Regenerative Joint and Tendon/Ligament Therapy
What is the difference between Platelet Rich Plasma (PRP) and prolotherapy?
Prolotherapy is a nudge to the immune system to bring growth factor healing cells to the area of injury. It has been shown to increase platelet-derived growth factors and signaling mechanisms of tissue where repair is needed. In contrast, PRP actually concentrates the platelet-derived growth factors from the patient’s blood and then the doctor injects it into the area of injury.
Both PRP and prolotherapy injections have been shown to stimulate natural healing and can be effective for connective tissue repair and pain relief. Both therapies use the technique of stimulating the natural healing process to “wake up” and increase the rate of repair in and around the areas of injection. Both therapies do so through the micro-trauma of needling at the areas of chronic injury that have lost the proper signaling to fully repair the injury. It is considered common for more severe injuries such as severe degenerative arthritis, chronic tendonitis or muscle injuries to utilize PRP over Prolotherapy for a better result. PRP is considered a “stronger” treatment.
In younger patients, prolotherapy is often a first choice given their vitality and ability to heal more completely. Prolotherapy is a favorable and safe option of young athletes to allow them to get back in the game as soon as possible. The therapy is non-toxic and well tolerated with minimal down time. PRP is also an option for youth and athletes with certain types of injuries.
What is the difference between Cortisone Injections and Regenerative Injections?
Regenerative injections are NOT the same as cortisone; in fact, they are can be thought of as opposing treatments. The most significant difference between the two joint injection therapies is that cortisone masks pain and does not repair the injured joint/tendon.
Regenerative injections, on the other hand, have healing properties that encourage cellular growth and tissue regeneration. In fact, cortisone shots shut down the healing inflammatory process. Corticosteroids help reduce pain by relieving inflammation; however, inflammation is the key element to encourage the body to repair.
Another consideration, given that cortisone masks pain, is that increased chance of injury can result because the necessary pain thresh holds to restrict movement will not occur. Inflammation is the body's rallying call to stem cells and other growth factors to mend the targeted area. Another concern with cortisone injections is that they prevent ligaments and joints from fully healing (because the inflammatory process is blunted or halted). This results in an increased change of an injury recurring several months down the road. Some cases of steroid injections cause thinning and deterioration of the tissue when done repetitively.
Although cortisone is widely utilized in conventional clinics for musculoskeletal injuries, cortisone is controversial. In 2010, researchers in the Netherlands published a two-year randomized controlled blinded trial with a large test group of 100 patients, comparing corticosteroid use to an injection of concentrated PRP. The PRP injection was given to the lateral epicondyle area of “maximum tenderness,” and a “peppering” technique was used in order to activate the thrombin release from the tendon. The researchers indicate the importance of the “inflammation” phase the first two days post treatment – during which there is an influx of healing cells to the injured tissue site. Those cells were shown to release additional growth factors, and therefore increased collagen synthesis on days three to five. The conclusion of the Netherlands study was that PRP reduces pain and significantly increases function, exceeding the effect of the corticosteroid injection.
Regenerative Injection Therapy History:
Regenerative Injection Therapy (RIT) is not a new technique. The concept of irritating tissue to promote healing dates as far back as the ancient Greeks. Hippocrates treated Olympic javelin throwers with unstable shoulders by touching what he described as a “slender hot iron” to the ligaments holding the shoulder joint together. The heat would irritate the ligament capsule, causing it to tighten up.
Irritant injections were first used in France to treat hernias before modern surgical. The techniques of prolotherapy used today were developed in the 1930’s by G.S. Hackett, MD, a surgeon from Ohio, along with other contributing doctors. The same techniques, with novel applications, have been used successfully for pain relief and ligament repair for nearly sixty years. Hackett coined the term “prolotherapy” because his initial work demonstrated that the new tissue laid down during the healing process was new healthy tissue, not scar tissue.
As techniques evolved, the use of Platelet Rich Plasma (PRP) was developed in the 1970’s. Its use started in cardiovascular surgery and expanded into maxillofacial surgery to aid in wound healing in patients. PRP was used in the treatment of non-healing wounds and reconstructive skins flaps during this same time period. In the late 1990’s, orthopedic surgeons began using PRP in surgical cases of fracture non-unions. Today, regenerative techniques such as the aforementioned are performed in primary care offices along with use of even more advanced methods such as adipose/bone derived stem cell therapy and umbilical (MSC) cell therapy.
Regenerative Injection Therapy Indications:
Regenerative Injection Therapies are used for a wide variety of conditions. There are a few cases, however, in which we do not treat a patient. Any patient that is an active smoker, has an acute infection, suffers from easy/excessive bruising, has coagulation disorders, is pregnant or has active cancer.
- Chronic Tension Headaches and Migraines
- Osteo Arthritis or Joints
- Small Tears in Muscle
- General Low Back Disk Pain
- Rotator Cuff Injuries, Including Partial-thickness
- Shoulder Pain and Instability
- Tennis and Golfer’s Elbow
- Hamstring and Hip Strains
- Knee Sprains and Instability
- Patellofemoral Syndrome and Patellar Tendonitis
- Ankle Sprains
- Achilles Tendonitis & Plantar Fasciitis
- Knee, Hip and Other Joint Osteoarthritis
- Nerve Entrapment Syndromes, such as Carpal Tunnel Syndrome
- Sacro-illiac Pain and Dysfunction
- Lumbar and Cervical Facet Dysfunction