Prolotherapy
Dextrose Prolotherapy, or Proliferation therapy, is an ultrasound guided treatment that works by injecting a sugar (like dextrose) into an area of healthy tissue to trigger the body’s natural healing cascade.
Sugar attracts water to the tissue treated, causing cells to lyse which re-starts the body’s natural healing response. Tissue repair leads to stability and improved function leading to pain control and even decreased healing times from sprain and strain injuries.
Prolotherapy is considered a viable alternative to surgery for appropriate soft tissue injuries such as ligament and tendon sprains and strains that are failing to heal with good therapy. It is a better long-term option than anti-inflammatory and narcotic pain medications and anti-inflammatory injections such as cortisone and other steroid injections which only mask symptoms temporarily but can impair tissue healing. Prolotherapy is a safe option that allows you to keep active during treatment.
There is good evidence that dextrose prolotherapy is safe and effective in treating musculoskeletal injuries of tendons, ligaments, cartilage and downregulates nerves. Examples include: Osteoarthritis, tennis elbow, rotator cuff tendonitis, ankle sprains, Osgood Schlatter, ligament strains, and even sports hernia pain
This depends on the severity of your injury, but as a general rule no physical activity should be done at least 2 days following the injection. Physical therapy guided activity, gentle range of motion (stretching), and non-weight bearing activity may be done 4 days to up to 2 weeks after your injection. After about 2 weeks, progressive activity is initiated, as indicated by your doctor.
On average, patients will receive 3-4 injections per anatomical structure (joint, meniscus, labrum, ligament, tendon, muscles, bursa, or fascia/connective tissue, etc.). Multiple structures can be addressed at each visit. The treatments are generally given monthly to allow sufficient time for healing between treatments.
You may experience redness, swelling, stiffness and temporary discomfort after the procedure. You may apply ice or heat to the area for 15 minutes every 1-2 hours for the first 48 hours. By day 3, symptoms typically resolve significantly. Rarely, flares can last up to 2 weeks. The day of and day after the procedure you should limit the activity related to the injection site to activities of daily living, but can do gentle range of motion exercises. Impact activity will be restricted based on the issue being treated and can range from 2 days to 2 weeks. In most cases, your physician will recommend physical therapy to aid in the return to activity.
Unfortunately, most insurance companies still do not cover Prolotherapy treatments. It is typically an out of pocket expense.
There are a variety of measures that can be used to measure progress. While pain relief is the ultimate goal, it is not the best way to measure early progress. Stability, strength and improved function are the first changes we typically see. Full recovery may take a few weeks to a few months.
The irritant introduced is Dextrose, a sugar solution. Lidocaine, a local anesthetic, is used to reduce the discomfort of the injection and sterile saline, salt water, is used to dilute the solution.
-Avoid anti-inflammatories for a minimum of 1 week before and 2 weeks after the injection.
-Avoid steroid medication (oral or injectable for 6 weeks before or after the treatment. Both impair the body's healing responses and the early inflammation needed for healing.
-If at all possible, stop your cholesterol-lowering statin medications for 2-4 weeks before and 2-3 months after treatment as they impair stem cell function.
-Consider supplementing with Fisetin, L-carnosine and Blueberry extract to improve stem cell function.
-Vigorous exercise the morning of your treatment has been shown to improve circulating platelet and stem cell numbers in blood and bone marrow.
-Intermittent fasting prior to your procedure can also help mobilize stem cells.
-You may pre-medicate with over the counter acetaminophen 1-2 hours prior to your procedure to help with pain.
-You may pre-medicate with a mild sedative after signing the consent form at the doctor's office to help with anxiety. Ask the doctor before hand so this can be prescribed ahead of time.
-Blood thinners are prohibited as bleeding in the bone marrow cannot be well controlled by compression.
As prolotherapy is intended to stimulate your immune system healing response, it's best to avoid things that would impair that response.
-As such, please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid high level activity for 3-4 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day
Plasma Rich in Growth Factors (PRGF)
Plasma Rich in Growth Factors (PRGF) is made by drawing then centrifuging a patient’s own blood in order to concentrate platelets and growth factors while also eliminating unwanted and inflammatory white and red blood cells.
When the platelets and growth factors are injected to the site of injury, the growth factors and plasma cytokines stimulate blood flow and signal cells crucial in the healing process to migrate to the site of injury. These “healing” cells repair injured tissues through matrix formation, which is considered the “foundation” of all soft tissue. This ultimately can help strengthen injured tendons and ligaments in the soft tissues, and can help decrease joint pain by improving the biologic environment inside an arthritic joint.
Plasma Rich in Growth Factors has been shown to be helpful in the treatment of joint Osteoarthritis (OA) as well as in soft tissue injuries of tendons such as tennis elbow and plantar fasciitis.
-We start with 1 treatment and see how well things go.
-Some studies suggest that additional benefit can be seen with a second or third injection.
-Based on the scientific studies to date, it appears PRGF can stimulate strengthening an repair of partially injured tendons and ligaments but may only help with pain from osteoarthritis for 1-2 years.
-This depends on the exact diagnosis and extent of tissue injury/degeneration. After the initial flare-up, it typically takes 3-4 months to see optimal results.
-Repeat treatments may be needed depending on how well one responds.
-Ongoing improvement may be seen up to 6-9 months, some studies suggest up to a year.
-Avoid non-steroidal/anti-inflammatory medications 1-2 weeks prior to procedure and 2-4 weeks after the procedure. These include: ibuprofen, naproxen, aspirin, advil, motrin. Tylenol or narcotics can be used as a substitute before or after the procedure.
-Avoid corticosteroids (oral or injected) for 6 weeks before and after treatment.
-Avoiding statins (cholesterol lowering medications) for 2-3 weeks before and 2-3 months after treatment is wise as these have been shown to impair your body's own stem cell function.
-Drink plenty of water. We recommend a minimum of 16 oz before blood draw and that you have someone drive you home.
• 20-120 cc’s of blood are drawn from the arm and put into the centrifuge, which spins the blood (for 10-15 minutes). • A small amount of local anesthetic is used to numb the area and is also placed within the PRGF. • Total time of the procedure is typically 1 hour. This includes the centrifuge blood spin. Each injection itself takes only a few minutes, so total time depends on the number of sites treated. • Like any injection, this procedure involves some discomfort. Local anesthesia is used to numb the areas being treated prior to the PRGF injection. Following the procedure, your physician typically prescribes medication for postprocedural pain.
-You will typically experience some increased pain, inflammation and discomfort for the first few days after the procedure.
-You may apply ice or heat to the area for 15 minutes every 1-2 hours for the first 48 hours.
-By day 3-5, symptoms should begin to resolve significantly. Rarely, some may experience soreness up to 2 weeks.
-Limit the activity related to the injection site significantly for 1-2 days, but you can do gentle range of motion and isometric exercises.
-Joint loading and impact will be restricted based on the issue being treated and can range from 2-8 weeks. In most cases, your physician will recommend physical therapy to optimize the outcomes of the procedure.
Unfortunately, most insurance companies still consider PRGF not medically necessary and therefore it is NOT covered. As such, costs for this treatment are the patient’s responsibility and are due at the time of service.
-There are a variety of measures that can be used to measure progress. While pain improvement may be part of the ultimate goal, it is often not the first sign of improvement.
-Initially, strength and stability followed by an improvement in function are most common. Improved functional movement and progressive loading of the area then hopefully leads to a significant reduction in pain.
-Avoid anti-inflammatories for a minimum of 1-2 weeks before and 2-3 weeks after the injection.
-Avoid steroid medication (oral or injectable) for 6 weeks before or after the treatment. Both impair the body's healing responses and the early inflammation needed for healing.
-If at all possible, stop your cholesterol-lowering statin medications for 2-3 weeks before and 2-3 months after treatment as they have been shown to impair stem cell function.
-Consider supplementing with Fisetin, L-carnosine and Blueberry extract to improve stem cell function.
-Vigorous exercise the morning of your treatment has been shown to improve circulating platelet and stem cell numbers in blood and bone marrow.
-Intermittent fasting prior to your procedure can also help mobilize stem cells.
-You may pre-medicate with over the counter acetaminophen 1-2 hours prior to your procedure to help with pain.
-You may pre-medicate with a mild sedative after signing the consent form at the doctor's office to help with anxiety. Ask the doctor before hand so this can be prescribed ahead of time.
Plasma Rich in Growth Factors injections are intended to stimulate your body's immune system healing responses.
-As such, please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid high level activity for 3-4 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day
Platelet Rich Plasma (PRP)
Platelet rich plasma (PRP) is made by concentrating the patient’s platelet concentration to 4-6 times that found in the regular blood.
When the platelets are injected to the site of injury, their growth factors are released. These growth factors then stimulate blood flow and signal cells crucial in the healing process to migrate to the site of injury. These “healing” cells generate new tissue through matrix formation, which is considered the “groundwork” of all soft tissue. This ultimately can help repair injured tendons and ligaments in the soft tissues, and can help decrease joint pain by improving the biologic environment inside an arthritic joint.
PRP has level 1 evidence (highest level possible) for treatment of Osteoarthritis of the knee. It also has high levels of evidence for tendinosis, specifically of the lateral epicondyle (tennis elbow), gluteal tendons (trochanteric bursitis), sacro-iliac ligaments (SI joint) and plantar fasciosis (plantar fasciitis).
It has also proven helpful in ligament sprains/strains, muscle tears, arthritis in other joints and even around inflamed nerves.
-We typically start with 1 treatment and see how well things improve.
-Some studies suggest additional benefit from a second or third injection.
-Based on the scientific studies, it appears PRP can help strengthen and repair injured tendons for the long-term, but may only help decrease arthritis painfor 1-2 years.
-Our experience in using PRP for over 10 years matches well with these scientific studies.
This depends on the exact diagnosis and extent of degeneration. After the initial flare-up, it can take weeks to months to see optimal results. Repeat treatments may be needed depending on how well one heals. Ongoing improvement may be seen up to 6-9 months, some studies suggest up to a year.
• 20-120cc’s of blood are drawn from the arm and put into the centrifuge, which spins the blood (approx 7-10 minutes). • A small amount of local anesthetic is used to numb the areas to be treated. • Most procedures are done within 1 hour. This includes the centrifuge time. The injection itself takes only a few minutes per site, but total treatment time depends on number of sites treated. • Like any injection, this procedure involves some discomfort. Low dose local anesthesia is used prior to injection of the PRP to reduce pain. Following the procedure, your physician typically prescribes medication for postprocedural pain.
-You can expect a significant increase in pain and inflammation the first night or two after the procedure as PRP stimulates a significant inflammatory response.
-You may apply ice or heat to the area for 15 minutes every 1-2 hours for the first 48 hours.
-By day 3-5, symptoms should begin to resolve significantly. Rarely, some may experience soreness up to 2 weeks.
-Limit activities that use the treated body parts for 1-2 days, but you can do gentle range of motion exercises.
-Joint loading and impact will be restricted based on the issue being treated and can range from 2-8 weeks. In most cases, your physician will recommend physical therapy to optimize the outcomes of the procedure.
Unfortunately, most insurance companies still consider PRP as not medically necessary and is therefore NOT covered.
-There are a variety of measures that can be used to measure progress. While pain improvement may be part of the ultimate goal, it is often not an objective way to measure progress.
-Initially, strength and stability followed by an improvement in function are most common. Improved functional movement and tissue healing then hopefully leads to a significant reduction in pain.
-Typically pain relief comes later while strength, stability and improved range of motion are seen first.
-Avoid anti-inflammatories for a minimum of 1 week before and 2-3 weeks after the injection.
-Avoid steroid medication (oral or injectable for 6 weeks before or after the treatment. Both impair the body's healing responses and the early inflammation needed for healing.
-If at all possible, stop your cholesterol-lowering statin medications for 2-4 weeks before and 2-3 months after treatment as they impair stem cell function.
-Consider supplementing with Fisetin, L-carnosine and Blueberry extract to improve stem cell function.
-Vigorous exercise the morning of your treatment has been shown to improve circulating platelet and stem cell numbers in blood and bone marrow.
-Intermittent fasting prior to your procedure can also help mobilize stem cells.
-You may pre-medicate with over the counter acetaminophen 1-2 hours prior to your procedure to help with pain.
-You may pre-medicate with a mild sedative after signing the consent form at the doctor's office to help with anxiety. Ask the doctor before hand so this can be prescribed ahead of time.
Platelet Rich Plasma (PRP) injections are intended to stimulate your body's immune system healing responses.
-As such, please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid high level activity for 3-4 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day
Microfragmented Adipose Tissue Graft (MFAT)
Microfragmented Adipose Tissue Graft (MFAT) is an autologous tissue graft (meaning it comes from the patient's own fat stores) used to provide structural support for soft tissue injuries. MFAT is a unique source of tissue collagen and helps fill tissue voids. It also is the richest source of autologous Mesenchymal Stem Cells (MSC's) per volume found in our bodies.
Obtaining MFAT involves removing a small portion of a person’s own fat (like a mini liposuction), cleaning and gently processing it to remove undesired components, followed by injecting it into injured tissue that has lost its structural integrity.
MFAT injections are ultrasound guided into the injured soft tissues (joint, tendon, ligament or muscle defect) to help provide structural support as a bioscaffold to help support tissue repair.
Our adipose tissues contain tissue collagen, fat cells and Mesenchymal Stem Cells (MSC's).
Autologous MFAT injections provide a unique complex tissue bioscaffold which can fill tissue voids and provide a structure upon which our own body's tissue repair cells can go to work. The tissue repair cells we add to the MFAT are typically the platelets and White Blood Cells (WBC's) found in Platelet Rich Plasma (PRP) or Bone Marrow Aspirate Concentrate (BMAC).
Mesenchymal stem cells and platelets are known to help stimulate and coordinate the body’s natural healing response. In many case reports and animal studies, they have shown to be safe and effective in treating osteoarthritis, ligament, tendon and muscle injuries.
To date, most clinical studies on MFAT have been for Knee Osteoarthritis (OA), with fewer data showing benefit in meniscus injuries and tendon tears such as rotator cuff tears.
Our own clinical experience and patient collected data has shown value in hip labral tears, gluteal tendon tears, SI ligament tears and muscle tears.
Before any Regenerative Treatment certain consistent recommendations are made:
-Avoid anti-inflammatory medications such as NSAIDs (ibuprofen, naproxen, celecoxib, aspirin) and even natural anti-inflammatories such as turmeric, oral CBD and fish oil for 1-2 weeks before and 2-3 weeks after the injection.
-If you're on blood thinners or statin medications for high cholesterol, please discuss with your PCP or Cardiologist about the possibility of being off these medications for 1-2 weeks prior and 2-3 months after your treatment.
-You may pre-medicate if needed for expected pain with over the counter Tylenol about 2 hours prior to your appointment.
-Blood thinners are generally prohibited as bleeding in the fat can be extensive and is not easily controlled by simple compression.
-We recommend using supplements shown to enhance stem cell function for 1-2 weeks prior to and 2-3 months post MFAT treatments (we'll provide you with this list at your pre-procedural appointment)
-Intermittent fasting (if safe for you) and moderate exercise have also been shown to help improve stem cell activation prior to Regenerative Treatments
This depends on the severity of your injury, the location of injury and activity you want to do.
As a general rule no physical activity should be done for 3-5 days following the injection.
Physical therapy guided activity such as passive or assisted range of motion and non-weight bearing activity of the injured body part may begin 4 days to up to 2 weeks after your injection.
After 2 weeks out from your procedure, light strengthening followed by progressive activity is initiated, as dictated by your doctor.
More activity is allowed at the 4 week mark and most restrictions are removed at the 6-8 week timeframe assuming your recovery is going well and you are on schedule.
It is common to experience bruising, redness, swelling and discomfort at the harvest and treatment sites after the procedure.
No immersion of the harvest or treated sites will be allowed for 5-7 days.
You may apply ice or heat to the area for 15 minutes every 1-2 hours for the first 48 hours.
By day 3-5, pain, stiffness and swelling symptoms will typically begin to resolve significantly. Rarely, flares can last up to 2 weeks.
For a few days, you should limit the activity related to the harvest and injection sites to activities of daily living, but can do gentle range of motion exercises after the first 2 days.
Impact or weight-bearing activity will be restricted based on the tissue being treated and can range from 2-8 weeks.
We ALWAYS recommend physical therapy starting 5-7 days post procedure to help with recovery. As we say, the injections are worth 60-70% of your improvement, but good PT with eventual strengthening by you is worth the other 30-40%.
Unfortunately, insurance companies still consider Microfragmented Adipose Tissue Graft (MFAT) treatments as too new of a treatment to be covered.
This is unfortunate as the relatively few clinical studies to date have demonstrated MFAT's safety and efficacy, albeit early and limited data.
Bone Marrow Aspirate (BMA) and Concentrate (BMAC)
Bone Marrow Aspirate is obtained by removing a small portion of a person’s own bone marrow.
Bone Marrow Concentrate is made by centrifuging the marrow to remove undesired cells and concentrate the desired cells, such as mesenchymal stem cells and platelets.
Injections are ultrasound guided into the painful tissue (joint, tendon, or ligament) and activate the body’s natural healing cascade.
Bone Marrow contains many cell lines, including Mesenchymal and Hematopoietic Stem Cells, platelets, megakaryocytes, and others.
Mesenchymal stem cells and platelets are known to help stimulate and coordinate the body’s natural healing response.
In case reports, cohort and animal studies, they have consistently been shown to be safe and effective in treating osteoarthritis, tendon and fibrocartilage problems.
Bone Marrow Concentrate injections are a type of Regenerative Injection therapy, and are intended to help heal a body part that has failed to heal. They are a regenerative alternative to the short-lived symptom-control measures such as pain medications and anti-inflammatory injections such as cortisone.
While well-controlled scientific studies are limited, multiple studies from around the world do show Bone Marrow Concentrate to consistently be safe and help decrease pain and improve function when used to treat joint problems such as osteoarthritis, tendonitis and ligament sprains.
Bone Marrow Concentrate injections are particularly helpful in painful musculoskeletal injuries of tendons, ligaments and arthritic joints.
Examples include: Osteoarthritis, fibrocartilage injuries (e.g. meniscus and labral tears), ligament, and tendon strains and partial tears.
Most impressive have been the long-term outcomes of Bone Marrow Concentrate when used to treat Bone Marrow Lesions under the cartilage of moderate to severely arthritic knee joints. (Dr. Hernigou Knee Osteoarthritis studies in 2020)
This depends on the severity of your injury, but as a general rule no physical activity should be done at least 2 days following the injection. Physical therapy guided activity, gentle range of motion (stretching), and non-weight bearing activity may be done 4 days to up to 2 weeks after your injection. After about 2 weeks, progressive activity is initiated, as dictated by your doctor.
On average, patients will only need 1 injection per anatomical structure (joint, meniscus, labrum, ligaments, tendon, or fascia/connective tissue, etc.). The treatments may take 4-6 months to see optimal healing. Repeat injections can be performed.
You may experience redness, swelling and discomfort after the procedure at the harvest and treatment sites. You may apply ice or heat to the area for 15 minutes every 1-2 hours for the first 48 hours. By day 3-5, symptoms will begin to resolve significantly.
Rarely, flares can last up to 2 weeks. The first 2 days after the procedure you should limit activity related to the injection site to activities of daily living.
Impact activity will be restricted based on the injury and can range from 2-8 weeks. In most cases, your physician will recommend physical therapy to optimize healing & return to activity.
Unfortunately, most insurance companies consider Bone Marrow Injections too new of a treatment to be covered. Feel free to check with your insurance provider for more information, but at this time we have not found insurers are covering this treatment.
There are a variety of measures that can be used to measure progress. While pain relief is the ultimate goal, it is not the best way to measure early progress. Stability, strength and improved function are the first changes we see.
-Avoid anti-inflammatories (Motrin, Advil, Alleve) for a minimum of 1 week before and 2 weeks after the injection.
-Avoid steroid medication (oral or injectable) for 6 weeks before or after the treatment. Both impair the body's healing responses and the early inflammation needed for healing.
-If at all possible, stop your cholesterol-lowering statin medications for 2-4 weeks before and 2-3 months after treatment as they impair stem cell function.
-Consider supplementing with Fisetin, L-carnosine and Blueberry extract to improve stem cell function.
-Vigorous exercise the morning of your treatment has been shown to increase platelet and stem cell numbers in blood and bone marrow.
-Intermittent fasting prior to your procedure can also help mobilize stem cells.
-You may pre-medicate with over the counter acetaminophen 1-2 hours prior to your procedure to help with pain.
-You may pre-medicate with a mild sedative (after signing the consent form at the doctor's office) to help with anxiety. Ask the doctor before hand so this can be prescribed ahead of time.
-Blood thinners are prohibited as bleeding in the bone marrow cannot be well controlled by compression.
Bone Marrow Aspirate (BMA) and Bone Marrow Concentrate (BMC) injections are intended to stimulate your immune system's healing responses.
-As such, please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid high level activity for 3-4 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day
Subchondral (Intra-Osseous) Bone Marrow Concentrate
Subchondral Bone Marrow Concentrate injections involve removing a small portion of a person’s own bone marrow and injecting it into the bone under the cartilage of a joint with osteoarthritis (OA). Injections are ultrasound or fluoroscopically guided into the degenerative bone and activate the body’s natural healing cascade.
Bone marrow contains a variety of cells and blood products including hematopoietic and mesenchymal stem cells, platelets, megakaryocytes and a variety of other blood cells. It also includes a rich supply of growth factors and is a rich source of Interleukin-1 Receptor Antagonist (IL-1Ra or IRAP)
Bone Marrow Concentrate contains many cell lines, including Mesenchymal and Hematopoietic Stem Cells, platelets, megakaryocytes, and others. Mesenchymal stem cells and platelets along with growth factors and Interleukin 1 Receptor Antagonist (IL-1Ra) are known to help stimulate and coordinate the body’s natural healing response. With subchondral injections, they help stimulate healing of the damaged bone and improve the pain and function of the arthritic joint being treated.
Subchondral Bone Marrow injections are a type of therapy intended to help treat more severe osteoarthritis of a joint such as the hip or knee. They are a superior alternative to symptom-control measures such as pain medications and anti-inflammatory injections such as cortisone as they have been shown to slow the progression of knee osteoarthritis while helping with pain and function. In long-term outcomes (15 years) for medial sided knee osteoarthritis, these treatments have performed similarly to a joint replacement. (Hernigou 2020, International Orthopedics- 3 separate articles)
Subchondral Bone Marrow Concentrate (BMC) Injections have been shown to provide very good long-term outcomes in more advanced knee osteoarthritis (OA), with 10-15 year outcomes being essentially equal to total knee replacement in terms of pain and function for medial compartment OA. In fact, 80% of patients treated with subchondral BMAC for medial knee OA did not need knee replacement out to 10-15 years (Hernigou 2020, International Orthopedics- 3 separate articles)
-Avoid anti-inflammatories (NSAIDs) for 2-3 weeks before and after injections.
-Avoid corticosteroids (oral or injected) for a minimum of 6-8 weeks before and after treatment.
-Avoid statins for 2-3 weeks before and 2-3 months after treatment as they downregulate your body's own stem cells
-You may pre-medicate with acetaminophen about 2 hours prior to your appointment.
-Blood thinners are prohibited as bleeding in the bone marrow cannot be well controlled by compression.
-If anxious, the doctor can provide a mild sedative or we can arrange for in-office conscious sedation if preferred.
-For arthritic joints treated with Subchondral BMC injections, we recommend non-weightbearing for a week followed by partial weight-bearing for 3-7 days.
-Physical therapy is strongly advised to restore range of motion and strength. After about 2 weeks, progressive activity is initiated, as advised by your doctor.
On average, patients will only need 1 injection per joint and as per Dr. Hernigou’s studies, the majority of times this treatment will last for many years.
-The treatments may take 4-6 months to see optimal healing.
-Repeat injections can be performed if necessary.
-Many times we recommend Platelet Rich Plasma (PRP) injections either before or after the subchondral injection to help decrease joint inflammation and decrease pain.
-You can expect bruising, swelling and discomfort after the procedure at the harvest site and/or the treatment site.
-You may apply ice or heat to the areas for 15 minutes every hour for the first 48 hours.
-By day 3-5, pain should begin to resolve significantly.
-Rarely, flares can last up to 2 weeks.
-Post injection precautions will be provided by your doctor.
-Impact activity will be restricted for 2-8 weeks. In most cases, your physician will recommend physical therapy to aid in your return to activity.
Unfortunately, most insurance companies do not consider Subchondral Bone Marrow Injections to be medically necessary and therefore do not cover these treatments.
There are a variety of measures that can be used to measure progress. While pain relief is the ultimate goal, it is not the best way to measure early progress. Strength and improved function are the first changes we see.
-Avoid anti-inflammatories (Motrin, Advil, Alleve) for a minimum of 1 week before and 2 weeks after the injection.
-Avoid steroid medication (oral or injectable for 6 weeks before or after the treatment. Both impair the body's healing responses and the early inflammation needed for healing.
-If at all possible, stop your cholesterol-lowering statin medications for 2-4 weeks before and 2-3 months after treatment as they impair stem cell function.
-Consider supplementing with Fisetin, L-carnosine and Blueberry extract to improve stem cell function.
-Vigorous exercise the morning of your treatment has been shown to improve circulating platelet and stem cell numbers in blood and bone marrow.
-Intermittent fasting prior to your procedure can also help mobilize stem cells.
-You may pre-medicate with over the counter acetaminophen 1-2 hours prior to your procedure to help with pain.
-You may pre-medicate with a mild sedative after signing the consent form at the doctor's office to help with anxiety. Ask the doctor before hand so this can be prescribed ahead of time.
-We can arrange for you to have IV conscious sedation with a nurse anesthetist if desired in-office.
-Blood thinners are prohibited as bleeding in the bone marrow cannot be well controlled by compression.
Subhondral I/O Bone Marrow injections are intended to stimulate the immune system's healing response.
-As such, please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid high level activity for 3-4 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day
Shockwave Therapy:
There are 2 kinds of Shockwave Therapy:
1) Radial Shockwave (EPAT)
2) Focused Shockwave (FSW)
Radial Shockwave or Extracorporeal Pulse Activation Therapy (EPAT)
Extracorporeal Pulse Activation Therapy (Radial Shockwave) is a non-invasive treatment that takes advantage of radial shockwaves that cause tissue deformation (mechanotransduction) which leads to improved tissue metabolism, collagen synthesis and neuromodulation. All this leads to improved function, motion and decreased pain.
The technology is based on the idea that pulsed pressure waves stimulate metabolism, enhance blood circulation and thus accelerate the healing process in the tissues treated. Damaged tissue is gradually able to regenerate and heal in most cases.
EPAT has proven success equal to or greater than that of traditional treatment methods (including steroid injections and surgery) in soft tissue injuries, without the risks, complications and lengthy recovery time. It does not require anesthesia, takes a minimal amount of time, and does not require any activity restrictions post-procedure.
EPAT treats both acute and chronic musculoskeletal soft tissue injuries and pain.
The most common conditions studied are chronic tendinopathies such as Plantar Fasciitis, Lateral Epicondylitis (Tennis Elbow), Achilles Tendonitis, and Patellar tendonitis.
Other injuries treated include ligament strains, muscle strains and fascial injuries involving the neck, shoulder, back, upper extremity, lower extremity, foot and ankle and myofascial trigger points.
Yes- avoiding anti-inflammatory medications (such as NSAIDs and coritcosteroids) before and after each treatment is recommended, as these medications impair the body's natural healing abilities we are trying to stimulate with shockwave therapy.
There are NO activity restrictions post-treatment. It is safe and encouraged for patients to continue their physical therapy and home exercise programs during the course of treatment.
Treatment sessions each take between 5-10 minutes per treatment area. Generally, 4 once-weekly treatment sessions are necessary to satisfactorily treat a condition. In some instances, an additional 1-2 treatment sessions may be indicated in order to get maximal functional improvement and pain reduction.
Some patients report relief after only one treatment, but it is much more common to take up to 4 weeks and 3-4 treatments for pain relief to begin.
As with all "regenerative" treatments it takes 3-4 months for the body to go through the natural healing cycle, so pain relief can take up to 3-4 months as a result.
Most studies (and there are many) report 75-80% of patients to have significant pain reduction with a 4-treatment course of therapy.
While pain reduction is our ultimate goal, improvements in strength and function are often the first changes seen and are a good indicator that pain-relief is on the way.
Unfortunately, insurance companies do not yet cover EPAT treatments, despite the wealth of proven benefits in studies across the globe. We have thus created a 4-pack bundled payment option to help reduce the cost per treatment, and also offer individual treatment sessions for a slightly higher per-treatment cost.
EPAT is intended to stimulate your body's immune system healing response and blood flow.
-As such, please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid high level activity for 3-4 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day
Focused Shock Wave (FSW)
Focused Shock Wave (FSW) is a non-invasive treatment that takes advantage of electromagnetically-generated pressure or shock waves that cause tissue deformation (mechanotransduction) which leads to improved tissue metabolism, blood vessel growth, growth factor release, collagen synthesis and nerve pain downregulation. Ultimately, FSW is a completely noninvasive, needle-free Regenerative Treatment.
This game-changing technology utilizes focused electromagnetic pressure waves to stimulate metabolism, enhance angiogenesis (new blood vessel growth), release growth factors and strongly upregulate the healing process in the tissues treated. Damaged soft tissue injuries (tendon, ligament, muscle and even bone/cartilage) are gradually able to regenerate and heal in most cases.
FSW treats both acute and chronic musculoskeletal soft tissue injuries and pain.
The most common conditions studied are chronic tendinopathies such as Plantar Fasciitis, Lateral Epicondylitis (Tennis Elbow), Achilles Tendonitis, and Patellar tendonitis.
Other conditions treated include ligament strains, muscle strains and fascial injuries as well as bone injuries, non-unions and even osteoarthritis.
Unlike EPAT, there are very short-lived activity restrictions post-treatment with FSW.
We advise avoiding heavy lifting and exercise for 2 days post-treatment while soft tissues recover from the treatment. Exercising at 60% of your normal intensity and volume is the recommendation for those first 2 days.
Otherwise, it is safe and encouraged for patients to continue their physical therapy and home exercise programs during the course of treatment.
Treatment sessions each take between 15-30 minutes per treatment area. As with all Regenerative Treatments, the body typically takes 2-4 months to repair a soft tissue injury. This is no different with FSW.
For soft tissue healing of the injury, 6-10 once-weekly treatment sessions are usually necessary to heal tendon/ligament/muscle injuries 80% of the time. We often recommend treating with BOTH FSW and EPAT in combination for better healing.
In some instances, an additional 1-2 treatment sessions may be indicated in order to get maximal functional improvement and pain reduction.
Unfortunately, despite the vast body of clinical evidence demonstrating its proven efficacy in dozens of studies, FSW is still not covered by insurance. We have thus created a 6-pack bundled payment (for the cost of 5 treatments) to help minimize cost while optimizing outcome potential.
As FSW stimulates your body's healing response, blood flow and tissue synthesis, we advise the same precautions as for other Regenerative Treatments.
-Please limit icing to 10-15 minutes per hour; warm heat is better as it stimulates blood flow but may increase pain a bit short-term.
-Avoid NSAIDs such as ibuprofen, naprosyn, meloxicam, diclofenac, aspirin, etc as they stifle the body's healing responses
-Avoid natural anti-inflammatory supplements such as Curcumin/Turmeric, oral CBD and high-dose fish oil/SPM's for 1-2 weeks after FSW
-Avoid high level activity for 2-3 days and instead keep activities that utilize the treated area to a light or moderate level
-Limit alcohol intake to 1 glass per day