This article describes prolotherapy and stem cell therapy. It is the 5th blog and the last one of a series that dealt with telomeres, lifestyle and stem cells, topics that were on the agenda of the 22nd Annual Anti-Aging Conference in Las Vegas (Dec.10 to 14, 2014). Here are summaries of two talks from this conference that dealt with methods of repairing damage to your joints or bones without surgery. Treatments consist of stimulating local stem cells through a treatment called “prolotherapy” where needles are used to inject concentrated dextrose. I will explain below why this method is effective.
Modification of original prolotherapy
A modification of this original prolotherapy is when the effect of it is amplified by growth factors from so-called platelet rich plasma (PRP), which is mixed with the dextrose injection. The ultimate healing jerk occurs when you mix in stem cells with the PRP into the injured tissues. In both lectures the speakers showed images before the procedures and images some time after with impressive results.
1. Dr. Fields’ talk had the title: “Repairing joints and spine without surgery: prolotherapy/PRP/stem cell therapy”
This talk concentrated on the use of prolotherapy with concentrated dextrose and prolotherapy with platelet rich plasma (PRP) with or without the addition of stem cells in the treatment of various musculoskeletal injuries.
When the doctor decides to do prolotherapy by itself, the therapeutic modality is 12.5% Dextrose. The therapist injects it into the area of injury. Dr. Fields said that the reason it works is that local stem cells in the area of injury undergo activation from the Dextrose. Since Dextrose activates stem cells, they now can do the healing. The physician can improve the results further by injecting a small amount of PRP very focally to an area of ligament rupture. Centrifuging blood from the patient’s vein separates the red blood cells from plasma, which is where the platelet rich plasma (PRP) originates from.
Stem cells and PRP
The physician discards the red blood cells, but the platelet fraction and some of the plasma becomes the PRP preparation. The PRP fraction amplifies the effects of the stem cells from bone marrow and from fatty tissue. The physician mixes all of them into the injection. Dr Fields explained that bone marrow is aspirated from the pelvic bone and in the same patient a liposuction is also done to receive adipose tissue. A cell separator is the next stage in obtaining pure stem cell preparations. This way stem cells that had their origin in bone marrow and mesenchymal stem cells that had their origin in adipose tissue are obtained.
Superior stem cell mix
The physician combines both fractions as they make a superior stem cell mix. Finally, the addition of platelet rich plasma activates the stem cell mix. This mix was used for bone fractures that were slow to heal, for ruptured tendons, ligaments, Achilles’ tendons and rotator cuff tears.
Healing without a residual scar
Dr. Fields showed before-slides and several weeks to months after-slides with MRI scans of the original injuries and the final healed tendons and ligaments. I have never seen such beautiful healing with no residual scar. Stem cells are the specialists of healing such defects. They change into whatever cell type is missing and they fill in the defects. This explains the perfect function after healing of the injury following stem cell and PRP injection. It also explains why many athletes who had this done went on to winning more medals after the repair. You do not hear about success stories that often after conventional surgery, because the range of motion and strength suffer from scarring following conventional surgical repairs.
Case histories
Several patients with knee injuries received prolotherapy. Dr. Fields recorded their video testimonials. They explained that their procedures only involved needles in the injured area, that they experienced almost complete pain relief on the day of the procedure and that they could rehabilitate right away.
Slides were also shown of specific knee ligament injuries involving the medial collateral ligament (MCL), the posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL). These are very important support ligaments within the knee.
Lower back injury with a ruptured disc
But this was not all: there were lower back injuries with ruptured discs. With conventional medicine the solution is a discectomy, but here these patients received prolotherapy. They experienced a stabilization of the weak areas, spontaneous resorption of the prolapsed disc and stabilization and strengthening of the weak spine. MRI scans of the spinal injury before treatment and several months after the treatment showed a complete normalization of the spine. In my work as a Medical Advisor for Workers’ Compensation cases that I was doing for 16 years I have never seen a single case like that.
Dr. Fields showed a similar spinal injury in the neck as well with a testimonial from that person. Again, following stem cell treatment there was minimal pain, immediate rehabilitation and a full range of motion several weeks after the injury.
What is treated with prolotherapy?
Basically all of the major joints lend themselves for treatment with prolotherapy: the shoulder, knee, back, the neck, ankle, elbow and hip. Typically, the types of injuries for prolotherapy treatment are sports injuries, fibromyalgia, sciatica, muscle tears, tendonitis, arthritis, bursitis and temporomandibular joint problems (TMJ).
Dr. Fields also stressed (and so did Dr. Purita, see below) that platelet rich plasma with its growth factors activates stem cells.
There was a presentation of two special cases, namely patellar tendinitis and Achilles tendinitis, which both respond very well to prolotherapy and PRP plus stem cell therapy. This provides complete healing of these otherwise very difficult clinical entities.
Testimony of a former Surgeon General of the US
An image was shown from the late C. Everett Koop, MD, the former Surgeon General of the Untied States who had this to say about prolotherapy: “I have been a patient who has benefited from prolotherapy. Having been so remarkably relieved of my chronic disabling pain, I began to use it on some of my patients.” This may yet be the strongest argument to at least consider prolotherapy in otherwise hopeless cases.
2. Dr. Joseph Purita gave a lecture on the “Effects of PRP And Stem Cell Injections”
As explained above PRP stands for platelet rich plasma, which is a “soup” of various growth factors and exosomes =cell-to-cell mediators). He discussed the importance of the proper harvesting of PRP. He explained that apart from white blood cells (WBC) and platelets an important component of PRP are very small embryonic like stem cells (VSELs). With a microscope you can visualize VSELs. The missing link has been the observation that white blood cells produce inflammatory substances, which have been detrimental when stem cell injections with PRP were done in the past (poor survival rate of stem cells). Research showed that photo-activation of the PRP before injection leads to anti-inflammatory behavior of the WBC in PRP.
Light activated PRP
Dr. Purita calls this “light activated PRP”, which leads to the best results with stem cell/PRP injections. Soft laser stimulation with red, green and blue soft lasers have been shown to improve tissue healing significantly when stem cells and light activated PRP are used. As already described in Dr. Field’s talk the main sources for good stem cells are the fat tissue (from the “love handles”) and the bone marrow (obtained from pelvic bone). Dr. Purita also explained that nitric oxide and electrical stimulation also help to improve stem cell survival and reduce inflammation. All of these methods revolutionized orthopedics where injured tissues can heal with the help of injecting stem cells and activation of PRP by laser treatments. Dr. Purita showed very detailed technical aspects of these procedures with various applications.
Treatment of osteoarthritis
For instance, he showed a slide regarding treatment for osteoarthritis of the knee. All this is contained in the plasma that is used to inject PRP into a joint with degenerative arthritis. You can mix this with stem cells from bone and from adipose tissue and inject it into arthritic knees. This is the ideal remedy for a person with degenerative arthritis. The stem cell/PRP mix calms down the degenerative process with instant pain relief. The stem cells are transforming into cartilage cells (chondrocytes) building up hyaline cartilage. The end result is a new knee surface; the old and the new knee surfaces form one seamless unit.
The doctor can use PRP by itself successfully for repairing bursitis of shoulders and rotator cuff tears, muscle tears and sprains, meniscus tears of the knee, mild to moderate osteoarthritis of various joints and spine disorders, particularly facet joint problems.
Prolotherapy And Stem Cell Therapy
Types of stem cells for joint injections
Dr. Purita gave a thorough overview of stem cells. He pointed out that stem cells fulfill two criteria:
- They are undifferentiated and they are capable of self-renewal by replication
- They can undergo differentiation into specific cell lineages.
From a practical point of view as already mentioned in Dr. Field’s talk there are two sources for stem cells that are important: stem cells from adipose tissue (also with the name MCS or mesenchymal stem cells) and stem cells from bone marrow, obtained usually from the pelvic bone. When the physician mixes them and stimulates them with PRP they are the miracle mix that helps to heal all these injuries.
Stem cells and other factors for healing
What does the FDA say to stem cell therapy? “The FDA states it is ok to use these cells as long as they are put back into the same patient and they are minimally manipulated.”
Dr. Purita listed a host of other factors besides platelet rich plasma. It supports stem cells, increases their survival on transplantation and stimulates them to differentiate and heal the defect. This happens at the recipient site as quickly as possible. Photoactivation of platelet rich plasma with low level lasers (soft lasers) will release exosomes. They are tiny particles, which platelets and white blood cells release. They contain proteins and genetic material required for wound healing and stimulation of stem cells.
Patient with avascular necrosis
Towards the end of the talk Dr. Purita showed an MRI scan of a knee with avascular necrosis (dead bone) before and after treatment with stem cells, PRP and low level laser therapy. There was a complete resolution of the avascular necrosis without any surgery. With a second case the initial MRI scan showed a complete tear of the MCL. MCL stands for medium collateral ligament (MCL tear) of the knee. The follow-up scan showed the same ligament intact. The physician achieved this without surgery, just by treating the patient with an injection of stem cells; PRP and using low-level laser therapy to activate PRP.
Conclusion
Prolotherapy and stem cell therapy are the hottest new treatment modalities. They can treat ruptured tendons, ligamentous injuries, and disc herniations in the neck and in the lower back. You will not get this from your primary care physician or your regular orthopedic surgeon. At the present time they tend to not have the insight. Besides, they profit from the conventional procedures. But you owe it to your health to try these alternatives first as they are much less invasive. They involve your own cells that will heal the defects with a very high probability. You still have the option to seek the advice of an orthopedic surgeon, should these alternative procedures fail. Unfortunately most insurance carriers will not pay for this service at this time.
Disclaimer
Dr. Schilling has no conflict of interest with regard to Regenexx . He also has no conflict of interest with any of the other companies of which images were shown. They simply displayed the best images with regard to the many illustrations in this blog.
