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Yoga, helping by shoulder problems

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					The Scalpel or the Needle
Saturday, June 25th, 2011

In the final day of the National Athletic Trainers’ Association Meeting and Clinical
Symposia at the Morial Convention Center, three experts who deal in biological therapies
presented the latest research on using stem cells and platelet-rich plasma (PRP) in
treating sports injuries.

Sports medicine professionals around the country are beginning to use patients’ own
blood matter — platelet-rich plasma and/or stem cells retrieved from the patient, and
injecting the healing-rich material into injury sites to promote faster and more effective
healing.

The most headline-grabbing example of this was Pittsburgh Steelers wide receiver Hines
Ward, who was injected with PRP to jumpstart the healing process on his knee injury
heading into the Super Bowl. He recovered enough to play in two weeks.

Tiger Woods was injected after his 2008 knee surgery. Baseball players Carlos Beltran,
Cliff Lee and other professional athletes also reportedly have had PRP therapy. The
procedure is allowed by the four major professional sports leagues, not regarded as a
performance-enhancer any more than a knee brace. And it now has considerable buzz
because of the star power using it.

The simplicity of the PRP procedure and the safety of it make it attractive to athletes who
would rather try it than a traditional surgery or invasive treatment. It is still considered
experimental by the medical insurance world, so most people pay out of pocket for the
procedures.

It’s a simple process that begins with blood drawn from the front of the elbow — just as
traditional blood samples are taken.

A citrate is added to the blood to inhibit clotting, and then the blood vial is placed in a
centrifuge, which spins the matter into several components: plasma, platelets, white blood
cells and red blood cells.

The plasma is then injected back into the patient at the injury site, usually with the aid of
ultrasound guidance to make sure it is deposited in the optimal location.

The healing properties of the platelet-rich plasma go to work, supposedly fanning the
healing process. Stem cells work similarly, only they can be extracted from the patient,
cultured and multiplied outside the body before re-injecting them.
“You have lots of different tools, and those tools can be enhanced and used to help
different areas,” Dr. Chris Centeno, a panelist who uses stem cells and PRP in his
practice. “You can move cells from point A to point B and make more of them and use
those to try to heal you.”

There is even talk about young athletes farming away their stem cells retrieved from bone
marrow aspiration to have for use in future injuries.

The use of stem cells in the medical world isn’t new, but it is new to orthopedic
medicine.

“We started doing some research in 2005, and in late 2007 we became convinced it was
working and started offering it to our general surgery population rather than just research
subjects, ” Centeno said.

His patients saw great reduction in pain and bounced back quicker than those who went
for more traditional surgeries. Centeno said he is on a team that submitted a study for
publication that includes 250 patients, and that study is encouraging for the field.

“I think PRP is exciting; I think it’s a new thing, ” Gerald Weniger, a certified athletic
trainer althleticwho administers such injections in his Harrisonburg, Va., clinic. “Before
we were doing it in our clinic, we had people coming to us and asking us to do it because
they were so excited about what they were seeing in the news. We only got into it
because people were asking us to do it.”

The problem is, there isn’t much research in the area.

Adding to the cloud of uncertainty is that there is no standard methods of collecting the
material or administering it. So comparing one study that used volumes of PRP material
and injected it into a human shoulder might not make an easy comparison to another
study that used teaspoons of it in a rat’s leg.

“I think we’ve got to slow down because there’s not a lot of research on it yet, ” Weniger
said. “I think the research that’s been done is pretty (vague). There is a lot that shows
PRP has a beneficial effect, and there is a lot that doesn’t show anything. I think we have
to hash that all out. I think we certainly have to keep doing it so we can figure that out
and keep trying on different things so we can narrow things down and get indications on
whether it should be ligaments or muscles or tendons, and whether it should be used in
acute settings or chronic settings.”

Corey Oshikoya, an athletic trainer with the Denver Broncos who sat on the panel as
well, said his profession is trying to make up rehabilitation schedules on the fly as more
and more players come in after PRP injections. If these athletes are recovering quicker,
do you up their rehab schedule? So far the answer to that is no. He advised caution in
ramping up rehabilitation steps.
“There is very little literature out there that displays or approaches how you should treat
an athlete that has had PRP therapy, ” he said in his lecture. “We’re all kind of searching
for answer.

				
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