A good place to begin exploring Regenerative Medicine is to ask, what kinds of orthopedic problems (i.e. injuries and degenerative conditions) can Prolotherapy/PRP heal? The short answer is – a lot. The long answer is more than you think. Let me explain.
I can start by saying that Prolo/PRP is treatment of choice for whiplash, knee and hip arthritis, rotator cuff, most forms of back and neck pain as well as most sports injuries. In fact, in the absence of a broken bone or muscle weakness (which indicates true nerve impingement) it is highly likely that the problem originates with the connective tissues. If your body is unable to heal itself in three or four weeks, Prolo/PRP may in fact be the only effective treatment to solve the problem.
What’s the Root-Cause of the Pain?
I think it is important to recognize that there are many painful and troublesome Orthopedic conditions that, at their root cause, are actually connective tissue problems. However, they masquerade as something else. In other words, there are many painful orthopedic conditions that are (often due to MRI findings) attributed to bone, cartilage and disc/nerve problems but are, in reality, due to damaged connective tissue (the body’s biggest pain generator(s).)
For example, the pain from knee arthritis, which is often attributed to loss of cartilage and a “bone on bone” problem, is largely due to the weakened (i.e. stretched) ligamentous capsule that surrounds the joint. Many people don’t realize that the ligaments that surround a weight bearing joint like the knee (or hip) not only hold the joint together, they also hold the joint apart. When we rebuild (regenerate) the ligaments of a joint we re-establish joint space. I have had several patients that have had MRI’s before and after Prolo/PRP that are told by their bewildered doctors that somehow the joint space has “miraculously” increased and they no longer need joint replacement.
I also frequently see patients (often a younger, more sports-oriented group) that have been told their knee pain is due to a cartilage tear and that if rehab fails, they may need arthroscopic surgery. More often than not, I find the pain is due to a significant (and undiagnosed) ligament sprain, for which Prolo/PRP would be the treatment of choice. In my experience, cartilage tears become important when they are large enough to cause mechanical obstruction of the knee joint. It is mainly in this latter case that I would suggest evaluation for arthroscopy. This is especially true if I cannot identify a damaged structure on palpation (via the “jump” sign) that is the likely cause of the pain.
It is also true that so called “sciatica” is actually very rarely an actual nerve problem and very commonly a pelvic strain. These strains radiate just like nerve pain and mimic disc problems. Yes, I know the MRI shows a disc abnormality but In most cases this is an incidental finding and not the root cause of the problem. Studies have shown that 40% of normal people (without pain) have disc abnormalities so it is clear that they often are asymptomatic.
Clearly Prolo/PRP represents a totally different paradigm for Orthopedics. I think it is often very helpful to review problems from a connective tissue standpoint to see if there is a simpler (and better) way to fix them.
Let’s Start with the Right Diagnosis
We have made the point, that it is vitally important to understand the root-cause of a problem if we hope to fix it. In other words, we need to start with the right diagnosis. Perhaps more than half of solving a problem is understanding and clarifying exactly what the problem is.
As we touched on above, when we say arthritis we refer to a joint that is painful. The question is what component of the joint is causing the pain? Is it the bone, the cartilage or the connective tissue that surrounds it? The question is more than academic. If I am right and it is the connective tissue- then we can fix it with Prolo/PRP with an 80% success rate. If I’m wrong and it doesn’t work, you can always consider other solutions (i.e. surgery) as a backup last resort.
Similar for backpain. If you do 2 months of Prolo/PRP treatments on your pelvis and the pain doesn’t improve substantially (or disappear altogether) you can always consider other treatments such as epidurals/surgery as a last resort. To exemplify, some of you may know that back surgery does not have a terrific track record to successfully eliminate backpain. Why? This is not because the surgeons are lacking etc. but because the diagnosis is wrong. Yes, there are abnormalities on the MRI but the pain is far more likely to be coming from an undiagnosed pelvic strain (from stretched gluteal attachments) which is actually pretty straight forward to fix by a doctor knowledgeable in Regenerative Medicine.
As another example; I often see patients who tell me they were told they have bursitis. More often than not these are undiagnosed (or misdiagnosed) sprains and strains. The distinction is important. Steroid injections or anti-inflammatories are contraindicated in sprains and strains and can further weaken or interfere with the healing of the connective tissues.
I think this gives a small snapshot of just how important the connective tissues are in the musculoskeltal system. They have been largely misunderstood and overlooked in conventional Orthopedic/Rehab practice. This is partially understandable because of our over-reliance on imaging technology such as MRI, which in the case of the connective tissues, is misleading.
To recap, Regenerative Medicine represents a different, new paradigm for Orthopedics and the treatment of many types of injuries/degenerative conditions. It is vitally important that one correctly identifies the root cause of a pain in order to fix it properly. In other words- start with the right diagnosis!
As a side note, it is also good practice when faced with two alternative approaches, to start with the least invasive, safest one first. God forbid that the more conservative approach doesn’t work, you can always progress to the more invasive, riskier approach as a backup plan.
