The promising concept of Stem Cells regenerating new tissues, replacing damaged and diseased organs, has created a new interest in tissue damage and healing. How do we turn Stem Cells on to regenerate the desired tissue? How do we keep them activated once “turned on”, and how do we create the desired tissue which is competent in achieving the desired physiological effect?
These questions have generated worldwide research, including studies of how Stem Cells work naturally in the fetus as well as in the adult. From these studies we have learned much about injury, inflammation and the healing process which causes Stem Cell activation. From these studies we have been able to tailor new treatments of chronic and
difficult to cure orthopedic and rheumatoid pain problems.
Trauma causes damage to a part of the body. The body responds by creating an inflammatory process. Inflammation is the body’s protective mechanism to prevent infection and start a healing process. Numerous chemicals, including Cytokines, Metalloproteinase, Leukotrienes, and Proteases, Phospholipase A-2, the Arachidonic Acid cascade and others are released with inflammation. Antibodies and specialized cells, such as Macrophages, Platelets, and Stem Cells, are attracted to the area of injury. Most of the time repair and healing is the result of this complex process.
Unfortunately, with repetitive stress and with some acute injuries, the inflammatory processes continue for long periods of time or indefinitely. This is frequently seen with chronic ligament pain, tendinopathies, tendinosis, and chronic joint inflammation. Some of the more common ailments exhibiting this pathology are: tennis elbow, golfers elbow, plantar fasciitis, neck and back pain, Achilles tendinitis, rotator cuff syndrome, sacroiliitis, chronic joint pain and many more. Almost any part of the body can remain chronically inflamed long after the precipitating injury.
Preventing Chronic Inflammation
Inflammation following both open and closed injuries should resolve in a few weeks, depending upon the severity of the trauma and injury. Immobilization and anti-inflammatory medication may be indicated. If, after several weeks the inflammation has not resolved, steroid injections are often indicated. Chronic inflammation should not be allowed to continue for long periods of time.
Effects of Chronic Inflammation
When inflammation persists, further tissue damage ensues, as the inflammatory process utilizes chemicals and enzymes that, in addition to destroying bacteria, can cause long-term damage to normal tissue. Tendinosis, chronic tendinitis and joint erosion are the result of chronic inflammation. In joints, arthritis and loss of articular cartilage result in joint dysfunction and pain.
Injection of Chemical Stimulants to promote healing and regeneration of new tissue has been used since 1937. There are numerous studies that demonstrate the effectiveness and safety of “Prolotherapy” http://fapmmed.net/Position.htm .
Since the interest in Stem Cell Tissue Regeneration, Human Platelets have become a focus of new research, as Platelets contain numerous growth factors that initiate the normal regenerative healing response.
Chemical Stimulants cause an irritation of connective tissue cells, initiating a release of chemical mediators which evoke a healing response. The most common stimulants create an osmotic gradient which is irritating but not lethal to the cells. Microscopic studies demonstrate increased collagen and cell matrix several months after treatment.
Platelet Rich Plasma (PRP)
Platelets contain Bioactive Proteins that initiate healing. These proteins cause angio-neogenesis (growth of new blood vessels) and collagen synthesis, increasing the matrix, vascularity, collagen content and strength of tendons, ligaments and bone. PDGF (Platelet Derived Growth Factor) is produced and helps stimulate the production of other growth factors and has roles in tissue remodeling. PDGF promotes mesenchymal stem cell replication, osteoid production (bone), endothelial cell replication, and collagen synthesis. It is likely the first growth factor present in a wound and starts connective tissue healing by promoting collagen and protein synthesis.
PRP has been used since the early 1970’s in Orthopedics, Wound Care, and Sports Medicine. Many famous athletes have been treated with PRP to promote fasted and more complete healing. Some of these athletes include: Tiger Woods, Rafael Nadal, Kobe Bryant, Hines Ward, and Alex Rodriguez.
Autologous Blood is collected and centrifuged to separate out the patients platelets. The platelets are reconstituted with the patient’s serum to make the Platelet Rich Plasma. The PRP is then injected into the affected tendon, ligament or articulation. It is recommended that three treatments of Prolotherapy and/or Platelet Rich Plasma are injected one to four weeks apart, depending of the location and injury. Later treatments may be required, contingent upon the response to treatment.