Regenerative Injection Therapy (RIT) is a non-surgical technique that stimulates the body’s own natural healing ability. Sometimes referred to as prolotherapy, It involves the injection of natural substances to the site of an injury. These injections stimulate a healing response, using body’s own immune system to repair the injury. RIT specialists, Dr. Thomashefsky and Dr. Adams have helped countless patients to reduce or eliminate chronic pain without recurrence as treated areas return to normal function. Patients have returned to the full, vigorous lifestyle they enjoyed before their injury or illness. We spoke with Dr. Justin Adams to learn more about prolotherapy and his practice with
Dr. Thomashefsky in Ashland.
Dr. Adams, thanks for speaking with us today. Will you please introduce us to Ashland Regnerative & Sports Medicine?
The core of the practice for Dr. Thomashefsky and myself is the belief that movement is important part maintaining a healthy and happy life. Both of us have competed in marathons and triathlons and we understand the athlete’s mindset, but we also work well with patients who want to get back to their yoga practices, daily walks or who’s pain is getting in the way of their ability to spend time with their family or do their work. It is important to us to help our patients live happy and pain free lives.
Ashland Regnerative & Sport Medicine has been in Ashland now for 18 years (and in Santa Barbara for 30). We are both MDs who recognize the limitations of traditional allopathic medicine in healing chronic injury and pain. We have both had regenerative injection therapy at various times and it has had a profound impact on our own lives.
Regenerative injection therapy, or RIT, begins with the concept that our bodies know how to heal themselves. We see this every day. In fact, most of the time when we hurt ourselves with a little bit of time our body is able to clean up the damage and grow new functional tissue. The problem is that this process isn’t perfect. The healing process following an injury generally lasts for about 4 to 6 weeks and sometimes we are not completely healed at the end of this process. Other times, our injury isn’t due to a single event but to months or even years of misuse or disuse. This is where RIT comes in. Working with the patient, we try to pinpoint areas of dysfunction and then stimulate a focal injury to that area using a needle and a mildly irritating solution. This then stimulates the same healing response and leads to the body to repair itself.
What kinds of solutions do you use?
Traditional RIT, called prolotherapy, is done with a concentrated dextrose solution, which is irritates tissue but completely natural and non-toxic. We may sometimes supplement this solution with other natural materials to encourage the healing response. Lately, the use of Platelet Rich Plasma, or PRP has been getting a lot of attention. Many professional athletes have used PRP to help them recover from acute or chronic injuries. In this technique we take the patient’s own blood and use a centrifuge to greatly concentrate the platelets, which is where the growth factors in blood are. This stimulates a very powerful healing response. Finally, we are now using a special liposuction technique that allows us to extract the stem cells found in our fatty tissue for use in helping to regenerate cartilage in our patients with arthritis.
Where did the concept originally develop for RIT Therapy?
Sure, the use of irritating solutions to stimulate healing dates back to the 1930s, though there is an acupuncture technique that is similar to prolotherapy dating back thousands of years. Doctors Hackett and Hemwall are considered to be the “father’s” of prolotherapy and their 1956 book documents their experience in using irritating solutions to stimulate a healing response in patients with chronic pain and dysfunction. They treated and published results on thousands of patients. The use of their techniques has been further refined and studied in the decades that have followed.
What evidence is there for it’s effectiveness?
A lot of our evidence is first hand, with patients that have struggled for months or even years with pain and dysfunction. Many of these people have explored many other options and consider us to be a last resort. Living in a small community, we get to see our patients at the grocery store at the gym and on the local trails. They send us emails to let us know how well they are doing and how much the work that we do has changed their quality of life. This is one of our favorite parts of what we do. As far as studies go, there are papers dating back decades that show prolotherapy can be an effective treatment for conditions ranging from low back pain to knee arthritis, from elbow pain to pelvic pain, from shoulder pain to plantar fasciitis. There are promising case-series on the use of PRP and fat-derived stem cells. More and more studies are coming out every year and most of these are very high-quality. Patients and providers who are interested are welcome to go to our website to review some of these articles.
Does this process ever hurt, it seems a bit strange and painful to be sticking a needle into a point of injury?
Obviously, getting poked by a needle is never fun, especially in an area that has been painful for a long time. Local anesthetic helps a lot to minimize the pain of our injections. In fact, the local anesthetic can often be really helpful in diagnosing our patients as well. If your pain is gone after treatment, we can be fairly confident that we got the treatment in the right place. Because we are causing a focal injury or bruise, patients often experience some increased soreness for a few days after treatment as part of the natural healing process, but this tends to fade fairly quickly.
What are some of primary benefits and how long does this normally take to occur versus not having the treatment done at all?
A vast majority of our patients experience improved function and a reduction or elimination in pain. The great thing about it is, that when people feel better it is because they are actually healed. That improvement is theirs to keep. They don’t feel better because some pill made their brain forget that their body was injured. Just like we were talking about earlier, healing occurs over a 4-6 week period following treatment with patients generally starting to notice an improvement after about a week to 10 days. We tell people to expect a total of 3-4 treatments, with an improvement after each one, though some people get an amazing response after one treatment and don’t need to come back. As for what happens without treatment, most of our patients already know the answer to that question before we ever see them.
Understanding Athletes is a large focus at Ashland Regnerative & Sports Medicine. Will you tell us more about this?
First, let me say that I do not expect someone to be a competitive athlete in order to come in and see us. We really focus and helping people to stay active, whether they are elite athletes or just enjoy daily walks. Allen and I understand how important this is to people’s lives. People don’t come to their doctor’s to be told that they need to stop doing what they love doing. “Knee hurt when you run? Stop running.” “Shoulder hurt when you swim? Stop swimming.” You won’t catch Allen or I saying this. Our focus is in getting people back to doing what they love. Often, we can get people healed without them even having to take time off from their favorite activities.
Both yourself and Dr. Thomashefsky have used RIT Therapy. Would you mind talking about your own experience with RIT Therapy?
My first experience with prolotherapy was when my left knee started bugging me while training for a marathon. The pain had started during ski season and was getting worse and worse as I upped my running miles. It was classic “runner’s knee”, also known a patellofemoral syndrome, which is essentially due to dysfunction of the tendon that surrounds the knee cap. I had one round of prolotherapy and within 2 weeks the pain was gone and it has never come back. That was now 6 years ago. I have run 7 marathons since and skied in the neighborhood of 200 days. Allen first started doing prolotherapy after he was cured of low back pain that started after a serious bike crash.
Can you tell me about your working relationship with Dr. Thomashefsky?
Allen and I are very collaborative in our approach to working with patients and regularly discuss patients and help each other with treatments. We regularly attend conferences together and review articles and techniques. Allen is one of the regional, if not national experts in regenerative injection therapy and has been very helpful in my training as well.
Let’s talk about some specific types of conditions you are able to assist your clients with in and around Ashland?
Any condition related to looseness or chronic dysfunction of ligaments, tendons or cartilage can be treated with RIT. This includes many if not most of the sources of chronic musculoskeletal pain and dysfunction. For example lower back pain is often due to weakness or looseness in the ligaments surrounding the vertebra and/or the sacroiliac joint. Similarly, after an accident or fall many people may end up with chronic neck pain and headaches due to damage to the ligaments and tendons supporting the neck. Many issues surrounding joints can be helped with RIT. We have treated patients rotator cuff problems, frozen shoulder, arthritis, runners or jumpers knee, chronic ankle sprains, tennis elbow and golfer’s elbow. We can also help with foot pain, like plantar fasciitis, wrist pain (including non-surgical treatment of carpel tunnel syndrome) and many other common conditions.
Dr. Adams, you also offer several other treatments at your office in Ashland. Will you please talk more about this?
Allen and I also specialize in taking care of patients who have been injured in motor vehicle accidents. We can be helpful both in healing the patients and in serving as advocates for the patients as they work with their insurers and the other parties involved in the accident. We also specialize in musculoskeletal ultrasound, which is a dynamic, low-cost and harmless imaging modality which can be used along side or in place of other modalities like MRI. We can also use ultrasound to guide more difficult injections. We also work with our patients to improve diet and hormone balance to promote healing, energy and overal health.
Do either of you have any new marathons planned for 2012 or 2013?
I just completed the Portland Marathon and am considering doing the Lithia Loop again this year. I also did the Mt. Ashland Hill Climb on my mountain bike and participated in the Siskiyou Challenge with some friends. Right now I’m gearing up for cyclocross and ski season. I am sure that I’ll do some races next year as well, though I haven’t picked them out yet. Allen at this point mostly focuses his attention on hiking, yoga, pilates and workouts at the gym. I join him a couple of days a week and struggle to keep up!
How can patients go about making contact with you?
We encourage patient to go to our website, www.ritdoc.net where they can learn much more about RIT and decide if it is right for them. They can also call to schedule an appointment at 541-488-5667.
Any final words or advice or wisdom for our readers?
Stay active, stay strong and flexible, eat good food, laugh a lot and enjoy this beautiful place that we live in.
Ashland Regnerative & Sports Medicine