Regenerative Medicine Insights | Dr. Glenn Flanagan
Understanding regenerative medicine begins with a fresh take on inflammation.
Inflammation is not all bad!
Your immune system is working 24/7/365 to replace old and damaged tissue. This baseline level of inflammation is essential to life. In response to injuries this process can ramp up when greater healing responses are necessary.
The cells in your blood and tissues have numerous functions that can be defined as “inflammatory” which you cannot survive without.
There are certain specific inflammatory and immune disorders that need to be controlled, but the more common day to day inflammatory responses related to degenerative orthopedic conditions is a natural healing mechanism. Without it, our bodies would fall apart.
On a day-to-day basis, our musculoskeletal health and immune systems require inflammation. After bigger traumas and injuries, the strong inflammatory response is essential to prevent bleeding, decrease the risk of infection, and ultimately to heal injured tissue over the ensuing months. Think of a swollen, sprained ankle. Without the inflammatory response, the torn ligaments would never heal.
So why do doctors prescribe anti-inflammatory medications, creams, patches, and injections to help patients with orthopedic injuries?
There are 2 main reasons why anti-inflammatory treatments have been popular:
1. When patients are in pain it makes sense to consider anti-inflammatory treatments to reduce the painful inflammation. This will help pain control, but unfortunately, it also prevents proper healing.
2. When inflammation goes on for too long (months instead of weeks) it can lead to replacing the injured tissue with weaker, less functional tissue. Unfortunately, using anti-inflammatories also causes this same problem by weakening or stopping the healing process.
TRADITIONAL TREATMENTS are a DOUBLE-EDGE SWORD. While the anti-inflammatory approach can help temporarily, it has been shown in numerous studies that there are not long-term benefits to using anti-inflammatory treatments. The pain relief is temporary, and the injuries do not heal well. The patients often continue to suffer from repeat and worsening injuries, chronic pain, and often require surgery as the body breaks down.
REGENERATIVE TREATMENTS can be described simply as boosting your own body’s healing mechanisms. We’ve learned so much more about the immune system and the healing process over the last few decades, and this new field of medicine has developed during that time. Instead of fighting against the natural process of inflammation with anti-inflammatory treatments, regenerative treatments can be a catalyst to help decrease pain and improve function faster than would happen naturally after acute injuries. Patients with more chronic issues – signaling that the body can’t fully heal or keep up with the degenerative processes – respond to regenerative treatments because they can tilt the inflammation towards healing and protecting tissue. Ultimately, many patients have less pain and improved function.
The cells in your body that help you heal are found in your blood and tissues. These are platelets, neutrophils, white blood cells and stem cells or progenitor cells. The “stem cells” can be harvested from your bone marrow and fat.
The two main ways to help boost your natural healing through regenerative treatments are called:
1. platelet-rich plasma (from your own blood)
2. stem cell treatments (from your own bone marrow)
A COMMON EXAMPLE of a regenerative treatment would be for knee arthritis. Usually, if a patient has knee pain, they are prescribed anti-inflammatory medications à if that doesn’t work, they get strong anti-inflammatory cortisone injections à if that doesn’t work, they often end up having surgery. A PRP treatment can be done instead of the medications and cortisone injection. When it is effective it does not wear off quickly like cortisone injections, it does not make things worse like cortisone, and it can prevent surgeries instead of lead to more surgeries like cortisone.
PRP TREATMENTS start with a simple blood draw, like you are having blood drawn at a lab, and then the blood is spun in a centrifuge machine in the office. The preparation of the PRP after the blood draw usually takes 20 to 30 minutes. Afterwards, the cells in your blood that help you heal (most commonly the platelets and white blood cells) can be isolated and used for injection(s) into the injured area(s).
TISSUE HEALING is accomplished by inflammation that works in a similar way throughout the body’s different tissues. Whether you have a wound on your skin, a broken bone, a torn muscle or tendon, a sprained ligament, or an irritated nerve, the same cells are usually required to start the healing process. Therefore, regenerative treatments have been used for decades to help heal wounds, help patients recover from tissue damage after surgery and to treat orthopedic issues. Different tissues and injuries will lead to slight differences in the healing process, but it is similar in more ways than not.
PLATELETS are known to be at the core of starting and coordinating healing throughout the body, so that is why PRP (platelet rich plasma) injections make so much more sense than anti-inflammatory cortisone injections for patients with orthopedic musculoskeletal injuries. Recently, these treatments have been referred to as interventional orthobiologic treatments – completed without surgery, steroid injections, or medications. These orthobiologic are not miracles, but when done properly they can:
- Heal injuries
- Preserve tissue
- Slow down degenerative processes
- Decrease pain
- Decrease reliance on medications
- Prevent surgeries