PRP is the abbreviation used for Platelet-Rich Plasma. This product is obtained by spinning down your own blood to get a rich concentration of platelets. Platelets are not only involved the clotting system, but also involved in the repair of the injured area. Once the platelets have migrated to the injured area they release from their alpha-granules a high number of different growth factors and a high concentration of chemotactic factors. The different growth factors prepare the environment in the injured area by causing angiogenesis (increasing the number of small blood vessels to the injured area—this allows the better transport of nutrients in and waste products out of the injured area); and proliferation of cells into tissue(inducing growth in the injured area). The chemotactic factors attract stem cells from other areas of the body, which are then induced by the growth factors to become the needed cell to lay down healthy, new tendon, cartilage or ligaments.
At Pain Care Boise we use your own bone marrow adult stem cells. We harvest your own stem cells with a simple procedure using x-ray guidance from your iliac crest/hip bone. Adult stem cells are oftentimes called mesenchymal stem cells or MSC’s. MSC’s are progenitor cells, meaning they are capable of differentiating into chondrocytes, which can become cartilage; tenocytes, which can become tendon; osteocytes, which can become bone; or myoblasts, which can become muscle. What the MSC’s become is highly dependent upon what cell it is living next to or what cell it is placed next to. In the end the stem cells are the building blocks to repair or replace the defect in the injured area. In addition stem cells secrete many factors to promote growth, angiogenesis (form new blood vessels), reduce inflammation and help prevent rejection (immunosuppression).
PRP provides the correct environment to allow healing to occur by releasing growth factors. Although PRP injections do not contain actual stem cells, the injected platelets release chemotactic factors which attract stem cells to the injured area. In a Stem Cell injection, we directly place stem cells harvested from your body- which serve as the actual building blocks of the injured tissue.
Oftentimes this is based on the present studies or research available versus also the somewhat more significant cost of stem cell therapy over PRP therapy. PRP has shown significant results for ‘partial’ tendon and ligament tears or tears of the meniscus in the knee, as well as for degenerative disc disease of the spine. Whereas stem cell injections are more often used for osteoarthritis of the large joints (shoulders, hips, knees) as well as ‘full-thickness’ tears of tendons (e.g. rotator cuff) and ligaments(e.g. elbow-collateral ligament or knee-anterior cruciate ligament).
I ski approximately 60 days/season in Sun Valley, ID and McCall, ID and have developed knee pain. Am I a candidate for PRP (Platelet-Rich Plasma)?
You may be a good candidate for Regenerative Medicine, either PRP or Stem Cell. Stem cells procedures are done primarily for osteoarthritis of the larger joints-knees, hips, shoulders. Whereas PRP is more typically done for a partial tear or sprain of tendon/ligaments. However, PRP can also be done for osteoarthritis (and degenerative discs of the spine).
Being Board-Certified in Pain Medicine, Dr. Binegar has always believed in determining the etiology or cause of your pain, prior to treating it. Following a thorough evaluation and examination further diagnostic studies such as x-rays, MRI or CT may be done. Dr. Binegar is the only pain physician in Idaho certified in Musculoskeletal Ultrasound, which not only allows him to make more accurate diagnoses, but also more precisely place PRP or Stem Cells to the damaged area. Dr. Binegar is also Board-Certified in Anesthesiology, an obvious advantage to making your procedure more comfortable and safer.
All procedures can be done with precisely placed local anesthetic/numbing medicine with ultrasound guidance. Typically this is the most painful part, but well tolerated by most. We are all wired differently and some patients request to receive sedation, please feel free to discuss this with Dr. Binegar. Regenerative medicine injection techniques use the body’s own inflammatory/healing response, so it is not uncommon to experience increased pain during the first 2-5 days post-procedure. You may also require a brace and/or a crutch for the first few days to a week. We also prescribe pain medications during this time period.
Unfortunately, the amniotic products, the freeze-dried powder or the fluid do NOT contain viable stem cells. This is a myth (or lie). If you are told this, ask to see where in the package insert it states this. (Companies have their representatives/doctors market this product as containing stem cells, but are very careful not to have this printed anywhere.) Even in a fresh sample of amniotic fluid one will find only maybe 10,000 cells/milliliter. Then any processing or freeze-drying and the thawing kills any remaining living cells. In fact independent labs have tested and found no viable cells (i.e. no live cells) within these highly marketed amniotic products.
This really depends on the significance of the injury. Most commonly, we recommend resting during the first week with bracing during the first few days, followed by gentle range of motion and intermittent bracing. During week 2 you should continue with gentle range of motion and begin doing isometric exercises twice a day- Dr. Binegar can recommend these, based on your injury location. By week 3, you will start formal physical therapy (typically with band exercises), advancing as tolerated to weight loading, light weights, and sport specific training.
The diagnosis is based on history, tenderness over the SI joint, and exclusion of other diagnoses. One needs to evaluate rheumatological disorders, most commonly ankylosing spondylitis. There are no good physical exam tests, laboratory tests, and or radiographic tests for SI diagnosis. However, if there is evidence noted on plain film x-rays, bone scans and/or MRI, it is felt to be a very specific diagnosis. Treatment is typically with anti- inflammatory medication, physical therapy, steroid injections either into the SI ligaments or the SI joint itself, chiropractic adjustments, and rarely fusion of the SI joint. Some will do radiofrequency procedures attempting to deinnervate the SI joint.