Regenerative medicine is a burgeoning field of medicine, with an incredibly high-value proposition for patients–healing and recovery without the need for major surgery–that has led to an explosion in popularity across the country. While the heightened profile of orthobiologic treatments is unquestionably a positive development, it has, to an extent, also opened the door to unsavory actors. At RestorePDX, we strive to provide our patients with innovative, effective, and safe non-surgical treatments for musculoskeletal pain. This approach requires us to provide patients with a clear and correct diagnosis, discuss in-depth the natural history of that pathology, review integrative and allopathic treatment options, and, finally, decide whether or not their pathology is likely to respond to regenerative medicine interventions. We are in the top echelon as far as regenerative medicine clinics in the country and have demonstrated efficacy treating ACL tears in the knee, rotator cuff tears in the shoulder, lumbar disc herniations, and many other conditions with our suite of regenerative medicine procedures.

Unfortunately, not all of the clinics that offer “regenerative medicine” or “cell therapy” have our same track record. As an integrative practice offering regenerative medicine, we are very wary of fly-by-night practitioners who perform illegal or unethical procedures. As a growing field, there is a lot of potential using cellular therapy, but our chances of ultimately realizing that potential can be undermined by rogue clinics that are performing illegal therapies. Consumers should be aware that not all platelet-rich plasma (PRP) or BMAC therapy is created equally, they could actually be referring to an acellular product that does not actually contain any live cells.

To that end, we’ve compiled four key questions you should ask any physician, naturopathic or allopathic, before undergoing a regenerative medicine treatment to determine whether or not they are properly trained to administer an orthobiologic treatment.

1. What is my diagnosis and what structures are you targeting for treatment?

If your provider can not clearly communicate what they think is happening in your body and how they think their proposed intervention will correct it, then that is a huge red flag. Trained regenerative medicine practitioners know that the first step before deploying orthobiologic treatments is to understand the underlying pathology, because how you can you fix something you don’t fully understand? Asking this question will help you determine whether or not your doctor has a firm understanding of your issue, or if they’re just throwing orthobiologics at the problem because they think it might help–or because it benefits them.

2. Are you trained to perform these injections? How will you ensure the treatment actually gets to the target areas?

Understanding the musculoskeletal pathologies that have a high chance of responding to orthobiologics and choosing the correct type of regenerative treatment is only half the battle; the real test comes when it’s time to deliver an orthobiologic payload to the site of injury. These target sites can sometimes be millimeters wide, so Precision Delivery, as we call it at RestorePDX, is incredibly important. Your physician should be properly trained in precision injections, and one of the surest signs that they are is their use of imaging guidance. It is virtually impossible to guide an injection where it needs to go without ultrasound- or fluoroscopic-guidance, so buyer beware if they plan to do an injection without this critical tool!

3. What are you injecting? How did you choose it?

If your doctor is injecting an off-the-shelf product, then it is very unlikely that your injection will contain live cells. There is a lot of data in the literature about the prevalence and vitality of cells in the bone marrow and adipose tissue, and these cells are superior to those purported by the “in the vial” or off the shelf cells for healing. If your provider has not taken the time to understand and adapt to this evolving understanding of the literature, then it is very unlikely that they are properly trained to select and administer a regenerative medicine treatment.

4. Do you think any improvement I experience will last?

This is a very important question to ask and understand because not all disease processes, even though they may share a name, are created equally. One person’s hip or knee arthritis may be a good candidate for regenerative medicine injections, while another person’s arthritis may respond very poorly. This is a critical, nuanced distinction that only a fully-trained regenerative medicine specialist will truly be able to understand and explain to you. Make sure to get a complete understanding of what your provider uses to determine your candidacy and what data they are relying on to inform that decision.