Regenerative injection therapies like Prolotherapy, PRP, and Stem Cell Therapy are becoming more widely known as treatments for joint pain. While Stem Cell Therapy has grown in popularity, it’s older counterparts – prolotherapy and PRP still serve a great deal of purpose when it comes to treating joint pain. When it comes to cost, risk, and invasiveness, Prolotherapy is the least, followed by PRP then Stem Cell Therapy. It can be advantageous to seek out a practitioner who has been doing this kind of work, starting with Prolotherapy, for many years. They will be your best guide for treatment. So before you race out to get Stem Cell Therapy, keep an open mind and consider that a lower cost, lower risk, (Prolo or PRP) therapy might be just the thing you need.
Dr. Michael Ruscio, DC: Hey everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio today I’m here with Dr. Tyna Moore, and we’re talking about ways to get you out of pain, specifically prolotherapy, which is essentially an injection that can be used to heal, regenerate different tissues of the body, most namely well be focusing on various joints. This is something I’ve had my eye on for a while and actually Tyna, I’m selfishly interested in this conversation because there are some knee issues my mother has been dealing with. And I’ve wanted to pick someone’s brain to get the straight talk on this, and I know that you’re very well versed in this, so I am both interested for our audience and selfishly for myself to dig into this topic. So welcome to the show.
Dr. Tyna Moore: Oh, perfect. Thank you so much for having me. It’s an honor to be here, and I’ve been following you for some time now. So it’s exciting to get to talk to you finally.
[Continue reading below]
Dr. R’s Fast Facts Summary
What are regenerative injection therapies?
- See the infographic below in the transcript where we break down Prolotherapy, PRP, and Stem Cell Therapy.
How to find a good provider?
- Find someone who has a solid background in Prolotherapy for starters
- Look at the websites of practitioners, look to see if there is video or blog content of practitioners talking about the different therapies
- Visit Dr. Tyna’s website and sign up for her free book to receive a cheat sheet on how to find a good practitioner
To image or not to image?
- Imaging findings do not correlate with pain and dysfunction
Who is a good candidate for the different regenerative injection therapies?
- 35-45 yr old – eats healthy, works out, sleeps well, takes care of themselves
- Good candidate for Prolotherapy treatments potentially followed up by PRP if needed
- 45 – 65 yr old – doesn’t exercise, overweight, does not eat well
- Ok for prolo but need to focus on nutrition and lowering inflammation before joint issues can be addressed further. Not a good candidate for PRP or Stem Cell
- Pain brought on by trauma – may be good candidates for treatment depending on the patient
How long do results last?
- Every practitioner does treatment a little differently so it really depends on the treatment
- Generally speaking, the second and third treatment are the most critical for longevity. One treatment is not always enough.
- Follow-up maintenance/treatment a year or two later is common
What does the research say?
- Prolotherapy – Dr. Dean Reeves – good prolotherapy literature
- PRP – results vary, research is early
- Stem Cell research is coming along
Where to learn more
- Get help using this information to become healthier.
- Get your personalized plan for optimizing your gut health with my new book.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
Download Episode (Right click on link and ‘Save As’)
DrMR: Yeah, I’m glad we’re able to connect and talk about this topic, which I found interesting. I haven’t looked too deeply into it. I hear things through the grapevine. I hear many people with great things to say. I haven’t heard many people have disparaging things to say about this, which tells me that it probably works pretty well. But before we launch into the particulars of prolotherapy, tell people about your background and how you’re currently using this in your clinic.
DrTM: Sure. So I am a chiropractor and a naturopathic physician. And my background is that many years ago when I came out of undergrad, I went to work for a naturopathic doctor and acupuncturist here in Portland, Oregon by the name of Rick Marinelli. He has now since passed. He brought naturopathic regenerative medicine to our profession. And in that lot was prolotherapy. When platelet rich plasma became available many years later he started using that and I had the honor of working with him for over 20 years.
So I was assisting him with procedures. I was running his front office. I was doing all kinds of things in the small clinic. I have seen countless, I don’t even know how many of these procedures administered. And then I have been in practice myself for 10 years doing just specifically since 2013 only regenerative injection therapy. So I joke that I drank the Kool-Aid, I wholeheartedly believe in these. I think they’re very low risk. They’re very conservative, and they’re so amazingly therapeutic when it comes to having the right patient and your hands and the right practitioner. We can talk more about that.
DrMR: I definitely would like to do so. Am I using too narrow of a term when I say prolotherapy? Is there nuance, are there are different types of injection? Help us with some of the definitions so that we’re all on the same page.
DrTM: Sure. So the big broad umbrella term nowadays is regenerative injection therapies. And that encompasses everything from prolotherapy up through stem cells and those different treatments. And I like to explain this to patients like this. I tell them it’s tea, coffee, espresso. So tea would be prolotherapy, something stronger like coffee would be PRP. And then if you want the crack, it’s stem cells. And I really believe that each one of these is important and has its own therapeutic benefits, and the application of them differs from patient to patient. So nowadays everybody comes in and they want stem cells with complete disregard to anything prior to that, like prolotherapy or PRP. And I can explain what those are a little bit more in detail in a second. But patients want all the sexy stuff, they want fancy things. There’s just this really elegant, affordable, approachable, accessible treatment called prolotherapy, which many people are overlooking. Which is to me the roots of all of these therapies. It’s a technique as much as it is what’s in your syringe. So finding someone who’s trained in traditional prolotherapy I think is a real benefit to your listeners.
DrMR: That’s music to my ears and it’s definitely something I’m sure that I share that type of philosophy. Which is, we don’t have to reach for the most invasive or most exotic, or newest treatments. And oftentimes, it’s mastering the fundamentals and knowing how to implement them correctly that can be the difference between success and failure. And in this case, I’m assuming the cost between prolotherapy and stem cells is quite significant. So there’s definitely a cost-effective piece that we can be mindful of here. And what is, just generally speaking, what is the cost difference between prolotherapy and stem cells?
DrTM: It’s about 10 times less. Or 20 times less, or 30 depending on what people are charging for stem cells.
Let me just quickly share with you how I explained prolo, and then you’ll see how it grows up. So basically, it’s the administration of injecting everywhere the ligament and tendon meet bone is called an enthesis. Right? And those things are highly innervated, those structures. And they hurt when they get compromised. So when people are diagnosed with arthritis or they have joint pain, what’s often done in this country is they get an MRI or an x-ray and they get told they have bone on bone or there’s something wrong inside the joint. But my argument is that often the pain generator is coming from inside as well as outside the joint, and all of those tendinous and ligamentous insertions. So for our shoulder for instance, gosh. That’s a big swath of land right, there’s a lot going on. So treating and injecting each one of those involved enthesis points is what the technique of prolotherapy is.
And we actually use sugar water. So it’s a low risk, low invasion, low cost in the grand scheme of things. None of these are covered by insurance, but it’s a low-cost entry point for a lot of people. And dextrose is the sugar we use. Not only does it regenerate tissues, but it decreases neurogenic inflammation. And I find that most patients have some underlying neurogenic inflammation along with the joint degeneration or trauma that they’re trying to deal with. So it’s an angry joint as much as it is a degenerating joint. And so dextrose is beautiful. It’s like a balm. It’s a therapeutic regenerative balm that we put in and around the joint.
PRP Therapy Defined
And then we can grow up to PRP. So let’s say prolo for the sake of things is $300. PRP is akin to two to three rounds of prolotherapy in its strength, and it’s where we take the person’s blood, draw it, we draw a large quantity, we concentrate it down, we concentrate the platelets and the platelet growth factors down into whatever concentrate. Each doctor does it differently. And then we re-inject that into the tissues.
If the patient’s real issue is some kind of systemic inflammation or systemic arthritis or immune regulated arthritis, or something more than just wear and tear, that PRP can be a bit of a bomb. Bomb B-O-M-B as in not so great. It can be really intense for the patient, so I’m really careful who I choose to start with PRP. I like to try to start everyone with prolo, prime the soil, calm the joint down. Then I can go to bigger guns.
Stem Cell Therapy
Then stem cells is where we take their fat or their bone marrow, concentrate that down, and we shoot that into the affected tissues. And that’s a huge, huge inflammatory cascade generator if that person is inflamed going in. So patient selection is huge and I have a lot of information on that that we don’t have to get into too much. But as you know, these therapies are only as good as the patient that is attached to. So we need healthy cells, healthy blood, healthy levels of inflammation, not too much, not too little. We need people who are good healers, who have a propensity to heal when they get wounded. Otherwise, you’re just shooting an inflammatory concentrated bomb into an inflamed joint, and that can be really troublesome. So PRP would be more in the $1000 range and then stem cells can be anywhere from $10k to $15k. It really depends on the practitioner and it’s the wild west out there with that.
DrMR: You make several great points there. I really, again appreciate the I guess methodical and circumspect nature that you’re using to identify a certain person with a certain therapy. And from the patient perspective, I’m sure people are probably grappling with, “I read an article about stem cell. It sounds really good. I saw some good reviews on it. I’m going to go find someone who does stem cell.” If that person doesn’t have the depth of knowledge, they could put a good therapy into a bad candidate of a patient and as you’re suggesting, the wrong place, wrong time with some of these therapies may lead to less than the desired outcome. And if you spend $10k or something of that nature, I’d be pretty irked. So I think it’s another reason why going through things in a stepwise, methodical nature, it’s a bit more of a tortoise approach. Yes. But I found time and time again that you get there. If you try to be the hare sometimes, you don’t get there. Maybe another way of thinking about this for any of the golfers in the audience. Not that I’m a good golfer, they say it’s better to hit the ball straight and short, whereas trying to crush it and then slicing it or hooking it and being way off the fairway.
DrTM: Absolutely. The thing about it too is a lot of orthopedic docs are jumping on the stem cell bandwagon because they’re realizing that they have three hammers. They have drugs, cortisone injections, and surgery. That’s it. That’s how reductionistic orthopedic medicine is in our country. And they’re realizing that these regenerative treatments are therapeutic. However, prolotherapy is hard to learn because it requires an incredible amount of palpatory skills which chiropractors get, but a lot of other practitioners do not. And so being able to palpate the tissues, even diagnosing the condition correctly. I keep seeing plastic surgeons doing stem cells and neurologists and ER docs doing stem cells on orthopedic joints. And I’m like, what are we talking about here? These people are not even trained in orthopedics. That’s kind of an issue.
So I can’t tell you how many people have come to me and said, “I want stem cells.” And they fly in from all over the country and the world at this point. And I’m like, “No, you just need prolo. I know it’s not sexy.” I know it seems really boring and it’s a lot less expensive, but I’m thinking a couple rounds of prolo, maybe some PRP. And if the person is healthy, fit individual and they’re eating well and they’re moving well, that’s a no-brainer. I’d be a lot richer if I had poor ethics. I can’t do it.
DrMR: Which I really appreciate it. And that begs the question. I’m wondering what your take is on this, which I think this is a natural business force. But because stem cells have a higher profit margin, I think you’re seeing more companies pick those up. Those companies have more margin to hire reps, to have reps go to doctor’s offices and make the doctor’s offices aware of this. So I think because of the higher price tag associated with stem cells, you’re seeing more of a push to market this service to doctors, and that might be part of the reason why there’s a skewing. Do you think there’s any validity to that thought?
DrTM: Yes. Because I’ll tell you the truth, the reps are often the ones training the doctors. The reps will come in and train them how to do a PRP or stem cell procedure and that’s how it’s left. And then the doctor’s free to do it, which I think is crazy and totally unethical. I’ve lost some fans with my opinion, but the other part is most docs just do ultrasound guided injections. And everybody wants ultrasound guided injections, which I totally understand. When you’re slinging something that expensive in a syringe, you want to make sure it got where you intended. However, shooting juice in the joint is not the way to fix the joint. It’s part of the problem, but that’s not the only problem. And as I said, take a rotator cuff, for instance, a shoulder.
A lot of the doctors, that’s all they know how to do is do an ultrasound-guided injection into the shoulder. But when it comes down to palpating and figuring out and using end play and joint palpation to find out where those pain generators are, and it’s sometimes just the smallest swath of tissue at the enthesis of a certain ligament or tendon. And they miss that, the patient will still have persistent pain and be upset and think that the treatment failed. And then the treatment gets a bad name. My question is what was in the syringe and who was holding it? That part to me is far more important than stem cells did or didn’t work or PRP did or didn’t work. Because again, it’s the wild west out there and you’ve got to look at your doctor’s bio and find out what their background is, and do they have orthopedic training of sorts. And also, everyone’s PRP production is different. We all make our PRP a different way. We all interact differently. People often contact me and say, “I want to find someone who treats just like you.” I train a lot of doctors, but no one treats just like me. It comes down to a lot of different variables.
Finding A Good Provider
DrMR: And that’s a good segue to another question I wanted to ask you, which is, can you expand on how someone could find a good provider? Is there a training association? You hinted at certain credentials, but maybe you could give the layperson who isn’t familiar with the amount of hands-on training, different credentials, get some specifics. What would you tell someone who’s searching, here’s what you do to find a good provider?
DrTM: I would find somebody who has a solid background in prolotherapy first. And anyone who’s what I call an old school prolotherapist will likely have very good skillsets. There are different organizations. There’s a website called getprolo.com, but I’ll warn you. You don’t get vetted out from there, you just have to pay to be featured on that page as a physician. So it’s pretty hard to tell who knows what and who does what.
I would look at their website. I like to see if there’s a video of them talking about it. Do they know what they’re talking about? Can they answer hard questions? I actually have a resource I made that the audience can go to my website at drtyna.com. I’ve got a free book there. I’m not trying to plug that. It’s a nice book.
It tells you how to prime yourself. But if you go through into the website there is, and I’m changing my website so it might be a little bit just hang in there. There’s a PRP 101 academy that interested folks can click on. And what they’ll get back as a cheat sheet. And I made this five-page document that has all the frequently asked questions that I could possibly think of were important so that patients are prepared when they go in. And if they ask their doctor, “What does my diet have to do with this? What does exercise have to do with this?” If that doctor says, “Nothing,” get out of there. And how long have they been doing these procedures? Find out how many have they done, how long have they been at? Those are important questions. What was their background training? Do they know prolotherapy? If they don’t know prolotherapy, I would say get out of there. But that’s my bias.
But anyway, it’s a nice cheat sheet and then it drops them into a sequence of emails that are highly educational. Because more than anything, I just want a person informed and educated and I want clinicians informed and educated so that they can make appropriate referrals too instead of just whoever the hotshot is down the street doing the latest and greatest, with the regenerative stuff.
DrMR: I’m assuming, and this is probably in that book. You want to look for someone who does all three of these therapies because I’m assuming again, if someone only does stem cell, then the probability you’re going to get that when you may not need it is going to be very high.
DrTM: I agree. And that’s tough to say because I have a lot of friends who just do stem cell and that are good doctors. And I’ll tell you, there was a big discussion recently on a listserv I was part of, a regenerative listserv. All these doctors were timing in about whether stem cell first, and I was over there trying to be the advocate for just good old fashioned prolo because it’s very accessible and again, affordable for most people. Why be in pain when you can’t raise $10,000 to go get stem cells? Why not just go hit it with some prolo and knock the pain down a few notches and get moving again? That was my argument. And all these different docs chimed in about the wonders of stem cell. And I’m sitting there thinking, I’m like, “That’s because you guys don’t do prolo. You haven’t had enough prolotherapy cases to know how effective it is. Or maybe you’re not performing it right to know how effective it is.”
But I think a conservative good old school prolotherapist loves prolo, and they’ll start the patient there, which is a really wonderful starting spot for anyone. And it dials down the pain in a way that’s very approachable. A stem cell procedure is, a big undertaking and there are some great docs out there doing that work. Some of them are my mentors. But you don’t always know based on what city you’re in, who you’re going to get and what their background is.
DrMR:Right. And to doctors’ points or therapists’ points in their defense, they may be very well intentioned and only knowledgeable about stem cells. So it’s not to say that they’re maliciously withholding another therapy. They just may be honestly unaware of the merits of prolo or PRP. But all the more reason why it sounds like it’s a good idea to find someone who has experience in all three.
DrTM: Absolutely. And something that I share with people, to each his own. Some people really love that medical model. They love that big hit, the big win. I think of it like this, as a naturopath when somebody presents with an infection, I want to use herbal medicine and nutraceuticals to knock the infection down. And to get that organism that’s pathologic, I want it knocked down until the immune system can take over. Versus allopathic medicine, they want to give you an antibiotic. Which is like shooting a fly with a shotgun. And some people depending on the severity of their pain, they want that approach. And that’s so valid and fair and I totally get it. So no judgment on anyone regardless of what they choose. But you don’t always have to shoot the flight with the shotgun. Sometimes you just need a flyswatter.
DrMR: Hey, everyone. I’d like to thank two companies that can improve your health and have made this podcast possible. Firstly, Platinum LED who sells perhaps the best red light therapy units on the market. Now, red light therapy can improve your health by stimulating mitochondria so you actually help to stimulate cellular energy, and the research here, while preliminary, has shown encouraging results for an array of applications, including thyroid, one very exciting study there; skin health; anti-aging; joint pain; and body composition.
Now, I’ve been doing an experiment with a Platinum LED unit at home for a few weeks now, and I have to say, so far, I am really liking it. I do feel like it is helping my skin look healthier and younger, which has been corroborated by a handful of clinical trials.
Now, importantly, in a direct side-by-side comparison, Platinum LED lights have produced the highest irradiance of any LED lights on the market. And this is the best part, all of their lights come with a 60-day trial period, so the risk is pretty much zero, and a full three-year warranty worldwide. Now, they are offering anyone from our audience a $50 off for select panels if you visit PlatinumThereapyLights.com, that’s PlatinumTherapyLights.com, and use the coupon code Ruscio50. So definitely check out Platinum LED.
Also, a thank you to GAINSwave, which this therapy can enhance sexual function. GAINSwave uses sound waves similar to ultrasound to stimulate angiogenesis or the growth of blood vessels and to break down plaques in existing blood vessels.
Now, GAINSwave has been shown to improve erectile function in men, according to med analyses. There have also been about 40 clinical trials looking at the efficacy of GAINSwave. I have done one full round with Dr. Judson Brandeis, who’s been on the podcast before, and I have been very happy with the results.
So if you’re a man wanting to enhance or improve your sexual function, I would definitely recommend checking out GAINSwave, and you can take advantage of one free GAINSwave therapy session if you go to GAINSwave.com/patient. And for medical professionals, you can learn more at joinGAINSwave.com/provider. GAINSwave, I would definitely check them out and also Platinum LED.
DrMR: Something that I’ve heard, I have not fact-checked this. But back in the days when I was doing some work in musculoskeletal care, there was one dictum circulating, which was there was not a high correlation between what you see on various imaging studies like MRIs or x-rays, and someone’s pain or dysfunction. And that it may actually be a bit erroneous just because someone has an abnormality, to assume that they’re going to have pain that needs to be treated. Do you find that to be true? And maybe it’s not that simple, but just wondering since you’re much more familiar with this, what you think.
DrTM: I totally agree. First off, I have a lot of friends who are radiologists that I’ve made over the years. And MRI results and reports are written to justify surgery. That’s just a fact. They are writing a report for whatever the doctor’s needs are. So when I needed to report to justify regenerative injection therapies, I would have them focus on these enthesis points where these ligaments and tendons meet bone to see if there was any inflammation or edema there. That would justify clinically the application of the treatments I offer. Most orthopods do surgery, so they’re looking for justification to do surgery, right? Because that’s their hammer. And no disrespect, I get it. Whatever your hammer is that you’ve been trained in is what your tool is. So MRIs can come out looking horrible and scary, and they freak patients out. I would say that half of the work I do on a new patient visit is just interpreting a patient’s MRI in real words. Like, “Here’s the spine and here’s my plastic spine and model. I’m going to show you what your MRI says.”
And it’s really not ever as bad as what they perceive. But if you write a scary MRI or the patient’s in fear, they love to jump into surgery. And that is not so great. But if you took an MRI of everyone’s spine in my clinical building, everybody would have crummy results. The lumbar spine would look terrible. The cervical spine would show all kinds of variations that weren’t considered pathologic. And that rarely correlates with pain. So the new standard on low back pain is honestly, the American Medical Association flat out is saying, “Do not image. And do conservative care like chiropractic and rehab first. And then if the patient’s not responding, then you go for an MRI or something bigger.” But patients come in demanding imaging.
And just real quick for the audience, x-ray only shows bones. It only shows bones and bone fractures. So unless you think you broke something, an x-ray is just unnecessary radiation. An MRI shows soft tissue, but it shows frank massive changes. It doesn’t always show these subtleties, and it’s the subtleties where the pain is. So find someone who has really good palpation skills, that’s going to be a lot more informative, I think, in determining a proper diagnosis that figures out what the pain generator is versus an MRI that is going to justify a surgical intervention.
DrMR: Agreed. It think this need for parsimonious use of testing and imaging permeates many different disciplines. functional medicine, chiropractic care, even though they’re different. One being more structural, one being more, I guess you could say metabolic or internal. The same need to be a bit more cautious with your testing applies there. One of the things that disappointed me during my internship was that there were some circles in chiropractic, and again no judgment, to each his own. But I did have a hard time with this who were doing imaging right out of the gate. I remember scratching my head and saying, “But you guys saw the literature showing that there was this poor correlation.” Back to my earlier comment, poor correlation between radiographic findings and someone’s pain and dysfunction. And we know that you can initiate the therapy without needing those imaging findings. And there’s evidence showing that that therapy tends to work well for a lot of people, irrespective of if it was ‘guided by x-rays or not.’ So why not just use the therapy first with no imaging? And then if someone’s still struggling after that, consider the imaging after an evaluation of the conservative care.
DrTM: I totally agree. I totally, totally agree. And that’s how I practice. I’ve been in practice for over a decade, and I think I’ve ordered less than a handful of MRIs. And most of those, five were because the patient was in litigation from a car accident or some kind of accident and they needed proof. I am completely in agreement with you. I think the problem is doctors are scared, and most doctors don’t have great diagnostic skills when it comes to musculoskeletal conditions. And so they practice out of fear, and they practice out of defensive medicine, and they don’t want to miss anything.
So they over image their patients as a way to not only cover their buns but to punt and say, “Okay, well this is out of my wheelhouse. I’m going to send you somewhere else because I don’t know how to deal with [this].” Most doctors don’t even know how to touch their patients anymore. It’s crazy. In truth, I was telling you, I did my podcast episode this morning. I think most people’s joint pain is, yeah there’s trauma there, but I would say 99 percent of the time, there’s this concomitant enteropathic or gut-driven process going on. Hormonal imbalances contributing, and these people are just dealing, their joint is just a manifestation of what systemically is happening to them. And they want to isolate it and look at it as here’s this thing and I’m going to inject it with this stuff and it’s going to get better. And it’s like, “No, your bilateral hip pain is actually because you’ve got X, Y, and Z bugs in your gut and you eat inflammatory foods and your thyroid is low.”
DrMR: You’re preaching to the choir there. It is remarkable how many cases of joint pain and inflammation improve and go away and need nothing else, once we address their gut health. And there are exceptions to that. I totally think that’s valid. We’ve had a doctor on who practices ART, active release technique, and I think that can work wonders for some people. But myself included, I’ve noticed that my gut and my patients’ guts have a huge impact on their joint pain.
So there may be cases where those things are in order and there’s still joint pain or maybe someone has had an injury. Or for whatever reason, we need to escalate beyond just diet, lifestyle, and gut, which I think is clearly the foundation and we’re in agreement on that.
Best Candidates For Therapy
But what types of pain or conditions or diagnoses do you feel these therapies work best for and work worse for? I’m just trying to give people maybe if you have X, Y or Z, this may not work very well, but if you have A, B or C, this tends to work really well. If that does exist.
DrTM: Yes, I think there are some parameters you can put on it. So my avatar is someone like myself or you, and I don’t know exactly how old you are, but I’m almost 45. I’m in pretty decent shape. I mean I have a little bit of belly fat, but I lift a lot of weights. I love lifting weights. I love lifting heavy weights, and my joints don’t always like me for it. So I eat really clean. I don’t drink a lot of alcohol. I optimize my sleep. I do all the things as I call it, and that’s what my book is about, all the things that you should do, the basics. And so those people respond beautifully. It doesn’t matter what I inject them with, the outcomes are exactly as I expect. It’s so rare that that outcome isn’t what I expected. Even to that degree of how much better they get based on which therapy they choose.
So I can tell them with pretty good certainty. We’re going to start with one prolo. We’re going to do two PRPs that are spaced this much apart. You should be good. If not, we can go to bigger guns. And boom, it always happens like gold. Then there’s the Russian roulette group that’s the 45 to 65-year-old female. And let’s say she’s deconditioned. She’s not exercising. Maybe she’s never exercised. She’s got extra weight, she’s inflamed. She hasn’t been eating well. Maybe she drinks diet soda. Your quintessential American middle-aged postmenopausal woman. Those women, if they present, especially with bilateral pain, that’s a red flag. Those are not great candidates. In fact, we’re not going to make them worse, but we can flare them. I tell those patients these exact words.
I say, “By probably looking at you. I can tell that you’re a hot mess of inflammation, no disrespect. But if I take your hot mess of inflammatory blood and concentrate it down and shoot it into your hot mess of an inflamed joint, we’re going to have a nightmare on our hands for weeks. And in fact, it could cause a worsening of frozen shoulder or frozen hip. We could make things worse for a time.”
So those are the people I start with prolo and then I send them off to work with a functional medicine doctor or a naturopath and I say, “Get your act together and come back in nine months and we’ll go further.”
And then there’s just the, how do I put it? If there was trauma at any point that somebody can pinpoint, I think that’s a joint work trying to treat. If it’s just this general onset of joint pain that doesn’t seem to have any explanation, especially if it’s bilateral, those are not the people I would be shooting substances into their joints. So it doesn’t really include everybody, but I hope that makes it a little bit clearer.
DrMR: Yeah, it’s helpful. And just to maybe reiterate that for people. What I see when you describe that is people who are somewhat systemically inflamed because of poor diet and poor gut health maybe, as two of the chief. And then also perhaps poor lifestyle. They need to get those things in order first. And oftentimes what that looks like is this more broad spread no rhyme or reason to joint pain. It’s my hip or it’s both hips. And then it’s the knee and it’s the shoulder and it migrates and it’s all over the place. There’s no rhyme or reason for exactly why. And then we divide that against the other person who they’re doing all these dietary and lifestyle things right. Maybe they had an injury, maybe they lift a lot. They have some former orthopedic issue that they’re trying to deal with, and there’s more of “okay, we understand why this knee is a problem,” and so we’re going to focus on that knee. Would that be a fair reiteration?
DrTM: Absolutely. And then I think it’s a mixed bag too because once the joints become injured or the inside of the joints become compromised in any way, it can set off that whole inflammatory cascade that might be brewing. So a great example, just real quick as me. Last year or two years ago, I was deadlifting copious amounts of weight and I was trying to get a personal best every single time. It was just too much. I was doing way too much weight way too often. And I deadlift in a way that I was sharing the cartilage off of my joint with the ball and socket where it was not good and I tore my labrum. And I compromised the cartilage, and it hurt so bad. But, I also was in the midst of using a thyroid medication that had been reformulated that wasn’t really working. So I was slowly gaining weight from lack of activity, and my thyroid wasn’t working so well. And then the lack of activity was causing my hormones to dump out because the level of activity I had been doing was what was keeping them happy. I’m in that 45 to 65. I’m kind of that woman. I’m autoimmune. I already have some autoimmune conditions. And then both my hips start hurting and I was like, “Oh heck no. This is what’s going in my mouth right now.”
So I really focused on my sleep. I pulled back on my sugar and alcohol intake. I really did all the things I know how to do that you probably talk about in optimizing your gut and wellness. And boom, the hip pain abated. And it comes back when I start to mess with those things too much. So it’s a both. If the woman reaches for a basket up high and she does something to her shoulder. And next thing you know, she has a frozen shoulder. That’s a hormonal and immune-driven phenomenon, but it started with a traumatic injury. So you kind of have to realize there’s often a mixed bag.
Which can confuse things. But I think that’s why it’s worth working with someone who can look at you for more than just your joint.
How Long Does It Last
DrMR: Well said. Now I know this is probably highly variable, but how long do these therapies last? Are there a few kinds of segments you can break this into a sense? And essentially what I’m curious with is, I guess, how long the therapy lasts, and then also is there a certain maintenance? Would someone has to do a course of intensive injections over two weeks and then they do one injection a year? Is there some general rhythm that this falls into?
DrTM: Well, unfortunately, every doctor I know performs these differently. So for instance, Regenexx is a big stem cell company and they get great results. They do prolo, a PRP, and a stem cell procedure all within the same week or two periods. So it’s just boom, boom, boom, back to back. And then there’s me. I do prolo. I make people wait about a month and then I might do another promo, or I might jump to PRP. If I’m doing PRP, I usually have them wait six to eight weeks between therapies. So there is some upfront loading, regardless of which route you take. Another example, I was just with a colleague at a conference and he’s an MD, really smart guy though. He does the same treatments I do and a gentleman was asking us the same question. I said, “Okay, well get your first one.” He goes, “Okay, well how long until the next one?” And I said six weeks exactly the same time this other doctor said six months. So we both had a totally different treatment program in our head.
So it’s pretty variable, but there is some upfront loading and then that usually gets people to a pretty good point. I would say my goal is to get them 90 percent better, and then to get them active and rehabilitating. And then they might need tune-ups, and I call them oil changes. So I might see them again in a year. I might see them in two years, I might see them in six months. But the follow-up is just a one off once in a while. Whereas the initial loading period, you’ve really got to get your one, two, three treatments done upfront and really commit to that process so that you can get healing. If you just do one and then throw the baby out with the bathwater, you’re wasting your money because it’s the second and third treatment that really close the game out. And then you’re probably good to go for a while. So hopefully that’s not too big. But that’s how I’ve seen it work, and most people show up about a year or two years later saying, “Hey, can you hit this joint again? It’s getting a little naggy.”
DrMR: So my mother has bone on bone in her left knee. Is that someone who’s too far gone, or do you think that perhaps being fairly severe degeneration to bone on bone, she would need to escalate all the way to stem cells? What do you think her prognosis would be in that situation?
DrTM: I would start her with prolotherapy, because most everyone who comes into my clinic with knee issues says, “I’m bone on bone.” And I’m like, “Welcome to the club.” That’s pretty much everyone who walks in here by a certain age is bone on bone. And sometimes it’s neurogenic inflammation that’s causing all the pain. And one round of prolo knocks that right out, and other times they need something much more intensive. So I would take them up that cascade. Again, I would start them conservatively and then I would jump them to PRP.
DrMR: But to your point and just to make sure that we touch on this. Even that imaging finding of bone on bone could still not be the cause of the pain. It could be more so neurogenic like you’re saying. So it’s just another great reminder of even what we would think a severe case is, may not always need the highest level of treatment.
DrTM: Totally. And just to nerd out for a second, there’s some talk and I believe this, that there are biofilms that form inside the joints too. We know it happens with joint replacements. That’s the big concern, biofilm. And I think that dextrose acts in a way as a biofilm buster. And so sometimes just that one time, it cuts their pain so much, it’s phenomenal. I’ve seen people come in and looked crippled and their MRIs were horrible and I put 20 percent dextrose in their knee. And that was the last time I saw them and they’re happy as a clam, and I put them on some collagen and curcumin. It was that easy. And other people, it’s a whole different ballgame. And so I would start slow and low. I’m all for slow and low and I think nudging the body back and then getting your mom moving, getting her proper rehabilitation, strength training. If your knees are jacked, your glutes are probably compromised and not working. So getting all those things better will really help.
The point being is when you do prolo or you do PRP before a stem cell, it’s actually preferred because what it does is it gets the stem cells in the area activated and woken up, and it primes the joint. So when you do hit it with something bigger, it’s not as painful, and it might be and hopefully will be more effective. So that’s what I tell patients. I’m like, “We can always go to stem cells. But why don’t we try this first, save you tens of thousands of dollars potentially? And if we have to go there, we can go there later. Why not start with a .22 instead of a shotgun?”
DrMR: Sure. Again, you’re preaching to the choir. I love it. Quickly, or not quickly actually. For as long as you want to have the floor on this one, what does the research say? Because this is something I haven’t looked too deeply into. I’m assuming there’s at least some preliminary evidence, but what kind of body of literature do we have behind them?
DrTM: So prolotherapy is really coming along with the literature. Dr. Dean Reeves, if you Google him and go to his website, he’s got a lot of good prolotherapy literature. Good studies, good level one studies are coming out on prolotherapy, which is awesome. Showing actual cartilage regeneration, all kinds of good stuff.
PRP is a little more varied. I think for a couple of reasons. But one is the studies early on were done by the PRP companies themselves. So that’s all over the place. PRP kits come from different manufacturers. And every kit concentrates the platelets down differently. So that’s all over the place. And then truthfully, I’m always at these orthopedic conferences, I’m the token naturopath over there going, “You guys, these studies are apples to oranges. My PRP is not your PRP, is not your mom’s PRP. Is not a 600-pound man who drinks mountain dew PRP. Is not an 85-year old’s PRP.” So how do we standardize that in a study to really look at it objectively? I think that’s quite impossible.
But I do know good studies. The studies on PRP are all over. I’ll just tell you from a lot of experience. I see great results when done appropriately. I see terrible results when I see people slinging PRP randomly at people without knowing their orthopedic skills. So again, choose a good doctor. And then for stem cells, there are some really great studies coming out. I think even injecting saline into the joint is effective because really what happens, you’ll love this. Really what I think is happening is not so much the solution we’re using. It’s changing the microenvironment inside the cell, and it’s changing the microenvironment and cell signaling within the joint. When you change that, the joint wakes up and goes, “We need to pay attention here.”
Because as you know, when regions of our body get sick, oxygen starts to get cut off. Things just start to die. A lot of times it’s the slow death of tissues that are causing all the problems. And if we can wake it up, that’s why these injections, not just intra-articular but all around the joint, are so critical. We’re trying to wake the joint up. I don’t care if you’re slinging saltwater. Just getting that proliferation and activity going in that joint is often so, so therapeutic. So we have studies showing sailing being effective. So it doesn’t matter so long as you have a responder in your hands as a patient.
So when patients come in I say, “When you get a cut, do you heal well?” If they say no, I won’t inject them. Because that’s not someone who’s going to respond. I want a robust cell signaling event to occur, and that comes down to yes what’s in my syringe, but also what my technique is, and how many times am I injecting that region.
When I do a shoulder let’s say, I might apply 40 injections. And it sounds terrible, but I’m fast and comfortable. But that’s a robust therapy versus one time in into the joint then, “Oh hey, it didn’t work.” So that mixes up the bag even more. These are nerdy thoughts I have, but I’m really interested in cell signaling. And I think with stem cells, that’s really what we’re going to find is that it comes down to the cell signaling, not the actual stem cell turning into something magical, you know?
DrMR: Gotcha. I certainly appreciate again, your careful approach. If there’s some nuance here that has to be navigated on an individual basis, I think it’s worth investing in finding a good clinician. Because as I’m sure you know and I know in my area, the same tools that the doctor down the street has access to could lead to clinical failure. And then when applied by someone who has the necessary training, can really lead to the results that we’re looking for. And again, just want to be careful we’re not saying, anyone, if they do fail with a case, is doing that on purpose. It’s just we all have varying degrees of specialty and focus in different areas, and sometimes you need someone with more focus in one area to get the results that you’re looking for.
DrTM: Absolutely. And sometimes you just need a different set of eyes and hands. Sometimes my therapies don’t work for someone and they go to someone else, and it does work. So just know that it’s not so much the therapy. It’s is the patient a good candidate, and is the person applying the therapy doing it in a way that’s conducive to what that person needs? Don’t give up, I should say. Because being crippled with joint pain is the beginning of the end for so many points. It just takes away the quality of life so much, it breaks my heart. And if an inexpensive sugar water injection could abate that, and that’s why I do what I do.
DrMR: Sure. Is there anything that you want to leave people with you as we moved to a close?
Episode Wrap Up
DrTM: Just where they can find me. And also, I have a podcast. Not to deflect from your awesome podcast, but I have a podcast where I discuss these exact things in detail, in hour-long segments. So it’s on my website. If patients want to check it out, I do have a few episodes that are just specific to this and I have other videos with other people really digging into PRP and prolotherapy. And I want people to really do as much research as they can and I just try to provide that on my website for people as a living library of holistic regenerative injection therapies so that they don’t get led astray and they don’t get snake oil put in them.
DrMR: I love it. And what’s the URL again?
DrTM: It’s drtyna.com. Again, grab the book. I’d love it. I wrote it and give it away for free on purpose. I want to have access to it. And then grab that PRP 101 academy. Link to that, and you’ll be emailed that cheat sheet. And that should arm you with some good information. It also gives you access to an online school where there’s video research. Everything’s contained there so they can find it all in one place. And I hope people will just dive into that so that they walk into a practitioner’s office and they come in armed with information.
DrMR: Perfect. I love it, and I will be sending that resource over to my mother and I hope we can get her the care that she needs. But being totally candid with you, I feel much more confident now after having this discussion that we’ll be able to get her what she needs. Because I was getting a bit wrapped into the well this being bone on bone, maybe she needs stem cells. But I absolutely know in my areas of knowledge that more often, it’s knowing how to apply the tools rather than going to the ‘strongest tool.’ So I’m very grateful that I have that level of knowledge now, or at least the arrow to spring us to how to find the right provider to get my mother the help that she needs. So a big thank you for that.
DrTM: Absolutely. It’s my pleasure. We need our moms and we need them mobile. My mom will joke. She’s been my guinea pig. Every injection therapy I’ve learned, I’ve learned it on her. But she’s so grateful because she’s still rocking and rolling in her seventies.
DrMR: Awesome. Awesome.
DrTM: Great. Well so nice to connect with you. Thank you for having me on.
DrMR: You too, Tyna. Thank you again.
What do you think? I would like to hear your thoughts or experience with this.
- Get help using this information to become healthier.
- Get your personalized plan for optimizing your gut health with my new book.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.