Image Credit: Boulder Prolotherapy
“Keeping your body healthy is an expression of gratitude to the whole cosmos — the trees, the clouds, everything.” – Thich Nhat Hanh
Authors: Gordon Slater |Tandose Sambo
What Is Regenerative Injection Therapy?
Orthopaedic conditions have a variety of classifications. Within the specialty of foot and ankle conditions, there are various chronic ailments that are identified. The list below is by no means exhaustive, but if you experience painful conditions such as:
| Achilles tendonitis ACL injuries Biceps tendinosis Golfer’s elbow Iliotibial band syndrome | Ligament injuries Osteoarthritis Rotator cuff injuries Sports injuries Tennis elbow |
you will be the ideal candidate for an emerging technology known as regenerative injection therapy (RIT). RIT enables the body to heal itself. As a therapy that involves the injection of natural healing solutions in order to facilitate the natural healing mechanisms within your own body. With age and dietary changes, the body’s ability to regenerate and heal can diminish. Once the treatment is administered via injection therapy, new healthy tissue will then begin to form.
Regenerative Injection Therapy (RIT)
Regenerative Injection Therapy is also known as prolotherapy, and classifies as a minimally invasive injection that helps to stimulate the body to restore itself. The root causes of damaged ligaments and tendons, is as a result of overuse of the joints during activities such as sports. Healing is administered via the injection of an irritant such as dextrose, a numbing agent, and the healing agents which then take the time to heal the wounded site.
Sites that are healed by RIT include those that contain ligaments. Ligaments are structurally like the elastic rubber bands that hold bones together. Ligaments can become weakened or injured, and they may not always heal to their original strength. The changes in the healing of ligaments is attributed to the reduction in blood flow to the ligaments. With restricted blood flow, the healing of torn ligaments can be reduced and the site may not heal completely. The utilisation of prolotherapy is one of the ideal means to restore the sites by factoring in the healing of the nervous system and restoring the integrity of the ligament system.
Tendons are also sites in the body that can be significantly affected by a weakness in their structures. As the tissues that connect muscles to bones, they too can become injured and cause the patient to experience pain due to their nerve rich centres. RIT is a suitable means to improve circulation to the affected tendons, and with the facilitation of a regenerative system the integrity of the tendons can be restored.
Benefits of Regenerative Injection Therapy
The body is designed with natural healing mechanisms that are able to restore it when there’s an indication of an injury. For example, when a tissue is injured, there are chemical signals that are released in the body that will enable the body to begin the healing process. The healing of tissue is one that involves restoration and repair. The body will remove the damaged tissue, and replace it with newer healthy tissue. During the process there is an autoimmune response that results in an inflammation of the site. Inflammation can be a painful process that can cause discomfort to the patient. The orthopaedic specialist will prescribe anti-inflammatories or steroids that will be able to treat the pain of inflammation. In some adverse conditions, the utilisation of anti-inflammatories can cause a suppression of the healing process.
RIT as a treatment, is designed to replicate the normal healing process. With a stimulation of the body’s natural ability to heal, only the enhancement of the body’s healing mechanisms will be enabled.
Benefits of regenerative injection treatment include [1]:
- An increase in movement and functional ability
- Improved muscle strength
- Reduced pain levels
- Possible alternative to prescription medication or surgical procedures
Types of Regenerative Injection Therapy
There are two primary methods that RIT can be administered to patients. These include prolotherapy and platelet rich plasma.
What is prolotherapy?
Prolotherapy, as a regenerative therapy, has existed for over 40 years and is a method that stimulates the body’s natural healing response. As an injection technique, proliferant (growth promoting) and irritant solutions are injected in multiple areas in and around the injured joint or body part to stimulate the body to respond through inflammation, which brings new blood cells, nutrients, and the body’s natural healing response[2].
In some instances, the injections can be painful to the patient, and cause swelling after administration, but the patient must resist the utilisation of anti-inflammatories. The natural healing response is actually induced via the initial inflammation that takes place during regeneration. With time, the pain and swelling will subside as the body restores itself.
The healing mechanisms in our bodies are facilitated by our blood, and the agents that are infused in the bloodstream. PRP is a healing therapy that is able to utilise a patient’s blood and transfuse it to an injured site in order to stimulate the regenerative process. Blood plasma can be extracted and concentrated via a centrifugal process. The advantages of concentrating plasma is that it has the ability to enhance healing via an enriched presence of growth factors. The growth factors, as specialty proteins, have the ability to improve the recovery and healing of wound sites.
PLATELET RICH PLASMA (PRP):
How does the Injection of PRP into the body work?
Platelet rich plasma (PRP) is a tissue graft administered to the body via a transfusion methodology called ultrasound-guided injection technology. The tissue graft is highly concentrated, and contains up to six times the concentration of platelets and growth factors compared to the natural blood stream. With an enhancement of these critical healing components, tissue repair and regeneration are facilitated.
The treatment process with this technology involves 2-3 injections every 6-8 weeks. The extent of treatment is individual to persons. Many people do experience improvements after two treatments with PRP. With all treatments, the enhancement of the treatment can be achieved via the utilization of optimal nutrition and appropriate physical exercise.
The Regenerative Injection Therapy Process
The regenerative injection therapy process is usually administered via a specialist such as a foot and ankle orthopaedic surgeon. The doctor will apply a local anaesthetic in order to numb the site, prior to the administration of the injection.
Once the anaesthetic has worn off, as a patient, you will experience small amounts of pain or soreness. Minimise strenuous activity immediately during your treatment in order to ensure that you are allowing the body to regenerate in an undisturbed state. You may experience slight discomfort for up to five days after the treatment. Where possible, apply heat or ice, and utilise a mild painkiller such as acetaminophen.
During the recovery process, your doctor will formulate an appropriate pain management and healing plan that will enable you to ease into your normal routine, or even restore physical activity. Take good care during the healing process, as the absence of pain is not an indication that the tissues or ligaments have completely healed. Incrementally increase your workouts, and after the five week mark, you may be allowed to return to your normal exercise routine, according to your doctor’s permission.
ADVANCES IN REGENERATIVE INJECTION THERAPY
Osteoarthritis is one of the most prevalent orthopaedic conditions in adults. It is generally induced by the ageing process, however with the advent of sporting activities that cause stresses on the joints, the increased rates of joint degradation is often observed in athletes of all ages. The inflammation, pain and discomfort that the arthritic condition induces is such that many patients seek medical care in order to improve their quality of life.
The utilisation of a scaled application of intra-articular injected adipose-derived stromal cells is a therapy that was applied to patients with knee osteoarthritis. Phase I Clinical trials conducted in France and Germany with a predominant focus on safety, pain and function. The patients of the clinical trial showed significant improvement in their arthritis. With the anticipated biological responses that occur subsequent to local injection, there was an intermittent period of pain and swelling, followed by the healing mechanisms of the body. Differing dosages of the cells were administered to the patients, and it was identified that low dosages of the stromal cells actually seemed to have higher impacts on the health improvement of the patient. The introduction of intra-articular injections of the stromal cells has proven to be effective. To gain further knowledge of the mechanism of action, further clinical trials are being conducted in order to determine the clinical and structural efficacy of the stromal cells in the body.
Leukocyte Impact
With various elements present in the platelet-rich-plasma, one of the key components that is studied is the presence of leukocytes in the body. The range of leukocyte presence in the body is from leukocyte-rich to leucocyte poor. With these parameters and their relevant quantifications, the human body’s reactions to healing were monitored. Medical studies have indicated that the advantages of each can be applied to the treatment of lateral epicondylitis and osteoarthritis of the knee. The administration of leukocyte rich plasma benefits the former, while leukocyte poor plasma benefits the treatment of osteoarthritis. Further studies remain to identify the full effectiveness of the leukocyte infusions as some conditions such as patellar tendinopathy, plantar fasciitis, for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains have proven to have alternate treatment effects.
Overall, osteoarthritis in some instances is the perfect candidate for regenerative injection therapy. The utilisation of local treatment via regenerative injection therapy has proven beneficial for the treatment of osteoarthritis, with a key focus on the knee. The most stable results have been generated from studies of this location. As a minimally invasive procedure, the regeneration of articular cartilage via this methodology remains very promising.
References:
- UPMC: https://www.upmc.com/services/rehab/physical-medicine-rehab/treatments/regenerative-injection-therapy
- RiodanClinic: https://riordanclinic.org/what-we-do/regenerative-injection-therapy/
- What to Expect After RIT: https://www.semisportmed.com/what-to-expect-after-regenerative-injection-therapy/
- Adipose Mesenchymal Stromal Cell-Based Therapy for Severe Osteoarthritis of the Knee: A Phase I Dose-Escalation Trial: https://pubmed.ncbi.nlm.nih.gov/27217345/
- Current Clinical Recommendations for Use of Platelet-Rich Plasma: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220007/
- The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757490/
- Intra-articular Treatment of Knee Osteoarthritis: from Anti-inflammatories to Products of Regenerative Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932822/
- Perspective on Intra-articular Injection Cell Therapy for Osteoarthritis Treatment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675827/
- Journal of Orthopaedics and Traumatology: https://jorthoptraumatol.springeropen.com/articles/10.1186/s10195-022-00628-9
