Tom Pernice, Jr., an American professional golfer who plays on the PGA Champions Tour, had injured his shoulder.In fact, he had a full thickness tear of his rotator cuff tendon, an injury that often requires surgery.The pain continued for months despite physical therapy and other medical treatments.
Pernice’s colleague, Dr. Greg Rose, co-founder of the Titleist Performance Institute (TPI), recommended that he consult with Dr. Chris Rogers at the San Diego Orthobiologics Medical Group.Dr. Rogers evaluated the large, retracted tendon tear with high-resolution ultrasound imaging.Conservative care had not been effective and the current standard of care would include an arthroscopic surgical repair.Given that Pernice was preparing to start the tour season, he preferred to avoid surgery and a potentially long recovery.At that time, Dr. Rogers shared his experiences using a patient’s own cells to stimulate tendon healing.
For more than 12 years, Dr. Rogers has used platelet rich plasma (PRP) to heal small tendon tears with good results.PRP uses cells from a patient’s own blood to stimulate healing.For larger tendon tears, regenerative cells obtained from a patient’s own adipose (fat) tissue via a mini liposuction procedure would often give good results.Dr. Rogers shared that he had treated several patients with similar injuries, but Pernice’s injury was severe and the tendon had retracted away from its insertion on the bone.After careful consideration of his options, Pernice elected to give cell based therapy a try.
In May 2019, only a few weeks after his treatment, Pernice had already noticed decreased shoulder pain and improved range of motion.After eight more weeks of physical therapy, he was able to compete and won the Legends of Golf at Big Cedar Lodge.“Surgery would have prevented me from playing altogether.This was a very special win,” stated Pernice.
Now, one year after treatment, Pernice notes, “I have no pain in my right shoulder, movement, range of motion… everything’s as good as it could be, or better than it was.”Dr. Rogers was pleased and surprised when his recent repeat ultrasound exam showed that the tendon was nearly completely healed.“This is a very remarkable outcome, a testimony to Tom’s hard work and this treatment’s ability to heal a very bad injury.”
Great bakers know that when it comes to delivering the best treats and sweets, you have to carefully measure your ingredients.
The same applies to Platelet Rich Plasma (PRP) therapy. The measured amount, the dosage, of concentrated platelets and other cells in the plasma, must be customized to each patient’s specific condition to achieve the best outcomes.
Platelet rich plasma uses highly concentrated platelets to speed up the healing process, decrease inflammation and stimulate tissue regeneration.See our blog on PRP. As we go in-depth in the study of PRP, we now know that determining the best PRPtreatment is not just about how much platelets are in the injection.
Not All PRP are the same
There are other factors that need to be considered to obtain the best PRP treatment. There are other other cells in the PRP, specifically the red blood cells and white blood cells that need to be adjusted depending on the patient’s condition. Platelets release growth factors that facilitate the healing process. The timing and pattern of growth factor release and the individual’s cellular response to growth factors may vary. This can affect outcome and should be thought out in determining PRP treatment. There is a wide variety of methods used to harvest, process and deliver PRP therapy.The resulting platelet count, cell composition and PRP quality are highly variable and can affect clinical outcome.
Only physicians truly experienced in using PRP know how to adjust the dosing appropriately. Joints, tendons, ligament and nerves require their own specific PRP formulation. Imagine if a doctor writes the incorrect kind and amount of antibiotic to treat your specific infection.Patients should make sure that they do their homework in seeking skilled and experienced physicians providing their PRP treatment. These physicians should not only know how to provide the best customized PRP for your need, they should also be adept in the delivery of PRP therapy. These physicians should have advanced training in diagnostic ultrasound or fluoroscopic (xray) guided procedures to make the procedure safe, comfortable and effective.
Not all PRP dosing is the same. Patients should choose physicians who have the knowledge and expertise to ensure they get the right kind of PRP for their orthopedic condition.
Dr. Christopher J. Rogers and Dr Mary A. Ambach are experts and key leaders in the field of regenerative medicine.They are board certified doctors with over 20 years of combined research and clinical experience in platelet rich plasma and other cell based therapies.
Platelet Rich Plasma Therapy (PRP) is minimally invasive pain relief option for patients who don’t want to rely on medications or surgery and prefer to heal naturally. For more serious injuries, PRP therapy may be combined with surgery to accelerate healing and reduce the risk of infection. The plasma from your own blood contains several proteins that reduce pain and inflammation. Plasma carries the hormones, electrolytes, and nutrients required to nourish cells during the healing process. Here are 5 steps you can expect to take during your PRP treatment process.
Step 1 – Comprehensive medical evaluation
Prior to receiving your PRP treatment, every patient will undergo a comprehensive medical evaluation in order to establish an accurate and complete diagnosis. This may be the most important part of your entire treatment. We will review your medical history, previous records, imaging studies such as MRI, X-ray or CT scan. We will evaluate your medications, nutritional status and exercise activities. You will have the opportunity to learn your treatment options and have all your questions answered.
Step 2 – Supplements
PRP does not come in a bottle, it is produced by your own body. The quality of the PRP is influenced by the foods you eat, the medications you take and your genetic profile. Before your treatment, you may need to stop aspirin or other medications that interfere with platelet function. You may need to eat certain foods or take supplements to optimize the PRP solution for your condition.
Step 3 – Draw blood and spin it in a centrifuge.
Our phlebotomist will draw a small amount of blood and spin it in a centrifuge to isolate the platelets for your treatment.
Step 4 – Prepare the injection area while PRP is prepared
While our technician prepares the PRP in our lab, your physician will perform an ultrasound guided exam of the injured area. The area will be cleansed with antiseptic soap and numbed with a local anesthetic.
Step 5 – Direct injection using ultrasound imaging
PRP will be placed directly using ultrasound imaging. X-ray imaging will be used if we are treating the spine.
These time proven injection techniques are performed safely, comfortably and with high precision. After your treatment, you may apply ice as needed for up to two days. We will give you specific instructions for the first week to minimize discomfort and maximize a positive outcome.
What to expect after treatment
Most people experience results within 4 to 8 weeks following treatment. Some people feel relief almost immediately. You can resume normal activities including exercise within 4 to 7 days. As long as you don’t overdo it, physical activity actually accelerates the healing in most circumstances.
PRP therapy is a revolutionary breakthrough in the treatment of difficult orthopedic conditions. We think you will be pleasantly surprised to experience this therapy and the amazing results it offers. If you are in pain, there is no need to wait any longer. Come visit us and see if you are a candidate for this remarkable therapy today. 760-909-2355
Platelet rich plasma therapy augments your body’s natural healing capacity to reduce pain and improve function after a tendon, joint, disc or ligament injury. PRP may also reduce the pain from inflammation and osteoarthritis.
At San Diego Orthobiologics Medical Group, we use the latest in cellular biology and orthopedic clinical research to optimize your care. We use advanced technology to harvest, process and administer PRP to maximize your results. Because we use your own blood to stimulate healing, each treatment is unique and must be customized to your personal situation.
QUESTIONS FOR YOUR DOCTOR
Regenerative Medicine is an exciting new field that will forever change the way we treat orthopedic injuries. Many physicians are excited to leap into this field with varying levels of knowledge and experience.
So how do you, the patient, decide if you are a good candidate for this therapy. And who should you decide to use as your treating physician? We suggest that you ask your doctor the following questions to help you understand your care. Dr. Rogers has provided his responses to these questions below.
How much experience do you have treating musculoskeletal injuries?
Musculoskeletal injuries are best managed by specialists in the field of sports medicine. These include board certified physical medicine and rehabilitation physicians (physiatrists), orthopedic surgeons, and fellowship trained sports medicine physicians. It takes years to gain the experience and knowledge necessary to appropriately treat these kinds of injuries.
Accurate diagnosis is essential to successful treatment. And, in many cases, it is necessary to exhaust all conventional forms of treatment before even considering PRP therapy.
Dr. Rogers graduated as chief resident of the University of Texas, Health Science Center in San Antonio, Texas Physical Medicine, and Rehabilitation program in 1997. He completed a nonsurgical interventional spine fellowship in 1998 before joining the University of California, San Diego Orthopedic Surgery Department as an assistant clinical professor. He has practiced nonsurgical musculoskeletal medicine in private practice since 2000 and has treated more than 80,000 people just like you.
How much experience do you have with PRP?
PRP is a relatively new technology to orthopedics and our field is learning more about it all the time. Dr. Rogers was one of the first physicians in San Diego to use PRP for his patients in 2009. The protocols and algorithms that he uses have been shaped by his experience and the current medical literature to produce the best results possible. Dr. Rogers teaches PRP therapy to physicians at the Regenerative Medicine Therapy Institute, the BREG musculoskeletal ultrasound course, and The Orthobiologic Institute (TOBI) courses.
It is not a bad idea to ask your doctor how he or she stays up to date on Regenerative Medicine. As this is a new field, most physicians did not receive any specialized training in medical school. Doctors advance their knowledge by participation in continuing medical education, reading medical journal articles or attending Regenerative Medicine conferences. This discussion will give you an idea of the commitment your doctor has made in this emerging field.
How much experience do you have with diagnostic musculoskeletal ultrasound?
Administration of PRP with high precision and comfort leads to better outcomes and reduces the likelihood of additional expensive or risky procedures. Diagnostic ultrasound has radically changed the practice of orthopedic medicine allowing for better diagnostics and improved comfort with office based treatments.
For more than a decade, Dr. Rogers has trained his fellow physicians in the proper use of diagnostic musculoskeletal ultrasound. Dr. Rogers currently teaches musculoskeletal ultrasound at the BREG ultrasound courses, the American Academy of Physical Medicine and Rehabilitation workshops, and the OrthoBiologic Institute (TOBI) courses. He utilizes the most advanced diagnostic ultrasound equipment for his patient care.
What kind of PRP will you use?
There are many methods used to harvest, process and deliver PRP therapy. The cost and clinical results of each method vary widely as well. For example, the platelet concentration may range from two to fifteen times baseline in the blood depending upon which process is used. The healing response is largely determined by the concentration and quality of the proteins released from the platelets. Improvements in your condition may be slower or faster depending upon the method used to concentrate your platelets.
White blood cells are helpful in reducing the risk of infection and eliminating debris from a chronic injury. They also stimulate resident cells to produce healing proteins. However, these cells also release cytotoxic proteins and free radicals that can lead to cellular damage and a delayed healing response. Your doctor will need to assess the risk and benefit of using white blood cells in your PRP therapy.
Nutritional status, hormonal status, exercise, medications, and supplements all influence the quality of the cells and proteins in your blood. Prior to performing PRP therapy, we will often need to assess and modify these factors to improve your results.
What system (s) do you use to produce your PRP?
There are several commercially available products that assist in the production of PRP. The cost of each system varies and more sophisticated systems are generally more expensive. However, more sophisticated systems will allow your physician to customize your treatment and optimize the results. At San Diego Orthobiologics Medical Group we use three different cell concentrating systems depending upon the goals of treatment. Furthermore, we can measure the cell concentration which allows us to better understand why treatment results may vary from one person to the next.
Will you combine PRP therapy with any other form of therapy?
PRP often functions very well as a stand-alone treatment. However, many times additional forms of treatment need to be performed at the same time to maximize outcomes.
How many treatments will I need?
More than 90% of our patients only require one treatment. More challenging conditions may require additional PRP treatments or be combined with other cellular-based therapies.
Have you ever had a complication?
PRP is generally a very safe procedure. It is certainly safer than most other orthopedic treatments and surgery. Potential complications include pain, infection, fever, allergic reaction, swelling, tissue injury, and a failure to relieve symptoms. At the San Diego Orthobiologic Medical Group, we have never had a significant complication with any procedure in more than 20 years.
Do I have any reason to not consider PRP therapy?
Contraindications to PRP therapy include infection, very low platelet count, fever, anemia with symptoms, or use of anti-platelet medications, anti-inflammatory medications, steroids or statin medications.
Will you combine exercise or physical therapy with my PRP therapy?
This important step is often overlooked by some medical clinics. Exercise is crucial to expedite and maximize healing with PRP therapy. PRP simply addresses incomplete healing of a specific tissue, whereas stretching and strengthening are necessary to restore function to the entire joint. We have developed physical therapy protocols that you can do at home or with your therapist to allow the restoration of mobility, strength, and endurance.
How long will it take for my condition to improve after treatment with PRP?
This depends on the severity of your injury and your ability to regenerative healthy tissue. Some people heal very quickly and others more slowly. However, on average, most people feel some significant improvement within six to eight weeks. Healing will continue for many more months after treatment. Many studies have demonstrated continued healing for up to a year.
What are your clinical results?
Very few medical practices track clinical outcomes. Although there are several clinical outcome studies in the medical literature, consensus regarding the exact type of PRP to use for a specific condition does not exist. Therefore, it is critical that each physician tracks the results of their treatment and share this information with prospective patients. At San Diego Orthobiologics Medical Group we have been tracking our results for years.
Your body has an amazing ability to heal itself. Over the last decade, significant advances in Regenerative Medicine have led to a greater understanding of healing. This knowledge allows us to stimulate healing using your own stem cells and other orthobiologics. The new science of Regenerative Medicine supports and enhances your body’s natural abilities in ways never before thought possible.
Effective
More and more scientific articles are published each year demonstrating the effectiveness of Regenerative Medicine. For example, there is now validated scientific evidence that platelet rich plasma is more effective than surgery for certain forms of tennis elbow, lower back pain, and knee osteoarthritis. More importantly, our patients have shared their life-changing results with us every day.
Safe
Scientific studies have demonstrated the safety of using your own cells to treat many different kinds of orthopedic conditions. Unlike prescription medications, Regenerative Medicine therapies do not cause side effects or allergic reactions. Unlike surgery, we do not disrupt healthy tissue which minimizes the risk of injury or infection.
Actual Healing, Not Just Pain Relief
Many traditional forms of medical care simply mask pain. Regenerative Medicine actually leads to healing. Once the injury is healed and rehabilitated, no further treatment is necessary.
More Comfortable than Other Forms of Treatment
Most Regenerative Medicine treatments involve office based procedures and do not require anesthesia. To minimize discomfort we use local anesthesia and, rarely, mild sedatives. Our doctors are experts in interventional procedures and can perform your treatment quickly and comfortably.
Evidence Based Therapy
Researchers are making new discoveries every week. But those advances don’t always translate into clinical solutions. Our physicians are knowledgeable in the field of Regenerative Medicine and do not leap recklessly to offer unproven treatments. We only offer medical treatments that are deemed safe and effective.
Faster Recovery
Many professional athletes have turned to Regenerative Medicine therapy as a way to quickly recover from a sports injury. Unlike surgery which may require several months to completely recover, Regenerative Medicine treatments require only a few days of down time.
Safe to Repeat
Corticosteroid injections and surgery can result in difficulties when repeated. Most patients improve from a single Regenerative Medicine treatment, however it is safe to repeat if necessary.
Saves Time and Money
Regenerative Medicine therapies are cost effective and save time. Most of our patients have alreadly tried multiple forms of other treatments such as chiropractice care, physical therapy or surgery. These forms of therapy can be time consuming and expensive. After a Regenerative Medicine physician has made an accurate diagnosis, treatment often results in resolution of the problem without the need for additional costly therapies.
Real Hope
Regenerative Medicine therapy fills a critical gap in the conventional medical model. Many patients have not responded to conservative care, but are not candidates for surgical care either. In the past, these patients were told to “just live with the pain”. Regenerative Medicine therapy has offerred new solutions and real hope for these patients.
