What is the winning formula to treat your pain or injury?
You’ve heard about different things people do for pain management like surgeries, steroids, painkillers – they have been used for decades. More conservative options include massage, acupuncture, manual therapy, energy medicine, and magnetic therapies. Conservative options are effective for minor injuries, but not for more chronic and severe pain and injuries.
Cell therapy and regenerative treatments are a very significant advancement in medicine for treating chronic pain and more severe injuries.
Many top research and educational institutions are now using cell therapy because regenerative injections are extremely effective. The most common regenerative injections include stem cells, platelet rich plasma (PRP), and prolotherapy. At the Osteopathic Center, we do not use steroid or chemical injections. We focus on minimally invasive, nonsurgical treatments to regrow tissue and alleviate pain.
What kind of painful conditions can be treated?
Headaches can come from tendon attachments at the back of the head. They can also come from TMJ problems in the jaw.
Neck pain can occur with the cervical spine muscles being really tight and even pinching on nerves.
Similarly, the cervical spine, thoracic spine, or lumbar spine can create pain from muscle tightness and ligament weakness. Another common cause of back pain is degenerating disks.
As for shoulder pain, rotator cuff injuries are the most common cause. Labrum tears and osteoarthritis are common in the athlete and as we age.
Elbow pain can make simple actions such as opening a door feel like the most difficult activity. Golfer’s elbow, also known as medial epicondylitis, is pain on the middle of your elbow. Tennis elbow, also known as lateral epicondylitis, creates pain on the outside of your elbow.
Carpal tunnel syndrome decreases strength in the hand and can feel like pins and needles. If you have finger pain, arthritis is usually the main culprit.
Sharp pain in the mid sternum makes breathing feel like a knife in the chest. People tend to think there is something wrong with the lung. However, it is most commonly caused by inflammation near the rib attachments called costochondritis.
A lot of abdominal tears and groin tears can cause pain. Typically, you feel these in the lower abdomen.
Hip instability, arthritis, and labral tears create significant muscle tension and groin pain.
Gluteal injuries, trochanteric bursitis, TFL, and IT band syndrome are all possible pain generators around the hip area.
Knee pain makes you hate the stairs. This is one of the most injured areas of the body. The knee support infrastructure – quadricep tendon, patella tendon, meniscus, medial collateral ligament (MCL), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL) are commonly injured. That’s why for long-term healing, you have to address the stability of the joint and that often means injecting ligaments along with the joint.
Ankle sprains keep you sidelined from activities and not able to wear shoes that you love. Plantar fasciitis and Achilles tendon injuries are often nagging injuries that need more intense long-term care.
What’s the first step?
You have decide it is time to do something. And that you want the effort to be effective. Make an appointment to meet with us so we can perform a full assessment and share with you what it will take to put an end to your pain. Remember that the earlier we treat it, the easier it is to successfully resolve your problem. It may be, that early on, PRP will do the trick instead of more expensive stem cells.
What happened to you?
How did it happen? Is it a direct injury? Did something happen forcefully like a car accident or athletic injury? Is it a chronic, repetitive injury? Or is it something that nobody really understands why it happened? It’s just because you are getting old, right? I’m sure you’ve heard that pretty often. “Getting old” really means there are minor injuries built up over years that have not been treated proactively.
Instability can result in pain and injury. Instability in the body really means weak and injured ligaments. Even if they do not show up on imaging, weak and injured ligaments can create pain themselves and they can also create compensatory patterns. These compensation patterns tighten muscles to protect for the injured ligaments. Ultimately, this can translate into pinched nerves, create chronic tension in your muscles, or even cause tendon and joint tears.
To give you a solid “fix,” I need to understand why and where your pain is coming from.
Your ability to communicate as many details as possible is very important to me. Did something happen? How long the pain has been there? Does it hurt when you’re waking up? Or at night? Is your pain when moving, sitting down, or laying down? What daily activities does the pain keep you from performing? How do you describe your pain? What is the severity of your pain on a scale of 1 to 10? Sharp? Burning? Dull? All of these things matter when I assess.
The Physical Exam
There are defined tests and evaluations I will need to perform. We’ll begin with range of motion, palpation to tenderness, and resistance testing.
Imaging
I make use of diagnostic ultrasound. This technology has improved drastically in the last couple of decades. In skilled hands, tendon and ligament injuries are seen more specifically on ultrasound than even MRI. I use MRIs to look at soft tissue injuries and especially inside the joint itself. X-rays, of course, identify the bony abnormalities that one may have injured.
What Are Your Treatment Options?
The combination of your history, physical exam, and imaging gives us the right tools to identify what’s going on with your pain and injury, especially the type and severity.
Musculoskeletal treatment options at the Osteopathic Center are almost always nonsurgical injections, what we call regenerative injection therapy. It means we are doing injections to regenerate tissue: muscle, tendon, ligament, etc. The most common types of regenerative injections are stem cell, PRP, and prolotherapy.
Frequently after an injury, the body does not heal completely. Many factors could contribute to this. Without complete healing, instability is created. And scar tissue often develops as well. The nonsurgical, regenerative injections help remove scar tissue and build new, healthy tissue. These treatments will maximize your range of motion, decrease your pain, and give you lasting relief.
The different kinds of injections
1. Stem Cells
Stem cells trigger the body to regrow tissue and they are showing a marvelous ability to live up to expectations. The particular cell we are looking for is called a “mesenchymal stem cell” or MSC. Arnold I. Caplan, Ph.D., first coined the term mesenchymal stem cell in 1992. In 2017, he wrote a paper suggesting the term should be changed to “medicinal signaling cells” because they do not actually become the new tissue; they signal the body to make new tissue.
As our technology has improved, research has shown the characteristics of these signaling cells do not necessarily fit the mold of a true stem cell. The medicinal signaling cells activate our tissue-specific stem cells. Basically, it’s like watering flowers: the plant uses the water to grow. In the same way, MSCs are the water for your muscle, tendon, ligament, joint, or injury. Your tissue-specific stem cells are activated by the MSCs. Your stem cells then regrow injured tissue.
The most common sources of MCSs in the United States are bone marrow aspiration, adipose tissue, amniotic fluid and tissue, and umbilical sources. I have been thoroughly trained in all of these treatments. Research studies have shown each of these treatments to be successful and have life altering improvements when applied appropriately.
Platelet rich plasma (PRP) injections have become extremely popular in the past 30 years. To get material for PRP injections, we take a small amount of your blood and spin it down to concentrate your own platelets and growth factors. Afterward, this concentrated solution is precisely injected to your area of injury. PRP signals your tissue-specific stem cells to become mobilized to regrow your tendon, ligament, muscle, meniscus, etc.
PRP got everyone’s attention when it was applied to heart surgery. PRP injections would help enhance wound closure after open heart surgery. PRP also made headlines in dentistry. Rather than use bone grafts, PRP would help the bone in the mouth regrow for certain dental procedures. Treatments with PRP then moved into the musculoskeletal field. The last decade has seen a flood of research.
Musculoskeletal, sports, and pain medicine all use PRP to some degree in practice. As the science of PRP has advanced, we are now able to limit variability. Research is currently focused on the optimal concentration of platelets and growth factors in order to regenerate tissue.
Both PRP and prolotherapy treatments trigger inflammation that creates the healing effect. Stem cell treatments do not. You are going to get sore after a PRP or prolotherapy procedure.
Many people do not know that there are different ways to concentrate PRP. There is the test tube method which has significant practitioner-to-practitioner variability. There are also many companies that make kits. In addition, there are differences in how much volume each practitioner injects to the injured area. This is why the research has not been consistent.
Our office uses a double spin method that results in highly concentrated platelets and growth factors. This also ends up creating a very strong inflammatory reaction to activate stem cells that regrow tissue; thus, there is significant pain after the procedure. The pain is pretty severe for two days. Usually, pain from the treatment lasts for about three weeks. PRP therapy, depending on the pain and severity, usually has to be repeated a couple of times to get maximum and optimal benefit.
PRP injections are about three times as effective as prolotherapy.
3. Prolotherapy
The first and the oldest type of regenerative injection is called prolotherapy. Prolotherapy treatments primarily consist of dextrose injections to a very specific area of injury. These precise injections cause an inflammatory response where injected, which makes your platelets and growth factors activate your tissue-specific stem cells to orchestrate repair of the injured tissue. Normally, this is a treatment that needs to be done multiple times to achieve the desired result. This is the oldest, yet most unknown, regenerative injection treatment available.
Prolotherapy is usually a minimal soreness, but sometimes with high volume and more concentrated solutions there can be significantly more pain. The dextrose solution used in our clinic typically causes mild inflammation anywhere from two days to a week. The healing takes place over the next couple of weeks. Ordinarily, prolotherapy is repeated every one to two weeks depending on the type and severity of the injury.
Which procedure is right for you?
First, some questions. What type of procedure do you want? How much recovery time can you handle? What kind of volume do we need? Are there medical conditions or medications that prevent us from using one of these procedures?
After the evaluation, you and I talk and decide what the best treatment is for you. Stem cell treatments do not trigger inflammation for healing and they usually give us the best effect after one treatment. Some people are okay with some downtime and can resolve their problem with a less expensive solution – let’s look at what will work best for you.
Finding the right solution
Defining a specific treatment requires a complete understanding of your pain, your injury, and the compensatory patterns involved.
LEARN MORE FROM PODCAST WITH RICH FRONING.
Often times, your pain and injury can be treated with any of the three regenerative injection procedures I described. Keep these questions/issues in mind when debating which treatment option is best for you:
1. Resolution of injury or pain: next week or next year?
2. Recovery time post procedure: short or long?
3. Treatment sessions: single or multiple?
4. Medical conditions that can limit the treatment.
5. Allergies.
6. Budget.
All of this new research in cellular therapy is wonderful, but is it right for you? Let’s begin with those individuals who rely upon their body to make a living. Professional athletes are the primary ones we think of, but gym owners, construction workers, firefighters, surgeons, and hairstylists are a few professions in which our body is critical to make money and provide for family.
When a professional athlete gets injured, he or she needs to be back on the field immediately. Stem cell injection is by far the best option because this will give you the best results after one treatment. Before we get too excited, let’s remember that one treatment does not always completely heal an injury. Recovery and number of treatments depend on how severe the injury is.
There are some cases where stem cells would not be the best option. In addition, there are cases where combining surgery and stem cells together is the proper treatment. We have to be able to talk about your injury and figure out if this is the proper plan for you.
Realistically, most patients I see are people who are weekend warriors; they perform chronic repetitive activity at work, home, or the gym. I also see a lot of people who are getting older and have built up injuries over the years.
Many people work at a computer. These individuals are constantly looking down with their heads, which creates a lot of strain in the cervical spine. Oftentimes people working on a computer are also turning their head one direction. The muscle imbalance that results can eventually cause microinjuries to the tendons and ligaments. Over time, these microinjuries build up and eventually develop into bigger muscle, tendon, or ligament tears.
Though we tend to think of injuries as forceful impacts, such as falls, car accidents, or trauma, they do not always occur this way. No matter how the injury develops, prolotherapy, PRP, and stem cells are potential treatments. The process starts with your commitment to “fix” what is wrong. We’ll start with a thorough examination and explanation of your options.
Digging deeper into why your body part(s) cause pain
Pain is the body’s clearest communication. It is a call for help. We just have to figure out what the body is asking for. What is there to know about your specific pain or injury? Well, that depends on where it is and how you got it. Let’s take a deeper dive into some common conditions:
Knees
The main structures inside our knee are the meniscus, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and cartilage. Ligaments and muscles/tendons provide movement and stability on the outside of the knee. Primary takeaway: there are MANY different areas that can cause pain.
So, when somebody says they have knee pain, where is it coming from? What you tell me, the physical exam, plus the diagnostic tests (such as MRI, X-ray, and diagnostic ultrasound) give us the full picture to determine if your pain is the result of a tear or instability of the joint. Once the source of pain has been identified, a plan can be developed to treat it.
Are we injecting just the joint to help with arthritic pain or meniscus tears? Or one tendon? Or, does the treatment consist of many injections to the ligaments and tendons? This last approach stabilizes the joint and takes away the repetitive stress on the tendons.
Carpal tunnel syndrome
This one is accompanied by pain and weakness in certain fingers of the hand and sometimes atrophy of the muscle near the thumb. The median nerve is the culprit. It is compressed by tendons traveling through a compartment in the wrist and gives these sensations.
The nonsurgical, regenerative treatments for carpel tunnel syndrome are twofold. One option is to utilize diagnostic ultrasound to evaluate the median nerve and then hydrodissect the nerve from surrounding tissue. The second option is to evaluate and treat the muscles associated with the tendons that compress the nerve. When there is injury to the muscle, it causes inflammation which enlarges the tendon and, thus, compresses the nerve. I have treated many people with carpal tunnel in this way with long lasting success.
My training in osteopathic manipulative therapy has given me an added skill to identify injuries, inflammation, and instability. Whether it be the hand, wrist, elbow, shoulder, jaw, spine, hip, knee, ankle, or foot, the proper identification of the injury and/or instability is the key to an effective, long lasting, nonsurgical, regenerative injection treatment.
Spinal pain
I have treated minor back aches as well as patients who have been told they need surgery. These patients might have localized muscle spasms or pain. Frequently, they have nerve pain, loss of muscle, and decreased strength. Based on history, evaluation, and imaging, we can ascertain if the injury is one that could be treated successfully with nonsurgical, regenerative injections. Most of the spine patients I see have significant instability. Once this is corrected, muscles relax, and pain is relieved.
Based on my training in osteopathic manipulation, I look at rotations in the vertebrae. This evaluation gives me an ability to see how stable or unstable your spine is. Once instability is found, injecting the facet joints, supraspinous, interspinous, and iliolumbar ligaments will regrow this tissue and relieve your pain. I can’t stress enough that stability is what gives you long-term results.
Another part of back pain is the psoas muscle. In my musculoskeletal and alignment exam, I’ll sometimes find one hip higher than the other. Is this because the alignment happened to be off that day? Or, is it related to something more serious?
The iliopsoas muscles and tendons attach on the femur, pelvis, and to the lumbar spine. Therefore, the iliopsoas muscle and tendon can create pain in the hip and the back. If the back has instability, the psoas could tighten to try to protect the lumbar spine. If the hip has instability or arthritis, the psoas may tighten to try to protect the hip. After a thorough evaluation and imaging, I will often inject the back and psoas tendon for back pain. This approach has significantly improved my results. This is why a thorough assessment is very important, especially when the spine is involved.
Temporomandibular joint disease (TMJ)
This can be treated very successfully with regenerative injections. This injury is actually what got me interested in the field. I personally went to many physicians before finding these injections combined with osteopathic manipulation and acupuncture to help me resolve my pain from a sports injury. Ligament laxity is the typical cause. Severe arthritis and difficulty opening the mouth are the end result if no preventative measures are taken.
Tension headaches
These come from the back of the head due to tendon injuries and ligament instability. I’ve had very good success by injecting what we call the attachment, the tendon or ligament that attaches to the bone at the base of the skull.
Arthritis
The familiar arthritic condition in the fingers, wrist, elbow, shoulder, spine, hips, knees, ankles, and toes have all been treated successfully with nonsurgical, regenerative injections. Osteoarthritis is the most common form of arthritis; we inject the joint to stimulate the regrowth of cartilage and then inject the ligaments to stabilize them. In mild cases of “gnarled” fingers, I have sometimes seen them straighten out.
SUMMING IT UP
Partial tears of the rotator cuff tendons, hamstring tendons, anterior cruciate ligament, medial collateral ligament, lateral collateral ligament, posterior cruciate ligament, ankle ligaments, plantar fasciitis, medial and lateral epicondylitis, radiculopathy, degenerative disk disease, labral tears, bicep tendon injuries, costochondritis, and Achilles tears are just a few of the injuries that can be treated successfully and with long-lasting results with stem cell injections, PRP, and prolotherapy.
Prolotherapy is the oldest type of regenerative injection but usually takes multiple treatment sessions. Works well for small injuries to ligaments, tendons, and joints.
PRP is roughly three times as effective as prolotherapy. Works well for small and bigger injuries to ligaments, muscles, tendons, and joints.
Stem cells are roughly three times as effective as PRP. Work well for all types of injuries. If injuries are severe, this is your best option. Labral tears are improved significantly more with stem cell than any other injection procedure.
How does your body heal?
These treatments rely on the ability of your body to heal. It comes down to your genetics, nutritional status, and toxicities that could be inhibiting critical metabolic processes. Through our initial assessment and testing, we can determine what impediments to healing you may have and address those before we start regenerative injections.
Is post procedure care important?
Good physical therapy is very important. Injuries cause your body to develop compensatory patterns around that injury. Many people I see have had injuries for years, if not decades. The body tightens muscles surrounding these injuries; usually scar tissue has formed in the associated muscles and tendons.
The first step after injections is to have a physical therapist who understands compensatory patterns work to reset those patterns. This step could last a couple weeks.
The second step is muscle balancing, which also could last a couple weeks. For example, look at the hip. Usually after an injury, one side has compensated –tightened – more than the other. We have to achieve the natural balance again before we get to too much strengthening.
The final step is strengthening. Too many people perform strengthening exercises in the gym. But be forewarned: without the first two steps, you can actually regress.
When will I see results?
The type of injury and severity of injury will influence how quickly you will heal after the procedure. The type of procedure you opt to use for repair and regeneration will also influence how quickly you will heal. Most patients see results from nonsurgical, regenerative injections anywhere from four to twelve weeks. I have had some patients see results sooner (they tend to be professional athletes) and some take quite a bit longer (they tend to be individuals with multiple medical issues).
SECRET FORMULA FOR YOUR PAIN:
H— HELP yourself by coming in and being evaluated
E— EVALUATE and identify the pain, the injury, and the severity
A— ASCERTAIN which treatment option is best for you: prolotherapy, PRP, or stem cells
L— LEAVE with optimal and long-lasting results
Be educated.
Be healthy.
Be proactive.
Be strong enough to help yourself.
Be a part of the future of medicine.
Act now.
I look forward to meeting you,
Dr Kristopher Sean Goddard
