What are Regenerative Injection Therapies like Prolotherapy and Platelet Rich Plasma?
We will dive into the history, application, and mechanism of Prolotherapy and Platelet Rich Plasma therapies for orthopedic conditions and beyond! What are these therapies all about and how can they help you?
You likely have questions. I have compiled a cheat sheet with all of the answers to all of the most common questions that I’ve encountered in the past decade of practice. If you want to know more, and would like to find a practitioner in your area, be sure to grab my Insider’s Guide to Prolotherapy and PRP within my PRP 101 School HERE!
Hello, and welcome to Pain Free and Strong Radio. I'm Dr. Tyna Moore, and this is my second episode. Today I'm gonna talk to you about regenerative injection therapies, and what are they all about?
My practice is 100% regenerative injection therapies and often when I'm asked, "What do you do for work?", and I try to quickly explain it to people, it can be a little bit confusing for people because often these therapies are unknown. People are unaware that they exist. They don't know how they work, and often they seem almost too simple or too good to be true.
So what I wanted to go through today was the different types of therapies I do, how they work, why they might be helpful for you or somebody that you love or know, and answer my most common questions that I get in practice and just out in the world. So, that's what we're going to cover today. And I hope it's interesting. I hope that you hear something that you haven't heard before. And I hope maybe that it enlightens you about how to manage your pain or how to manage the pain of somebody that you love.
So, regenerative injection therapies, basically the idea is based on regenerative medicine and it is the concept that we were taught in naturopathic school, as well as chiropractic college. I'm both a chiropractor and a naturopathic physician.
And we were taught that the body has the innate ability to heal itself. It's called a lot of different things in different medicine paths. In acupuncture and Chinese medicine it's called the Chi. In chiropractics, it's called the innate. In naturopathic medicine it's called the vis naturae metacatrix, which is the healing power of nature.
And I'm really a subscriber to this idea. It's a very simple concept. You cut yourself, and the wound heals itself up, right? As long as you don't get an infection, or even if you do get a small infection the body has the ability to overcome that and heal. And so this translates into virtually everything in your body. And people don't often ... I think we've moved away from this idea in medicine. And it's just the concept that, I think allopathic medicine has turned the way of, let's give you a pill for every ailment, versus how about we support your system so that you can heal yourself naturally. And that's my motto. That's where I'm coming from. That's my paradigm.
So regenerative injection therapies started a long time ago. Back in the 1930s there was a doctor named Dr. George Hackett. And he was basically injecting somewhat noxious substances into ligamentous structures to heal them up. And why was he doing this? Well, back before the advent of the MRI machine, before we could supposedly look at pictures ... I'll do another episode another day on why I think MRIs and imaging are a little overrated, or greatly overrated.
Before the advent of MRI, before we could actually see structures that were damaged, there was a great respect for ligaments as being pain generators. And ligaments are what hold bone to bone. So tendons are what come at the end of your muscle. Your muscle has a big, red muscle belly and on each end is a tendon. And it turns into a different type of tissue and inserts on the bone. There's also ligaments, which hold bones to bones. And so underneath all of your muscles, you have a very intricate ligamentous structure that's holding your spine together. The muscles lay over the top, or intermingle with and that's what structurally holds you together.
So, ligaments and tendons, where they meet bone, is called the enthesis point. And all that is simply a fancy word of where these ligaments or tendons insert on the bone. It's not a really clear-cut junction. It's not one type of tissue and then strictly another type of tissue. These tissues turn into one another. The tissue and the cells go from muscle belly to tendonous structure into bone structure.
And the same thing goes for the ligaments. Where these areas meet bone can be very highly innervated, meaning they have a lot of nerves, and they can be really tender for people, especially when they get pulled and stretched. And the simplest idea here is, ligaments have some tensile strength, meaning they have some give and some integrity, but sometimes they become stretched out. And why would that be? There's a lot of reasons.
You could have a trauma. You can have a quick stretch to it. And you could just have a slow creep to it because you sit in a chair all day. There's lots of different reasons. But most notably, it's usually just the conditioning. People sort of don't use their bodies and the ligaments tend to stretch out over time, much like a rubber band.
So if you think about, I always tell my patients ... So I have a funny fact about me, is I have a Barbie collection. I've always been a huge Barbie fan, and I've dwindled it way down. But when you put a rubber band around your Barbie's hair, and you stick 'em out in the garage for years on end in the hot and the cold, and all the different temperatures of the seasons, when you go to retrieve them, those rubber bands are often just crumbly, or they're stretched out. And they won't go back to being elastic.
And that is sort of what happens to your ligaments. It can be a very, very painful experience for people. And when you think about MRIs ... First of all, X-rays only show you bones. Okay, they show you bones and they show you how much joint space you have where soft tissue should be.
MRIs only really show you, they're looking for discs and nerve roots. They're not really looking for ligaments or ligaments as attachment points, as pain generators. And what I do all day in practice is look for the ligaments as points. I'm using my fingers. I'm using palpation, which I think is the most potent imaging tool. It's a good palpation. Good palpation skills are hard to come by.
And then I'm trying to figure out where people hurt and how they hurt, and recreate their pain by palpating all the ligamentous structure surrounding the joint that they're complaining about.
So when patients come in and say, "Oh, I'm bone on bone in my knees". Well, welcome to the club. So is everyone else who comes into my clinic. And the cartilage being worn out may not be what's causing all the pain. It may be the joint capsule, which is a soft tissue structure. And it may be all the ligaments. And often it is the ligaments. Usually, if you have knee pain right now, if you go to the inside of your knee, and poke around there, that's probably where it's the most painful for you. It's usually that medial collateral ligament, is a big one.
And so, my job is to inject the ligamentous structures as well as inside the joint, and I use a variety of different solutions to do that. And so, [Probo 00:07:00] Therapy was developed by George Hackett in the 1930s, like I said. And he was basically injecting ligamentous structures, more specifically in the low back, which is a big one. There's a lot of ligaments holding your low back together. And getting really great results ...
So there's a lot of different solutions used, but most commonly today, what doctors use is a solution of sugar water, basically. It's dextrose and it's a dilution. We use different ratios, different concentrations of dextrose to get different effects. And we inject the painful structures. This causes your body to mount an immune response. So your body basically wakes up and says, "Hey, we've got some action over here", because we just put a hyper-osmotic, and if you know what that word means, it's basically we've ... It's a concentration higher than the surrounding fluid.
So we just injected a hyper-osmotic solution of dextrose into the region. The body reacts by mounting a low grade, controlled, amagulated inflammatory response. So just like when you sprain your ankle, we're actually creating a small, much less painful version of that. We're creating an inflammatory response in the area, to get the body to wake up and come over, and start to heal that region.
And so what that leads to is a tightening of the ligaments, sometimes up to 40% improvement. It leads to improved tensile strength in the area, improved function, improved integrity, improved stamina, really, for the joint. And then we also inject inside the joint, where the cartilage is often wearing out, and we get regeneration of the cartilage cells as well, and this has been proven in good studies. So it's not, often times doctors will be quick to dismiss Prolotherapy, but there's been some really solid studies that have come out in the past decade or so, and even longer, showing efficacy, good level one studies.
So, this isn't made up. This is just, if a doctor dismisses it, more often than not, they just don't quite understand how it works. Or they haven't stayed up on the literature, yet. So, anyway, we're asking the body, we're asking the cytoblasts, which make collagen, and we're asking the chondracites, which make cartilage, to kick up gear. And to go into action. And to lay down new healthy tissue.
And it works. Nine times outta 10 it works. It works best on patients who are healthy already because we're asking the body to mount a healing response. And people who are unhealthy who are excessively obese, who are excessively deconditioned, who have very poor diets, who have blood sugar issues, or diabetes, they more often than not, will not get a good response 'cause they're not good healers. Anybody who has poor wound healing abilities, will probably have poor responses to these treatments.
And so that's Prolotherapy in a nutshell. Something else to mention about it, is that it's not just about the solution we inject, it's about the technique. And so, ligaments and tendons notoriously have a poor blood supply. So think about, again, let's go back to the ankle.
You sprain your ankle and it takes forever to heal. That's because the ligaments and tendons don't have a good blood supply. And when you don't have a good blood flow to an area, it has a hard time healing itself up. So, we go in there, and we actually, with the needle, it's not just about injecting some solution nearby. We actually touch the affected tissues with our needle. And the needle counts. So the needle creates little micro traumas, little areas that we, we cause little bits of bleeding in the area.
And that, again, blood is always good. That's something my mentor, Rick Marinelli, used to always say. The needle counts, and blood is always good.
So getting some blood flow into the area is always effective. We're calling in the [inaudible 00:10:32], or we're calling in the innate. We're calling in the body to heal. And we're getting the area to, with blood flow comes the nutrients, comes the right cellular composition, comes the right chemical storm that induces healing. And so, it's a wonderful treatment. It's very simple in concept. I think anybody who has a basic understanding of how ... I think the patients who understand this the best, honestly, have been farmers or other health care professionals, or just anybody.
It doesn't take a rocket scientist to understand the body will heal itself. And we can simply assist it by A, creating micro trauma in the area with a needle. That's the technique of Prolotherapy. So we inject all of the ligaments and tendons in the area, and then B, we're injecting a solution that causes the body to chemically respond and wake up, and the immune system to rush in and say, "Hey, let's get some action going over here".
Something else that comes of this is, the stem cells in the area, you naturally have stem cells lying in wait in different areas of your body. And this will often activate them or get them to kick up. It will cause a cell signaling response. So, like I said, the immune system goes through a bit of a cascade. And that response gets called in. And so you get a new chance at healing, a new chance at a low grade inflammatory response.
Simple concept ... A really exciting thing about dextrose is that, we've learned in recent years, that it's actually, it calms neurogenic inflammation. And it does so in a variety of fashions. But it sits on the trip V-1 receptor, which is ... Long story short, any of you have ever used chili pepper or [Capsasin 00:12:11] to help with pain, in maybe a balm or a cream that you apply topically ... That Capsasin, that molecule sits on the trip V-1 receptor.
Dextrose does the same thing, and so it cuts off neurogenic pain. And I used to not understand. I would inject a patient. My puppy's making noises if you hear him in the background. Don't mind him. He wants my daughter to wake up, and come take care of him.
Anyway, I would inject a patient with Prolotherapy solution, and they, now we add a little bit of a local anesthetic like lidocaine or procaine to it as well, to make it more comfortable. And dextrose itself works as a local anesthetic. It hurts a little bit. It's a little dull, low grade, dull kind of ache, wouldn't say painful. And then it allows the area to numb off a bit. But we do add a little bit of a very low concentration of local anesthetic, very safe. And I would inject the joint. I would inject the knees, let's say. And the patient would stand up and say, "I feel better immediately".
Well now, yeah, of course there's lidocaine in there. It numbed the region, and so, of course they feel better. But then, the pain would not return. And it would continue to feel better, and it would continue to feel better, and this would persist on for weeks. And I kept thinking, how is that possible, because the mechanism, the underlying mechanism of Prolotherapy as we understood it, was to be regenerative.
And there's certainly no way these tissues have regenerated in a day, or two days. So what is that pain, or how are we cutting that pain, even after the lidocaine has worn off, how is that happening? And it's because dextrose actually quells neurogenic inflammation. And it does so beautifully. So low concentrations of dextrose are now being used in a technique called Neuro Prolotherapy, if you've maybe heard of that.
And really, it's just the idea that we're injecting adjacent to irritated nerves to call them down. So dextrose is really quite magical. It does really wonderful things for the body. A common question I get and some of you may be thinking this, is "Well, I'm diabetic. Will that mess up my blood sugar?"
And the answer is generally no. We use such a low grade. Now if you had many joints injected in one day, sure, but one joint shouldn't really do much to your blood sugar.
Again, though, I don't really inject diabetics. I'm very careful about my patient selection because I want to, these are cash services. They're not covered by insurance. They are considered investigational by Medicare. I don't know why because we have good studies to show that they do work. And they're very affordable in the grand scheme of things, when you look at how pain is managed in this country, on the allopathic model.
However, they're not covered. So, any doctor that tells you they're covered, or is billing insurance for them, is, in essence, committing fraud, insurance fraud.
So, we don't bill for these services. They're cash, and because of that, I'm very careful about who I will agree to treat because I don't wanna take somebody's money when they're not gonna get a good response. I don't think that's fair. I don't think that's ethical.
There are some doctors who will treat anyone and everyone, and sometimes we just have to cut the pain. And I think that it's fair to treat somebody perhaps one time. But if they're not gonna have a good healing response, or they're on medications that don't allow them to heal well, then I'm certainly not going to risk that.
There's some other factors that you have to watch out for. When you're diabetic, you don't tend to heal well, so you have an increased risk for infection. And we certainly don't want an infection in the joint. That's a no-no.
Increased obesity leads to more risk for infection, so that's a concern as well. So there are some reasons to not treat.
Anyway, that's Prolotherapy in a nutshell. That's how it works. And you can apply that to any ligament or tendonous structure in the entire body. And so I treat necks. I treat spines. I treat low backs, love treating low backs. That's one of my favorite areas. Knees respond really well. Shoulders, ankles, elbows, fingers ... I treat lots of fingers in elderly people as they age, even rheumatoid arthritis. I can dial that dextrose down in concentration so it's not too inflammatory, and I can treat fingers.
And so it's a really wonderful treatment. I have a lot of patients in various age groups, honestly, and they use it just to keep themselves going, because they're not a surgical candidate. And there's this huge gap in the way musculoskeletal medicine is handled in this country. Where you either are put on N-SAIDs, which are non-steroidal anti-inflammatories. And then you're given, maybe some muscle relaxants for your pain, or maybe some opiods, but less and less now, right? The opiod epidemic is really coming to the surface. And we're seeing how dangerous these drugs can be.
And I'll talk about that in another episode. And then you are basically told that you should heal. And if you don't, maybe, if you're lucky, which most aren't, you get sent to physical therapy, which I think is a wonderful idea. But often that's not offered. And so the next step is you're given some cortisone injections, right? This is probably a very familiar story to many of you.
Or you're given hyaluronic acid injections. And those don't tend to work very well, and in fact studies are coming out as of late, on cortisone showing that it just absolutely does not work, pretty much anywhere in the body. It's not good in the epidural space. It's not good in the knees. It's catabolic. It chews up your tissue. So every time you receive a cortisone injection, your tissues are literally melting, literally.
And the studies are showing this. Long term effects of these injections are very damaging to the tissues. So, in the short term it cuts your inflammation, and it makes you feel great. But in the long term, and sometimes a very low dose of cortisone is indicated, and that can be very helpful to just sort of shut off that inflammation cycle. But more often than not, people get whopping huge doses and they're allowed to have a series of up to three, usually, and then when that doesn't work, they say, "Sorry, there's nothing we can do for you".
Now, maybe you're one of the ones who gets sent to surgery. And often people who come into my clinic are not surgical candidates. They failed cortisone, and they don't want cortisone 'cause they know how bad it is for them. And so, they come to me looking for a different solution that's natural. That's the thing. This is all natural solutions. We're not putting anything in you that's gonna, nothing, unless you have an allergy to local anesthetic, there's really no contraindication here, except for any condition that would lead to increased risk for infection of bleeding such as being on a blood thinner or being diabetic or being very obese or being a poor healer.
So, very safe treatment ... Now this treatment grows up. Back in the early 2000s, my mentor, Rick Marinelli, who was a big ... He brought Prolotherapy to the naturopathic profession, really, many decades ago. He came to me and said, "There's a new treatment. And it's where we take your platelets, which are in your blood. We do a simple blood draw, in office procedure. Put it in a special centrifuge. We spin out the platelets. We concentrate them down. It turns out they have a myriad of growth factors in them. And then we re-inject that into the damaged tissues".
Now the injection technique of Prolotherapy is the same. A lot of doctors are jumping on this platelet rich plasma kick, and I'm glad. I'm glad it's getting more widespread, but a lot of doctors just sort of shoot some juice in the joint, and then, if you fail care, they say, "Well, oh well, sorry, there's nothing we can do".
It's because they're not treating all the ligaments and tendons that surround the joint. It's not easy to become a skilled Prolotherapist. It's a learning curve, and it takes years and years and years. And so, just any monkey can shoot juice in a joint. And that's not hard to teach anybody. And I teach people how to do that all the time. I teach other doctors. But really learning how to palpate and find and treat the ligaments and tendons, that's the real skill set.
And that's really where, I think the best healing comes from, and the best effects come from.
So, PRP, platelet rich plasma ... Now my chihuahua's talking. PRP is simply these concentrated platelets, which are concentrated growth factors. Everybody's is different. So it's very, I think it's very hard to do studies on this. And studies are kind of all over the place when you look at them. Some of these studies have been sponsored by the companies who make the PRP kits and centrifuges.
And others are more of a double blind placebo, well round study. However, we're comparing apples to oranges, right? My PRP is not your PRP is not a 25 year old male PRP is not a 65 year old female, post-menopausal woman's PRP. All of our PRP is different. And all of our abilities to heal is different. And so doing really good, solid studies on PRP is hard to do. It's hard to accomplish.
So I don't rely terribly on the studies. Although, we do have some good studies. We also have some poor studies, poor outcomes. So, all I can say is I've been doing this for 10 years in practice. I have a cash practice, and I am busy. And I get people better. And it works.
It works when you have the right patient selection, for sure. It works even better. So, a person with really healthy hormones and a healthy, gut, and a healthy body is gonna have very potent blood, and that blood is gonna make very potent, PRP.
And then you combine that with a good technical skill set on the physician's side, meaning injecting all the pertinent and involved structures in the area, and you get great resolution for most patients.
Not everybody, I've actually had PRP work complete wonders in certain parts of my body, and in other parts of my body, it didn't do so great.
So, really varies by the joint, varies by the person, varies by where my hormones are at, and how I've been eating, how I've been sleeping, et cetera. That all will change the content of your blood.
So, PRP is basically the same idea. We treat all the affected ligaments and tendonous structures. We just have a much more potent solution in our syringe. And that solution is, I would say PRP is about two to three times as potent as Prolotherapy. And I'll talk in a minute about how we space treatments. So that you can have an idea of what you're looking at if you go seeking these out.
So we ask people to, it kinda depends on where they are in their lifestyle, and PRP might be a much more potent thing to go after. I do think certain areas of the body respond differently, and so there are some conditions where I just absolutely jump straight to PRP, and there's other times when I really like to start with Prolotherapy. And that just comes down to my experience with patients.
I've done thousands of these cases over the past decade. I spent a long time with my mentor, assisting him in cases. And so I've seen a lot of Prolotherapy and PRP cases come through the doors of the clinic, and I can tell you with fairly good certainty, just by looking at somebody how they're gonna respond at this point. So, it's a learned skill. And it works.
This grows up. I tell my patients, I joke. I say we have tea. We have coffee, and we have espresso. And I would say espresso would be the stem cell treatments. And there's different kinds of stem cell treatments. And so, the first one that I do in my practice is adipose stem cells.
This is a simple harvesting of stem cells from the adipose tissue, or the fat tissue. Your fat is rich in stem cells, [inaudible 00:23:00] stem cells. And they basically are the type of cells that, they will turn into whatever they need to, when they land, when they touch down.
So, wherever you inject them is what they will differentiate and turn into. Your belly fat happens to be a very rich source of [inaudible 00:23:18] stem cells, that happens to be a, compared to the fat on other parts of the body, the belly fat tends to be the richest, the flank in the belly.
And so that's where we harvest it from. It's a very simple, in office procedure. It's a sterile procedure. It's a minor surgery. And you get left with a tiny little incision and a bit of bruising where the canula was introduced, and takes the fat out. Some people do it with a motorized suction, and some people do it just using the syringasuction. That's what I do. I think it's a little less traumatizing, but, very simple in-office procedure.
We centrifuge the adipose tissue in a special way. The FDA says that it has to be minimally processed, otherwise it's considered a drug. And so we don't mess with it too much. And then we combine that with a platelet rich plasma, and that is essentially a seeded feed. When we inject that stem cell solution, back into the joint, or back into the affected structures, and then we inject the platelet rich plasma, what we're doing is we're seeding the region with the stem cells, and then we're feeding it with the PRP. And the PRP kicks in, and a simple explanation is that the PRP kicks in, and helps those cells. It tells them what to do. It tells them what to do, and it tells them how to differentiate, and it sends the whole process going faster.
So, that's one treatment. The other stem cell treatment that is popular is bone marrow. And that is most often harvested from the iliac crest. My friend, Doctor Harry Adelson in Park City, Utah, is a very skilled stem cell doctor. I do the simple procedures, and I send the complicated ones to him. He does a lot of bone marrow. We call it BMAC for short.
So bone marrow is also rich in stem cells. It doesn't have as many stem cells as the adipose does. However, they tend to act a little bit differently from what I understand, and may be better for musculoskeletal conditions.
However when I go to the big conferences, and I listen to the different doctors talk each year, it's always changing. We can't seem to agree on what's best for what. So, one year they'll say adipose is best for the knees, and the next year they'll say, that it's not, and the next year they come back and say, "Actually, yes, we think adipose is best for the knees".
What a lot of doctors are doing is combining the two. And so you get an adipose combined with a bone marrow, and that's being injected into different regions, in different concentrations. And that's really exciting.
You can have that. It depends on where you are, and who you have access to. But, that can be injected into the disc, into degenerated discs in the spine with very good results. Platelet rich plasma can be injected into the discs with very good results. I don't do discal injections. I'm not set up with fluoroscopy. And so, I use ultrasound guidance for my injections. I don't use fluoroscopic guided injections because that's a big X-ray machine, and I'm not interested in that.
But Doctor Harry Adelson does. And that's essentially it. So you've got three different types of treatment. You've got dextrose Prolotherapy, and then you've got platelet rich plasma done in a Prolotherapy technique, if you have a skilled Prolotherapist as a doctor. Otherwise you're probably just getting an injection of a solution under ultrasound or even blind, just into the joint.
And then the last one would be the adipose or the bone marrow stem cell treatments. And so that's the three. Hopefully that's clear, and clears up some confusion for people. If you want more information, and you wanna, especially on the platelet rich plasma, which seems to be the most popular. It's really my favorite. I love PRP. I put PRP into the scalp. I put it into the genital area. I put it into the face. I put it into the joints. I'll inject wounds that are having a hard time healing.
I have inhaled it in intra nasally, when I've had sinus infections. It's just wonderful stuff. It heals pretty much everything. I've had patients nebulize it when they have pneumonia. So, PRP, it helps heal up wounds that don't wanna heal, either topically or in injected form. PRP's pretty magical, especially when the patient's healthy, and they've got good platelets.
So if you want more information about this, you can head over to my website at DrTyna.com, D-r-t-y-n-a.com, and I've got a free PRP school there. I've made a PRP Academy where you can log in, and you'll instantly get a five or six page handout pdf that answers essentially every question I have ever been asked about PRP, and that I find myself answering frequently in clinic.
And you can access that immediately, and then it will also give you, you'll get sent an email, and it will give you access to the school that you can log into. There's an online school, and there's videos there. And there's more content. And I'm growing that every day. I'm adding to that as it comes up. So, it's a really wonderful resource. I put it together because I wanted you guys to have information no matter where you lived in the world. I wanted you not only to be educated, but I wanted you to be able to ask the right questions of the practitioners, because, while it's wonderful that these treatments are being offered so widespread, it's also a little concerning in that a lot of doctors who maybe don't, you may actually end up knowing more about PRP than they do, if you go through this program.
And that's what I wanted to have happen. I wanted the patient to be educated, and not be taken advantage of. And also, all my pricing is on my website, so you can have an idea. And that's a fairly general price point, price range for PRP. I'm hearing about some doctors charging exorbitant amounts of money, and I'm hearing about some doctors charging virtually nothing.
And something about PRP to keep in mind is that, it's not all created equally. Each kit, so there's companies that make centrifuges and they have different kits. And each kit produces a different kind of, or each company's kit produces a different kind of PRP. And so they're all different. And there's argument over, do we keep the red blood cells in? Do we keep the white blood cells in? Do we get the red blood cells out? Do we get the white blood cells out?
And that science is also ever-changing. We make our PRP manually, and I take the red blood cells out as much as I can because they can be very inflammatory inside the joint. But outside the joint, they actually can be helpful, because they might really help keep that tendon and ligamentous structure. They might give a good inflammatory response.
And so, PRP, so when people come in, and they say, "I had PRP. It didn't work". Well, what kind of PRP was it? They don't know. Who was making it? And who was the technician injecting it? Who was the doctor? How were you injected? There's so many variables, as you can see here, that, just saying, "I had PRP and it did or didn't work" ... There's more to it than that.
And so that's what I'm hoping to clear up, particularly with this PRP 101 school, on my website, so that you can at least have some idea of what's going on.
We all do it differently, and to each doctor's credit, I'm sure everybody is functioning on the most highly ethical level. We all just wanna help people in the end. But there's also just some variables that might be wanting, people might wanna take into consideration.
That same goes for stem cells. We all process everything a little bit differently. So, you're getting a different recipe, essentially, from each doctor, and then you're getting a different injection therapy technique from each doctor. And there's no way to standardize that because many doctors don't think Prolotherapy technique is valid, and they don't think that it's necessary. And others think that that's everything.
Some doctors don't think they need ultrasound, others do. Others don't rely on any palpation whatsoever. They rely specifically on what the imaging says, and what the ultrasound says, and they don't palpate. They don't actually do, many of these doctors are either interventional doctors or radiologists, which is also great. There's a place for all of us. But you're just getting a different kind, depending on what your needs are, you might be getting a different kind of treatment.
And that's all I wanna put out there on that. We're all here to help people. We're all doing good medicine. It's just a matter of what you're needing and what you're looking for, and what you're jam is.
What else did I wanna say?
Treatments, treatment frequency ... Prolotherapy is best done about a month apart, and you're looking at four to six treatments, spaced one month apart. And that is because that two week healing cascade that occurs, after you get treated is really important, and it's really important to harness that. And then you give it about two weeks to calm down, and then you treat it again.
Some doctors will treat more frequently. Some will treat less frequently, depends on the joint region. Again, hips, I will treat more frequently than I will, say, a shoulder. But Prolotherapy is four to six rounds, spaced about a month apart.
PRP, now I never usually get to four to six rounds of Prolo. That's kind of the rare case. Usually, I'll jump to PRP after two rounds of Prolo because if I'm not getting the results I want, I want something stronger on board.
PRP, I suggest, two to three rounds, spaced six to eight weeks apart. That's my clinical experience. That's my clinical opinion. Other doctors will say, "We're gonna do five or six rounds. And then we'll re-evaluate".
I think that that's unethical. I personally believe if I'm not getting you 80, 90% improved after two treatments, I'm missing the boat or something else is going on that's a variable that we need to consider hormones, or stress level, or something systemic with the person.
For instance, women often will have shoulder issues that are hormone related, and not necessarily musculoskeletal related. Although they're handled like a musculoskeletal issue, they don't resolve completely until their hormones are treated.
So, post-menopausal women in particular, it's kind of a crap shoot. It's kind of a mixed bag with that age group. And I'm in that age group. So, I'm peri-menopausal, but that 45 to 65 year old female age range ... So, two to three rounds ... Otherwise we either jump to something stronger or I'm missing the pain generator. I'm always looking for the pain generator. I'm not necessarily just shooting up a joint region. I'm specifically trying to get significant improvement in a very short amount of time.
Because each time I treat a patient, I ask them to take about two weeks off of activity. So they're taking two weeks off of their sport, or two weeks of of their activity. I only treat athletes and athletic people. So the patients that come into my clinic really are anxious to get back to the activities that they enjoy. So whether they hike or lift weights or run or cycle or yoga, whatever it is, they're anxious to get back to that. And so we can't load the joint for about two weeks.
You can walk on it. You can go about your day, activities of daily living. You can do light stretching, light movement, keep the range of motion going in the area. But we don't want it loaded. We don't wanna challenge it until those two weeks are up.
Again, different doctors will say different things. I find that the two weeks is, that came from personal experience. I've had many joints in my body injected. And I've also got back to activity way too soon, and sort of undid the goodness of the treatment.
So I think that two week window is very important. And then I ask the patient on the third week to start to challenge it a little bit. So, really, just start to give it a lit... just push it a little bit and see how it'll start to do, back to activity. So if you're strength training, I ask that you start, if you're gonna do squats, you squat with just the bar. Or maybe you do body weight squats. Just very slowly, but surely, testing that joint out.
This is best done out of the guidance of a physical therapist, really, truly, and I'm seeing this more and more and more, as I get further and further into practice. I think it's so critical to get a good physical therapist who has a good respect for strength and conditioning. Not just the kind of physical therapist who's gonna put a machine on you, and ultrasound you, and do some e-stem, but somebody who's actually gonna make you do some work, and some strengthening work for the region, and some mobility and some [inaudible 00:34:50] work for the joint.
I think that's really critical, and I usually ask patients to do that around the two to three mark after, week mark after being treated with me.
So with PRP we treat two to three times, six to eight weeks apart. That gives people a lot of time to have that two to three weeks off, and then they've got several weeks back on, where they're active. I think activity is what really heals joints the best. So takings somebody outta commission, and not letting them move their joint is, in my opinion, the worst thing you can do.
Again, many doctors, after they treat, will immobilize the patient after they do PRP or stem cells. They will put the patient in a brace. Or they will put the patient in some kind of restrictive dressing. To each his own. They have their reasons. I don't disagree with them. I don't do that personally. I think the sooner we can get back to movement, the better.
In truth, I don't necessarily think it has every ... Some will say, "Well we wanna keep the stem cells in the area. We wanna keep the PRP in the area". I think that that is a erroneous way to look at it. I think that these cells probably get out of the region pretty quickly. I think the bulk of what's happening, and we may find this with studies. And we're already starting to see it a little bit. This is why I'm so adamant that patients who be treated with these treatments are the healthiest that they can be. I think it has everything to do with the cell signaling.
I think it has everything to do with the body's ability to heal. And so, whether it's PRP or saline or dextrose or stem cells, I think it's somewhat irrelevant, in that, yes, we're using a stronger solution. We'll ignite a stronger cellular signaling response. I do think that that is true. So I do think that what you're putting in there counts.
But, I think that it has everything to do with the body's ability to react.
So for instance, they just found in a study in mice. They looked at hair follicles. And these follicle, the stem cells that regenerate the follicle, weren't able to turn on, or go, unless there was a certain immune cell present, called a TREG cell. And TREG cells, T regulatory cells, that's TREG for short. T regulatory cells are kind of in a wonky state when a patient is auto-immune. And so, that really backs up what I have been saying.
Auto-immune patients don't tend to do as well as patients who are not auto-immune with these treatments. And this makes perfect sense because if the stem cell will only go, or activate in the proper manner when these TREG cells are present, well then here we have an actual immune cell signaling a stem cell to do its thing. And that says everything about how regenerative medicine works.
We're trying to get cells to talk to each other, and we're trying to get them to ignite one another in a proper fashion and not an improper fashion. We don't wanna cause a flare, and that can only happen in a system that is in homeostasis to some degree. And homeostasis is just the idea that the body wants to go back to normal, what is normal and healthy for that organism.
So there's that in a nutshell. Oh, stem cell treatments. That's kind of all over the board as far as how often people wanna treat. I personally prefer to do a PRP on the front end or the tail end of a stem cell treatment. And some will do it on the front end and say, "That's the way to do it". Others will do it on the tail end to kind of kick up and kick into gear, the stem cells they've laid down. It just depends on the patient, depends in the region. It depends on their activity level. Depends on a lot of factors, and so ...
But I do like to tell patients, when they come in for stem cell therapy, I like to say, for one, I'm doing a fat graft. I'm not necessarily, I'm not igniting stem cells in any particular way in the lab. I am literally taking the fat out of you, centrifuging it down into a concentration, and injecting it back.
So I'm doing a fat graph which is rich in stem cells and also I inject PRP into the region, which kind of creates a fat graph niche that holds the stem cells in place and holds the PRP in place. And it's creating a level of cushioning. If you are missing cartilage in your joint, and we put the adipose fat graph in there, that's rich in stem cells, and rich in PRP, we're adding that cushion layer. And hopefully those cells will turn themselves into that cartilage, or turn themselves into whatever they need to in that area to help heal it up.
And so, that treatment, I do think, is best to add a PRP on the front or tail end, like I said. And so I let patients know that so that they can budget appropriately for that.
So that's about it as far as what is Prolotherapy? What is platelet rich plasma? What are stem cells? How does it work in the body? What are the treatment timelines or guidelines? How do I like to treat? And like I said, every doctor's different. Everybody has a different timeline in there.
And then, what I wanna talk about for the last part of the show is just some cases, and what I see most of. So, like I said, I treat mostly athletes. And I treat people who are, and what does that mean? It does not mean that it's a 25 year old who is a football player. It just means anybody. It could be an 85 year old. It could be a 95 year old. It could be a 15 year old.
I don't treat below 15. I don't like to treat. I don't wanna treat children with these modalities. They have been treated with them, but I just don't treat anybody below the age of 15 or 16. It kinda depends.
But I think that these treatments are best done in people who are active, who have good muscle mass. Bottom line, if you don't have muscles to hold your joints together ... So the ligaments and tendons are what are supposed to be holding your spine together. But muscles are movers. Ligaments are supporters. And so, when you have a chronically tight muscle and you're going and getting massage, and you're getting that muscle worked out all the time, and it keeps getting tight. Or you get adjusted, and the joint starts to let go very quickly and the muscles like to spasm, that suggests an underlying ligamentous [inaudible 00:40:42] issue. That's saying that the region underneath is unstable, and that the muscles over the top, are not doing their job.
And so a lot of that really just comes down to deconditioning. Over the past 10 years, and then the time I spend with Doctor Marinelli, helping with patients, I have to say, the bulk of people's pain comes down to deconditioning. People are very de-conditioned in our country, and all over the world for that matter, but they don't have good muscular integrity. And so, what's the point of continually putting Prolotherapy or PRP or stem cells into a shoulder when that person has no muscles to hold that arm on to the body.
There's no point. If you don't have a deltoid muscle, and you don't have strong musculature to actually hold your ... The arm is a heavy appendage and so is the leg. If you don't have a good muscular layer to hold that joint on, it's kind of a moot point, in my opinion, to continue to inject.
Same goes with the knees. If you have poor knees, you have weak gluts, or no gluts. Most people have no gluts. That's glut amnesia. And I'll do a whole episode on gluts, 'cause I'm kind of obsessed with them.
But, bad knees, especially chronically bad knees that don't respond to, and if I'm doing these treatments, and they're not getting much better, I need to send them to a P.T. for sure. I need them to go. But I think also importantly, they really need to build a butt. They need to build a shelf back there. Those strong gluts are what's gonna keep their knees tracking correctly, 'cause these are, this is a closed chain system.
Same goes with the spine. Without strong musculature at the core and also along the spine, we don't have a good spinal stability. You really don't want laxity in your spine because that's then how the discs get worn out. Anytime you have ligamentous laxity in a region, say, a knee, for instance, that means that those two bones are moving all over the place when they should be tracking in a certain way. And if they're not tracking correctly, the cartilage isn't wearing correctly. If it's moving all over the place because of underlying ligamentous laxity, well then you start to get arthritis because you start to get [inaudible 00:42:45] joint motion, which starts to wear out the cartilage, kinda like your shoes, the bottom of your shoes. If you look at them you'll see that you wear your shoes out in a very specific pattern, based on your gait and how you're walking.
And so it's important to understand that ligamentous laxity, that's why it's so important to treat the ligaments surrounding the joint, and not just shoot juice in the joint. We have to actually stabilize down the joint, in my opinion, and in many Prolotherapists' opinion. And that's where a lot of the pain is lying, is in those ligaments as well.
So, it's important to have a good muscular integrity. So that's, in my patient selection, that's what I'm looking for. I'm looking for anybody who is on the path to getting stronger, with specific health goals in mind, and specific physical goals in mind. And people who are training ... I train for life. I train. I train three times a week. I lift weights and do other activities because I'm training for life, and it's really important to acknowledge that in people, because a lot of people are training for longer, healthier lives.
And they're not just spinning their wheels to get skinny or spinning their wheels for some other reason. They're training. And anyone who's willing to put that kind of commitment and schedule in activity into their daily life, is somebody that I'm very happy to treat.
So that's what I mean by an athlete. Some cases that I would bring up are the ... I don't know. Let's see. I wanna think of some of my favorite ones.
Knees, I love treating knees. I often see people with cartilage defects or worn out cartilage, or chronic cranky knees, or knees that are somewhat unstable. And this could be any age group. This could be somebody with terrible arthritis or it could be a young person who maybe was skateboarding or playing basketball and had an injury, or soccer injury. And after we treat them, some of my favorite things that I hear are: one, people need far less pain medication, meaning over the counter ibuprofen, different kinds of N-SAIDs or Tylenol.
I'll often hear people saying, "Gosh, I just don't need to take anything for the pain anymore".
Or, and/or, they will mention really improved integrity, so they're able ... My mom, for instance, she notes that she's able to get up from the table or get up from the couch, and she doesn't have to take that extra few seconds to stabilize herself. If you ever see elderly people get up from the table, they all have to take a minute to kind of stabilize before they can get ambling. And she finds that she doesn't need to do that if she receives treatment.
And how often do you get treatment once you've sort of managed the issue? I don't know. Maybe once every year, two years, three years ... I just had a gal return yesterday. I hadn't treated her neck in about four years. And it was three or four years. It was time. Very active individual, she's a surfer. She gets a lot of whiplash. She does jujitsu. And so it was time to treat her neck again.
So every couple of years, we sort of do a tune up after we go through that first initial series. But people report improved stability when they get up from a seated position or out of bed. They're like, "Oh, I don't need to take a few minutes to really figure out where my joints are in space. They just work".
Another thing that I find people report is just improved functionality. So that goes on the stabilization tip, that just improved function. So they're able to navigate terrain they maybe weren't able to before. Maybe hiking, a trail they weren't able to hike before, or taking stairs, or being able to get up and down off the ground to play with their grandkids, which was something that was out of reach for them before.
And that's really exciting. That's probably my most rewarding thing to hear, is when people are able to live their lives the way they want, and their joint isn't hanging them up, which is such a bummer. It's a bummer when you look at something, and you think, "I wanna do that". Or, "I wanna go on that hike". Or, "I wanna take that trip". Or, "I wanna go to that concert", and the next thing is, "Well, I could never make it up and down those stairs". Or, "I don't feel stable going up and down that hill". And I don't mean cliffs. I just mean basic stuff. Going on a mile hike with your family on a holiday, or being able to go visit somebody at their house because of the way their house is laid out.
And I think it's really exciting when people get improved function.
Pain relief, obviously, is a big one, which is amazing and great. When you have chronic pain in a joint, or you have some kind of internal joint derangement, the muscles around the joint, spire really [adverently 00:47:02], and don't fire well. So, I love doing these treatments and then having the patient go to physical therapy because sometimes physical therapy before, they may fail it, because their muscles won't fire appropriately.
But if we can cut the pain, then they're able to really rehabilitate that joint in an effective manner. I love that, absolutely love that. Something else I hear, people have improved sex lives because they're able to actually move better, which I think is great. Something, I had a new patient yesterday tell me he hasn't been able to lay on his, young man, younger than myself, he's not been able to lay on his shoulder for 10 years, I think he said.
And I thought, "Oh, no, your wife can't like that at all". That really inhibits proper cuddling. So, being able to give somebody, the ability to lay on their shoulder, is awesome. That's what keeps me going as a practitioner. I love when they say, "I can lay on my shoulder. I can sleep on my shoulder".
Sleep is a huge one. People have so much disruption. I do, too. I have a lot of chronic pain. I get a lot of sleep disruption when it's really acting up. And so, being able to lay on certain joints, or get a good night's sleep without waking up all night from pain is really priceless.
Getting people off of their medications for pain is priceless. Having especially elderly people feel more secure on their legs, so that they don't feel like they're gonna fall and break a hip, is really, that's priceless.
And so these are treatments that are accessible. They really are accessible. If you're looking for somebody to treat you and you're interested in receiving them, go to my website, log into that PRP 101 school. And on that pdf that you'll get sent, is a website that you can go to, and you can find practitioners in your area who are doing these treatments, and who are more specifically, Prolotherapists.
And I think that's really important that you find someone who's a good Prolotherapist to deliver them because I do think you'll get a different kind of treatment. I am admittedly, I drank the Prolotherapy Kool-Aid. I'm a big believer in the actual technique of Prolotherapy being a more effective route.
However, there are other great doctors in the country doing awesome regenerative medicine that are not Prolotherapists that are doing more spinal type things, and I love them just as much. I think that they have a very important role. I do think that getting these treatments sometimes into the spine is critical for some patients. And I'm happy to refer to them when that's needed. That's not so much a palpation issues, is they need to be very good with imaging, and they need to be very good with doing the image guided injections into the spine.
And that's a whole different skill set. So, if you're looking for ... It kinda depends. I would find a practitioner in your area. See what they have to say, and then go from there.
Let's see. What else did I wanna share with you before our show's over? Be sure to log in to DrTyna.com, at my website, and give me your, go ahead and put your name and email into that PRP 101 school. If all you want out of that is the PRP 101 access, you can go ahead and unsubscribe. That'll put you on my newsletter. And I talk about this stuff in my newsletter every week. I try to put out some content for you that's valuable.
And if you're unhappy with it, you can just unsubscribe, but at least, you'll be on the newsletter. That's one great way to get on my newsletter if you're interested. And I can go ahead and make sure that we get you an email every week. I talk about all kinds of things, too. I don't just talk about musculoskeletal conditions.
I talk about all kinds of different naturopathic treatments, specifically for pain, and most often how to manage and deal with pain, and then strength and conditioning.
And then lastly, I think being comfortable when you do go in for a visit with one of these physicians, and having, that's why I created that PRP 101 school so you could download that hand out and read through it, and really understand these treatments well. And go through my website. There's a lot of video, and a lot of content. There's research. There's a whole page of research.
I think it's important that you be empowered and that you be educated, so that you can ask the right questions of your doctor. And you can find out what's best for you because I understand that this can be overwhelming. I hope this podcast was helpful. I hope it answered some questions for you. We love hearing from you guys. You can find us through my website. Email is honestly the best, but log into that PRP 101 school. I think you'll find most of the questions you have are in there, honestly.
And go through that first, and if you don't have your questions answered, I can't talk specifically to anybody about their own individual conditions. I can't consult on conditions like that, but for general stuff, I have a feeling you're gonna find it on my website. I tried to make it really content rich.
And I hope that this has been helpful to you. I hope it's been valuable information. And I hope that it's give you a head's up on what regenerative injection therapies are, and how they can help you.
So thank you so much. Be sure to visit my website at www.DrTyna.com. That's D-r-T-y-n-a, and I'm here every week at 10 am on Friday, and I'll be interviewing some people in the near future on all kinds of subjects, so I hope you'll come back. And I hope you'll share this out with people.
Thank you so much.
If you are interested in becoming a patient or simply having a conversation about your pain, would like me to review your case or would like a referral to a practitioner in your area, this can be done via an Online Consultation.
Due to the high volume of requests, I am unable to answer individual requests for specific doctor referrals in your area. To find a doctor in your area who offers these therapies, please refer to my PRP 101 Insiders Cheat Sheet and Free Academy.
There is a tremendous amount of information on my website about these therapies, so please have a look around and see if you can’t find answers to your questions there. We have testimonials on every page and even a Research page with supporting studies. Enjoy!