Watch Basics of Stem Cell Development video here
Imagine having the ability to signal the body to transform injuries into healthy tissue, and to transform degenerative tissue into younger tissue. This ability exists. We call it stem cell therapy and it is repairing a number of issues from tendons and joints to organs and heart muscle. In people with diabetes, for example, stem cells can prompt the pancreas to regrow its cells. [1,2] With stem cells, heart tissue has been able to regrow after a heart attack. [3,4]
There is still some conflicting research on the benefits for metabolic disease states, but when it comes to the musculoskeletal, there is no doubt of the healing power of stem cells. At The Osteopathic Center, we utilize stem cell therapy for pain and injuries. Stem cell therapy has the ability to “fix” things that we have not previously had a good way to fix.
Whether you are a professional athlete dealing with major sports injuries or a person with a desire to push back the hands of time, the application for stem cell treatments are many. Stem cell injections are used to heal lower back pain, joint degeneration, arthritis, Achilles tendon pain, rotator cuff injuries, TMJ (temporomandibular joint dysfunction), carpal tunnel, heel and foot issues, hernias, epicondylitis, facial wrinkles and dark spots, and more. Pain is the body’s way of telling us we have an injury. Our high quality and concentrated injectables, along with a unique injection technique perfected by Dr. Kristopher Sean Goddard, delivers accelerated healing and pain-free, long-lasting results.
Stem cells, as wonderful as they can be, are sometimes sold with a lot of hype that doesn’t stand up to reality. Whether stem cell therapy will work for you requires a thorough evaluation of both the type of your injury and the severity of your injury.
Dr. Goddard assesses your injury in terms of mild, moderate, or severe. “If you have a mild or moderate injury, I am about 90% confident we can fix it,” he said. “Otherwise, I’m probably inclined to say something more like 50%.”
Technique is a critical part of the equation. “Two physicians could treat the same type of injury with the same degree of severity and get different results because their technique is different,” Dr. Goddard explained. “Say you are working on a knee joint. You want to palpate the tendons and ligaments surrounding that joint to look for instability. Chances are if you don’t look for instability and if you don’t inject the ligaments when you find it, you won’t get good long-term results.”
A far too often overlooked part of the healing process is bringing stability to the injured area. It is not enough to just use stem cells to heal injured tissue – that’s a half-done job. The technique needs to address both injured tissue and stability. You can’t always see instability – the MRI or X-ray image of the injured area may readily show joint deterioration, but not the weakness of the supporting ligaments and tendons. Also, when we stand for an X-ray or lay down for an MRI, our bodies are still. But in our daily lives, we are anything but still and the imaging techniques cannot grasp what happens when we are in motion. We want to identify the injuries limiting our functional movement. Let’s take a deeper look at this.
Our bodies are an intricate and complex balance of muscle, bone, and tissue. Muscles move our bones. Ligaments give our joints stability. The instability caused by weakened ligaments makes the muscle tighten and that is why you lose range of motion and have pain. There are four things Dr. Goddard uses to assess the degree of injury and instability: the physical exam, the imaging, your pain level, and your activity level. “Is the pain coming from the injury and/or is the instability causing the injury? This is the core philosophy of what I do.”
You may have heard from some people who received stem cell therapy for back problems such as degenerative disks or pinched nerves (radiculopathy) that they didn’t get the results they were hoping for. This is likely an issue of technique. Many practitioners will do just one or two injections. Fact is, to see results, you have to inject enough ligaments in the back for stability; experience tells us it takes 10 to 20 injections of the right concentration into the right locations to correct this. Stem cells can only fix so much if the instability is not also given the opportunity to be corrected. Does that take more time? Yes. Does it cost more? Yes. Do you get a way better result? Yes. Hate to toss out that old cliché, but it’s true – you get what you pay for.
Let’s dig a little deeper into this business of technique. Let’s take severe chronic degenerative arthritis in the knees as an example. Over the years, cartilage has been wearing down in the joint. You feel pain, so you begin to shift your body posture a bit to accommodate the pain. That puts even more stress on the ligaments, tendons, and muscles. The quad muscle, over time, usually becomes smaller, even if you are working out or going to physical therapy, because the brain wants to protect the joint; if your ligaments are weak, the body is going to use the muscle to protect that joint. There is considerable instability, which then creates friction. If you inject only the joint, your pain will initially be less, but good luck getting the cartilage to heal and being pain-free long-term because you still have instability. However, if you also inject the ligaments surrounding the knee joint with stem cells or PRP (platelet rich plasma), you can stabilize the joint and then the cartilage will heal because you addressed the whole problem, not just part of it.
Let’s take a moment to compare stem cell therapy for your knees versus surgery. Knee replacement surgery tends to need to be repeated every 10 years. Surgery is invasive. The use of general anesthesia has been linked to dementia  and immune system suppression.  If you go straight to knee replacement surgery, you can’t go back to stem cells.
Professional sports injuries, degenerative conditions in knees and hips, lower back pain, athletic hernias, abdominal muscle tears, carpal tunnel, golfer’s elbow, tennis elbow, shoulder injuries, rotator cuff tears, osteoarthritis in joints, ankle sprains, TMJ – these are the conditions to which we most often apply our stem cell and stabilization techniques. Stem cell injections have a very low risk of any side effects, and often our patients no longer need to be dependent upon pharmaceutical medications.
Watch Dr. Goddard performing a Stem Cell procedure for shoulder injury, click here
The field is evolving so quickly now that our use of stem cells is evolving. The FDA’s governance on stem cells is also evolving. Even the language used to describe stem cells is evolving.
When we say stem cells, we are really talking about mesenchymal cells. A mesenchymal cell is a messenger signaling cell, an adult cell that is very potent and signals tissue-specific stem cells and site-specific stem cells to activate. You can think of them as cellular packets of high potential that are directed to where the body has a need to fix something. In medical parlance, mesenchymal cells are “multipotent adult cells.”
Dr. Goddard explains the different sources of stem cells, and their advantages:
AMNIOTIC STEM CELLS
Amniotic stem cells work really well for many, many people. Amniotic stem cells are obtained after a live birth C-section from a healthy mother. There is amniotic fluid which has cells and growth factors. And there is micronized tissue from the amniotic sac that will work as an allograft – tissue that is transplanted from one person to another to facilitate a structural component for regrowth. The FDA classifies the use of amniotic stem cells as a tissue allograft. The body can use it and build new tissue on top of it. It is almost like a mini-surgical procedure. You get growth factors and stem cells in the amniotic fluid, and more stem cells, plus a grafting effect from the micronized tissue.
Not every practitioner uses both the tissue and the fluid; not every company’s amniotic stem cell product has both. I like to use both when injecting joint/ligaments/tendons, for example, because it gives the patient a double whammy. I like to use just the fluid, however, when injecting the face and scalp because I can use a smaller needle and I have not seen a difference in the results in those areas when using both.
The source of any kind of stem cell product is important. As is the case so often in life, some companies deliver a much better product than others.
There is a Chinese manuscript dating back to 1593 called the “Compendium of Materia Medica” which describes using the placenta for medical treatment. By the 1900s, the practice was used for skin grafting, ulcers, wounds, burns, ophthalmology, and it grew from there.
Stem cells from amniotic tissue are fabulous for professional athletes, for example, who want to get right back in the game. Different kinds of stem cells trigger different kinds of healing. What’s key here is that amniotic stem cells do not trigger an inflammatory healing response. If we used stem cells from adipose tissue or bone marrow, athletes would be sidelined for about three weeks because the body would be using inflammation to promote the healing process. When platelets (clotting factors in our blood) and red blood cells are in the mix, you get an inflammatory response; stem cells from amniotic fluid/tissue do not contain these blood components.
Amniotic stem cells are great for people who need the least amount of down time.
BONE MARROW STEM CELLS
Stem cells sourced from your own bone marrow are the most used stem cells in the world. Using bone marrow won’t necessarily give you the largest number of mesenchymal cells, but it gives you a nice mix of mesenchymal cells, growth factors, red blood cells, platelets, and hematopoietic cells (cells that make your blood regrow).
The procedure to obtain stem cells from bone marrow has gotten much simpler over the years. It is an out-patient procedure that takes about 45 minutes and requires only local anesthesia. Our aspiration procedure is minimally invasive. We use a needle to withdraw bone marrow which is the source of the stem cells. Technique is an issue here – some practitioners know how to pull out more stem cells than others. After the marrow is removed, we can either inject immediately to capture the platelets and all the other components, or we can we spin it down to concentrate just the stem cells which are then injected directly into the site of the injury.
Note: People on blood thinners, people with cancer, and people with certain diseases are not candidates for bone marrow or adipose stem cell procedures.
ADIPOSE TISSUE STEM CELLS
Like bone marrow, adipose tissue is part of your own body. Adipose tissue is body fat. We do a mini-liposuction procedure to extract your own fat cells from just below the skin where stem cells are abundant. The tissue is mechanically micronized with filters to prepare it for immediate injection at the problem site.
There are more mesenchymal cells in fat cells than in bone marrow, and obtaining cells from adipose tissue is less invasive than bone marrow. If a high number of mesenchymal cells is the primary goal, stem cells derived from adipose tissue will deliver.
UMBILICAL CORD STEM CELLS
These are sourced from the umbilical cord of healthy, newborn babies whose mothers have undergone a number of screening tests. The FDA classifies umbilical cord stem cells as a human tissue product. Umbilical cord stem cells may contain the highest number of those potent mesenchymal cells that signal healing of damaged body parts. These are adult stem cells meaning they are naturally limited in what other types of cells they can become which makes them very safe to use.
There has never been a reported case of amniotic or umbilical stem cells – the two types of stem cells that you would source from someone else’s body – causing a rejection reaction. Stem cell therapy mimics a process that is ongoing in our body every day.
EMBRYONIC STEM CELLS
These are the most controversial of all sources. They are not allowed in the United States and we do not use them at The Osteopathic Center. Embryonic stem cells come to life when the egg and sperm first come together, first begin to multiply, and these first few cells are allowed to develop into every other kind of cell for a short period of time. They are not adult cells and that raises concern as to whether their use would promote cancer or other disorders. You could say that because they are so primitive, it is hard to predict what they will do.
CULTURE EXPANDED STEM CELLS
Some practitioners use what are called “culture expanded stem cells.” They take a cell into the lab, grow it with nutrients, and end up with a million or more mesenchymal cells. Generally, these come from amniotic or umbilical sources. But there is some evidence that if you grow them in a lab, they are not as effective in the body, so you do not get that extra bang for your buck. They are only used in the United States for research studies at this time. All stem cells used in this office are ADULT derived stem cells injected the same day of the visit sourced from amniotic tissue/fluid, bone marrow, or adipose tissue.
The number of our mesenchymal cells decreases with age. At age 30, we have a lot more stem cells in our bone marrow and adipose tissue than we do at, say, 50 or 60. That means our body has decreased tissue repair capacity as we get older. This is why injecting stem cells – potent medicinal signaling cells and growth factors – can be so helpful.
Stem cell therapy is one of the safest things we can do for musculoskeletal conditions. Compared to surgery, stem cells and PRP are antibacterial. I personally have never seen an infection in my practice in more than a decade of using stem cells. This treatment has the lowest risks and highest rewards available.
There is a lot of research which has shown significant promise in the field of musculoskeletal injuries and pain – rotator cuff injuries, osteoarthritis of the knee, Achilles tendon rupture, cartilage repair, back pain, and more. [7,8,9,10,11,12]
Study after study reports positive results with various stem cell treatments. For example, here is the conclusion of a study of 44 patients with chronic foot pain – plantar fasciosis and Achilles tendinosis. All the patients had all been “unresponsive to multiple standard therapies” for a minimum of six months. Then they were given injections of amniotic tissue and stem cells:
After treatment all patients noted significant pain reduction, indicating that granulized amniotic membrane and amniotic fluid can be successfully used to treat both chronic plantar fasciosis and Achilles tendinosis. … No adverse reactions were reported in any of the patients. 
Stem cells maintain, heal, and regenerate tissues throughout our body. Without them, we would die because there would be nothing to replace exhausted cells or damaged tissue.
It used to be people thought of stem cells like a wild card that can become any other kind of cell. That’s incorrect. When we inject stem cells, regardless of the source, we are injecting signaling cells that direct the body to produce a healing response in the tissue and organs.
For each patient, it comes down to
• Are you candidate based on health issues, imaging, pain level, stability issues?
• What result do you want?
• What is likely to promote the best healing for you?
• What is your budget?
Most of these procedures are not yet covered by insurance.
Stem cell therapy helps you heal from degeneration and injuries, and many people return to a fully functional lifestyle free of medications and constant follow up visits to the doctor. The Osteopathic Center is proud to be one of the few practices in the country that offers a diverse and ample practice specializing in regenerative medicine that offers all of these types of stem cell treatments.
Stem cell therapy can:
• Repair tissue that is too damaged to heal on its own or just doesn’t heal properly: ankle sprains, knee meniscus tears, plantar fasciitis, ACL tears, rotator cuff tears, labral tears, arthritic joints.
• Regenerate tissue that is missing: cartilage in arthritic joints, cellular re-growth in trauma sites, reinforce muscle and connective tissue that is lost through the aging process.
• Provide a source of immunomodulation: it balances out the pro- and anti-inflammatory forces in the body; this is why it works so well in autoimmune diseases.
• Be used in cosmetic procedures to fight aging, such as microdermabrasion, wrinkles, and sunspots. With direct injections under the skin, we see collagen growth.
Mesenchymal stem cells are being studied extensively. The ongoing breakthroughs resulting from this vast medical research is exponentially increasing every year. [14,15,16,17,18,19,20,21,22,23,24,25,26,27]
Here’s a sample of the medical literature’s evolution from Dr. Arnold Kaplan, the scientist who coined the term “mesenchymal stem cells”:
“Mesenchymal stem cells (MSCs) were officially named more than 25 years ago … Unfortunately, the fact that MSCs are called “stem cells” is being used to infer that patients will receive direct medical benefit, because they imagine that these cells will differentiate into regenerating tissue-producing cells … I now urge that we change the name of MSCs to Medicinal Signaling Cells to more accurately reflect the fact that these cells home in on sites of injury or disease and secrete bioactive factors that are immunomodulatory and trophic (regenerative) … It is, indeed, the patient’s own site-specific and tissue-specific resident stem cells that construct the new tissue as stimulated by the bioactive factors secreted by the exogenously supplied MSCs.” 
The more we work with mesenchymal stem cells, the more we learn. In late 2019, for example, stem cells were found in tendons. This is great news because tendons are easily injured. Tendon injuries rarely fully recover because (1) the tendon stem cells are usually not activated, and (2) scar tissue resulting from the injury changes the structure of the tendon for the worse. Timely injections of stem cells can head off scar tissue damage:
Because tendon injuries rarely heal completely, it was thought that tendon stem cells might not exist. Many searched for them to no avail, but our work defined them for the first time. … Tendon stem cells exist, but they must outcompete the scar tissue precursors in order to prevent the formation of difficult, fibrous scars. Finding a therapeutic way to block the scar-forming cells and enhance the tendon stem cells could be a game-changer when it comes to treating tendon injuries. 
This study proves another point: We are discovering that mesenchymal stem cells are acting more like medicinal signaling cells as Dr. Kaplan said due to these tissue-specific stem cells needing to be activated.
The FDA (Federal Food and Drug Agency) agrees that “stem cell therapies may offer the potential to treat diseases or conditions for which few treatments exist.” The agency also realizes that some “stem cell clinics” have sprung up with poorly trained staff using poor procedures, poor accuracy of placement, and their offices need to be shut down. If you watch the video of my treatment of a shoulder injury (click here), you’ll realize that the procedures for stem cell therapy require a very high level of training, experience, and medical skill. To put it bluntly, it should not be done by a technician who attended a weekend seminar.
Earlier I mentioned combining ozone with stem cell injections to boost healing. This is why: Ozone has three molecules of oxygen; the air we breathe has two. That extra molecule gives ozone its healing properties because it easily penetrates membranes and increases oxygenation. It is very effective when injected into joints, especially rheumatic joints. Inflammation decreases, swelling decreases, and pain decreases. Ozone has been shown to stimulate local stem cells and repair tissues, including cartilage cells. [30,31]
Ligaments and joints are notoriously known as areas of “decreased oxygen tension.” The oxygen tension in a healthy ligament is often only 1/10th that of the tissue only several millimeters away from it. The same is true for joints. And as we get older, our circulation decreases. When a trauma occurs, it will produce edema (excess fluid) and inflammation, both of which cause a further localized decrease in oxygen utilization. This decrease in oxygen utilization produces a localized increase in lactic acid production, free radical damage, and necrosis which serves as the foundation for sensory irritation and injury, all of which causes chronic pain. Ozone has unique properties for alleviating chronic pain because it stimulates oxygen utilization. 
Before stem cells came into use, we relied on prolotherapy and PRP. And they are still useful. To read about them, click here.
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