a patient’s own stem cells to heal joint, back and neck pain and avoid the need for invasive surgery. Dr. Walter is author of Stem Cell Orthopedics- A New Way to Fix Joint, Back and Neck Problems (available on amazon). By virtue of his training, his extensive experience, and his writings, Dr. Walter is considered amongst the top 50 in the country in this exciting new field.

For additional information, to book a consultation or reserve a seat at an upcoming free seminar (given bi-monthly) please call Dr. Walter’s office in Sarasota at 941-955-4325 or email

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