What is PRP and how does it work?
Platelet-rich plasma is a concentration of your platelets (a part of your blood) obtained by spinning your whole blood in a special centrifuge. Platelets are what naturally begin the healing process in your body anytime an injury occurs. The platelets release proteins that attract your body's stem cells to the injured area. The concentration of platelets in PRP allows your body to recognize the injury as a priority and heals it more quickly and more thoroughly than your body can by itself.
What is BMA and how does it work?
Bone marrow aspirate (BMA) is a procedure in which the doctor removes your own body's bone marrow stem cells, concentrates them in an FDA approved device and injects them into the area(s) of injury with ultrasound guidance to ensure exact placement. The concentration of stem cells works directly at the site of injury or degenerative tissue to increase the healing potential tenfold.
What is ADSC/fat graft and how does it work?
Using a special device, adipose tissue (fat) is removed from an area of your body where it is stored easily. Fat has a very high concentration of stem cells that live on the stromal tissue. Also, fat cells are often needed as a matrix and become the scaffolding for the platelets or bone marrow stem cells to adhere to and activate your healing cascade.
How is the PRP/BMA delivered to the injured area?
The doctor uses ultrasound or fluoroscopic guidance and aseptic techniques to inject the PRP or BMA into the injured tendon, ligament, muscle, joint, bone, or nerve.
How do I choose — PRP or BMA?
It is an individualized decision, made by the doctor based on the severity of the injury and/or disease involved and your medical history. Some diagnoses require PRP alone, some BMA alone, and others adipose (fat) with the PRP or BMA. The physicians use our clinic's experience as well as the experience of other practitioners who perform regenerative therapies around the world.
What can be treated with the PRP/BMA injections?
Many soft tissue injuries and degenerative conditions of muscle, tendon, ligament, joints, bone, and nerves, as well as many eye issues, can be treated. The success rate of our regenerative techniques depends on many factors and these will be discussed at your initial appointment.
Is PRP/BMA covered by insurance?
Most insurance companies do not cover these procedures and consider them investigational. We offer multiple payment options through our financial partners.
Why is an X-ray ordered before I see the doctor?
Our physicians require that you have an X-ray or MRI done before you visit our office for the first time. The only exception is that we can provide an X-ray in our St. Louis office. If you come from out of town or are visiting one of our other offices, you must get this exam performed and sent to us before coming for a visit. This provides our physician an opportunity to review your damaged area and assess to what degree they may be able to help you.
Why do you order lab tests?
During the initial evaluation process, we will most likely order laboratory blood work to check the complete blood count, testosterone, and vitamin D levels.
The Complete Blood Count (CBC)
The CBC will let us know if you have had any recent infections and measures platelet count, volume of fluid (plasma) and the number of cells that make up your blood. This will give us a good idea of the overall health of your blood.
Testosterone is the chemical signal of your body to tell it to build new tissue. Both men and women have testosterone in their blood in varying degrees to assist in the healing process, as well as for other processes in your body. Without an adequate supply of testosterone, you will not heal as effectively.
Vitamin D also plays an important role in the body's healing process. Vitamin D helps calcium to be absorbed from your digestive tract to be stored in the bones. It also provides support to the immune system and supports the chemical processes that result in healing.
If these levels are low, your physician will likely suggest supplementing the testosterone and/or the vitamin D to assist in your healing. The supplementation of these is optional and is not required for your treatment to be done, but they can assist in a faster recovery and support better end-results.
Why do I need a knee brace?
A knee brace may also be suggested by your physician during the evaluation process and is usually prescribed for only one knee. The brace will be put on the knee in the worst condition or causing the most pain or problems. The brace will assist in alleviating pressure in the knee joint that could otherwise slow the healing process. The brace will also provide more space for the stem cells to better perform their job.
When do I start to feel better or see results?
This varies from patient to patient. Generally, patients report feeling less pain or seeing improvements in their symptoms as soon as 4 weeks post-treatment. More concrete improvements can be identified by patients in as soon as 12 weeks post-treatment. Visual improvements can be confirmed with MRI, X-ray or ultrasound approximately 12 months after treatment. Back pain can take longer.
How long does the procedure take?
The procedure will typically take between 1 and 2 hours.
Can I drive or be active after the treatment?
Pain medication or other medication may inhibit your ability to drive. This will be dependent on your specific treatment. You can be active after these treatments but it is encouraged that frequent breaks be taken when pain becomes problematic. We do not want a patient to fight through pain to finish an activity.
When can I start to work out again?
We will usually have you rest and only do regular daily activities (e.g. washing, walking, light household chores, etc.) for the first 2 weeks post-treatment, then start to incorporate regular workout routines or physical therapy after that time.
When can I go back to work?
Generally, patients are able to return to work after a couple of days post-treatment. This may be dependent on your profession and the area(s) that are being treated. It is best to ask your physician for a more reliable estimate on when you may return to your work.
May I continue to take anti-inflammatory medications?
We recommend you not take anti-inflammatory medication starting 5 days prior and 4-6 weeks after your treatment. We recommend Tylenol for pain relief.
Will I experience pain after the treatment and if so for how long?
Most patients will experience 1-3 days of discomfort that is easily managed with Tylenol or a prescription pain medication that the physician will prescribe at the time of your procedure.
Will the injections be painful?
There will be a varying degree of discomfort or pain associated with the initial injection of local anesthetic as one would expect. Many patients find the local numbing agent helps the pain for the first 30 min to I hour after the procedure. The area injected will likely be very painful for the first 24 to 72 hours and your physician will prescribe pain medication that you should begin taking soon after the procedure for comfort. (Plan to have someone drive you home after the procedure.) If you are concerned about discomfort the pain medication can be prescribed before the procedure or we can prescribe an oral medication to decrease anxiety. If you are interested in having any pretreatment medication be certain to request these at least one week before your scheduled procedure to provide adequate time for it to be filled at your pharmacy.
How long before I can resume activity?
Usually 2-3 days after treatment you are able to resume normal daily activities with less pain. You may resume exercise 2 weeks after treatment cutting your time or distance in half. If your activity is painful, stop. Let pain be your guide.
Are there any adverse effects?
The main adverse side effect is post-treatment discomfort. Some patients experience a low-grade fever, swelling of the injected area, body aches, and fatigue for the first 72 hours (inflammatory phase). Specific risks and success rates will be discussed with each patient individually at the time of your initial appointment and at time of treatment - don't hesitate to call if any questions or concerns.
How many treatments will it take to heal my injury and how far apart are the treatments?
The average patient requires one to two treatments. Rarely a patient will require three. Treatments are spaced usually 12-16 weeks apart.
How will I know if I need more treatments?
We strive for 80-90% improvement in pain and function, but your exact goal will be discussed at your initial appointment and can vary based on the severity of your disease.
How long is the healing process?
Abnormal or damaged collagen takes 9-12 months to completely heal, but you should experience less pain and increased mobility within 4-6 weeks.
Will I be able to go to work/school after treatment?
Most people are able to return to work and/or school the next day. Occasionally we have patients that require taking a day or 2 off. Everyone responds differently to the acute inflammatory phase. We will provide a note if necessary.