Regenexx has seen and treated many NFL athletes throughout the years, helping them to return to play with the world’s most advanced stem cell injections. For NFL players, one of their most pressing concerns after an injury is How soon can I play again? The traditional solution to NFL injuries is surgery followed by physical therapy, requiring lengthy recovery times. Players can lose months or even a whole season or longer of training and play time. Stem cells, on the other hand, are a nonsurgical solution and a great tool to help NFL players return to the field faster than ever before.
In this article, I’m going to discuss the common orthopedic injuries in the NFL and the top 10 things NFL players need to know about stem cell treatment, the topic I presented at the NFL Combine this past February.
Common NFL Orthopedic Injuries
Some of the more common NFL injuries include knee injuries, such a torn meniscus, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL); ankle injuries, such as a sprain; shoulder injuries, such as an acromioclavicular (AC) sprain or a rotator cuff tear; and back injuries, such as a herniated disc. There is mounting evidence that stem cells work very well for some of the common NFL orthopedic injuries, and Regenexx has successfully treated many NFL athletes over the years and helped them return to play much faster than they would have using the traditional surgery path. However, with stem cell clinics popping up on every corner (nearly 600 clinics currently in the United States) it’s very important that NFL players know what’s fact and what’s fiction when it comes to stem cell therapy.
Top 10 Things NFL Players Need to Know About Stem Cell Treatment
In February of 2016, I was honored to speak in front of 300–400 team doctors at the NFL Physician’s Society Scientific Session at the NFL Combine in Indianapolis. The talk on NFL stem cell therapy was educational for these doctors as they’re getting bombarded by requests from their players for this technology. The players themselves are being bombarded by influencers who rarely know which end is up (providers who’ve taken a weekend course on stem cells and think this qualifies them to perform these very precise procedures) when it comes to orthopedic stem cells. The top 10 things NFL players need to know about stem cell treatment are outlined below, and you can listen to my full presentation in the video above.
1. What Are Stem Cells?
Stem cells are undifferentiated blank-slate cells that can differentiate into other cells. Most importantly, adult stem cells are the repairmen of the body. The main adult stem-cell players for orthopedic injuries are mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs).
2. Where Can You Get Stem Cells?
You can get stem cells from pretty much every tissue: bone marrow, adipose, synovial tissue and fluid, and so on. In other words, every tissue in the body has a stem cell content. Two of the main tissues being used for orthopedic applications are bone marrow and adipose (fat). Currently, there is a great deal more research on bone marrow stem cells for orthopedic use—about 100 to 1. You may have heard that adipose has more stem cells than bone marrow, but this is mostly false as it was based on a math error, which you can read more about in detail (and watch a video) in my post on fat vs. bone marrow stem cells.
3. Where You Can’t Get Viable Stem Cells
So we know we can get viable stem cells from bone marrow and adipose, but there is one tissue currently being sold we can’t get any viable stem cells from, and that is amniotic stem cells. Sales reps often claim that amniotic tissue and fluid products do have MSCs, and if this were true, we’d be their biggest customer; however, we’ve tested these products extensively in our lab and have found no viable stem cells. So make sure your provider is not using amniotic tissue or fluid (aka placental tissue) as their orthopedic stem cell source. While these products do contain growth factors, cytokines, and extracellular matrix, the Interventional Orthopedics Foundation testing showed them to be weaker in biologic effects than platelet rich plasma (PRP), so they are basically extraordinarily expensive weak PRP shots. So, again, no viable stem cells in amniotic fluid, so steer clear of providers using this stuff.
4. What Are the Different Types of Stem Cell Procedures?
There are two types of stem cell procedures. One is same-day bone marrow concentrate (BMC). This one is done a couple of different ways. Most physicians use kits and machines (using a bedside centrifuge—I don’t recommend this). The other is the process we use, which is processing samples in an in-clinic lab.
The second type of procedure is the culture-expanded stem cell treatment, which means that your cells are grown in culture to get more cells. This is currently not allowed in the United States, but there are sites in the Cayman, Mexico, Europe, and Asia that perform this procedure. In this procedure, cells are plated in monolayer culture and grown in an incubator. Interestingly, there is much more orthopedic basic-science research on cultured procedures yet same-day procedures are more common.
5. Are These Procedures Safe?
There is a lot of safety data supporting these procedures. A few links, including our own recent safety paper follow:
- Getting More Stem Cells Through Culture
- Safety and Complications Reporting on the Reimplantation of Culture-Expanded Mesenchymal Stem Cells Using Advanced Platelet Lysate Technique
- Regenexx 2016 Stem Cell Safety Paper
6. A Significant Amount of Stem Cell Research Has Already Been Published…
You may hear physicians say there’s really not any data on the use of stem cells for orthopedic injuries. And while it’s true that we need more randomized controlled trials (RCTs), it’s not true that we don’t have a lot of data. The stem cell research in orthopedics is rapidly expanding as is shown by my most recent graph on bone marrow stem cells research (current as of April 2016).
The total number of patients represented in this infographic increased from 5,513 last year to 8,207 this year. Reports of clinical outcome are mostly still small to large retrospective or prospective case series, but a few smaller randomized controlled trials are shown. Finally, almost every body part is represented: knee, hip, shoulder, ankle, lumbar spine, and hand.
7. Stem Cells May Be Able to Help RC Tear Healing
One of the interesting things about the NFL player injury report from this year is that rotator cuff (RC) tears are on the rise. I shared research information last year answering the question “Is surgery the only answer for rotator cuff tears?” The answer is no. Stem cells may be able to help RC tear healing. Our early RCT data on proprietary BMC ultrasound-guided injections for partial-thickness and full-thickness nonretracted RC tears shows improved function and improved pain in our treatment group, and in our control (nontreated) group, the results were just the opposite.
8. Stem Cells Likely Help Knee Osteoarthritis
There are a lot of NFL players playing with cartilage lesions or partial-thickness cartilage loss, and they get by through nursing these things along as they go. So this is the osteoarthritis (OA) group we are covering here. In the video above, I cover five studies, three of those RCTs, showing reasonable findings that bone marrow stem cells likely help knee OA.
9. Can Stem Cells Help Speed Fracture Healing?
A prospective RCT was published in Molecular Therapy: The Journal of the American Society of Gene Therapy (Aug. 21, 2013, pp. 1631–8) that looked at delayed union distal tibia fractures injected with same-day bone marrow concentrate. The result showed the mean time to achieve union was 71 days in 12 patients receiving the stem cell injections (directly into the fracture line, not through IV) compared with 112 days in a control group of 12 patients receiving usual care. I’m not sure that this says that acute fractures can be healed quicker with stem cell injections, but it’s certainly promising and something we need to watch.
10. Where Is All of This Headed?
We’ve already seen the use of stem cells in sports medicine explode over the past five years, and that will continue. By the year 2020, this will all be pretty commonplace. There will be some home-run injection applications, and we’ll see more precise injections and fewer surgeries. Several culture-expanded MSC products will be available, and insurance coverage for orthopedic applications will be spotty. PRP will get insurance coverage for a few applications.
One NFL Player’s Stem Cell Success Story
At Regenexx we treat many NFL players (as well as many other professional athletes). We love it when our patients share their stem cell success stories. Two-time Super Bowl champion Jarvis Green is a former New England Patriot and Denver Bronco who came to us for his back and his knee issues after a failed microfracture surgery. We used a combination of the Regenexx-PL-Disc procedure on his back and the Regenexx-SD and -C procedures on his knee. Jarvis did great and went on to play another year with the Houston Texans after being told he was done. His moving story is told in his own words in the video below: