Frequently Asked Questions
Regenerative Injection Therapies (RIT) are an advanced, nonsurgical medical procedure the treats chronic pain often caused by compression of nerves or weak or damaged connective tissues – namely ligaments, tendons, and cartilage. Small amounts of natural substances are injected to stimulate healing and regenerate new connective tissue.
Regenerative Injection Therapies do not just cover up the pain, but actually, heal and cure the condition. Many patients say, “a few injections are nothing when it gives me my life back.”
What is the background of Regenerative Injection Therapies?
The first recorded use of this type of doctoring was used by Hippocrates. He used it on soldiers with torn shoulders and joints. His method was to stick a hot poker (needle) into the join, after which the joint would miraculously heal.
Our understanding of how to evoke a healing response in the body has advanced dramatically since the days of hot pokers, but the principle is the same – tell the body to repair itself, as it naturally has the ability to do so.
Regenerative Injection Therapies have been in practice for more than 70 years. The original therapy was called Prolotherapy – “Prolo” is short for “proliferation,” because the treatment caused the proliferation (rapid-growth formation) of new tissues in targeted areas.
It was reintroduced in 1939 with vigor by Dr. George S. Hackett, a medical doctor who was contracted to do special examinations for 70 insurance companies. He discovered car accident victims who suffered from chronic pain seemed to have chronic pain because of injured or non-healed ligaments and tendons.
Dr. Hackett reasoned that repairing these connective tissues would resolve much of their pain. He introduced an irritating compound, activating the body’s natural healing mechanisms.
Dr. Hackett is considered the “father” of modern Prolotherapy because of his extensive research and lectures on the subject, and that he introduced the technique to many other physicians. One physician that he taught was Gustav A. Hemwall, M.D.. Dr. Hemwall later treated future United States Surgeon General C. Everett Koop, M.D., who, after his own dramatic results with Prolotherapy, offered the treatment to his patients.
Dr. Hanson has helped thousands of his patients regain their physical abilities – golfers golf again, skiers ski again, dancers dance again, skaters skate again. Many who did not think they could golf, skate, ski, or run again have discovered that with the help of a knowledgeable doctor, they can heal and regain their strength and vigor.
How important is it to guide injections?
Consider how confident you feel walking down a busy street with your eyes closed. This example will give you an idea of the difference between guided and unguided injections. Being trained in 3 different types of guidance, Dr. Hanson stands out nationally in his experience using guided injections. In fact, when he first started using ultrasound in 2007, after performing thousands of injections blindly, his comment was “It’s like I’m seeing the body for the first time!”
Guidance systems are not “one-size-fits-all.” Each has strengths for different types and depths of tissue that are not shared commonly amongst them. Ultrasound is easily best at seeing soft tissues, especially the more superficial soft tissues. The vast majority of tendons, ligaments, and joint injections in the periphery are best completed with an ultrasound. Deep structures, such as in the spine and pelvis are best completed using fluoroscopy, or a combination of fluoroscopy and ultrasound together. Fluoroscopy has the advantage of “seeing” exactly where an agent is flowing by using contrast before the regenerative agent. This process is crucial for very deep joints and ligaments around the spine – some procedures are only performed here at OrthoCure Clinic because we employ both forms of visualization simultaneously.
How should I decide which type of regenerative injection is right for me?
This is a very common question. There are several points to consider. First, how many procedures will it take to produce the anticipated relief? Our goal is to do the least amount of procedures possible, this will be the first priority for us, improving you with the least amount of intervention and returning you to your life as quickly as possible. All but 6 patients since the clinic was created in 2015 have required only 1-2 procedures to produce the desired results. Second: cost. Each agent carries its own cost based on the amount of intervention required to obtain the sample and the cost of the equipment/kits to process the sample. Some patients decide to use a less robust regenerative agent more times to spread the cost of treatment out. This is always at the patient’s discretion, we do try to create the appropriate expectations for what any single treatment regimen will cost. Third, the location of the degeneration will sometimes determine which agent is needed to help it heal. For example, certain tendons trend toward needing more potent agents than others, such as the Achilles tendon. Fourth, the severity of the degeneration. Though we will always leave the ultimate decision up to you, Dr. Hanson will explain why he suggests certain agents for a given severity of degeneration.
The overall goal is to get you back to life in the least amount of time, with the right amount of procedural intervention, the most appropriate regenerative agent and at the least cost.
There is a rough equivalence of different types of injections for any given location in terms of how many it will take to produce desired results. This is not a rule, but more of a clinical sense that Dr. Hanson has developed over the years. Basically, one PRP injection is equivalent to the effects of 2-3 prolotherapy sets of injection procedures. Likewise, one PRP together with marrow/adipose healing cell concentrate is equivalent to about 2-3 PRP sets of injection procedures alone. These equivalence estimates are only true when comparing apples to apples – that is, a highly experienced physician who has used advanced regenerative agents for a long period of time and uses multiple forms of guidance for every injection. In the final analysis, for any given region/structure treated and its amount of degeneration, using the regenerative combination that will most likely produce 1-2 sets of procedures is the fastest, most efficacious and least expensive overall course of action. This is part of the advantage of using a provider who has nearly 10 years of experience using advanced biologic regenerative agents.
How often are injections given?
Since the inception of OrthoCure Clinic, our goal has been to decrease the number of treatments needed for any single condition. With that as our guide, in our first 18 months, we have had only 6 patients require more than 2 treatments for a given area. The precision of both ultrasound and fluoroscopy during injections, the completeness of each injection procedure, procedure planning and the number of sites treated has made all the difference to achieve this goal. When a subsequent injection is needed, we only perform the set of procedures after a patient has stopped improving. Depending on how much the patient improves, we may perform the same procedures, add additional locations, concentrate the PRP/adipose more or add another regenerative agent. Sometimes, we do something altogether different as we reassess and listen to you. We tailor our treatments to how you’re progressing because healing is a different journey for each patient.
What should I expect after procedures?
For the first week after the injections, it is critical to avoid anti-inflammatory medications, including Advil, Motrin, ibuprofen, Aleve, Celebrex, and Mobic. Frankly, these medications should be avoided altogether if possible. These will interfere with the healing response. Dr. Hanson prescribes pain medication for post-injection discomfort. Most patients have pain for 2-7 days after the injections. We employ a class 4 laser for 2 sessions after treatment. We have found that this treatment significantly reduces pain, muscle spasm, and has overall decreased the total number of procedures we perform.
When can I expect to see improvement?
On average, most patients start to see signs of improvement anywhere from 2-12 weeks after treatment. This can be less overall pain, an ability to do more activity before pain sets in, and/or faster recovery from pain.