"Degenerative change is not something we really want to put cortisone in and around if we can avoid it, because the pathology in that situation is not inflammation...On top of that you've added a drug that can be degenerative to tissue that already is degenerative, and for that reason again I'm reluctant to use cortisone in most situations."
In this podcast, Dr. Douglas Stoddard (MD, Sports Medicine Physician and Founder of RegenerVate) gives an overview of therapeutic medical injections, including: Cortisone, Prolotherapy, Viscosupplementation, Platelet-rich plasma (PRP), and Stem cells.
These injections are used to treat a variety of musculoskeletal injuries and are considered if conservative treatment fails. Controversy still exists around regenerative and non-regenerative injections. Conflicting research shows either favourable or unfavourable results depending on the type of injection. Whether medical injections will be standard in musculoskeletal medicine remains to be seen.
00:28 Can we start by having you introduce yourself?
00:44 So what are the different types of injections used in sports medicine?
02:01 What are the differences between the injections? How do you determine which one to use?
03:33 What are the physiological mechanisms of how these injections work?
04:30 Can you explain the procedure of these types of injections?
06:27 Are all the injections done using ultrasound guidance or just the PRP and stem cell?
06:57 With stem cells, are there different types of stem cell procedures?
07:35 What are the criteria for someone to be eligible for these treatments?
09:04 So for healthcare practitioners who treat that level 1, at what point would you say that they should refer a patient on to discuss injections?
10:16 How long do the results of the injections normally last?
11:15 For someone who does get an injection, do they need to then continue with those level 1 interventions, like physiotherapy, after the injection?
12:19 Are there are specific protocols that therapists should be following for patients post injection?
12:54 What are the risks of the injections?
16:01 Are there any patients who you would not give an injection to, for example someone with a lot of comorbidities?
17:55 What are you noticing clinically with your outcomes of these injections?
19:15 How do you determine whether an injection is successful? Is that largely based off of the patients’ report of pain levels and function?
20:38 What is your opinion on the use of corticosteroids in sports medicine?
23:05 For a patient wanting a repeat cortisone injection, would you direct them more towards the regenerative injections?
24:04 With any of these injections do you do imaging before to find out the condition of the tissue?
26:04 I know there’s a bit of skepticism around PRP and stem cell injections because they’re still consider new and there’s not a ton of research on them and they haven't been proven in clinical trials. So what are your thoughts on this?
29:37 Are there any regulations around the field of regenerative injections?
32:19 Where do you see the future of these types of injections going?
33:45 What is the training like to be able to provide these services?
34:37 Where can people find out more about you?