Growth and Bioactive Factors: Injections To Accelerate Healing
At The Stone Clinic, an evolution of anabolic therapy has occurred using biologic, regenerative injections. We started with blood injections in the 1990s intuiting that our patients’ blood had all the healing components required. This evolved to isolating the platelets in the blood that release the most important growth factors. These growth factors act to both directly stimulate healing and to recruit stem-derived self-repair cells from the walls of vessels to migrate to the site of injury. Today growth factors of platelets drawn from the patient in the office combined with bioactive factors from amniotic fluid and hyaluronic acid constitute an important part of our injection therapies.
The broad field of anabolic injections focuses on stimulating injured tissues to heal—accelerating healing, shutting down inflammation, limiting scar formation, and recruiting the body’s self-repair cells. At The Stone Clinic, we no longer focus on injecting cells directly. Since the body has billions of stem cells and their derivatives, and since directly injected cells die quickly, it makes more sense to stimulate and recruit the body’s own vast reserves of healing agents.
Currently, injections of biologic agents are incorporated into the treatment of our patients recovering from knee, shoulder, ankle, and spine injuries. Since an arthritic knee is different from an ACL-injured knee or a spine afflicted with disc degeneration, the future will bring customized injections that produce more targeted responses. Meanwhile—as we await the results of further studies—we combine PRP with HA and amniotic fluid to create a broadly stimulating "cocktail." Here is a brief summary of our choices today—with the understanding that we are actively engaged in research to improve and target these injections for the future.
What is PRP
Platelet-rich-plasma is obtained by concentrating a patient’s own blood platelets in a centrifuge, then injecting the concentrated platelets into the site of injury.
Why we use PRP
The platelets have high concentrations of growth factors and cytokines. These stimulate tissue healing, reduce inflammation, and recruit the body’s own stem-cell-derived self-repair cells. The positive is that PRP comes directly from you, the patient. The negative is that PRP platelet and growth factor concentration varies in each person, even by the time of day.
What to expect
When combined with other factors (HA and amniotic fluid) we see relief of pain and inflammation generally peaking at one month and lasting up to one year in arthritic joints and damaged tissues.
Hyaluronic Acid (HA)
What is HA?
Hyaluronic Acid is the natural lubricant of all joints. When injected, it lubricates the joint surfaces, decreasing pain.
Why we use HA
HA is more than a great lubricant—it also acts as a carrier, dispersing injections of growth factors and cytokines around the tissues. When used alone, the beneficial effects of HA included great relief for some arthritic patients, though this usually declined after a short time. Our research study showed, however, that when HA is used in combination with anabolic stimulants (growth factors) the cells of the joints produce more lubricant and the benefit lasts longer.
What to expect
When the injections are combined, the body responds by decreasing inflammation and increasing cell turnover, lubrication, and repair. Pain is relieved over the course of one month and lasts up to one year.
What is Amniotic Fluid?
Amniotic fluid surrounds the fetus during development and provides nutrition and lubrication. It is a potent anti-inflammatory, anti-fibrotic (anti-scarring), anti-microbial, and anabolic (stimulant for cell & tissue formation). It is obtained by volunteer donation at the time of healthy C-Sections.
Why we use amniotic fluid
Amniotic fluid has 2x to 60x times the growth factors and cytokines as PRP. It is a potent addition to the patient’s own healing factors. In our studies, amniotic fluid alone stimulated the joint-lining cells to produce more HA.
What to expect
Orthopaedic issues related to inflammation, arthritis, and injury, as well as spinal issues related to disc tissue degeneration, nerve impingement (where the sheath of the nerve is inflamed by the impingement), facet joint irritations, and SI joint irritation may all respond to these combination biologic injections.
While therapeutic injections are certainly the future of patient care, no injection alone is ever enough. Injuries and arthritis are opportunities to focus on becoming fitter, faster, and stronger than you have been in years. We combine every injection with rehabilitation. Our team will work with you to create a fitness program designed to help you become better than you were before you were injured.
The risk of any joint injection is possible infection or reaction. For each of these preparations the risk is extremely low but not zero. The amniotic fluid is from healthy mothers at C-section fully tested for all known diseases and provided by an approved tissue bank. The Stone Clinic and Stone Research Foundation collaborate to push forward the research and development that can improve the efficacy and document the outcomes of this regenerative therapy.