Regenerative Injections

PRP and Biologics Injection Orthopedics

When we incur an injury or develop pain due to overuse, our tissue goes through an initial attempt at healing. Either this is successful and you feel and function back to normal, or the amount of attention and bloodflow necessary for complete healing simply ends and your body walls off the rest of the injury. Of course, this is what leads to chronic pain and dysfunction.

In the space of Regenerative Medicine, we now have options to help heal orthopedic conditions. PRP ( platelet rich plasma ) treatments are an excellent way to kickstart and hopefully complete the healing process of this chronic injury and pain. By drawing and spinning your blood, a concentrated platelet solution can be created which holds millions of growth and healing factors. By applying this directly to a targeted tendon, ligament, labrum, meniscus or even joint, you can achieve great benefits in re-stimulation and continuation of necessary healing. PRP is also frequently used as a prep or support to the biologics injections.

The biologics injections available today are:

Autologous (i.e. coming from one’s own body) regenerative tissues - these are typically taken from the bone marrow or adipose (fat) cells. These have the advantage of no risk of rejection by the body, but the procedure to harvest bone marrow or fat cells is long, uncomfortable, and risky. Drilling a hole into bone, typically the pelvis, to get bone marrow, and making an incision in the abdomen to macerate, or “mash up” adipose cells, in effect a mini liposuction, can cause pain, bleeding, and even serious infection given the degree of bone and soft tissue penetration.

Additionally, it’s been documented that the stem cells sought in doing such procedures drop severely in number as we age. A study by AI Caplan et. al. showed that the percentage of mesenchymal stem cells, or MSCs to bone marrow cells, drops from around 1 in 10,000 at birth, to 1 in 100,000 by the teenage years, to as low as 1 in 400,000 by age 50 and 1 in 1,000,000 by age 70. While some physicians have claimed to be able to boost this number in older patients by selective exercises and a nutrition program, the concern still exists that you’re going through a long, uncomfortable ordeal without much yield to show for it.

Some of the most well-known of biologics today are those that come from the umbilical cord (the tube attached the baby’s navel that provides oxygen, food, a blood supply and waste removal up until birth). The umbilical cord contains several valuable substances that are being used at the cutting edge of regenerative medicine today which our patients have benefitted from:

1. Wharton’s jelly: this makes up much of the substance, or tissue, of the umbilical cord that provides most of the support around the blood supply (umbilical artery), and yes, it looks like clear jelly. This is composed of a multitude of “scaffolding” proteins (which provide an “anchor” or network for the other injected substances to stick to and not drain away), growth factors, and in some cases (depending on the preparation) live cells that can stimulate your body’s own healing factors to repair damaged tissue.

2. Exosomes: these are tiny vesicles that “bud” off from live cells, that are the newest exciting frontier in regenerative medicine. Exosomes are composed of messenger-RNA (which sends a “code” to the host’s cells to begin repair), micro-RNA (which has anti-inflammatory properties), cytokines (small proteins that act as messengers for cell-to-cell signaling that can, among other things, strengthen the immune system, carry growth factors, and provide instructions from one cell or cell to others). Because of their small size, they can cross the blood-brain barrier, and have higher concentrations of growth factors than adult stem cells.

Each of these regenerative modalities has been used and can be applied with great success for partial tendon and ligament tears, tendinosis, tendonitis, joint inflammations, arthritis conditions, as well as chronic nerve pain.

Dr Birch has performed over one thousand regenerative injection treatments under ultrasound guidance. This has helped him hone his skills and expertise in order to develop his own special techniques and protocols for orthopedic support and healing. Every orthopedic injection you will receive will be under ultrasound guidance in order to minimize pain and maximize benefit of the treatment modality you choose.

Orthopedic conditions most commonly treated include:

  • Back pain

    • Low back - lumbar ad sacroiliac

    • Neck (cervical spine)

    • Facet joint pain

  • Shoulder pain

    • Frozen shoulder

    • Rotator cuff tear - infraspinatus, supraspinatus, subscapularis etc.

    • Biceps tendon tear and tendinosis

  • Elbow Pain

    • Tennis elbow

    • Golfer’s elbow

    • Elbow joint arthritis

  • Wrist and finger pain

    • Wrist and finger arthritis

    • Wrist tendonitis

    • Trigger finger

  • Knee pain

    • Knee arthritis

    • MCL and LCL ligament instability and partial tears

    • Meniscus tears

  • Foot and ankle pain

    • Tibiotalar arthritis and other ankle and toe joint arthritis

    • Partial tendon and ligament tears

    • Tibial nerve pain and vague pain under the foot

Q: What are regenerative injections?

A: Regenerative injections are treatments that aim to stimulate the body's natural healing process by injecting concentrated growth and healing factors, such as platelet-rich plasma (PRP) or biologics, into damaged or injured tissues like tendons, ligaments, or joints.

Q: What is PRP (platelet-rich plasma) treatment?

A: PRP treatment is a regenerative therapy that uses a concentrated platelet solution derived from the patient's own blood. This solution, rich in growth and healing factors, is injected directly into a targeted area like a tendon, ligament, or joint to stimulate and promote healing.

Q: How are stem cells used for regenerative orthopedic injections?

A: Stem cells, which have the potential to differentiate into various cell types, are used for regenerative orthopedic injections to promote tissue repair and healing. They can be obtained from sources such as bone marrow aspirate concentrate (BMAC) or placenta, umbilical cord, and Wharton's jelly matrix.

Q: What conditions can be treated with regenerative injections?

A: Regenerative injections can be used to treat a range of orthopedic conditions, including partial tendon and ligament tears, tendinosis, tendonitis, joint inflammations, arthritis, and chronic nerve pain.

Q: Who performs regenerative injection treatments at the clinic?

A: Dr. Jonathan Birch NMD, RMSK, an experienced specialist, performs regenerative injection treatments under ultrasound guidance to ensure precision and minimize pain while maximizing the treatment's benefits.

Q: What orthopedic conditions are most commonly treated with regenerative injections?

A: The most commonly treated conditions include back pain, low back pain, neck pain, facet joint pain, shoulder pain, frozen shoulder, rotator cuff tears, biceps tendon tears, elbow pain, tennis elbow, golfer's elbow, wrist and finger pain, arthritis, wrist tendonitis, trigger finger, knee pain, meniscus tears, foot and ankle pain, and tibial nerve pain.

Q: Are regenerative injections performed under guidance?

A: Yes, all regenerative injections are performed under ultrasound guidance, ensuring the precise delivery of the treatment and minimizing pain while maximizing the benefits.