What Is Regenerative Medicine?

When you’ve optimized your health and wellness, but still experience pain from a long-lasting injury or arthritis, you start searching for another option. Regenerative medicine, an innovative field of medicine that aims to support the body in restoring itself, might help.

Regenerative sports medicine

Regenerative sports medicine can help address long-lasting joint and tendon problems all over your body. These therapies, offered at Mass General Brigham’s new Regenerative Medicine Program, are intended to improve function, reduce pain, and decrease chronic inflammation.

“Regenerative sports medicine and orthobiologics, a subset of treatments, can be effective for some patients in enhancing the ability to heal and recover from injury,” explains Joanne Borg Stein, MD, a Mass General Brigham physical medicine and rehabilitation (PM&R) and sports medicine specialist. She has treated patients with regenerative medicine therapies for over 20 years.

When should you consider regenerative medicine therapies and orthobiologics?

“Regenerative medicine shouldn’t be a first-line therapy,” says Dr. Borg Stein. When conservative treatments haven’t worked, specialists consider whether you’ve:

• Adequately rested or adjusted the load of your training
• Done consistent rehab (physical or occupational therapy)
• Optimized your nutrition and sleep

She explains that all of these things have been shown to promote healing on their own. They also may improve the success of regenerative medicine therapies if you choose to move forward with treatment.

What are regenerative medicine treatments?

Regenerative medicine procedures include noninvasive therapies, joint injections, and surgeries. Specially trained sports medicine doctors provide these procedures. Most of these procedures are done in a doctor's office using image guidance to clearly view the injured area and precisely target treatment. While these therapies don’t directly treat cartilage injuries, they’re often done in combination with cartilage treatments and/or surgeries.

Extracorporeal shockwave therapy

Extracorporeal shockwave therapy is a noninvasive therapy that uses fast-moving pressure, sound, or electromagnetic waves. The therapy is approved by the U.S. Food and Drug Administration (FDA) for the treatment of plantar fasciitis and tennis elbow, and research shows that it can also help treat sports injuries such as Achilles, hamstring, and shoulder tendonitis.

“When applied to an injury, shockwave therapy can improve blood flow, reduce pain, and promote a healing response,” says Dr. Borg Stein. “It also has been shown in clinical studies to prompt the release of growth factors in the body.” Growth factors draw helpful building blocks to the area that can help support new tissue growth.

Prolotherapy injections

Sports medicine specialists use prolotherapy injections to address connective tissue injuries. Research on prolotherapy highlights its potential  to reduce pain from early to moderate osteoarthritis, sacroiliac (SI) joint ligaments, and tendinopathy.

Prolotherapy injects a solution made of specific concentrations of dextrose (sugar water), saline (salt and water), and a numbing medication into damaged tissue. “Studies have shown the dextrose concentrate itself can stimulate the release of growth factors,” explains Dr. Borg Stein. “It can also cause some temporary inflammation in the area, which is intended to help kickstart a healing process that may have stalled."

Like all injection therapies, prolotherapy uses a special needling technique during the injection with the goal of increasing your body’s healing response.

Both prolotherapy and extracorporeal shockwave therapy are attractive treatment options when taking time off isn’t in the playbook. “We often do these treatments with athletes who are in season, sometimes in combination with each other,” says Dr. Borg Stein. “In most cases, there’s really little to no downtime.”

Platelet-rich plasma (PRP) injections

PRP injections, the most common orthobiologic, rely on platelets in your own blood. Platelets contain hundreds of proteins called growth factors that play a role in the healing of injuries. Specialists isolate these platelets and inject billions into the target area.

“These powerhouses have growth factors within them that are used to help stimulate a healing response. They also have chemicals that can help reduce inflammation,” explains Dr. Borg Stein.

PRP injections are appropriate for a broad range of injuries, especially chronic tendon injuries and low to moderate osteoarthritis. You’ll need some time to recover, so plan to ease back into activity slowly after treatment.

Tissue transfer

Orthobiologics also include procedures that involve taking fat or bone marrow from your body and transferring it to the damaged area. While these procedures  are more invasive, expensive, and require a longer recovery time than other injections, our clinicians have found they can have long-lasting benefits for some patients.

“Fat transfer procedures involve a variety of cells that we use to support arthritic and injured tissues. And bone marrow aspirate has a very powerful anti-inflammatory molecule in it,” says Dr. Borg Stein. Specialists often turn to these procedures when PRP injections haven’t worked or haven’t worked well enough. They also are appropriate for patients with bone injuries or multiple arthritic joints.

Minimally invasive tendon procedures

Your doctor may recommend a specialized tendon procedure instead of extracorporeal shockwave therapy or injections to provide relief for tendinopathy. Tendon pain often happens when the structure gets overloaded or breaks down.

Percutaneous needle tenotomy passes through the injured tendon with a needle, which is meant to prompt a healing response. Percutaneous ultrasonic tenotomy (PUT) uses a specialized needle device that releases ultrasonic energy to help remove abnormal tissue from the injured tendon.

The role of physical therapy in sports and regenerative medicine

Physical therapy and continued movement play a crucial role in the success of your treatment. At the Regenerative Medicine Program, you get at least one physical therapy consultation before your procedure and another 2 weeks after.

“Physical therapy is a huge part of what we do,” highlights Dr. Borg Stein. “We don’t want to hold you back for too long, but we don’t want to push you too fast. We work hand in hand with our physical therapy colleagues to optimize your treatment and recovery.”

Is regenerative sports medicine safe?

We carefully consider who will be a candidate for which treatment, given medical history and research evidence,” says Dr. Borg Stein. “There’s risk inherent in any procedure, such as soreness, bruising, and bleeding. You may feel worse before you feel better. It may not work. You have to be mindful of all of those things.”

Most importantly, Dr. Borg Stein advises finding a doctor you can trust. Not every place that offers regenerative sports medicine treatments is equally diligent, cautious, and responsible.

“Our program prioritizes patient safety,” emphasizes Dr. Borg Stein. “We have very strict and well-controlled operating procedures in place. We use careful, sterile techniques, and image guidance. And we’re very specific in delivering the therapy precisely to the target tissue.”

Continuing research for quality care

Sports medicine specialists at Mass General Brigham continue to study regenerative medicine at the cellular and rehabilitation level. Their robust research strives to advance science and treatment, putting the Regenerative Medicine Program at the forefront of leading-edge innovations.

Within the program, you’ll find recognized leaders in regenerative sports medicine and highly skilled physical therapy staff. “There are a lot of places you can go and get regenerative medicine therapies and orthobiologics. But there aren’t that many places you can go and get this level of care and expertise,” reflects Dr. Borg Stein.