How we can regenerate damaged joints?
But how does it work? How can injections stimulate healing?
Here, the most important thing is to realize that healing of connective tissues is totally dependent on blood flow. The body can only heal what it can get blood flow to. This is why the connective tissues are so problematic. Their blood supply is tenuous. If you look at ligaments and tendons in the body, they are white. This means that there is little blood flow, versus something like muscle that is red and hence has a lot of blood flow. You tear a muscle, it usually heals with not too much trouble. If you tear or sprain a tendon or ligament it very well might take weeks to heal if at all. These damaged structures may cause pain and debility for weeks, months and years, if not attended to. The general rule is if your body can heal it it will do so in a about4 weeks. If the pain persists more than this it may be permanent, unless you intervene with Prolotherapy or Regenerative medicine to stimulate the blood flow.
What do we inject?
I use two formulas. the first is a very concentrated sugar (i.e. dextrose) solution. Why sugar you ask? Because it’s safe. It works as an osmotic shock that dries the area out and actually causes localized inflammation, This will bring new blood flow and over the ensuing 6 or 8 weeks will cause a healing cascade where specialized cells such as macrophages clean up the debris and fibroblast move in to help the body regenerate the damaged tissues.
The second formula which is really a type of “super” Prolo is to use a patients own blood to isolate growth factors and use that as the proliferant. Many well known athletes have used this technique, with or without surgery, to heal sports injuries.
I usually start with regular (“classic” Prolo and only progress to PRP (Platelet rich plasma) if the regular solution fails.) However in cases where people want optimal results as fast as possible, I might offer PRP as an option to start with.
Our overall success rate is about 85% but it may take 5 or 6 before you notice an appreciable difference and 6 to 10 before the problem is solved. I urge my patients to be patient (no pun intended). The good news is once it works it should be a permanent improvement.
Using PRP (i.e. your own growth factors) to stimulate healing.
More on Platelet rich plasma, since I have many inquiries about it. In essence, the technique is exactly the same, the only difference being the proliferant (what you inject to stimulate proliferation and regrowth of connective tissue). We now refer to PRP sessions as Biosurgery, since the results can be extraordinary and perhaps one day more and more surgery will be replaced by this minimally invasive technique.
The key for successful Biosurgery remains that you must inject the correct spot, and enough times to stimulate healing correctly. As such the success of the program is totally dependent on the experience and expertise of the connective tissue specialist you see. I personally have been doing regenerative medicine almost exclusively for a decade, but many doctors only dabble. Ask them how long they have been doing it and where they got their training. There are a few exceptional teachers around and I was lucky enough to train with some of the best in the world.
The PRP is taken as a regular blood draw and spun down to isolate the platelet rich component. this fraction is the richest in growth factors. THe PRP then should be injected promptly into the affected areas. A word of notice, the pRP may be more irritating than the regular dextrose, so you might be extra sore after it. Most people accept this aggravation of their condition I have a little saying- “No pain. no gain”. Some people dislike this saying but it remains true that if you have a prolotherapy /regenerative med session and you feel absolutely nothing, it is unlikely that the doctor hit the right spots. Conversely, I frequently have patients who observe that the sessions where they were most sore, were also the ones where they achieved the most improvement.
What you can do to help the healing and relieve pain.
First of all, I ask all my patients to discontinue anti-inflammatory medication prior to Prolo/Biosurgery this interferes with the healing cascade that I am trying to set up.
Second of all I encourage movement of the affected region. If it is a shoulder, I suggest swimming. If it’s a knee or hip I suggest swimming or light cycling. The goal is movement without stress. walking can be harder and weights are out for a couple of months.
Third, I might suggest a homeopathic medicine like arnica gel for superficial joints like the shoulder, wrist, knee and arnica pellets for deeper structures like the pelvis or hip.
I also suggest a good vitamin C like Emergen-C and fish oil (the brand I prefer is called eskimo3 as I have found the purity/ efficacy is superb.
Aside from this I usually do weekly sessions (every 2 weeks for PRP) until I get the patient over the hump, meaning where they notice some improvement. Then I can afford to spread session to every 2 or 3 weeks.
Since heat help promote circulation I often suggest hydrotherapy in a hot tub or spa, or at least an extended shower to heat the affected areas.