REGENERATIVE TREATMENTS

Platelet Rich Plasma (PRP)

Bone Marrow Aspirate Concentrate (BMAC)

Stem Cell Expansion

Biopuncture

Platelet Rich Plasma

What is PRP?

PRP is an acronym for Platelet Rich Plasma which is an emerging modality being used in the treatment of orthopedic, musculoskeletal, skin and dental conditions as well as sports injuries. This procedure is rapidly becoming "mainstream" with many professional and elite athletes having received the treatment. The process involves preparing an autologous (same donor and recipient- it’s yours) tissue graft of platelets from a patient’s own blood. The person being treated has some blood removed, which is spun in a centrifuge that separates the blood components eventually creating a solution of concentrated platelets.

Depending on the indication, the solution may be injected into ligament, tendon, joint, or grafts (tissue or hardware) prior to being transplanted or implanted to aid in healing and improved structural integrity. PRP is being used with success to promote wound (ulcer) healing in diabetics and people with bad circulation. PRP is being used to coat titanium implants during lumbar spinal fusion and to aid healing from complicated fractures and post joint replacement procedures¹. One study demonstrated treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma significantly reduced pain.

How does this stuff work?

Platelets are known to most as blood cells that help the blood clot. However this is only one of many roles that platelets play. In fact, by being the first cells on the scene of an injury they have a key role in initiating and coordinating the healing response. In ones body, receptors on the surface of platelets tell them to go to the sight of injury where they initiate clotting and interact with signaling factors released by injured tissue. Platelets can release a multitude of signaling proteins, growth factors, chemotactic factors which stimulate tissue repair and vascular remodeling. This returns the tissue to a normal structure to do its job and results in less or no pain.

Through scientific research much is known of the armamentarium contained within a platelet. Through electron microscopy and biochemical studies it is known that platelets have many different granules or storage containers for different signaling proteins, structure proteins, coagulation factors and proteases. The surface of the platelet has a variety of membrane embedded protein which provide for a dynamic action in response to tissue damage. By receiving signals from the local environment platelets have the ability to release their healing factors in a control and appropriate fashion.

A possible healing mechanism proposed is the precise delivery of growth factors by platelets. These growth factors include Platelet Derived Growth Factor (PDGF) which plays a role in attracting other cells and is a stimulator of cell proliferation. Transforming Growth Factor β (TGF-β) promotes the production of martrix proteins. There are a multitude of growth factors associated within platelets.

Safety?

There are no known major health problems that have been reported through the use of PRP¹. A low red cell count and/or a low platelet count may preclude PRP; however, there are no formal guidelines available. People on blood thinners like Coumadin (warfarin) cannot have the procedure because the medication affects the graft.

1. E. Anitua, I. Andia, B. Ardanza, P. Nurden, A. T. Nurden: Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 2004; 91: 4–15

2. Mishra and Pavelk: Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma. The American Journal of Sports Medicine, Vol. 10, No. 10

Platelet rich plasma (PRP) is a biological concentrate of platelets that are harvested from the patient's whole blood. The advent of new technology has brought this cutting edge treatment into the physician's office. The procedure involves drawing a patient's blood as one would experience when they have blood drawn for routine testing. Then a tissue graft of platelets is created.

Platelet rich plasma (PRP) centrifuge

This graft is then injected using ultrasound imaging to guide the injection into the site of the damaged or diseased area. The graft contains at least 6 times the concentration of platelets and growth factors. Typically most people will require 2-3 sets of injections usually spaced 6-8 weeks apart. This graft is embeded into the damaged/diseased tissue and will accelerate recovery. This treatment can be beneficial in tendon, ligament and joint problems. This may preclude the need for more aggressive treatments and/or surgery in some cases. PRP may be effectively used in the treatment of sports injuries, arthritic joints, lower back pain, degenerative disc disease, tennis elbow, golfer's elbow, carpal tunnel syndrome, ACL injuries, shin splints, rotator cuff injuries, plantar fasciitis, iliotibial band syndrome (ITB) and Achilles tendinopathy. Platelets are a normal component of blood that are traditionally remembered for their role in stopping bleeding (clot). However, the platelet not only provides a scaffold for clotting, but actually begins the innate healing response. Platelets contain multiple granules which are released at the site of injury. These granules hold countless growth factors which signal other cells to begin the removal of damaged/diseased tissue and stimulate other cells to begin laying down new normal healthy connective tissue. These bioactive proteins are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins activate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process.

Hines Ward of the Pittsburgh Steelers received PRP which enabled him the play in the 2008-09 Superbowl

NY Giants defensive tackle Chris Canty tries platelet-rich plasma therapy for hamstring tear

Cliff Lee a pitcher for the Seattle Mariners had PRP for his stomach muscle injury

Stem Cell Treatments

Bone Mineral Aspirate Concentrate (BMAC)

This is a process that can is performed in our office with musculoskeletal ultrasound or if technical need arises a surgical center for the use of fluoroscopy (x-rays guidance). The fist step differs from PRR in than we have to obtain the patient's bone marrow. This usually comes from the back of the pelvis and sounds painful, but when performed under local anesthesia to the site and slowly there is minimal discomfort. The first portion of this treatment is the PRP and the BMAC is then added. The patient's bone marrow and blood are processed at the procedure appointment and used for the treatment at that time. The bone marrow provides a higher quantity of stem cells than are "floating" around our blood.
BMAC is typically used for failures of PRP treatment or more severe disease such as osteoarthrosis (OA or arthritis).

Autologous Stem Cell Treatments and Expansion

**There is more to come as this is advanced

Safety of one's own stem cells when cultured is without issue at this time whentalking about ones used for musculoskeltal problems. Ceneno, et al. Current Stem Cell Research & Thearpy 2010

Biopuncture

Are aches and pains getting to you??

Afraid of Cortisone?

NJSM uses Biopuncture as an effective alternative therapy whereby specific locations are injected with biological products. The majority of the products are derived from plants. Most of these injections are given into the skin or into muscles.

These Biopunctures are safe as they do not contain high concentrations of active substances. They usually contain diluted products. As a result, toxic side effects are very unlikely. Clinical studies on thousands of patients have confirmed the safety of Biopuncture products such as Traumeel.

We consider "inflammation" to be an important element of true and lasting healing. The goal of Biopuncture is to support the natural inflammatory processes in order to achieve a complete and natural healing of the injured tissues. So, we do exactly the opposite of conventional drugs.

Usually proper treatment requires you to receive several injections at each of several sessions. So in most cases, several little injections are given in a specific zone (or in several areas) of the body at each session.

The fact that your provider uses small doses of natural products instead of cortisone injections means that you have to be more patient. If you have had problems for several months or even years, your provider must work on different layers of tissue. If it is a complicated case, your provider must also look for deeper causes of your complaints and work on these as well.

Neck pain and back pain respond well to Biopuncture, but we also treat ankle sprains, pain in the shoulder and Achilles tendonitis using these natural vaccinations. Biopuncture is also very successful in treating tennis elbow and golf elbow. Here at NJSM we are experienced in the technique, and use Biopuncture for migraine, tension headache, sciatica, and so on.

Biopuncture is a safe and efficient technique in complementary medicine. It uses biological injections to stimulate the natural self-healing capacities of your body. Come to NJSM and see the difference Alternative Health Care makes.