How Your Plasma or Stem Cells Can Help Ease Joint Pain
If you suffer from joint pain, you know how hard it can be to perform everyday tasks, much less doing the activities you enjoy. If you have exhausted every conservative treatment option available to you, surgery may seem like your only option – but now there is a new, natural form of treatment that can help if you’re not ready for surgery.
Steven Singleton, M.D., a Texas Health Physicians Group orthopedic surgeon and sports medicine physician on the medical staff at Fort Worth Orthopedics – Southwest, and his colleagues strive to stay at the forefront of advances in medicine to offer patients new, progressive treatment options, like injections using an individual’s own cells to promote repair and healing. These injections are called Platelet-Rich Plasma (PRP) and Bone Marrow Aspirate Concentrate™ (BMAC).
“We now have treatments available to help people with musculoskeletal injuries or arthritis get better without using artificial substances like steroids. In the past 15 to 20 years, we’ve learned that steroids, and other medications like Marcaine and lidocaine, can all be harmful to cartilage in the joint when given in excess,” Singleton says. “Twenty years ago, and certainly thirty or forty years ago, people might repeatedly get injections of steroids or Marcaine and while they help numb the joint and reduce inflammation, we now know they led to further cartilage deterioration and worsening of the problem.
“We now have available biologic treatments like PRP or bone marrow concentrate injections, and what those injections do is to provide a concentrated growth factor solution, and these growth factors decrease inflammation and provide a better healing environment for joints that have been injured or have arthritis.”
What is Platelet-Rich Plasma (PRP) or Bone Marrow Aspirate Concentrate™ (BMAC)?
Human blood is composed of four main components—red blood cells, white blood cells, plasma, and platelets. Over the years, research has shown that platelets release healing proteins that stimulate cellular growth. These proteins are aptly called “growth factors.”
PRP injections are prepared by first drawing a patient’s blood, then spinning it at a high speed in a centrifuge to get a concentrated solution. That solution is then injected into the affected joint area to provoke an inflammatory response.
BMAC comes from your own bone marrow, which is an excellent source for the cells and growth factors that are responsible for healing and tissue regeneration.
BMAC injections are prepared by first taking bone marrow from a patient’s pelvic bone using a needle and syringe. This process is called bone marrow aspiration. The patient is given a local anesthetic at the injection site and may also be given a sedative, if there is some anxiety prior to the procedure. Similar to PRP, the bone marrow is then placed in a centrifuge to separate the cells and a liquid is produced that has a concentration of stem cells and other growth factors. The concentrate is then injected into the affected area, whether that be a joint, muscle or tendon.
Both therapies are performed in-office as an outpatient procedure.
Benefits and Limitations of Plasma and Stem Cell Therapy
Both injections are designed to activate growth factors and stem cells to help repair damaged tissue, and since each injection is created with blood or bone marrow straight from your own body, they typically carry fewer risks than traditional injections.
“When they’ve been compared to steroid injections, there’s a lower risk of infection because all these things are natural,” says Singleton. “And because they’re coming from you, there’s no allergic response. I’ve been doing PRP since 2008 and I’ve never had an infection. I’ve been doing BMAC since 2012—no infection.”
PRP therapy has also been shown to promote a healing response in tissues and decrease inflammation in joints, potentially stimulating the formation of new cartilage and increasing the production of natural lubricating fluid in the joint, which eases joint friction that causes pain.
BMAC stem cell therapy has been shown to benefit people with severe arthritis, with younger patients who suffer from mild osteoarthritis or cartilage damage having the most treatment success. BMAC stem cell therapy can also be highly effective in aiding the body in its own recovery from a muscle, tendon, ligament or cartilage injury.
Similar to steroid injections, PRP and BMAC injections can be given in a series depending on the severity of arthritis or injury.
“If we take knee arthritis, for example, with PRP injections often one injection can be helpful, but a series of injections can be even more helpful,” Singleton explains. “Typically, I would do three injections and separate them out between ten days and three weeks. With BMAC, these injections work the same way except I think BMAC is even more effective than PRP, so for the same level of arthritis it may take two or three PRP injections to provide good relief and just one BMAC.”
That being said, Singleton adds that even though a patient may want to jump straight to a BMAC injection, many times finances become the deciding factor for what route a patient takes, since insurance coverage ranges from full to minimal to no coverage of these still relatively new treatments.
“Usually when I talk to a patient about how to proceed, and we’ll have patients who will come to our office who have already had a steroid shot or two with some relief or not much relief, we talk about beginning with a joint fluid or hyaluronic acid injection because sometimes that’s still covered by insurance,” he explains. “If they’ve already had that and there’s no relief, or they’re interested in just doing something natural, we’ll talk to them about PRP and then BMAC, because each of those becomes increasingly expensive.”
Who is an Ideal Candidate and What Happens Post-Injection?
PRP and BMAC injections can be used for those suffering from arthritis, but can also be used due to an injury of a muscle, tendon, ligament or cartilage. But Singleton adds that if a patient’s arthritis has progressed to bone-on-bone or the shape of the joint has changed, biologic treatments may not be effective.
“The patient who is in their 50s or 60s and in relatively good or great physical shape but has arthritis and hurts, and is not ready for a total knee replacement and doesn’t necessarily have bone on bone arthritis everywhere in the joint—that’s the ideal person,” Singleton says. “If [the arthritis] is limited or moderate, [the injections] can be very effective. If [arthritis] is all over the joint and the shape of the joint has changed, so that a person might not have a normal range of motion, that’s not the ideal patient.”
Singleton says treatment doesn’t stop at the injection; many patients enter into physical therapy to help increase mobility and then strengthen surrounding muscles.
“In general, I recommend a patient get in with a physical therapist for joint mobilization, stretching and then learning a strengthening program,” he says. “They work on their range of motion of their hip or knee, whatever joint has been injected, but they don’t load it too much. By avoiding loading, like weight lifting and running for the first four to six weeks following the shot, that allows [the injection] to really take effect and work better.”
If you are one of the approximately 50 million Americans suffering from arthritis, you know that the pain, stiffness and swelling it brings can keep you from being strong and active. If you’re hesitant to undergo surgery or if you’re looking for an alternative to traditional methods, PRP and BMAC injections could be an appropriate course of treatment.
“It’s a lot cheaper and easier than having your knee replaced or some major surgery,” Singleton adds. “That’s one advantage, and the other advantage is you can potentially repeat these things an unlimited number of times. You are less likely to have the same damaging effects that steroids do in the joint or outside the joint.”
As with any new treatment plan, it is recommended that you speak with your general practitioner to discuss if PRP or BMAC injections are an appropriate course of treatment and to assess any potential side effects or interactions.
Interested in platelet or cell therapy for relief of arthritis? Learn more about Steven Singleton, M.D., his colleagues, and the specialized orthopedic and sports medicine care they provide by visiting FortWorthOrthopedics.com.