R.I.P Cortisone Injections?

If you are in pain, especially chronic pain, you are probably trying to decide if rehab, surgery, injections or maybe a combination are right for you.  Well, there is a relatively new injection in town for your joint and muscle aches and pains: “stem cell injections.”  These promise to “regenerate” tissue that is no longer healing properly by itself. Treatments that “regenerate” tissue are typically categorized as “Regenerative Medicine”. Unlike the more commonly used cortisone injections or over the counter anti-inflammatory pills, regenerative medicine injections can theoretically give your immune system a boost to self-heal, a treatment effect that no anti-inflammatory drug can deliver. In fact, cortisone and over the counter anti-inflammatories (e.g. Aleve, Ibuprofen) are often not allowed before or after the procedure for some time. This is so that an appropriate inflammatory response can be triggered. Inflammation is the first step to healing, and isn’t always the enemy!

Regenerative medicine injections, including stem cells,  often involve your own bone marrow, blood or fat cells, processed and injected directly into the site of your problem. Some physicians choose an alternative method using umbilical cord blood (collected immediately after childbirth). There are benefits/drawbacks to each method, and those details should be discussed with your physician.  Dr. William Cimikoski of Utah Stem Cells, located in Cottonwood Heights, UT (just outside of Salt Lake City) says, umbilical donor blood is my go-to for stem cell injections. The risk of rejection of umbilical cord blood is very low and the results are fantastic, even for my patients that have painful and severe arthritis. 90% of my patients with severe arthritis report moderate to excellent relief. But, it’s important for patients to know that many people have severe arthritis and no pain and some have minimal arthritis and a lot of pain. Therefore, the treatment selection & dosage is not based on the severity of the disease on imaging. Dosage must be determined based on symptoms and a collaborative decision making process between patient & physician, and at times in collaboration with your physical therapist.”  

This is where “regenerative rehab” and physical therapy come in. Most if not every physician will say, “exercise and movement are critical for your injections to take hold long term”. More often than not, that involves formal physical therapy after your procedure, even if you had PT prior to your procedure. The challenge is that generic guidelines are not yet available to guide your physical therapist. This requires a physical therapist that is knowledgeable about regenerative medicine procedures and tissue healing principles. Additionally, it is key that your physical therapist has a good working relationship with your physician to personalize your treatment. Finally, your physical therapist should customize your rehabilitation program based on your specific injection(s) as well as on the unique reasons that you are having pain.

Does all this sound like science fiction?  Well, it is and it isn’t.  Stem cells have been around for a long time, are FDA approved, and have been successfully used for bone marrow transplants for over 50 years. In the orthopedic world, stem cell injections are a relatively new procedure to be brought to the masses for orthopedic disorders like knee arthritis, disc herniations, ligament sprains (e.g. ankle) and tendon disorders (e.g. achilles). Furthermore, most of these applications are not FDA approved and are rarely if ever covered by standard healthcare insurance. Stem Cell procedures usually cost between $3000 – $5000.

However, there are other options if that is too rich for your blood, pun intended!  Most “Regenerative Medicine” physicians in the Salt Lake Valley also provide a cheaper type of regenerative medicine procedure call Platelet Rich Plasma (PRP) that uses your own blood, which is concentrated (by rapid spinning and separating of cells) and injected back into your problem area to promote your own body’s natural regeneration. PRP has been around for over a decade in clinical practice, but is still considered experimental and therefore rarely covered by insurance. PRP injections are typically much less expensive than stem cell injections and are sometimes used in conjunction with stem cell injections. However, they can be used as a standalone procedure.

There are a plethora of options to treat your chronic aches and pains, and medicine is rapidly changing. It should be expected that if you are considering this procedure, that you ask the physician to point you to research that shows that the specific procedure they are suggesting for you is safe, and that clinical human trials have proven some level of effectiveness. For some patients, all they need is a physician that gives them some hope because they have tried everything from surgery, to rehab, and maybe even aggressive lifestyle changes. If you are looking for more information from a reputable source on the safety and effectiveness of stem cell injections, I suggest you check out The International Society for Stem Cell Research (ISSCR) and take a look at their Patient Handbook.

With this kind of expense involved and the experimental nature of this treatment, it makes sense that a patient would want to exhaust conservative options that are well covered by insurance and are evidence based prior to launching into regenerative medicine treatments (e.g. Physical Therapy). Please don’t hesitate to reach out directly to me (kris@fasttrackphysicaltherapy.com) if you have questions about how physical therapy and/or regenerative medicine options might be able to help you. Also, don’t hesitate to give Fast Track Physical Therapy a call (801-649-4690) to setup a free 15’ consultation. The consultation involves a 5-10 minute conversation and a few physical examination tests to find out if you are appropriate for physical therapy or should be referred to a physician, and what physician could best help you get on the “Fast Track”!

 

Kris Porter, PT, DPT, OCS

Doctor of Physical Therapy and Board Certified Orthopedic Specialist

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