Over three years ago, an article from ESPN, featuring Dr. James Andrews, highlighted the interest in stem cells as a way to help athletes heal. Platelet-Rich Plasma (PRP) injections for athletes and other attempts to accelerate healing are exciting and very promising. Unfortunately, the media misunderstand regenerative medicine and fail to see the bigger picture of what else is needed to keep athletes on the court or the field. As a medical professional who employs PRP injections and collaborates with doctors who use stem cells, my perspective is that we need to put prevention first, and deploy therapeutics only when necessary. I believe in regenerative medicine, but without doing the basics first through blood analysis, reactive medical care can be severely limiting.
Regeneration – From Professional Athletes to your Grandma
Defining regeneration medically is easy, but the average person with an Achilles tear just wants to know how well and how quickly they will get fixed. Simply put, regenerative medicine in sports medicine is about assisting the body in repairing; and that can come from two other less-known options, such as tissue replacement and / or tissue rejuvenation strategies. We are all familiar with hip replacement surgery, but science is moving towards self-healing options that could delay or completely replace the need for surgical options, whenever possible. Minimally invasive procedures have often replaced traditional open surgery over the years. Now, injections with PRP and soon stem cells may replace minimally invasive surgical techniques and could eventually expand beyond that scope even more.
Regenerative medicine, specifically with PRP treatments and stem cells, is the idea of using our own or donated biological cells to heal from the inside out. Cell-based therapy is growing, but injections are still reactive and only can help after a problem arises or is identified. Many of the injuries I see regularly are treated with corrective options such as gait analysis and many do indeed require surgery. Despite these treatment techniques, a repeatable injury prevention screening never seems to catch these problems until it is too late, indeed.
I believe in the value of PRP and used it recently with an Olympic level 100m sprinter and a Division 1 volleyball athlete. These are not the typical patients who come into the clinic, of course. The average person wanting PRP doesn’t fully appreciate the tragic irony of the need for repair via blood products, when often the injury could have been identified and prevented through proper evaluation of their own blood initially. Taking the blood out of the body and injecting it back after being centrifuged sounds like an amazing advancement to most patients. Unfortunately I often consider this a failure if the patient's blood profile comes back identifying problems with Vitamin D, cortisol and other key healing factors in the blood. If the patient's blood was on its own richer and optimized, perhaps the injury wouldn’t have happened in the first place? But, without examining this vital component regularly, how would anyone, let alone the athlete, ever know. Take a look at the most recent NFL research and see how biomarkers are indicating who plays and who ends their career early just in reference to vitamin D.
The saying “an ounce of prevention is worth more than a pound of cure” is great, but it seems lately that we are putting a ton in regeneration and still fail to close the gap by using simple blood screening we have had available for decades. We can do better, and it seems the problems are not going away, but are often getting worse.
External Variables and Internal Chemistry
I blood test myself to manage my own internal chemistry for my health and longevity. Many athletic trainers and coaches are surprised that as a podiatrist I know a lot about biomarkers when they assume I would be specialized only on the foot and ankle. As someone who handles very complex problems with professional sports and regular patients, I understand the need to cover more bases so that I can improve outcomes for my patients, and not just hope for the best. Results in patient care, be it a senior citizen struggling with a broken foot or an elite NBA player coming back from multiple surgeries, are highly relatable to blood and dietary nutrients, assisting the body to load intelligently to maximize adaptation, and one’s overall day to day living environment.
No matter if I correct a foot problem perfectly, when the foot hits the ground the stress can do three things, and one of them is really bad. A bone and joint system improves if sufficient rest and the right nutrients nourish it, it can break down when the load is too high and diet and lifestyle are compromised. I wish that everyone could be injury free just by buying a good looking running shoe and taking a vitamin and mineral supplement, but both paths require personalized strategies and that means screening.
Starting with Vitamin D- Androgens and other Biomarkers Matter
Like my own very specific and specialized foot evaluation, blood analysis is about getting the right components objectively measured and risk profiled, utilizing the latest research. Nearly all sports professional are aware of the risks associated with Vitamin D deficiency, but fatigue (testosterone) and other factors can compromise a body and expose athletes and the general population to increased risk. How many times have we heard “it was a freak accident” when likely the problem was never properly screened or identified initially. Finally, along comes a straw that breaks the camel’s back and the “freak accident” occurs. NBA teams should really consider the research on the Testosterone to Cortisol ratio research provided here, and adjust accordingly.
The body can repair itself naturally if given the right balance of rest, diet, and stress management. The only way to know if internally the body has a chance to do its job is for us to view periodically how we are supporting it, and that starts with a monitoring approach beyond the annual checkup. I can count on one hand how many patients came to my office so they can screen potential injuries, but every injured athlete who saw that it was in fact preventable wished they came in before the season started. The goal of monitoring is to repeat the process of screening (once seen as a once a year process) and make it a never-ending commitment. I am excited about the future of regeneration medicine and will be a part of it, but I am also wise enough to know we can prevent many of the problems we are seeing today by making the right data accessible and actionable before any invasive regenerative technique is necessary.
Breakthrough Sports Performance was founded on the vision of improving athletic performance by utilizing a combination of evidence based medicine with quantified clinical experience. Breakthrough Sports Performance promises an athlete-centered and transparent methodology for all patients, from world class athletes to serious non-professional competitors.
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