Our Medicine

Overview of Regenerative Medicine

Regenerative medicine at ICM refers to various injection procedures, such as Prolotherapy and Platelet-Rich Plasma (PRP). These therapies stimulate the body's innate healing processes to regenerate the connective tissues of joints, ligaments, and tendons harmed from overuse or injury. Conventional treatments, such as surgery, steroid injections, and pain relievers commonly do not address the core issue, improve the patient’s musculoskeletal dysfunction, or provide lasting pain relief. Regenerative medicine, in contrast, addresses the root causes of pain and aims to heal the connective tissue structures causing dysfunction, potentially offering lasting relief and well-being.

These emerging technologies of regenerative medicine are backed by evidence-based research and are reversing the ailments of degenerative disease and aging. Conditions addressed with these therapies include chronic overuse injuries to the ankles, knees, and shoulders, arthritic joints, chronic back pain and degenerative disc disease, tennis elbow, carpal tunnel syndrome, knee ligament tears, partial thickness rotator cuff tears, plantar fasciitis, Achilles tendonitis, and IT band syndrome.

Regenerative treatments include the use of mild-irritant solutions such as dextrose (glucose) or Platelet-Rich Plasma (PRP) are injected into injured musculoskeletal structures in order to activate the healing process. Prolotherapy acts as a local irritant and creates an increased inflammatory response. This increases protein synthesis and collagen formation and increases cell proliferation. Prolotherapy is also thought to increase the presence of immune cells into the affected area and to increase platelet-derived growth factor (PDGF) and interleukin-1β (IL-1β) (chemical building blocks), which improve connective tissue thickness, mass, and strength.

PRP is derived from the patient's own blood and then separating out the plasma through a centrifugation process. The resulting substance (PRP) is an injectable solution with high concentrations of platelets, containing large reservoirs of healing compounds, including transforming growth factor beta (TGF-B1) and vascular endothelial growth factor (VEGF), both of which increases tissue repair. PRP stimulates the wound-healing process resulting in new ligament, tendon, and cartilage formation. SEE FINAL SECTION

Overall, PRP and Prolotherapy are similar, in that they both initiate the body’s innate wound-healing response and both follow an identical injection procedure. PRP provides the healing process with more resources for tissue regeneration than Prolotherapy and is also more expensive than Prolotherapy. Each of these therapies are beneficial for different medical applications, depending on the current state of the patient’s degenerative condition.

Frequently Asked Questions

How often are treatments needed?
Treatments with Prolotherapy or PRP range 1 to 6 sessions, spaced 4 to 6 weeks apart. The average patient needs approximately 2 sessions for maximum benefit.

What’s the likelihood of a successful outcome?
The healing outcome depends on a number of variables, including the patient's overall health, the region of the body being treated, and the quality of nutrition received during the healing process. At the Institute of Complementary Medicine, we have formulated a nutritional supplement to enhance connective tissue healing following regenerative medical procedures. The majority of patients receiving these procedures at ICM report notable improvement; however, like all medical procedures, these procedure do not succeed in all cases.

Are Prolotherapy and PRP procedures painful?
Pain varies according to the part of the body being treated, the choice of solution, and degree of physical trauma present in the injury. Sometimes these procedures can be moderately painful; however, a local anesthetic is used to palliate pain, and your physician is focused on successful pain management before, during, after your procedure. Treatment typically results in swelling, achy pain, and restricted range-of-motion for 1 to 7 days. During this phase, patients commonly report that their discomfort is palliated with Tylenol.

Healing Mechanism of Prolotherapy & PRP

The procedures of Prolotherapy and PRP work by initiating three distinct phases of wound healing: Inflammation, Granulation, and Remodeling. Figure 1 displays the phases and time requirements for complete wound healing.

In the first phase, Inflammation, the inflammatory response is activated via a precise injection of a mild irritant directly on the torn, stretched ligament or tendon. During the first 100 hours after the injection, a blood clot forms, sparking several cellular and chemical reactions. The clot gathers platelets, which contain numerous growth factors that drive the inflammatory phase. The platelets attract various white blood cells (leukocytes and macrophages) to the site of injection. These white blood cells kill bacteria and clean up the dead tissue within the wound (neutrophils), and further progress the repair process. The platelets also send chemical signals to the healthy cells adjacent to the wound and the incoming macrophages specifying which ligament, tendon, or cartilage is wounded. Furthermore, platelets direct the reparative cells to “download” the regenerative information needed from their genes to reconstruct the damaged tissue. Once the chemical reactions are finished and the cells have obtained the necessary genetic information, the inflammation phase ends.

The second phase, Granulation, begins 100 hours after the onset of the injury, initiating reparative cells to multiply and change shape. Macrophages morph into fibroblasts, which secrete collagen (building block of ligaments, tendons, and joints). Angiogenesis is stimulated at the wound site, creating new blood vessels that supply the regenerating tissue with oxygen and nutrients. Working together, the fibroblasts and blood vessels surround the injury and granulate the wound with newly formed collagen. This cycle of collagen formation proceeds for the next 3–5 weeks until collagen reorganizes into the matrix of the injured connective tissue.

The final phase of wound healing, Remodeling, lasts for 12 weeks. Within the reconstructing collagen, a handful of fibroblasts morph into a different functioning cell called a myofibroblast. In response to mechanical stress and instability sensed on the collagen, these cells synthesize muscle-contractile fibers into the area, firming the collagen into a uniform, compact matrix. This process continues until all of the myofibroblasts no longer sense the mechanical stress and instability placed on the newly formed connective tissue. In the conclusion of the Remodeling phase, the gelatin is securely organized into new connective tissue, repaired to its original strength and length, and is indistinguishable from the original tissue, with no scar formation.