What is stem cell therapy?

As we age, we are in a continuous battle between activity-induced stress on our musculoskeletal system and our ability to recover. During this cycle of tissue breakdown and repair, our body responds to repetitive stress (injury) by using specialized cells called mesenchymal stem cells (MSC) to make new tissue to help in the recovery process. During our lifetime we use up millions of these cells that are held in reserve throughout our body. Although we have an abundant supply of these special stem cells, the aging process seems to reduce their ability to “turn on” and repair damaged tissue. With continued stress we develop chronic pain and loss of function. Stem cell therapy is the process of injecting high concentrations of these special cells into tendons, ligaments, joints, nerves, and muscles to help your body repair itself.

What are the potential benefits of regenerative therapy using MSC?

Mesenchymal stem cells (MSC) can help repair and regenerate injured or damaged tissue such as cartilage, ligaments, and tendons. They also help treat degenerative diseases like osteoarthritis, delaying or avoiding the need for joint replacement surgery. Stem cell therapy decreases pain and improves function. The procedure is done in our office under local anesthesia, eliminating the risks associated with surgery or general anesthesia.

How is regenerative therapy performed?

We can obtain stem cells from one of two areas of your body: fat (adipose tissue) or bone marrow. Adipose-derived stem cells (ADSC) are collected from fat via a lipo-aspiration technique (NOT liposuction) while bone marrow aspirated cells (BMAC) are collected from your hip crest bone. ADSCs have more regenerative properties to form new ligaments, cartilage, and bone. This technique is best utilized to help fill tissue that has larger defects and/or torn tissue. BMACs have a superior ability to help those patients that need enhanced oxygen and nutrient delivery to damaged tissues. Your doctor will determine which method is appropriate for your particular diagnosis. If we use BMAC, we will spin down the sample in a centrifuge to concentrate the cells. Then, using ultrasound guidance, we inject the concentrated cells directly into the area that needs healing. If we use ADSC, we do not manipulate the sample. We simply inject the cells into the targeted area using ultrasound guidance.

What are the risks and side effects of regenerative therapy?

These procedures are considered very safe. You may experience mild pain and soreness during and after the procedure. Because your own blood and bone marrow or fat is used, there is no chance of rejection by your body. This procedure is done under sterile conditions and the risk of infection is low. While the treatment is typically mildly painful we use oral medications and local anesthetics to help reduce your pain during the procedure. You may notice some pain and discomfort after the procedure. This is more frequent after bone marrow aspiration. Most patients find over-the-counter medications, ice, and rest sufficient to help with the pain.

Are there any ethical issues with adult regenerative therapy?

No, because adult cells are from YOU. They reside in your bone marrow and fat and they exist in large quantities. We use your own stem cells and do NOT store or alter them in any way.

What is PRP therapy and why is it used with regenerative therapy?

Platelet-rich plasma (PRP) therapy is a type of regenerative medicine used to speed tissue recovery. Platelet-rich plasma (PRP) is found in your own blood. Platelets carry several important growth factors and other proteins that are activated and released when they form a clot. These growth factors recruit mesenchymal stem cells (MSC) to the area to initiate the healing cascade. MSCs are pleuripotent, meaning that they can change into whatever cell type is needed to repair the injury. These cells can help regenerate tendons, muscle, cartilage, bone, and nerve cells. Injecting PRP releases a powerful dose of growth factors to accelerate and enhance tissue repair and healing properties of the stem cells. By using PRP with stem cell therapy, we increase the wound healing and reparative potential to your damaged tissue.

How is PRP therapy performed?

PRP is obtained with a simple and safe blood draw. We collect a sample of your blood, about 30 to 50cc, or roughly 2-3 tablespoons, and spin it down in a centrifuge to separate the plasma, which contains a high concentration of platelets. The PRP is then ready to be injected or mixed with bone marrow or fat stem cells for treatment to relieve your pain and heal arthritis and injuries. We use ultrasound guidance to precisely place the concentrated platelets or PRP-stem cell mixture into the injured tissue to enhance the healing process at the site.

What does PRP therapy treat?

We have successfully used PRP therapy to help heal many different types of musculoskeletal injuries:

• Tendinopathies: Partial and degenerative tears to tendons seen in injuries like tennis elbow and golfer’s elbow, plantar fasciosis, patella tendinosis, partial rotator cuff tears, and Achilles tendon tears
• Muscle and ligament conditions: Muscle tears such as hamstring tears or chronic ligament sprains like medial collateral ligament tear (knees) and ankle ligament tears

What are the advantages of regenerative therapy?

• Safety: Numerous studies have shown that PRP and stem cell therapy are safe alternatives to surgery, with no long-term complications.
• Autologous: The biologics come from you and are injected back into you. There is no chance of a reaction to your own blood. The procedure is done all in one visit.
• Regeneration: New tissue is formed without the risk of scarring from surgery.
• Faster Recovery:Compared to surgery, PRP and stem cell therapy involve less pain, early return to motion, and less muscle atrophy.
• Less Expensive: No anesthesia, no operating room expense, no facility fee. The procedures are done here in our office and take about 30 minutes to an hour to perform. The only downside is that many insurance companies deny coverage of these procedures, as they are considered to be experimental. Some Montana workers’ compensation do pay for it along with some other commercial carriers. If you have a large deductible or health savings account, the expense is considerably less than surgery.
• No preclusion of surgery: If the procedure failed to work, you can still consider surgical options. Studies have indicated that regenerative therapy reduces the need for surgery about 70-80% of the time.
• Effective: Numerous laboratory and animal studies have shown biologics work! Human trials are ongoing. Ask around…we have already helped many people get back to sport, work, or play.

How long has PICSM been doing these types of procedures?

At Performance Injury Care & Sports Medicine (PICSM) we are a leader in using regenerative therapy. We have years of experience using ultrasound-guided injections to help repair chronic and acute injuries. Dr. Steele has been using platelet-rich plasma (PRP) therapy since 2008 and we are continually updating our techniques to better help you get back on track with a healthy lifestyle.

What sets PICSM apart from other stem cell clinics?

Many stem cell clinics are popping up all over the US and are advertising here in Montana. Many of them are using marketing and very little science or expertise in using stem cell therapy. Here at PICSM, we evaluate you to determine why you have pain. We utilize X-ray, MRI, and diagnostic ultrasound to determine what led to the tissue breakdown in the first place. We do all of our injections with ultrasound guidance to ensure proper needle placement inside your body. We pride ourselves in the advanced imaging that we offer here in Helena. We will not just inject your injured area and wave goodbye with a sheet of instructions. We typically see you back for 4 follow-up visits to discuss range of motion, strengthening, and other exercises, along with checking your progress. During your follow-up visits we may use low light laser therapy over the treatment site to enhance your recovery. We believe that the newly formed tissue is very fragile and needs to be protected with bracing and/or crutches to allow for complete regeneration and healing. By coordinating your care with an accurate diagnosis, ultrasound guidance for correct placement of the stem cells, protection of the newly formed tissue with proper bracing, and follow-up visits to help with strengthening and motion of the tissue, we have superior outcomes. If you do not try and restore normal movement, function, and balance to the injured area, your pain will return.

How do I know if I’m a candidate for PRP or stem cell therapy?

Consult with Dr. Steele to see if you have any type of joint or tendon pain that hasn’t resolved with conservative therapy. After a complete medical evaluation, Dr. Steele will determine which one of the biological regenerative procedures will best help you recover. Stem cell therapy works best for moderate arthritis, joint pain, or degenerative tendon or ligament disease. Stem cell therapy helps YOU fix you.

How do I know if PRP and stem cells are injected into the correct place?

At our clinic we know that the success of any treatment relies on having the correct diagnosis and an accurate delivery system to the diseased tissue. By using ultrasound imaging, we can see exactly where the needle is being placed. By visualizing the correct site of injury, we can provide an accurate and effective treatment that helps you to get back to work, sport, or play. All of our regenerative procedures are done with advanced musculoskeletal ultrasound imaging. We not only utilize the best ultrasound imaging equipment in Montana, we are also the most highly trained diagnostic musculoskeletal clinic in Montana. Dr. Phillip M. Steele and Abbey M. Barnhart, PA-C are both Registered in Musculoskeletal® (RMSK®) Ultrasound certified by the Alliance for Physician Certification & Advancement. Dr. Steele is recognized regionally as well as nationally through his many lectures and faculty positions in advanced ultrasound courses. He works as an advisor to RMSK helping to write the training exam and works with other leaders in the field of diagnostic ultrasound imaging to promote the diagnosis and treatment of nerve entrapment injuries.

What do I need to do to prepare for my stem cell or PRP treatment?

We recommend that you discontinue nonsteroidal anti-inflammatory medications such as ibuprofen for 2-3 weeks before the procedure and 4-6 weeks afterwards. You should stop using all tobacco products for 2 weeks before the treatment date and for 6 weeks after. When we are treating a joint for osteoarthritis we may ask you to come to the clinic about one week before the procedure to receive a joint injection with 5% dextrose. This “primes the pump” before your procedure, acting to rev up your immune system’s response to the stem cell procedure. In some cases we will fit you with a brace and/or crutches before your procedure date. It is important to not damage newly formed tissue so we typically fit you for these items prior to your procedure.

Will I need to take time off from work? When can I go back to my regular activities?

The procedure is performed in our office and only takes 30 minutes to an hour to complete. Patients are usually sore during the first couple days after the injection. Depending on the work you do, you may be able to return to work the next day, but we recommend taking at least one day from work to allow you to take it easy. Depending upon your lifestyle and the type of procedure you have, you may return to work with some bracing to prevent re-injury.

How soon will I notice improvement?

Stem cell treatments stimulate the growth and repair of connective tissues but require time to complete the healing process. Typically, patients notice improvement after 2 weeks and continue to notice improvement for months after the procedure. One study on ankles showed continued improvement up to 22 months.

I hate needles and am nervous about having any procedures.

We can prescribe an oral anti-anxiety medicine and pain medicines that you take prior to the procedure. During the procedure, we use a local anesthetic. Most of our patients feel minimal discomfort. Feel free to bring your favorite music device and ear buds!

Does insurance cover PRP and stem cell therapy?

PRP and stem cell treatments are considered an experimental procedure by most commercial insurance plans. While workers’ compensation may authorize these procedures in Montana, most insurance companies will not pay for PRP or stem cell treatments. You may use your health savings account for payment.