Integrative Osteopathic Regenerative Medicine

Regenerative Medicine is the use of agents that contain or stimulate the production of growth factors and stem cells that are part of the body’s innate healing mechanism. The field has matured over the past 20 years and has recently gained more recognition due to high profile athletes utilizing regenerative medicine procedures to accelerate healing.

In 2016, Steph Curry suffered an MCL injury in the middle of the Western conference finals. The very next day, he and his doctors decided to utilize platelet rich plasma to accelerate his recovery. He was back out on the court two weeks later and did not need to miss any games for the rest of the playoffs.

In the medical community, traditional establishment physicians have been slow to embrace regenerative medicine due to lack of evidence as well as lack of training in the technique. A meta-analysis published in June 2016 in the American Journal of Sports Medicine looked at 18 studies testing platelet rich plasma, which showed a significant benefit for the treatment of tendon injuries. An important point of this study is the content of the injection was Leukocyte Rich Platelet Rich Plasma, which contains higher levels of growth factors than Leukocyte Poor Platelet Rich Plasma.

The technique of assessing and injecting is equally as important as the content of the injection, especially when treating more complex structures like the hip, shoulder, knee, low back and neck. Most conventional sports medicine and pain management physicians have been trained to inject steroids, which often involves a single injection placed into the joint or around a nerve.

In contrast, an Osteopathic approach to Regenerative Medicine involves assessing the biomechanical forces that have caused the pain generator(s). As an Osteopath, assessing posture, gait, and structural alignment all play into what can cause something as simple as a tendon injury. Osteopathic Manipulative Medicine is a technique that utilizes knowledge of the biomechanics of the musculoskeletal system to realign vertebra, ribs, hips, shoulders as well as more subtle inter-osseus strains and craniosacral restrictions. Many times part of the reason why a muscle won’t fire or is overactive is that it is stuck short or long due to misalignment of a bone which needs to be brought back into its proper position through the correct utilization of manual medicine techniques.

As a Prolotherapist, assessing for ligamentous laxity of the affected joint and related joints is an important part of looking for joint instability that can cause arthritis and tendon injury. Ultrasonography also plays an important role because after assessing the biomechanics of muscle imbalance, postural alignment and ligamentous laxity, we can then assess those structures under ultrasound to get a more precise diagnosis of the location and degree of the injury.

The administration of regenerative agents, be it concentrated Dextrose, Platelet Rich Plasma, Amniotic Membrane Derived Growth Factor, Adipose or Bone Marrow derived Stem Cells, should be Ultrasound or Fluoroscopically guided to ensure the correct placement of the solution. Ultrasound also allows for monitoring the progress of healing during the weeks after the injection so the correct level of physical therapy and neuromuscular reconditioning can take place at the right stage of healing.

Knowledge of the proper functional exercises to train the body to work together as a whole is as important as any of the above steps. The rehabilitation process is often different after a regenerative injection than it would be after attempting to treat the injury with physical therapy from the outset or after surgery. Depending on the extent of the original injury, type of regenerative agent used, location of the injections and stage of healing, the physical therapy program will need to be modified and tailored to the patient. This is where a combination of Osteopathic and Regenerative Medicine principles are necessary to move back from the state of injury to health and wellness.

Lastly, and sometimes most importantly, systemic conditions like autoimmune disease, digestive imbalances, poor sleep, hormone and nutrient deficiencies, can significantly affect the body’s innate healing capacity. Addressing these underlying physiologic conditions requires an intimate knowledge of both Conventional Internal Medicine and Functional Medicine. Knowing the lab tests and pros and cons of conventional treatments allows for fully integrated care. Functional medicine is about looking deeper at the roots of our health so we can optimize the system in which disease arises. I often use the metaphor of tending to a garden. We can identify weeds and uproot them or spray them with a weed killer, which helps to manage symptoms, but looking at the soil and conditions in which those weeds are growing allows us to address the underlying cause and prevent the need for management of these symptoms.

Regenerative Medicine practiced in isolation from the larger milieu of Integrative and Osteopathic Medicine can work in simple cases and may be all that is required. The correct placement of a high quality regenerative agent into the pain generator may be all that is required for healing up the problem that brings a patient to the doctor. Even in these straight forward success cases, by not addressing the deeper roots, the problem may return in the future or show up elsewhere. In more complex cases, looking deeper is necessary and can make the difference between a successful outcome and a failure of Regenerative Medicine.

As the popularity of the field continues to grow and more physicians come on board, the need to further clarify the correct method of evaluation, treatment and rehabilitation will become more apparent. Even the current Regenerative Medicine speciality clinics are often dressed up pain management doctors applying principles that applied to the injection of steroids. Integrative Osteopathic Regenerative Medicine is about knowing how the body is put together and how to rebuild it. Applying these principles requires knowledge of biomechanics, manual medicine, musculoskeletal ultrasonography, orthopedic examination and functional rehabilitation as well as Integrative and Functional Medicine.

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