The hurt locker

From stem cells to PRP, we dissect the most cutting-edge sports injury treatments.

In the world of sports injuries, operating rooms are so yesterday. Who has the time for a hospital stay and that kind of R&R anyway? Certainly not NFL Quarterback Peyton Manning, who made headlines this year for visiting a stem cell treatment center in Europe to address the season-ending nerve issues in his neck. But you don’t necessarily need a passport to save yourself from going under the knife. Increasingly, docs in the US are exploring alternative — albeit controversial — methods to heal.

An injury is often a weakness — and in such cases, repairing that injury means nothing more than strengthening the weakened area. Often the body, in all its glory, is able to heal itself through a natural inflammatory response and generation of scar tissue. But sometimes (whether because that natural process is disrupted or the injury is too severe) the body can’t seem to self-soothe and needs some assistance.

With significant ligament or tendon tears and sprains, that assistance commonly comes in the form of surgery. But lately, that thinking has shifted. Instead of stepping in and manhandling the injury, why not simply help the body repair itself by enhancing the natural healing process?

This is the heart of the stem cell philosophy. During the procedure, a patient’s own blood, bone marrow and/or fat is extracted and manipulated in a lab, then re-injected into the ailing area. The hope is that the manipulated cells will turn into the type of cells you’ll need to rebuild your tendon, ligament or the like. (Research is ongoing in this area, read about the latest breakthrough). It’s simply an amplification of your body's own natural repair efforts.

The most controversial move in the stem cell game regards the amount of manipulation those extracted cells undergo. The top player, a clinic called Regenerative Sciences, was slapped with an injunction from the FDA in 2010 and forced to take its more "extreme" practices offshore to the Cayman Islands. (Certain procedures can still legally be completed at their original Broomfield, Colorado post — though it will cost you.)

"We’re only allowed to go so far as to manipulate our own existing cells. In this country, we cannot legally clone them," says Alexander Kulick, MD, an integrative medicine specialist who practices alternative sports injury treatments in his New York City office and closely follows the stem cell debate. "But it’s the cloning that gives you a much richer harvest and is reportedly much more effective."

But before you book your ticket or surrender your bone marrow: more commonly practiced sports injury treatments are becoming increasingly available on an exam table near you. Prolotherapy and PRP, two relatively unknown treatments that have gained traction in the past five years, urge the body to repair itself using less controversial methods — although the results are mostly anecdotal at this time.

"I consider myself a fairly open-minded physician, but at some point I think you really need to see the science in terms of both alternative treatments and emerging technologies," says Nick DiNubile, MD, an orthopaedic surgeon specializing in sports medicine and author of the bestselling Framework book series, "and the research isn't there yet."

The first, prolotherapy, is most commonly used for tendon and ligament repair. Dextrose (a simple sugar solution) is injected directly into the point at which the tendon or ligament connects to the bone (since that is assumed to be the site of greatest weakness), causing the area to inflame. Theoretically, this causes an increase in the amount of blood flow and nutrients to the area, stimulating the tissue to essentially repair itself.

"For some, prolotherapy can be effective, but the research isn’t really there regarding the number of injections necessary," says Dr. Kulick, who practices the treatment in his New York City office, "but in my experience, four to six sessions is usually the average."

And the lack-of-lab-time problem surfaces here again: "Success with prolotherapy has only been anecdotal at best thus far," Dr. DiNubile says, "and although detrimental effects have not been documented, there is always some risk associated with any invasive treatment."

The second, PRP (short for Platelet Rich Plasma), is most frequently used for soft tissue injuries (such as tendonitis, muscle sprains and tears), joint issues (such as rotator cuff and meniscus problems) and various ligament injuries. A small amount of blood is taken from the patient’s arm, spun in a centrifuge to increase the concentration of blood platelets, then injected back into the injured area. As this theory goes, the mixture accelerates tissue repair by promoting the development of new blood vessels and sending signals to the body to call naturally occurring stem cells to the site to help heal.

"Again, here, the precise number of treatments is unknown, but it usually hovers somewhere between one and three sessions," Dr. Kulick says. "I've seen some docs insist you commit to six sessions upfront. I'd be wary of that."

"I've personally seen more success with PRP over prolotherapy, and there's been more scientific data to support PRP, but again, more research is needed," Dr. DiNubile says. PRP's biggest advertisement came in 2009 when Pittsburgh Steeler Hines Ward's torn MCL was healed by the treatment just in time for the Super Bowl — not a bad billboard. But again, anecdotal.

In both protocols, the whole idea is to literally add insult to injury. "Prolotherapy and PRP purposefully inflame the injury site, and pain is a direct result of inflammation," says Kulick, "so you’ll be uncomfortable for a few days, but the pain is certainly bearable." During this time, anti-inflammatory medication and icing are off limits, since they will mitigate the effects of the treatment.

Bottom line: For moderate injuries, prolotherapy and PRP may be worth exploring — but they are certainly not a sure thing. For more severe trauma, stem cells are increasingly looking like a viable option. "We're probably about ten years off from really perfecting regenerative type cell therapies," says Dr. DiNubile, "but when we get there, it's going to be huge — not only for its ability to treat injuries, but its power to literally turn back the clock."