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The Joint and Spine Institute
9730 Wilshire Blvd. Suite #110

Beverly Hills, CA 90212 

Most patients notice some level of improvement by 2-6 weeks following BMC.  Increased stability and strength are typically reported along with the decrease in pain.  A second level of benefits may be obtained between 6 weeks and 3months. Patients are encouraged to remain active with a functional rehabilitation program and strengthen surrounding muscles during this period.

For the first 2-3 days, swelling and discomfort are typical in the injected area.  By the end of the first week, these symptoms usually begin to resolve and physical therapy is started to optimize BMC effects and facilitate recovery.   Patients have responded to BMC treatment at varying timeframes.

Most patients require only a single BMC treatment depending on the degree of the injury.  However, in challenging cases, if a patient experiences significant relief that plateaus, they may consider a second BMC injection months later.

Unlike cortisone shots which mask symptoms and can damage tissue, BMC targets the root of the problem and attempts to heal the tissue.

While there is some slight discomfort, most patients tolerate the procedure very well and with minimal pain. The procedure is done under local anesthetic to minimize any discomfort. Post-injection soreness at the injection site is sometimes present because of an inflammatory response caused by BMC therapy. This soreness usually resolves on its own within a few days after the injection. It is important that anti-inflammatory medications such as Ibuprofen, Naproxen and Aspirin be avoided following treatments because these medicines may block the effects of the intended healing response facilitated by the post-injection inflammation. It is acceptable to use pain medication such as Tylenol, and in some cases a prescribed pain reliever which does not have anti-inflammatory properties, to control discomfort as needed.

The process is relatively simple. The patient is first numbed using a mixture of local anesthetics. Under the guidance of an X-Ray machine, the physician then removes a small amount of the patient’s bone marrow from the hip bone which is then placed into a centrifuge to separate the regenerative cells and platelets from the rest of the blood products. The final product is a concentrate which has approximately 5-10 times the baseline levels of regenerative cells and growth factors. This concentrate is then injected to the injured area under ultrasound guidance. Once introduced at the site of injury, the platelets release growth factors that tell the regenerative cells what to become, thereby initiating the regenerative response. The entire process takes approximately 2 hours and patients go home the same day.

In general, PRP may be more appropriate for mild to moderate osteoarthritis or tendon injuries. BMC may be reserved for more challenging cases such as moderate to severe osteoarthritis or when more potent effects are desired.

No. While there are currently several publications in peer-reviewed medical journals showing the positive effects of BMC therapy on tendon, soft tissue, and cartilage injuries, BMC is still not covered by insurance companies at this time.

Bone marrow derived cancer (such as lymphoma), non-bone marrow derived cancer or metastatic disease (should be checked with your oncologist), and active systemic infection are all contra-indications. Blood thinning medications such as Coumadin must be discontinued and managed appropriately by your cardiologist or primary doctor prior to the procedure.

Unlike other cells of the body, bone marrow cells are “undifferentiated”, which means they have the ability to replicate themselves into a variety of tissue types.  When an injury occurs, the usual number of regenerative cells needed for tissue regeneration is often inadequate. With BMC, the concentrate of regenerative cells provides a more robust healing of the damaged tissue and aids in growth and repair by accelerating the body’s natural healing mechanism. While the full benefits of BMC are still unknown, it has been shown to reduce swelling, relieve pain, and enhance healing of articular cartilage and bone.

Numerous conditionscan be considered for treatment with BMC. Based on current research and clinical experience, moderate to severe cases of osteoarthritis and severe tendon injuries show promising results.

BMC therapy is a promising non-surgical regenerative treatment used to treat various orthopedic injuries, including moderate to severe osteoarthritis and tendon injures. BMC is a concentrate of regenerative stem cells obtained from a patient’s own bone marrow. The physician removes a small amount of the patient’s bone marrow and spins it in a centrifuge in order to generate a powerful concentrate that is injected into the injured area. In the past, these types of cells were often very difficult and expensive to obtain from the body. With recent medical advancements, the cells can be easily obtained and the procedure can be done with minimal discomfort by a simple office procedure.

BMC stands for Bone Marrow Concentrate. It is also sometimes referred to as BMAC or Bone Marrow Aspirate Concentrate.

No. Neural Prolotherapy is still not covered by insurance companies at this time.

Neural Prolotherapy is considered safe when administered by a properly trained physician.  In fact, the solution (D5W) is the same solution used in IV bags in emergency rooms and hospitals.  Injections are done under sterile conditions with minimal risk of infection.  While uncommon, possible adverse effects include local swelling, bruising and mild temporary pain.

While each case is unique and treated on an individual basis, most patients respond to 5-8 treatments depending on how long the injury has been present as well as the degree of the damage. Treatments are typically spaced 1-2 weeks apart.

Most patients notice an immediate reduction of pain immediately after the first injection.  This initial analgesic effect may last anywhere between hours to days. Pain is generally reduced by 10-20% with each subsequent treatment as the tissue is progressively healed.

Neural Prolotherapy is generally very well tolerated, even without local anesthetic which is generally required for other types of injections.  The injections are administered with very small and short needles just beneath the surface of the skin.  Multiple injections are performed along the course of subcutaneous nerves.  Some points may result in mild discomfort, and cold spray can be used to make the patient more comfortable.

Neural Prolotherapy solution contains either 5% Dextrose in sterile water (D5W) or 5% Mannitol in sterile water (M5W). Both Dextrose and Mannitol are sugars originally derived from a plant sources.

Neural Prolotherapy was developed by New Zealand physician Dr. John Lyftogt, who has been using this method to treat musculoskeletal injuries and various pain conditions over the last decade with outstanding results.

The theory behind Neural Prolotherapy is based on “Hilton’s Law”, named after British surgeon Dr. John Hilton.   An extraordinary anatomist, Dr. Hilton noted that the nerve that innervates a joint also innervates the skin overlying that joint and the muscles that move that joint.  Using this simple model, Dr. Lyftogt hypothesized that irritation to a nerve that supplies sensation to the skin over a joint may also cause dysfunction and pain to the muscles and tissue around that joint.

It has long been known that dextrose in traditional prolotherapy promotes healing in connective tissues such as ligaments and tendons.   Because nerves also contain connective tissue, Dr. Lyftogt postulated that dextrose could allow for the same healing in nerves.  He injected small amounts of dextrose under the skin which resulted in decreased swelling, reduced pain, and improvement of function.

Dr. Lyftogt postulated that restoration of subcutaneous nerve function (those just beneath the surface of the skin) will lead to healing in deeper structures and reduction in pain. This method to treat musculoskeletal injuries and pain conditions has been used over the last decade with outstanding results, and Neural Prolotherapy is now being taught around the world.

Neural Prolotherapy is effective in treating nerve pain associated with injuries to joints, muscles, tendons, and ligaments.  Treatment areas include the neck, back, knee, shoulder, hip, elbow, wrist, hand, foot, and ankle.

Neural Prolotherapy has also been shown to be effective with chronic pain after surgical procedures such as total knee replacements and Failed Back Surgery Syndrome.  These patients often find relief when other traditional treatment options have failed.

When tissue is injured, it causes a release of pro-inflammatory substances (e.g. Bradykinin, Prostaglandins) that activate a channel on nerves called the “Transient receptor potential V1” (TrpV1) cation channel, also known as the capsacin receptor. When this channel is turned on, it results in nerve release of substances that cause inflammation (substance P and calcitonin gene related peptide (CGRP)) leading to leaky blood vessels (swelling), hypersensitivity, and painful sensations.

It is postulated that dextrose and mannitol, the active ingredients of Neural Prolotherapy, bind to and inhibit the TrpV1 nerve receptors, preventing this cascade and restoring normal nerve function.

No. Prolotherapy is not covered by insurance companies at this time.

Prolotherapy is effective in treating pain syndromes associated with lax, weakened, or elongated tendons and ligaments in a variety of areas including the neck, back, knee, shoulder, hip, elbow, wrist, hand, foot, and ankle.

Unlike steroid (cortisone) injections which provide temporary pain relief by inhibiting inflammation, Prolotherapy induces a mild inflammatory response to stimulate healing. Because Prolotherapy works to repair weak and painful joint areas, it is a long-term solution rather than a temporary measure such as drugs or Cortisone.

Prolotherapy is considered safe when administered by a properly trained physician.  Injections are done under sterile conditions to minimize the risk of infection. Risks of Prolotherapy are similar to conventional joint injections.  Possible adverse effects include local swelling, bruising and transient pain.

Some patients prefer to go home and rest after treatment while others continue work or other activities immediately after treatment.  Strenuous workouts or sports may need to be stopped or modified for two or three weeks after injections to give the repaired tissue a chance to mature.

While each case is unique and treated on an individual basis, most patients respond to 3-4 treatments depending on how long the injury has been present as well as the degree of the damage. Treatments are typically spaced 2-3 weeks apart depending on the condition being treated and the patient’s response to the treatment.

Most patients tolerate the procedure well with local anesthesia (lidocaine).  Because the treatment induces a mild inflammatory reaction as part of the healing process, you may experience some stiffness or soreness for 3-5 days following the injection.  Pain can be controlled with pain relievers if needed.

The dextrose, which is an irritant, is hypothesized to initiate a mild inflammatory process to recruit the body’s natural repair mechanisms and start the healing cascade.  The result is repair and growth of new ligament and tendon fibers that strengthen lax, weakened, or elongated tendons to restore strength and function.

The concept of creating irritation or injury in order to stimulate healing dates back to Roman times where hot needles were inserted into the shoulders of injured gladiators.

In the US, Prolotherapy originated in the 1950s by American surgeon Dr. George Hackett who used a sclerosing agent in weakened or elongated ligaments to make them stronger.  Hackett reasoned that if weak ligaments were the cause of most joint and ligament pain, strengthening them would resolve the pain.  He was quite successful, publishing 16 articles and a textbook on his procedure, and claiming an overall 80% success rate. In 1955, Dr. Gustav Hemwall became acquainted with George Hackett at a medical meeting and started practicing prolotherapy shortly thereafter.  Dr. Hemwall is regarded as a pioneer of Prolotherapy, and taught the treatment to numerous physicians until his passing in 1998.

Unlike a cortisone injection which typically provides rapid pain relief within a few days, symptom improvement following PRP therapy is more slow and subtle, but the positive effects are longer lasting when compared to cortisone.  Most patients receiving PRP notice some element of improvement between 2-6 weeks after the injection. “Good days” become more common and “bad days” become less common as time passes. Patients typically report reduced pain intensity, increased endurance, and improved strength.

Temporary pain and stiffness is expected and is the most common side effect of PRP therapy, although these symptoms generally resolve within the first 5-7 days after the injection. Ultrasound guidance is utilized to minimize risk of nerve or vessel injury and to ensure proper placement.  As with all injections, a sterile technique is used to minimize the risk for infection.

Yes.  Approximately one week after PRP therapy, physical therapy is started to optimize PRP affects.

While each case is unique and treated on an individual basis, most patients respond to 1-3 treatments depending on how long the injury has been present as well as the degree of the damage.  In some instances, a fourth treatment is provided.  Treatments are typically spaced 4-6 weeks apart.

Local anesthetic is used to minimize any discomfort associated with the injection and patients typically tolerate the procedure well. Some post-injection soreness is expected given that PRP induces a mild inflammatory response as part of the healing process. This soreness generally resolves within the first 5-7 days after the injection. Patients are given a prescription for pain medication to take as needed, although this is seldom required.

The PRP process is simple and generally well tolerated. First, the patient’s blood is collected and placed into a special container. The blood is then placed into a centrifuge and spun to concentrate the platelets. Once the PRP is harvested, it is injected to the damaged area using a local anesthetic for comfort and under the guidance of musculoskeletal ultrasound to ensure proper placement.

In the field of Orthopedics and Sports Medicine, PRP therapy has been used for approximately 10 years.

PRP stands for Platelet Rich Plasma. While platelets normally constitute only 5-10% of the cellular components in our blood, the PRP centrifugation process concentrates the platelets so that they make up approximately 90-95% of the cellular components of the platelet concentrated end product, thereby giving this therapy its name.

PRP therapy is a progressive non-surgical treatment to treat a variety of orthopedic conditions including arthritis, tendon injuries, and ligament injuries.PRP is part of a group of state-of-the-art treatments collectively referred to as Regenerative Medicine. PRP treats an injured area naturally using your body’s own growth factors to accelerate healing.

Numerous conditions can be considered for treatment with PRP. Based on current research and clinical experience, osteoarthritis, cartilage defects, soft tissue injuries, and tendon injuries show promising results with PRP therapy.

Unlike steroid (cortisone) injections which provide temporary relief, PRP actually heals the injured region using your body’s own growth factors.

PRP treats an injured area naturally using your body’s own growth factors to accelerate healing. These growth factors, which are released from activated platelets, induce a mild inflammatory reaction that initiates a powerful healing cascade. Blood flow to the damaged area is increased and matrix formation is promoted. This results in firmer and more resilient cartilage, as well as restoration of tendon and ligament proteins which may have been damaged.

Conditions and exclusion criteria that would inhibit someone from getting PRP therapy include severe anemia, low platelet counts, abnormal platelet function, active systemic infection, or active cancer.

No. While there are currently several thousand publications in peer-reviewed medical journals showing the positive effects of PRP therapy on tendon, soft tissue, and cartilage injuries, PRP is still not covered by insurance companies at this time.