Last Updated on February 17, 2023 by Andre Panagos M.D.
What is regenerative medicine?
Your body is constantly focused on the repair, replacement and maintenance of tissues in your body. Tissues such as nerves, bone, tendon, muscle, ligament and connective tissue need constant maintenance to function properly. Long-standing disease, injury or poor lifestyle and dietary choices can overwhelm your body’s natural repair mechanisms creating a cascade of breakdown. At first micro-injuries can occur which go unnoticed. Overtime repeat injury at the same location builds up resulting in a macro-injury that can be very noticeable when it interferes with your daily or recreational activities. This is the time you consider a physician’s visit.
Conventional treatments such as corticosteroid injections decrease inflammation and pain and delay the repair of tissues. Physical therapy is helpful in improving biomechanics which changes with the onset of pain and tissue damage as your body finds ways to limit further injury and pain. Surgery can help repair severe injuries but it is focused on salvaging the remaining tissues. New regenerative treatments have been found to restart and promote the healing process giving tissues a second chance to return to normal. Different approaches are used, based on the type of tissue injury and can include a subcutaneous perineural injection series, nerve hydrodissection, fascial interrogation or barbotage, prolotherapy, platelet-rich plasma and stem-cell based therapies. These therapies are gaining popularity as emerging clinical experience and research validates their utility and superiority in tissue repair compared with conventional treatments.
What steps are involved in regenerative medicine techniques?
The first step in regenerating tissue is to correctly and accurately identify the source of the injury or pain. This can be a challenge as by the time the patient is seen in the office their body has accommodated to the pain resulting in biomechanical deterioration. Biomechanical deterioration places surrounding tissue at risk of injury as well as potentially creating several layers of painful tissues.
The first step is a comprehensive history and physical examination by an experienced physician. This may be accompanied by dynamic musculoskeletal ultrasound imaging or magnetic resonance imaging (MRI) to determine the status of the underlying tissues. A treatment plan is then decided upon based on review of all the data. Treatments can include:
Perineural therapy (Neural prolotherapy)
Perineural therapy involves the use of micro-injections to treat the small nerves within the fascia that often endure chronic nerve compression due to poor posture or biomechanics.
Nerve hydrodissection is an ultrasound technique for nerve compression which is used to free compressed nerves from surrounding soft tissues. This allows the blood supply to the local nerve tissue to recover which decreases nerve sensitivity.
Fascial interrogation/barbotage is an ultrasound technique for soft tissue compression which is used to soften sclerotic and fibrotic fascial tissues that have sustained chronic and prolonged tissue overload.
Prolotherapy has been traditionally used to strengthen ligaments and tendons using a proliferation agent or newer agents such as platelet-rich plasma (growth factors) and stem cells.
Platelet-rich plasma (PRP)
Platelet-rich plasma entails isolation and concentration of platelets from your blood followed by placement at the site of injury. Platelets contain a large and concentrated amount of growth factors that, when released, hone in on the damaged tissue and signal for the recruitment of stem cells to repair the region.
Stem cells are used similarly but can be more robust and entail the isolation of stem cells directly from either bone marrow or fat. These treatments are a good option should an individual have insufficient success with simpler treatments and can offer superiority by beginning the process of tissue repair to promote long-term success.
How can I maximize the effect of regenerative treatments?
Healing is not independent of your biochemical and nutritional status. The more you can optimize your diet and nutritional status, the higher the likelihood of a great outcome. It is also important to maintain and improve your overall musculoskeletal strength and flexibility as well as optimize your sleep habits and decrease your stress levels. Finally, you should quit smoking, frequent alcohol consumption and any other substance abuse.
What else do I need to know about these treatments?
Regenerative treatments take patience and should not be considered a quick fix. When they are effective they are considered more permanent than conventional treatments. You have the best chance of having a great result with patience and some hard work on your part.
Amable, Paola, Rosana Bizon Carias, Marcus Vinicius Teixeira, Ítalo Da Cruz Pacheco, Ronaldo José Corrêa Do Amaral, José Granjeiro, and Radovan Borojevic. “Platelet-rich Plasma Preparation for Regenerative Medicine: Optimization and Quantification of Cytokines and Growth Factors.” Stem Cell Research & Therapy 4.3 (2013): 67.
Daftary AR, Karnik AS. Perspectives in ultrasound-guided musculoskeletal interventions. The Indian Journal of Radiology & Imaging. 2015;25(3):246-260.
Dechellis, David M., and Megan Helen Cortazzo. “Regenerative Medicine in the Field of Pain Medicine: Prolotherapy, Platelet-rich Plasma Therapy, and Stem Cell Therapy—Theory and Evidence.” Techniques in Regional Anesthesia and Pain Management 15.2 (2011): 74-80.
Dhillon MS, Behera P, Patel S, Shetty V. Orthobiologics and platelet rich plasma. Indian Journal of Orthopaedics. 2014;48(1):1-9.
Dufour E, Donat N, Jaziri S, Kurdi O, Couturier C, Dreyfus JF, Fischler M. Ultrasound-guided perineural circumferential median nerve block with and without prior dextrose 5% hydrodissection: a prospective randomized double-blinded noninferiority trial. Anesth Analg. 2012 Sep;115(3):728-33.
Heavner JE, Racz GB, Raj P. Percutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase. Reg Anesth Pain Med. 1999 May-Jun;24(3):202-7.
Lyftogt J. Prolotherapy and Achilles tendinopathy: a prospective pilot study of an old treatment. Australasian Musculoskeletal Medicine. 2005;10(1):16–19.
Lyftogt J. Pain conundrums: Which hypothesis? Central nervous system sensitization versus peripheral nervous system autonomy. Australasian Musculoskeletal Medicine. 2008; 13:72–74
Mulvaney SW. Ultrasound-guided percutaneous neuroplasty of the lateral femoral cutaneous nerve for the treatment of meralgia paresthetica: a case report and description of a new ultrasound-guided technique. Curr Sports Med Rep. 2011 Mar-Apr;10(2):99-104.
Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care 2010; 37(1): 65-80.
Schmitt A, van Griensven M, Imhoff AB, Buchmann S. Application of Stem Cells in Orthopedics. Stem Cells International. 2012;2012:394962.