Introduction

Natural wear-and-tear is deteriorating the joints of our aging population at an unprecedented, alarming rate. We are in the middle of a time when the United States is experiencing a considerable growth in our older population, as the elderly population (defined as individuals aged 65 and over) is projected to be 83.7 million in 2050, almost double its 2012 population of approximately 43.1 million.1 Furthermore, the percentage of persons aged 85 years and over is projected to steadily increase from 1.9% (2012) to 4.5% (2050). As such, many patients seek treatment options to alleviate their painful, troublesome, and life-limiting musculoskeletal injuries. Varying forms of treatment include the following: orthopedic stem cell therapy, physical therapy, orthopedic surgery, infrared light therapy, and hot and cold therapy, amongst many others. However, there are benefits and disadvantages to each of the aforementioned treatment modalities.
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Orthopedic Stem Cell Procedures

An emerging form of regenerative medicine, orthopedic stem cell therapy, is a natural form of healing the body without the use of invasive surgery. Stem cells can either be embryonic or they can be collected from a patient’s own bone marrow. This form of therapy possesses an abundance of advantages, such as the following: promotion of natural healing, prevention of complications, reduction of additional risks, and the ability to treat extensive, pre-existing conditions.2

 

Stem cell therapy takes advantage of our body’s innate ability to heal itself. Stem cells from bone marrow are able to transform into any type of cell within the body (e.g., nerve, blood vessel, cardiac muscle, liver, etc.). According to the American Academy of Orthopaedic Surgeons, stem cells injected into the site of injury promote an expedited healing process because healing can begin immediately upon injection without the cells having to travel throughout the body.

 

Traditional orthopedic surgery is associated with many side effects, including but not limited to the following: pain, arthritis, nerve damage, blood clots, post-surgery infection, bone fracture, scar formation, and re-injury to the operated area.3 Comparatively, orthopedic stem cell therapy is considered to have a safe profile, as it has virtually no side effects.4 Furthermore, stem cell therapy possesses healing capabilities as well as the ability to prevent infection. The potential of scarring, revision surgery, prolonged recovery, and the need for additional treatment are all reduced with stem cell therapy.

 

Embryonic stem cells have the ability to be rejected by the host’s immune system. However, the National Institute of Health reported that cells harvested from the patient themselves avoid this risk.2 This rejection risk is eliminated while using recognizable body material and re-implanting cells from the host’s own body.

 

One of our recently published blog posts discusses the benefits of stem cell therapy on degenerative disc disease (DDD).5 Damaged spinal discs, a key distinction of DDD, cause acute pain. According to Cedars-Sinai Medical Center, an injured disc lacks the capability to repair itself secondary to a lack of blood supply. As justified in the aforementioned blog post, stem cell therapy is a non-operative treatment method for DDD, among many other diseases.

 

Despite the multiple benefits of orthopedic stem cell therapy, or the use of mesenchymal stem cells (MSCs), there are far fewer documented contraindications. While there is a scarce amount of side effects, there is an insufficient body of present research regarding potential long-term side effects.6 Moreover, another con of stem cell therapy is that it is often not covered by insurance companies.7


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Physical Therapy

Patients with increased difficulty performing daily tasks, or who have sustained a recent injury or illness, are likely to receive physical therapy (PT) treatment. This form of therapy attempts to ease pain and improve a patient’s physical function, mobility, and life outlook. PT is often prescribed for the following reasons: pain relief, recovery from sports injuries, surgery prevention, stroke rehab, chronic illness management (e.g., diabetes, arthritis, heart disease), and artificial limb adaptation, in addition to others.8

 

Equinox PT reports primarily musculoskeletal advantages from physical therapy treatment, predominantly restoration of gait abnormalities, avoidance of unnecessary surgical procedures, and strength and mobility gains.9 Dr. Rick Olderman, a licensed Physical Therapist, also reports that positive results are likely evident after just a few treatment sessions.

 

Yet, the cons outweigh the benefits for this specific treatment modality. PT is delivered via a licensed Physical Therapist, who may practice and treat patients with a certain bias due to a limited skillset. In addition, treatment sessions are usually lengthy, and patients can acquire an inadvertent reliance on treatment.10

 

Traditional Orthopedic Surgery

Orthopedics is a branch of medicine which focuses on the musculoskeletal system, including bones, muscles, tendons, ligaments, and other connective tissues. Orthopedic surgery is often considered a last-option choice, as it comes down to the patient’s quality of life. Vijay Rasquinha, M.D., states, “You should try everything else first, including medication, physical therapy, swimming, ice, heat – the whole gamut. But if nothing is working, you have to ask yourself if pain and disability are ruining your quality of life. If the answer is yes, it’s time to talk about surgery.”11

 

Each year, more than a million American patients have a knee or hip replacement procedure. Recent research has shown that 95% of hip replacements last 15 to 20 years, whereas 85% of knee replacements last 20 years.11 An additional study, presented at the American Academy of Orthopaedic Surgeons in 2014, showed that of 2,000 individuals, 40% that had osteoarthritis and elective hip or knee replacements were less likely to have a heart attack or stroke than were those who did not have the surgery.11 Lastly, the long-term likelihood of developing depression, anxiety, and heart disease is significantly reduced because these stem from chronic pain and disability, which are both improved following orthopedic surgery. Regardless of an orthopedic surgeon’s specialty, common goals are to reduce pain, improve mobility, and improve their patient’s quality of life.12

 

Nevertheless, while surgeons strive for these goals, there are many drawbacks that accompany orthopedic surgery. Prior to having surgery, a surgeon may ask a patient to lose weight, quit smoking, or undergo other significant lifestyle changes. These significant lifestyle changes often present barriers to patients. A patient must also be fully committed to the lengthy recovery process in order to live as healthy and be as active as possible post-operation.13 According to the Arthritis Foundation, patients who receive knee replacements before they are 60-years-old are likely to need an additional operation later in their life.

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Infrared Light Therapy

Very few individuals are aware of light therapy. There is a current rise in addiction to opiates, along with a potential dependence on dangerous prescriptions. Painkillers are an easy answer for chronic pain, however they gradually deteriorate liver function and only serve to numb and silence the pain. Red laser light penetrates deep into the skin and works by targeting particular cells and combating the cause of pain and discomfort without the side effects that accompany opioids.14 The main focus is on using light to simultaneously manipulate and stimulate biological responses for rejuvenation and ultimately, better health.

 

Similar to orthopedic stem cell therapy, infrared light therapy is noninvasive. This is appealing to a large number of individuals as it significantly reduces time spent in recovery after the procedure. Hansen’s article further discusses an animal study that revealed using high-intensity red light therapy aided inflammation and stimulated mitochondria, whose function is to produce protein and collagen to repair cells and tissues. This research is encouraging evidence for human studies. A stark benefit for the use of light therapy is that it is best used while complementing other treatment forms. For example, if supplementing pain medication with light therapy, a physician may lower the dose of pain medication as part of a larger solution to the patient’s issue.14 Another benefit of light therapy is that there are no lasting scars or incisions, nor any injections or anesthesia.

 

 

 

 

 

 

A major drawback of light therapy is its accessibility. Currently there are no at-home solutions available because the nature of the procedure requires it to be clinic-only at this time. Hansen also comments that the main issues revolve around availability and cost. Trained clinicians at salons may offer this therapy, but it is often supplemented with a professional experience at a high price. Disabled patients may also have increased difficulty with attending the sessions.

 

Hot and Cold Compression Therapy

This form of therapy is an age-old remedy for any kind of pain. A common error in using this treatment modality is whether or not to use hot compresses or cold compresses. Hot compression is defined as the application of heat to the body to relieve pain. This can be accomplished using hot water, deep heating rubs, ultrasound, or hot towel heating pads. Conversely, ice is used as a form of cold compression, which also relieves pain.15 Additionally, cold compress can reduce swelling and is often used for pulled muscles.

 

There are pros to both heat and ice therapy. Primarily, heat therapy relieves intense muscle pain. It is easily accessible in a variety of forms, and it is conveniently transportable, as it can be applied virtually anywhere throughout the day. Ice therapy shares this benefit as well, as it is available wherever there is ice. As ice slows down nerve activity, pain is reduced.16 In a similar fashion, blood vessels constrict secondary to ice being applied, which resultantly reduces swelling at an injury site.

 

If used improperly, there are undesirable consequences of hot and cold compressions. If the hot pack is too warm, patients may unintentionally burn themselves. Heat increases circulation in the area in which it is applied to. This inadvertently increases swelling and would revert the intended use of the therapy. Ice therapy is very short-lived. The body is warmer than the ice pack, so the body’s warmth will quickly dissipate into the ice pack, reducing its effectiveness. Lastly, if ice packs are left on the body for too long, tissue damage can result and worsen the original injury.16

 

Discussion

Pros and cons come with any treatment modality. Each patient has a different need depending on their injury or ailment. Orthopedic stem cell therapy offers a promising and encouraging form of treatment. Physical Therapy is found to be convenient for some. Orthopedic surgery, an often last-option choice, is the choice for those that commit to a lifestyle change post-surgery. Infrared light therapy has its limits in terms of effectiveness and it is not readily available nationwide. Lastly, hold and cold compression therapy is convenient and is less of a financial burden for a majority of individuals. Ultimately, stem cell therapy offers a significant potential for success in the near future, as it is a non-invasive and long-lasting treatment option which will transform the way acute and chronic pain is managed, treated, and alleviated across our nation.