Dr Hal Brown, Naturopathic Physician
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Mesenchymal Stromal Cell (MSC) Prolotherapy

The next advance in Regenerative Medicine


 

Ultrasound Is Used for Needle Guidance in Regenerative Injection Therapy to improve accuracy and safety

Hip Injection with Ultrasound


8 year Shoulder Dislocation and Pain treated with PRP:

"From initially thinking I probably had to get surgery, to doing PRP and being back on skis"

"PRP completely changed the way I engage with the physical sports that I do"


PRP success with martial arts injuries


The American Journal of Sports Medicine; May 2013

Treatment of Partial Ulnar Collateral Ligament Tears in the Elbow With Platelet-Rich Plasma

This study gives positive evidence for the use of PRP in sports injuries.

Drs. Luga Podesta and Lew Yocum, demonstrated that 30 of 34 athletes (88%) had returned to the same level of play without any complaints.



Research In PRP Regenerative Injection Therapy:

    Platelet Rich Plasma - PRP Matrix Graft by David Crane, MD and Peter A.M. Everts PhD


 

PATIENT TESTIMONIALS;     PRP, Prolotherapy and More

 


What conditions are successfully treated with PRP?

If prolotherapy will benefit an area, PRP will provide greater benefit, with fewer treatment visits.

Athletes, high activity persons and those with advanced degenerative joints might consider PRP as an optimal treatment option.  For very bad tears or injuries, especially if someone has had some prolotherapy elsewhere, it should be considered as a first-line therapy. Because of the greater cost of PRP due to the cost of preparation and expense of the technology, some patients prefer to begin with regular prolotherapy as it provides excellent results most of the time. For those who do get PRP as their regenerative injection solution, we typically see them for follow-up in 3 to 6 weeks. Generally, if not already improved, people will either be recovered or know 6 weeks after the second PRP that it is working. Overall the results have been extremely positive, patient satisfaction is very high and It is very safe. There have been no reactions related to injecting platelets harvested from one's own blood.

When to consider PRP as your best option for Regenerative Injection Therapy:

  • regular dextrose prolotherapy has resulted in some benefit, you are confident the treatment has been done properly into the appropriate areas, but the results are not optimal.
  • Your injury is very severe or complex
  • labral or meniscal tears
  • advanced hip, knee. back, neck or other severe joint degeneration
  • high performance athletes who put more demand on joints
  • out of town patients who cannot return for visits frequently
  • persons who wish to maximize their results with a minimum number of injection visits
  • needlephobia: less visits are required, hence fewer injections overall
  • You always choose the best therapy options for your health needs.

Platelet injection for tennis elbow may replace surgery
By American Orthopaedic Society for Sports Medicine

At 6 months post-treatment, the PRP-treated patients' visual analog pain scores had improved 81 percent over their baseline scores. At a 2-year evaluation, 93 percent of these patients reported "complete satisfaction" with the treatment and 7 percent were "partially satisfied." Nearly all of the PRP-treated patients had returned to the activities of daily living and over 90 percent had returned to work or sporting activities.


PRP treatments were the most effective for me...

My hip injury in 2005 seemed to be the end of the road....The success of Dr. Brown’s treatment culminated in my 2011 performance at the World Masters Athletics Championship, where I finished 9th out of 27 in the 1500, running my best time since 2005!

Debbie Jordan, Vancouver


 

For 3 years I have been walking with a limp and back pain... (with) the amazing Prolotherapy and PRP I have recovered significantly... I am able to jog, work out and play competition badminton which I thought I would never play again since my injury.

Gary Joe,

Vancouver, BC

 

 

 

 

 


"I'm pretty wowed how my body has healed with the PRP over time"

Marg Fedyna, Edmonton, AB


Post PRP report: "It is the first time in almost 7 years she has had the mobility in her arm to stretch it over her head, she can turn her head & even her thumb mobility is better"..."Carolanne had even been up dancing with the 2 little boys. Amazing!!!"

Donna Miller,   Victoria B.C.


PRP and Meniscus

"The results are actually beyond my expectations, and I am able to run again and I had thought I would never be able to run again"

Shahram Malekyazi
West Vancouver, BC


A few sessions of PRP was well worth the time and money as it would have cost more time, money and inconvenience to have surgery again or to leave the injury to worsen over time 

Emanuela Bertoia Vancouver, B.C.


It was amazing, I feel like my old self, it was so rapid... I can't believe more people are not aware of the PRP treatment.

Russell Andrews, Gibson's BC


 PRP for knee osteoarthritis: "Best of all, I cancelled the knee replacement surgery....I can walk better, do normal household work again, feel more mobility and am overall happy with a better quality of life."

Hardika Sinha; Retired Registered Nurse; New Westminster, BC


"My hands and wrists are so much stronger and more comfortable now. I can pick up frying pans when full and no pain, using power tools etc are easy again.  My feet are fine, I can walk and hike without pain.  PRP was very successful"

Diane Molholm, Victoria, BC



PRP for knee osteoarthritis: Two orthopedic surgeons maintained I had a degenerative, osteoarthritic  knee, with very little meniscus left.... insisting I give up soccer and get an artificial knee... two treatments of PRP-therapy and 2 treatments of Prolo therapy...I am able to walk, jog and/or ride my bike after playing soccer a day later with out my previous characteristic limp...or need for Advil....  I am very pleased with the results.

Joel Grymaloski, Vancouver BC

 

 

 

 

PRP, Platelet Rich Plasma, Vancouver

PRP, Platelet Rich Plasma Regenerative Injection Therapy, for the treatment of back pain, neck pain, tendonitis, shoulders, elbows, wrists, fingers, hips, knees, ankles, feet, all joints of the body.

PRP Regenerative Injection Therapy, Platelet Rich Plasma

A new treatment for pain is becoming popular among orthopedic and pain specialists: the injection of platelet rich plasma PRP. Most everyone thinks of blood platelets as being responsible for blood clotting after injury which is true. What many people do not know is that blood platelets serve many other important functions. Blood platelets are responsible for bringing white blood cells to the injured area to clean up the remains of dead and injured cells, which is what most people believe is "chronic inflammation or tendonitis. This non productive stagnant "swelling" is called tendonosis and is not helpful for healing and must be resolved for recovery to proceed.  Most importantly, blood platelets release growth factors that are directly responsible for tissue regeneration. PRP has also been shown to increase chondrocytes, the cells which grow into cartilage tissue. PRP has been used for years in surgical centers around the US and abroad to improve the success of bone grafting (especially in dental surgery) and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. More recently PRP is being used for the treatment of chronic pain. All joints, ligaments and tendon injuries can be treated, whether chronic or acute, including: tennis elbow, plantar fasciitis, Achilles tendonitis, rotator cuff tears, shoulder dislocations, meniscal tears, osteoarthritis and chronic low back, neck pain and many more areas are are all being treated with the injection of PRP; the goal being to promote the regeneration of degenerated and/or torn or strained connective tissue, ligaments, tendons and joints.  The reports are of great success at a magnitude greater than regular dextrose prolotherapy, and of benefit where prolotherapy effects have plateaued or not been sufficient.

What is PRP - Platelet Rich Plasma ?
Platelet Rich Plasma or PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process.

While a normal concentration of platelets circulating in your blood is 200,000 per micro liter, the platelet count in Platelet Rich Plasma can exceed 2 million platelets per micro liter. To be considered PRP the platelet count must be 4x or greater above baseline.

Normal Platelet Count

Normal Platelet Count

Concentrated Platelet Count

Concentrated Platelet Count

How is Platelet Rich Plasma made?

The process of creating Platelet Rich Plasma begins by drawing 20 - 60 cc of blood (500 cc is taken in blood bank donations).

Figure 1: Draw the appropriate amount of blood from the patient.

 

The blood is then put into the Harvest SmartPReP®2 Platelet Concentrate System and spun down separating the red blood cells, plasma and concentrating the platelets.

Plasma

Here’s how it works:

All injuries result in tissue damage. The body’s natural response to injury is an organized process of regeneration and remodeling of damaged cells, ultimately returning the injured tissues to their normal state. Collectively this process is known as the healing cascade. This healing cascade is primarily controlled by bioactive tissue growth factors found in platelets. With PRP prolotherapy, these growth factors are concentrated and injected directly into the site of injury.

Growth Factor Biology

The response of living tissue to injury forms the foundation of all surgical practice: Healing Trinity

  • All surgery results in tissue and cellular damage
  • The body's natural response to this injury is a series of regeneration and remodeling steps collectively referred to as the "Healing Cascade"
  • The steps are initiated and controlled by bioactive proteins found in platelets, plasma, and white blood cells
  • Cellular regeneration, remodeling, and proliferation required a combination of:
    • Scaffold (structure or matrix)
    • Undifferentiated Cells (Mesenchymal stem cells)
    • Signal Proteins (platelets, plasma and white blood cells)
  • Increasing the concentration of the bioactive proteins acts as a catalyst for accelerating the wound healing process and forms the foundation of tissue engineering

Healing Cascade

Bioactive proteins replace, repair, and regenerate tissue. These proteins are natural components found in the body and are considered by many to be a “new frontier” of clinical treatment. Increasing the bioactivity at the wound site takes medicine one step closer toward its ultimate goal of naturally accelerating the body's normal healing process.

The bioactive proteins carried by platelets are already being used succesfully for hemostasis, wound sealing, and wound healing in surgical disciplines such as:  oral and maxillofacial, orthopaedic, neurology, otolaryngology, cardiovascular, vascular, general, plastic and reconstructive, non-healing wounds, and pediatrics.

 

Why use your own platelets?

 Platelets are tiny cells that are critical to healing. They are the body’s primary source of bioactive tissue growth factors, including CTGF (Connective Tissue Growth Factor) PGDF (Platelet Derived Growth Factor), TGF-β (Transforming Growth Factor-beta), EGF (Epidermal Growth Factor), IGF (Insulin Growth Factor), bFGF (basic Fibroblast Growth Factor), and VEGF (Vascular Endothelial Growth Factor. By concentrating these growth factors and injecting them at the site of injury or degeneration,, the body's own stem cells are drawn to the injured area and differentiate to cause regeneration of new healthy and robust ligaments, tendons and cartilage.. 

PRP provides a fibrin matrix graft. : Fibrin matrix provides the scaffolding for new collagen to form along damaged ligaments and tendons. With a fibrin matrix graft, even severely damaged tissues can re-organize and heal.Platelets

Blood

 

 

 

 

PRP concentrates Mesenchymal stem cells (MSCs).

MSCs are multi-potent stem cells that can differentiate into a variety of cell types during tissue repair processes. Cell types that MSCs have been shown to differentiate into include collagen secreting cells, bone forming osteoblasts and cartilage forming chondrocytes. Together these cells have the potential of rejuvenating tissues damaged by injury, degenerative changes, and osteoarthritis.

What does it do?

The PRP process concentrates fibrin, mesenchymal stem cells, and platelets so that each cubic millimeter of solution contains 1.5 to 2 million platelets, resulting in up to a five-fold increase in platelets and bioactive growth factors. Because it is so concentrated, PRP acts as a potent tissue growth stimulant, amplifying the natural process of tissue repair and healing. Studies show that PRP induces the production of new collagen by the fibroblasts, bone and cartilage cells at the site of the injection, rebuilding the joint cartilage and strengthening injured ligaments and tendons. This new collagen is naturally incorporated directly into your existing cartilage and ligaments, making them thicker, stronger and more elastic.

How Does PRP Regenerative Injection Therapy Compare With Cortisone Shots?
Occasionally a single cortisone shot may give someone significant relief. Usually however, cortisone shots provide temporary relief and stop inflammation, but may not provide long term healing requiring ongoing injections.  The problem is that cortisone is catabolic to tissues, meaning that its use will promote degeneration and wasting over time and with continued use.. PRP therapy is healing, regenerative and strengthening these tendons and ligaments and in some cases thickening the tissue up to 40%.

How Does PRP Regenerative Injection Therapy Compare With Hyaluronic Acid Injections?

Hyaluronic Acid injections ( Synvisc™, Hyalgan™, and Orthovisc™  and more) are very effective at increasing comfort and range of motion in injured joints.  It does not, however, provide a mechanism of regeneration and it is necessary to continue injections about every 3 months to maintain benefit.  PRP is regenerative, which means it stimulates the body to actually grow new ligaments, tendons and joint tissues which will last and function like normal healthy tissues.

How Does PRP Regenerative Injection Therapy compare with regular Dextrose Prolotherapy?

Clinical and anecdotal experience is demonstrating that using PRP as the regenerative injection method creates a much more profound healing effect and results in improved results in less treatments. Prolotherapy is a very effective and useful therapy, but PRP is especially useful when regular prolotherapy has provided positive results, but recovery has not been ideal.  In these cases PRP is often the treatment that will resolve these less responsive or more injured areas.

Frequency Of Treatments
While responses to treatment vary, most people will require 2 to 6 sets of injections of PRP. Each set of treatments is spaced 4 to 6 weeks apart. Usually positive development is evident after 2 treatments. Often satisfactory results may occur even sooner, but cannot be predicted with certainty.


The American Journal of Sports Medicine; May 2013

Treatment of Partial Ulnar Collateral Ligament Tears in the Elbow With Platelet-Rich Plasma

This study gives positive evidence for the use of PRP in sports injuries.

Drs. Luga Podesta and Lew Yocum, demonstrated that 30 of 34 athletes (88%) had returned to the same level of play without any complaints. The average time to return to play was 12 weeks. As well, real physical changes inside the elbow were observed.

Conclusion: The results of this study indicate that PRP is an effective option to successfully treat partial UCL tears of the elbow in athletes.


Articles

Platelet Rich Plasma (PRP) Therapy Literature Reviews

By Gary B. Clark, MD, MPA

Visions of Regenerations to Come

Published in the Journal of Prolotherapy


Mayo Clinic research identifies optimal treatment sequence for "tennis elbow"

The study included 34 patients with a wide range of tendon and soft tissue injuries, from rotator cuff tendinitis to plantar fasciitis, an inflammation on the bottom of the foot....patients received an injection of concentrated platelets from their own blood. The platelets release growth factors into the area to start the healing process. Researchers found maximum benefits tended to occur within four months after the procedure. More than 70 percent of patients had better use of their tendons, and 76 percent reported improvement in pain. In addition, researchers found some indication of tendon healing, which was detected with sophisticated ultrasound imaging.


 

The New York Yankees star third baseman Alex Rodriguez gets PRP

 Texas Rangers' 2nd baseman Ian Kinsler said he had PRP injection 

"I feel 100 percent ,and it's the first time I can say that in a long time," Kinsler said


 

       Tiger Woods discusses PRP Platelet Rich Plasma

VIDEO:

Tiger woods held a press conference a the Augusta Masters today to address concerns of his medical treatment among other issues that have been circling in the media. Tiger clarified that he has never used performance enhancing drugs (PED’s). However Tiger did confirm that he received 4 injections of PRP Platelet Rich Plasma to his knee ligament (LCL) following a slow post operative recovery from ACL repair. Woods also received treatment for his Achilles tendon which he tore & adversely affected his driving distance . He claims that the treatments were successful & he feels strong.

While Tiger Woods has been surrounded by disappointments  of his family & fans of infidelity, it appears that he has not violated any medical laws or restrictions in sport. PRP has been used to treat many athletes & even more weekend warriors. We are conducting several studies including a 10 multi center clinical trial on tennis elbow as well as a pilot knee arthritis study that was submitted for publication.

So hopefully the bright side of all this media frenzy will be the attention placed on an emerging therapy PRP. In no way is this a panacea but it appears a safe alternative to cortisone. More studies will emerge soon, some pro and some con to best determine which patients and injuries will be proper candidates for PRP.


Research In PRP Regenerative Injection Therapy:

    Platelet Rich Plasma - PRP Matrix Graft by David Crane, MD and Peter A.M. Everts PhD


PRP Articles

Globe and Mail: Injured? Heal yourself with your own blood

Journal of the American Academy of Orthopaedic Surgeons (JAAOS). Early outcomes of PRP appear promising

PRP Prolotherapy used successfully for professional athletes

PRP keeps Hines Ward and Troy Polamalu of the Pittsburgh Steelers  in the game

PRP used by figure skater Patrick Chan, Canadian Olympic Team, B.C. Lions

Takashi Saito, Dodger Pitcher, regains career after PRP elbow treatment

Houston Astro's Picture Doug Brocail recovers from hamstring injury with PRP and continues his season

PRP news show video of Doug Brocail

Sports Groin Injuries:

Efficacy of Dextrose Prolotherapy in Elite Male Kicking-Sport Athletes With Chronic Groin Pain Archives of Physical Medicine and Rehabilitation 2005; 86: 697-702
Conclusions: " marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes."


 

Stem Cell Prolotherapy in Regenerative Medicine
Background, Theory and Protocols

Donna D. Alderman, DO, Robert W. Alexander, MD, DMD, FICS,
Gerald R. Harris, DO, Patrick C. Astourian, MS, PA-C

Journal of Prolotherapy

 

 

 

 

 

 

 

 

 

 

 

 

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