Over the past 10 years there has been a proliferation of Regenerative Medicine providers with more and more doctors employing this form of treatment for many different medical conditions. Musculoskeletal disorders are one of the most successful sets of medical conditions showing good response to Orthobiologic injection therapy (PRP and stem cells). If you have knee, shoulder, hand, hip or ankle arthritis, a torn or inflamed rotator cuff, a tear in a knee tendon or ligament, can any Physician perform these types of injections? The simple answer is no!
Different types of doctors perform PRP injections when developing treatment plans for their patients. If you have a joint disorder or a condition that affects your musculoskeletal system, you should choose a doctor that specializes in that particular practice area. For example a Physiatrist, specialist in Physical Medicine and Rehabilitation, is a doctor with a great deal of experience and specialized knowledge in the rehabilitation and management of neuromuscular and musculoskeletal conditions. Their advanced anatomical training makes them uniquely qualified to know exactly where the Orthobiologic needs to be administered and how to ensure the correct placement of the injection. They understand joint function and can adapt each patient’s treatment plan according to their particular condition and need.
Because PRP and stem cell injections are becoming a more popular treatment option, doctors who specialize in other forms of medicine are starting to implement them into their practice. A doctor who specializes in internal medicine or dermatology may have some training in the musculoskeletal system, but not specialized knowledge or experience in joint disorders. Even family practice doctors should not be used for this type of therapy without the specialized knowledge the procedures mandate.
Successful treatment requires the highest quality PRP or stem cells. In the treatment of any medical condition, dose is important. The same applies to Orthobiologics. As a result, it’s important to use a medical facility that has a lot of experience processing cells and performing guided injections to achieve successful treatment outcomes. Platelet rich plasma can be used to elicit healing in muscle, ligament or tendons that may either heal on their, over time, or may be stuck in the healing process and need a little “boost” to get things moving towards resolution. In contrast, stem cells are capable of not only differentiating into new tissue but also coordinating the repair process. So stem cells are more appropriate for degenerative conditions where tissue is lost, such as advanced arthritis or muscle, ligament or tendon tears. While it may take weeks for the benefits to become apparent from either form of treatment, the better the quality - higher the concentration - the stronger the healing response.
Different conditions require different measures to trigger the healing response. Some patients respond better to aggressive forms of treatment, while others heal better with time, physical therapy and ample amounts of rest. For example, a torn meniscus in the knee of an athlete will be treated much differently than a patient who has been diagnosed with the beginning stages of rheumatoid or osteoarthritis.
Is the pain in your knee being caused by a torn meniscus or arthritis? Who is going to diagnose your pain more accurately and identify the correct treatment plan?
Are PRP or stem cell injections the right form of treatment option or is Viscosupplementation a better option?
Physiatrist diagnose the exact cause of the pain and develop a comprehensive treatment plan with the goal of recovering mobility and functional well-being. This is accomplished by focusing on the whole body-not just a single problem area- and creating a treatment plan to optimize care and recovery.
As the doctor develops your treatment plan, they will need to determine the primary pain generator, the exact location of the injury as well as the type and dose of Orthobiologic needed to initiate healing. This is done by obtaining a detailed history which directs the focused physical examination. Available diagnostic imaging (typically x-ray and/or MRI) is reviewed prior to confirmation of the diagnosis with musculoskeletal ultrasound. Once a treatment plan is determined the injection is performed with image guidance. By using ultrasound image guidance, the injectate is placed in the exact location of the damaged tissue to produce the best possible results. The dose of injectate combined with precise placement of the injection are crucial elements in the success of the treatment.
If your doctor does not use image guidance and indicates they can perform the procedure by hand, your chances of a successful treatment are very limited. Hit the wrong spot and the injection is useless. Hit the right spot but place poor quality platelet rich plasma or stem cells and the result will be the same. The success of PRP Injection procedures are dependent on 3 things:
Each patient is different and your doctor should do everything possible to accurately diagnose your condition. If your doctor indicates you need surgery before attempting or counseling you on the alternative treatments options, look for a second opinion. You should be given the opportunity to proceed with the most conservative options available prior to moving forward with more invasive procedures or “last ditch” options such as joint replacement.
So, let’s examine who we are. Way back in 2008, I started performing image guided PRP and Prolotherapy injections in Cedar Rapids. Shortly after moving to Des Moines in 2012 I continued performing PRP injections and in 2014 opened another site focusing solely on Orthobiologic treatment using platelet-rich plasma and bone marrow concentrate. From 2014 to 2022, I performed over 1200 image guided stem cell injections and more than 3 times that number of PRP injections using the best evidence based treatments available. At that time I was the only game in town. So, if you know someone local who had a PRP or stem cell injection with benefit, it was likely performed by me. Now, in 2023, as previously mentioned, there has been a proliferation of providers employing this form of treatment. A good example is the University of Iowa, who back in 2021 published an article reporting they were “the only evidence-based regenerative medicine practice in Iowa”. While I was excited to have validation in PRP and stem cells as a viable form of treatment from the University of Iowa, it was more than 7 years after my small local private practice had done the same and continues to do so. Not to shed a negative light on the University. It’s critical that they and other providers continue to employ Orthobiologics in the treatment of patients. However, they are following, rather than leading.