This week’s subjects

• A Listener’s Experience with PRP Treatments
• Using Ultrasound Guidance for injections
• Athlete Case: Achilles Tendinitis and Possible Tear
• Risks of Steroid Injections
• Understanding Overuse Injury and Tendon Healing Phases
• Patient Perspective: Rapid Relief and Treatment Insights
• Do anti-inflammatory medications help with healing?
• Risks and Side Effects of NSAIDs
• Risks and Outcomes of Meniscectomy
• Neck Discomfort and Crunching Sensation
• Thumb Injuries
• Knee Pain
• Baker’s Cyst: Diagnosis and Treatment

 

Are you currently experiencing joint or muscle pain? If so, stay tuned—this program is designed just for you. Welcome to Living Pain-Free with Dr. Marc Darrow, MD, and Dr. Thomas Grove.

Meet the Hosts

Dr. Marc Darrow is a board-certified medical doctor, having completed his studies at UCLA. He practices at the Stem Cell Institute in West Los Angeles, where he uses cutting-edge treatments such as stem cell therapy and platelet-rich plasma (PRP) to help heal the body. Dr. Darrow also educates others about the use of stem cells, PRP, and prolotherapy for pain management and recovery.

Joining him is Dr. Thomas Grove, a specialist in regenerative medicine and an expert in ultrasound-guided injections. Dr. Grove brings a wealth of experience as both an athlete and a strength and conditioning coach, providing unique insights into treating pain and getting people back to an active lifestyle.

This program offers effective solutions for the pain you may have been living with. With the expertise of Dr. Darrow and Dr. Grove, today’s episode could be the beginning of a new, pain-free chapter in your life.

Regenerative Medicine: Natural Healing for Active Lifestyles

Welcome back. It’s that time of the week—this is Living Pain-Free, and I’m your host, Dr. Thomas Grove, board-certified physician and sports medicine specialist, fellowship trained.

My passion in life is getting people back to being active again. After years of working as a team physician for Division I athletes and treating countless active individuals, I’ve traveled around the world searching for the best ways to heal soft tissue injuries. Whether it’s a ligament, muscle, tendon, or joint issue, I know how important it is to recover quickly and safely to return to your routine and avoid surgery whenever possible.

Today, we’re focusing on regenerative medicine—the healing cells of the body. This includes treatments like platelets, which can be obtained from your own blood, and stem cells, which can be harvested from bone marrow, for example.

There are many excellent methods available to naturally stimulate your body’s healing process and help you recover without relying on pain medications or unnecessary surgical procedures. Our aim is to get you back in action, pain-free, using the most advanced and natural approaches available. Hopefully we can get you off the anti-inflammatories, the pain procedures, the unnecessary surgeries.

Listener Questions

As practitioners, we frequently receive emails from people not only in our local area but also across the country and around the globe. This ongoing communication is one of the most rewarding aspects of our work, allowing us to educate a diverse audience and explore whether regenerative medicine could be a suitable solution for their needs.

A Listener’s Experience with PRP Treatments

Recently, a patient reached out to share their experience after undergoing three rounds of platelet-rich plasma (PRP) therapy with a local physician. Despite multiple treatments, they reported no pain relief. The physician had explained that there was no need for advanced ultrasound guidance during the procedure, prompting the patient to question whether this was accurate.

The Value of Ultrasound Guidance

This scenario is common in regenerative medicine. In my opinion, not using ultrasound guidance reflects a lack of proper training, especially given how valuable this technology is today. Musculoskeletal ultrasound is my preferred imaging tool for soft tissue injections, as it enables precise targeting. For example, when injecting into a small joint, I can visually confirm the needle’s placement before delivering healing cells directly to the intended area.

Regenerative medicine procedures can be costly, so it is crucial to ensure that the treatment is administered accurately. Patients are investing in these therapies, and it is only fair that the healing cells are delivered exactly where they are needed. Many injuries are located in areas with poor blood supply, making targeted delivery even more important. Ultrasound technology allows us to achieve this level of accuracy, offering higher definition imaging than MRI and dynamic, real-time visualization of tissues and needle placement.

Ultrasound not only assists in delivering treatment but also helps diagnose the underlying issue. The technology enables both the physician and the patient to observe the procedure live on screen, ensuring the healing cells are placed precisely. This reduces uncertainty about whether the cells reached their target, which can be a source of frustration for patients who have researched and invested in regenerative medicine but did not see the desired results. Often, the lack of ultrasound guidance is a contributing factor.

Training and Expertise Matter

Proper use of ultrasound requires dedicated training and experience. I have spent over a decade honing my diagnostic skills, including extensive time teaching anatomy to medical students, residents, and fellows. This foundation is essential for maximizing the benefits of regenerative treatments. In contrast, so-called “blind injections”—where no imaging is used—have been shown in numerous studies to be far less accurate.

Questions to Ask Your Provider

If you are considering a regenerative medicine procedure, it is wise to ask your provider about their experience with musculoskeletal ultrasound and how frequently they perform these guided injections. There is significant variability in training among practitioners, and your outcome may depend on their skill set.

Athlete Case: Achilles Tendinitis and Possible Tear

Athletes commonly face challenges with injuries such as Achilles tendinitis, and in some cases, a possible tear. One patient described persistent pain in their Achilles tendon for the past six months, which has prevented them from playing basketball. This scenario highlights the significant impact that Achilles injuries can have, especially for those participating in high-impact sports.

Understanding the Achilles Tendon

The Achilles tendon is a vital structure for athletes, particularly basketball players, as it connects the calf muscles to the heel and is responsible for actions like pushing off, running, sprinting, and jumping. It withstands a tremendous amount of force, acting like a rubber band that stretches and contracts under load. Even simple movements, such as jumping for a shot, rely heavily on a healthy Achilles tendon.

Challenges in Healing Achilles Injuries

Achilles tendinitis, even without a full tear, can be debilitating and extremely painful. Because this tendon bears a large portion of the body’s weight and is subjected to constant stress, injuries here are difficult to manage. Athletes often continue to exercise, which keeps the area inflamed and prevents proper healing. The Achilles tendon also has a limited blood supply, making recovery even more complex.

Natural Healing and Regenerative Medicine

Our bodies rely on natural healing cells, such as platelets, which release growth factors to attract other healing agents like stem cells. However, delivering these cells to the damaged Achilles tissue is challenging due to poor blood supply. This limitation makes injuries in this area harder to heal without intervention.

Risks of Steroid Injections

One common but risky approach to treating Achilles tendinitis is steroid injections. While these may provide temporary relief, they are toxic to tissue, especially in high-stress areas like the Achilles tendon. Repeated steroid injections increase the risk of microtears, which can progress to full ruptures and require surgery. It is crucial to address Achilles injuries promptly to avoid long-term complications.

Treatment Strategies

For those dealing with Achilles tendinitis—particularly athletes—regenerative medicine has shown promising results. The goal is to deliver healing cells directly to the affected area to promote recovery. Additionally, using a walking boot helps distribute force across the injured tissue, supporting healing and reducing further damage. This simple device, with Velcro straps, offers practical support for foot and ankle injuries.

Importance of Timely Intervention

Continued activity or masking pain with medications can worsen Achilles injuries. Early intervention is essential to prevent minor tears from developing into major ruptures, which can lead to lengthy surgical procedures and prolonged recovery—sometimes lasting over six months. Maintaining strength and activity while managing injuries appropriately helps athletes avoid devastating setbacks.

Athletes and active individuals must be cautious with Achilles injuries and prioritize proper treatment. Overuse injuries like tendinitis are common, and understanding the structure and healing challenges of the Achilles tendon is key to successful recovery and maintaining long-term activity.

Understanding Overuse Injury and Tendon Healing Phases

Overuse Injury and Inflammation

Overuse injuries, such as tendonitis, occur when repetitive stress is placed on a tendon, leading to inflammation. The “-itis” in tendonitis indicates this inflammatory response. Sometimes, this natural response enables the injured area to recover on its own.

Challenges in Healing

Certain areas, notably tendons with poor blood supply, struggle to heal completely without assistance. This limited blood flow means that healing cells and nutrients are not efficiently delivered to the site of injury, making recovery difficult. To support healing, regenerative medicine treatments are used to provide a “push,” delivering beneficial healing products and cells directly to the affected area. This targeted approach helps accelerate the healing potential of these injuries.

The Timeline and Phases of Healing

Healing from tendon injuries follows a specific timeline, even with intervention. After a patient receives treatment—such as regenerative medicine—a hands-on physical exam and diagnostic scan are performed to determine the most suitable approach. If the patient is a good candidate, treatment is initiated, and the recovery process begins, which typically unfolds in three main phases:

• Inflammatory Phase: This initial stage is marked by increased inflammation, contrary to common belief. After regenerative medicine treatment, patients may experience stiffness, soreness, and swelling as healing cells release growth factors. If stem cells are used, exosomes are released to further support healing. These events spark the immune response, jumpstarting tissue repair. It is crucial during this period to avoid strenuous activity, as exercising through inflammation can prolong recovery and increase discomfort.
• Proliferative (Repair) Phase: After a few days, the healing process enters the proliferative phase. Here, healing cells focus on rebuilding tissue, laying down essential proteins such as collagen and forming new blood vessels. This phase lasts several weeks and benefits from gentle movement, without overexertion. The repair phase establishes a strong foundation for lasting recovery.
• Remodeling (Maturation) Phase: Finally, after about a month or more, the maturation phase begins. During this period, newly formed tissue matures and disorganized collagen transitions into functional, resilient tissue. This mature tissue is what allows patients to return to activity and enjoy long-term benefits from treatment.

For injuries like Achilles tendonitis, the true benefits of regenerative treatment are realized after a month or more. It is important to recognize that these treatments do not typically provide immediate relief; instead, they promote gradual, lasting recovery as each healing phase unfolds.

Patient Perspective: Rapid Relief and Treatment Insights

The healing process is indeed a timeline, requiring patience and proper management. During a recent segment, a caller joined the discussion to share a personal experience with regenerative treatment.

Caller’s Experience with Shoulder Injection

The caller, Dr. Marc Darrow, recounted his own journey. After experiencing shoulder pain from repetitive golf swings, he received an injection in his right shoulder. Remarkably, he reported waking up completely pain-free the following day.

Understanding Rapid Pain Relief

In response, the host explained that while the overall healing timeline is typically long, clinical outcomes—how the patient feels—can sometimes shift quickly. Some individuals, described as “fast healers,” may experience rapid pain relief following treatment. For example, the host noted personal experiences of significant improvement in the thumb and wrist within days after treatment. This initial improvement may be attributed to the inflammatory phase: when tissues are damaged and inflamed, the resulting response can help “reset” the pain signals, leading to surprisingly quick relief in some cases.

Importance of Rest During Recovery

Despite fast symptom relief, both the Dr. Darrow and Dr. Grove emphasized the challenge of adhering to rest. To optimize healing, it is important to avoid returning immediately to physical activities, such as golf, that could re-injure the tissue. The best approach is to continue resting the affected area and allow the healing process to proceed.

Part 2

I’m your host, Dr. Thomas Grove, a board-certified physician with fellowship training in sports medicine.

Today’s Topic: Musculoskeletal Medicine and Orthopedics

Today, we’re returning to our topic: musculoskeletal medicine and orthopedics. We’re focusing on regenerative medicine—techniques that help the body heal itself. This includes treatments like platelet-rich plasma, which can be obtained from your own blood, and bone marrow-derived stem cells. These are powerful tools that promote healing and can help you return to activity naturally.

Benefits of Regenerative Techniques

These methods support the healing process and can help you avoid unnecessary surgery, getting you back in the game through natural recovery.

Anti-Inflammatory Medications and Healing After PRP Treatment

Here we address a frequently asked question regarding the use of anti-inflammatory medications following regenerative medicine treatments such as PRP (Platelet-Rich Plasma) therapy. The discussion is based on a recent email inquiry and reflects common concerns raised by patients.

Do anti-inflammatory medications help with healing?

Recently, I received an email from a patient who had undergone a PRP treatment about a month ago. The patient mentioned having an old prescription for Moxyam and asked, “Do anti-inflammatory medications help with healing?” This is a question I get asked almost every single day, and I am glad the patient reached out before starting the medication.

To understand the answer, it is important to review the basics of how healing occurs following regenerative medicine treatments. After delivering healing cells, often via injections guided by ultrasound, the first phase of healing is inflammatory. We do not want to take medications that block inflammation during this phase because inflammation is a crucial part of the body’s healing response. Moxyam belongs to the drug class of NSAIDs (nonsteroidal anti-inflammatory drugs). There are many types of NSAIDs available, including ibuprofen, Motrin, Aleve, Celebrex, and Toradol. These medications can be effective at reducing pain, and they are commonly used by athletes to get through their seasons.

Risks and Side Effects of NSAIDs

However, using NSAIDs comes with significant drawbacks. If you have an injury and want to promote healing, it is important to allow inflammation after an injury or regenerative treatment. Taking NSAIDs can block inflammation and therefore impede the healing process. It is generally recommended to avoid these medications as much as possible to optimize healing.

In addition to inhibiting healing, NSAIDs carry a range of side effects. Gastrointestinal issues such as nausea, stomach pain, and ulcers in the stomach lining are common. These ulcers can sometimes lead to serious GI bleeds, which I have seen frequently in emergency rooms and intensive care units. Chronic use can also result in tinnitus (ringing in the ears) and kidney problems, including acute kidney injury. NSAIDs can increase blood pressure, cause fluid retention in the feet and ankles, and raise the risk of heart attack and stroke. For individuals with heart issues, NSAIDs are especially risky.

Impact on Healing

The main concern with NSAIDs is that they inhibit the inflammatory process necessary for healing. They block platelet function, which is critical after treatments like PRP. While taking NSAIDs may provide temporary pain relief and enable a return to activity, this can lead to further injury and a negative cycle that ultimately worsens the original condition. Blocking pain can mask the underlying healing process, leading to more damage and, in severe cases, catastrophic outcomes. Anti-inflammatory medications like NSAIDs should generally be avoided following regenerative medicine treatments such as PRP. They may reduce pain in the short term, but they hinder the healing process and carry numerous health risks. It is best to optimize healing by allowing the body’s natural inflammatory response to proceed.

A patient writes to Dr. Grove about a recent knee injury sustained while playing pickleball. An MRI revealed a small meniscus tear. By the time the patient met with their surgeon, the pain had already disappeared.

Surgeon’s Recommendation and Patient’s Concern

The surgeon recommended a meniscectomy, prompting the patient to ask: “What is that? Do I really need surgery?” This case involves someone who suffered a knee injury, underwent an MRI, and was diagnosed with a meniscus tear. Meniscus tears are quite common and often do not produce symptoms. In this situation, the patient’s pain resolved before seeing the surgeon.

Understanding Meniscectomy

A meniscectomy is a surgical procedure where the damaged portion of the meniscus is removed. The meniscus is a shock absorber located between the thigh bone (femur) and the shin bone (tibia), sitting atop the cartilage. Removing or trimming the meniscus reduces its shock-absorbing capability. Outcomes after meniscectomy surgeries cab be unfavorable. Many times, patients end up worse after the procedure. There is a loss of stability and shock absorption in the knee, which can lead to early onset arthritis and increased instability. For patients without pain, pursuing surgery is generally not advisable, as there is no upside and only potential downsides.

Considerations for Athletes and Active Individuals

Even if pain subsides, instability might remain due to stretched ligaments around the knee. Athletes who experience instability, such as the knee feeling unstable during lateral movements or descending stairs, may have stretched ligaments rather than pain. In these cases, regenerative medicine can be considered to help restore structural integrity by tightening ligaments and improving joint stability. Whenever pain goes away after an injury, it is important to get a thorough evaluation and hands-on physical exam to assess the function of the knee tissues. Just because there is no pain does not mean everything is perfect—there may still be laxity or instability, which can lead to further problems and accelerate arthritis. Surgery should not be pursued when pain is absent, as it does not offer any real benefit and may instead cause harm.

Neck Discomfort and Crunching Sensation

Email reads: “Dr. Grove, please help.” I really appreciate when emails begin this way. It always motivates me to see how I can assist the patient.

The case describes a patient experiencing a peculiar crunching sensation accompanied by mild neck discomfort every time they turn their head to the side. The patient asks if this is something I can help with. Interestingly, I have personally experienced this same sensation myself, particularly after playing football, which involved considerable head trauma. The force exerted on the neck and base of the head can lead to these types of symptoms.

Whenever mechanical symptoms are present, it is crucial to quickly identify their source. In such cases, bringing the patient into the clinic for a comprehensive hands-on physical examination is essential to determine which anatomical structure is responsible for the sensation.

It is difficult to diagnose the cause from a brief question alone, but there is a good chance that facet arthritis could be involved. Reviewing spinal anatomy, the neck comprises several vertebrae with facet joints between them—one on each side at each level of the spine. The crunching sensation described by the patient is characteristic of facet arthritis, which I have also experienced. These joints are small, about the size of a finger joint, and can develop cartilage roughening and inflammation following trauma, whether minor or cumulative. This process often results in the crunching, uncomfortable sensation noted by the patient.

Treatment Approaches and Outcomes

This condition can be quite apparent; in my experience, the crunching sound was audible even across the room. Fortunately, with appropriate treatment, these symptoms can resolve. I have successfully treated this myself and found that surgery rarely addresses the mechanical symptoms like crunchiness. Pain can be managed with medications such as lidocaine injections, steroid injections, nerve blocks, and epidurals, but these do not necessarily promote healing.

When faced with such cases, regenerative medicine often proves to be highly effective. Treating these small joints can be challenging, but using ultrasound allows precise targeting, ensuring that healing cells are delivered directly to the affected area. This is especially beneficial for facet joint issues, where cells can also be injected into surrounding ligaments, tendons, and muscles to support the joint.

Regenerative Medicine and Its Applications

Many people assume that regenerative medicine is limited to hips, knees, or shoulders, but the tissue involved in facet joints is similar—collagen-based articular cartilage. Although these joints are located in different parts of the body and have different names, the underlying tissue is the same. The body has joints, ligaments, tendons, and muscles throughout, all of which can be targeted with regenerative medicine for effective treatment.

I have personally experienced how annoying and uncomfortable the crunchiness can be, requiring frequent adjustments for temporary relief. However, after undergoing regenerative treatment, I no longer needed those adjustments, demonstrating the excellent outcomes that can be achieved with these therapies.

Thumb Injuries

Thumb injuries are a common concern, affecting people from all walks of life. One typical scenario involves jamming the thumb after a stumble, which can result in a feeling of looseness or instability. This type of injury often stems from a minor trauma that stretches the ligaments or other supportive structures around the joint.

Understanding the Anatomy of the Thumb

The thumb is a complex anatomical structure, featuring numerous joints that connect the hand bones to the finger bones. The joint is surrounded by a capsule, tendons, and ligaments, all of which play vital roles in movement and stability. These structures enable the thumb to flex, extend, and move in various directions, making it essential for daily tasks and specialized work.

Symptoms of Thumb Injury

A thumb injury may manifest as a sense of looseness or instability. Medical imaging techniques such as MRI, CT scans, or X-rays may not always reveal ligament laxity, as this is often assessed clinically by physically stressing the tissues and comparing them to the other side or other fingers. If looseness is detected, it usually indicates ligament laxity or instability in the joint.

Impact of Thumb Injuries

Thumb injuries can be particularly limiting. Simple activities like opening a jar of pickles, holding a cell phone, or drinking from a coffee mug can become difficult. For individuals who rely on their hands for their profession, such as those performing frequent injections, artists, musicians, or office workers who type and write regularly, thumb injuries can be devastating and even career-ending. One well-known thumb injury is “gamekeeper’s thumb,” which occurs when the ligaments at the base of the thumb are stretched excessively. This results in a subjective feeling of looseness and instability in the thumb.

Treatment Options

Regenerative medicine is often used to address thumb injuries, especially those involving ligament laxity. Treatment typically involves multiple small injections around the thumb to enhance the structural integrity of the entire joint complex. These procedures use tiny needles and are guided by ultrasound to target the affected area precisely. The process involves minimal discomfort and a brief rest period for recovery. Thumb injuries are one of the most common issues treated in clinic settings. The thumb tends to wear out or get injured more easily than other parts of the hand, making regular treatment and

Knee Pain

So, speaking of emails, let’s get right back into another one. This is a good one. This one says, “Hey, Dr. Grove. I’m told I have osteoarthritis under my right kneecap and I’m looking into stem cell treatments, acupuncture, cupping, ultrasound, and want to know, will I get some results with platelet rich plasma or a stem cell injection?”

This is probably the most common presentation of knee pain that we see in the clinic. Osteoarthritis is characterized by an inflammatory process occurring inside a joint. It’s not just a cartilage issue. Typically, as we do imaging reports, we note that the cartilage is thinned out, the joint space starts to narrow, and bone spurs develop. Recent understanding shows that osteoarthritis involves a complicated picture with cell-mediated inflammation that drives the inflammatory process. This is one of the most common conditions treated, and month to month, it’s likely the number one or number two concern addressed with regenerative medicine.

Understanding Osteoarthritis

The core idea in treating osteoarthritis is to break the inflammatory cycle. Chronic low-grade inflammation causes pain, and healing cells are not reaching the joint due to poor blood supply. Treatments like platelet rich plasma (PRP) or stem cell injections are delivered directly into the joint to spike inflammation and hit the reset button, aiming to create a more optimal internal healing environment.

The goal is to break the cycle, promote healing, and achieve long-term benefits with regenerative medicine. Unlike steroid injections, which only decrease pain, regenerative treatments provide healing cells directly at the site, leading to a prolonged anti-inflammatory effect. The hope is to slow down the progression of arthritis, and ideally, help regrow some of the tissue.

Conservative and Regenerative Treatment Options

Acupuncture, cupping, and other conservative approaches are often considered first, which is fantastic. When these methods are not effective, regenerative medicine serves as a valuable tool to give the healing process a boost and speed recovery. The overall aim is to avoid total joint replacement and keep patients out of the operating room, facilitating healing without surgery.

Baker’s Cyst: Diagnosis and Treatment

We’ve got Nancy. Nancy asked, “Do you fix baker’s cysts?” She explained that she has two and no one seems familiar with them.

Baker’s cysts are common and are treated daily. They are essentially a fluid collection felt on the backside of the knee, usually on the inner half. It’s a potential space, meaning everyone has the ability to develop a Baker’s cyst, but not everyone has enough damage or inflammation to cause a significant one. Excess production of synovial fluid leads to the cyst, and when they grow, the knees can feel stiff and tight, sometimes decreasing range of motion and causing irritation. The cyst runs between one of the calf muscles and one of the hamstring muscles, so even a small cyst, like one the size of a golf ball, can be very irritating, especially for active people.