An Introduction to Regenerative Therapies
By Dr. Lisa Barr
Prolotherapy: Of the host of regenerative therapies, Prolotherapy is considered by most to be the “original” regenerative solution and for many years was our “go to solution.” Prolotherapy solution consists of a concentrated solution of sugar water and local anesthetics, as well as other substances that when injected stimulates a very localized inflammatory response that signals the body to heal itself. This solution also promotes tightening of lax connective tissue often seen in chronic or recurrent sprains and degenerative conditions. By improving joint stability, we can reduce abnormal loading forces around the joints and avoid activating “alarm cells” called mechanoreceptors which cause more pain and result in abnormal compensatory movement patterns. Over time, the domino effect of joint instability can result in irreparable changes to the bone structure of the joint, often leaving surgery as the only treatment option. Thus, Prolotherapy provides a unique service to the body and will be around for a long time to come.
PRP Injections: PRP (platelet rich plasma), on the other hand, is a newer technique that was originally used by dentists in the 1990s to help with implant dentistry. Later, large animal veterinarians used PRP to keep performance horses functioning at their best. PRP is all natural in that we obtain the solution by drawing a patient’s own blood, then concentrating the platelets and special proteins call growth factors in a special centrifuge. We then take this solution and under direct ultrasound or x-ray guidance, inject it into the damaged or degenerated tissue. This promotes a natural healing cascade of seemingly invisible cellular changes that, over time, heals the body. The healing process takes time and PRP injections (with or without the addition of Prolotherapy) takes 3-6 months. To optimize healing, we encourage our patients to modify their exercises in an effort to address some of the compensatory changes that have occurred in their bodies in response to the laxity and pain.
The growth factors also include a number of signal proteins that regulate the inflammatory process and facilitate natural wound healing and tissue regeneration by proliferating myoblasts (cells that form skeletal muscle). Pure PRP is distinguished from regular PRP by the absence of red blood cells and neutrophils, as well as by the sheer concentration of the platelets and growth factors contained in each sample. In this case, the old adage “more is better” is likely to hold true in so far as the number to platelets and growth factors are concerned. The irony is that Prolotherapy and PRP both work by the same mechanism- stimulating inflammatory and proliferative responses, thereby acting as signals to the cells and catalysts for tissue regeneration. Therefore, it appears clear that the addition of actual stem cells, be it fat derived or obtained by bone marrow aspiration, may only be necessary in select patients who have more severe muscle and tendon tears, cartilage loss and significant arthritis, as well as those who fail to respond to PRP and Prolotherapy injections.
Adult Stem cells can be obtained from subcutaneous fat and bone marrow. For the most part, stem cells are considered “non-committed progenitor cells” of the musculoskeletal system and also have an active role in the repair of connective tissue. In next month’s article I will review more information about stem cells themselves.