Try regenerative therapy for overuse injuries

Despite everything you’ve probably been told about aching joints and injuries, inflammation isn’t always a bad thing.

In fact, while it’s often a pain, inflammation is part of your body’s natural healing process. Figuring out how to harness that is a key part of the field of regenerative therapy injections.

“For a run-of-the-mill or acute injury, we talk about rest, ice, anti-inflammatories, corticosteroid injections, things that reduce inflammation,” says Brian Hill, MD, sports medicine specialist with MultiCare Orthopedics and Sports Medicine.

That’s because inflammation is painful and sometimes the body overreacts, so we need to counteract it.

But for chronic, repetitive use injuries, the playbook changes. Regenerative therapy “is turning that on its head and actually creating an inflammatory response in an intentional way to remind your body this is an area that needs to be fixed,” Dr. Hill explains.

While regenerative injection therapy isn’t “100 percent natural,” the healing it promotes is natural, he says.

“We’re attempting to harness the body’s natural healing abilities in kind of a pointed way to ideally have your body heal something that’s going on,” he adds.

The therapy, which is conducted with ultrasound guidance, is most useful for overuse injuries such as tennis elbow, tendonitis of the knee, golfer’s elbow, plantar fasciitis or injuries to rotator cuff tendons.

“The procedures are designed to initiate the tendon to undergo some healing changes to end up with a healthier tendon in the long run,” Dr. Hill says.

The same procedures can work to relieve joint pain associated with cartilage injuries or arthritis, with fewer downsides than corticosteroid injections. But in those cases, it’s not truly regenerative medicine because “it’s not doing any meaningful healing or recovery,” he says.

Types of regenerative therapy

The first type of regenerative injection is called tendon fenestration. It involves numbing the area and using a sugar-water and numbing solution while repeatedly needling the damaged area of the tendon.

“We intentionally irritate the tendon, a kind of pro-inflammatory treatment to cue the body to know that this is an area we need to heal,” Dr. Hill explains.

While the numbing solution helps, it’s primarily the repeated needling that does most of the work in irritating the tendon.

The next option is similar: prolotherapy. But in addition to needling the injured tendon, in prolotherapy the doctor will also inject the dextrose, or sugar-water solution, into some of the other structures in the area around the joints to promote healing and strengthen a larger area.

A third in-office option involves injecting the patient’s own platelet rich plasma (PRP). In this therapy, the visit starts with a blood draw. The doctor will put the patient’s blood into a centrifuge to create a solution rich in healing platelets, then inject that back into the injured tendon.

Finally, a more invasive procedure called Tenex percutaneous tenotomy uses ultrasonic vibration to break up unhealthy tissue. It’s considered a surgical procedure and is performed at MultiCare Gig Harbor Medical Park.

Regardless of which therapy is used, recovery involves rest, stretching, rehab and strengthening, along with some activity modifications. But though it might be sore, patients are asked to put down the ibuprofen — and even the ice.

“We actually want that inflammatory process happening,” Dr. Hill says. “That’s part of what will be helping with tissue recovery.”

(Patients can take acetaminophen/Tylenol, though, because it’s not an anti-inflammatory.)

And of course, don’t repeat the activities that caused the injury.

“Even if you have a very good response and over time your tendon is back to 100 percent health, if you are using it the same repetitive way again, you could end up in the same situation,” Dr. Hill says.

For anyone suffering chronic pain from a tendon overuse injury, regenerative therapies are worth considering, he says. Insurance usually covers tendon fenestration, but often considers the other procedures experimental.

Dr. Hill encourages anyone suffering from repetitive stress pain or other chronic pain to ask their primary care physician about a referral, or simply call for a consultation with one of the MultiCare Orthopedic and Sports Medicine clinics.