by Mark Walter M.D. | Apr 23, 2023 |  “Stem cell injections represent the most powerful non-surgical tool we have to heal knee pain.” -Mark Walter M.D., RegenOrtho.com Stem cells should be considered by anyone with significant knee pain. In many cases patients can avoid invasive surgery. Stem cells aren’t magic and certainly can’t fix everything. But, if done properly they have an excellent chance of success. Even with severe bone-on-bone arthritis we have at least an 80% chance of success. Our approach in regenerative orthopedics is totally different than surgical orthopedics. We like to think in terms of joint stability. If the joint is unstable, there is pulling on the attachments of the joint capsule which is a huge contributor to joint pain. Unfortunately, x-rays and MRI are poor measures of joint stability. The only way to properly evaluate this metric is with a technique called palpation interrogation Treatment of choice in most cases is to use a patients own stem cells (from fat) and growth factors from their blood (PRP) to help rebuild the joint and tighten the joint capsule, thus making the joint stronger and more stable. The procedure is done as an outpatient procedure and done in a single day. Patients walk in and in a few hours, walk out. The whole thing takes about 3 to 4 hours. Best of all, patients can return to activities of daily living almost immediately. Yes, you are a little sore where we take the fat and where we do the injections, but this passes quickly. How quickly can patients feel better? Since every patient has their own healing path, this varies quite a bit. I have patients that swear they are better even within the first few days. Others take longer and it may take up to about 6 weeks to feel the changes. The stem cells remain alive and working for at least 4-5 months, so in the case that a patient heals slowly or wants more improvement and  faster, we may opt to do a PRP booster at about the 6-10 week mark. The booster will reignite the stem cells and accelerate a patients healing.  How long does the improvement last? Please understand that stem cells are a structural rebuild not just a pain management. Once we are successful at rebuilding the structures that were the underlying root-cause of pain, the improvements should last for at least several years.  A stem cell procedure, if done properly, is very safe and highly effective. Using a patients own stem, cells from fat and growth factors from blood is about as safe as it gets. In addition, if you find the right doctor with the right skills, the procedure is highly effective. So, what’s the downside? The main risk is that you will pay your money and it won’t work. The it comes to healing the human body, one can never predict the outcome. Instead. I just focus on doing the best job possible and trying to set the patient up for success as much as possible. Proper rehab is very important to a great outcome. Patients should have optimal orthotics to properly support healing. Movement should start right away although we don’t want to load  the healing knee too much for at least 6 weeks. Cycling and swimming exercises can often be great rehab exercises.  In conclusion, in most cases the stem cells/PRP combo is a viable alternative to knee replacement or major surgery and should be carefully considered by all patients with serious knee issues. This is the medicine of the future. About Mark Walter MD: Dr. Walter has pioneered the field of Regenerative Orthopedics for the last 20 years and is one of Florida’s  top Stem Cell Orthopedic specialists. His new book Stem Cell Orthopedics is now available on amazon  QR Code for book For more information, to schedule a personal consultation or to sign up for a free seminar, please call Stem Cell Orthopedics in Sarasota, at (941) 955-4325 or email us at stemcellortho@gmail.com. Also, please visit us at DrWalterMD.com

by Mark Walter M.D. | Apr 23, 2023 |  “Stem cell injections represent the most powerful non-surgical tool we have to heal back pain.” RegenOrtho.com According to a 2016 review in the Journal of Pain Management 75% of back surgery fails to relieve the pain. This scenario is all too common and it’s called failed back surgery syndrome. If you or someone close to you has serious back pain, please take note. “To a man with a hammer, everything looks like a nail!” – Mark Twain Why on earth are the results so poor? The reason is simple. Orthopedic surgeons often miss the real diagnosis and the true root-cause of the pain. This is a huge problem. Good medicine starts with the right diagnosis. God knows that we as doctors can’t fix everything, but if you have the right diagnosis, your chances of success are of course, much better. The problem starts with an over-reliance on MRI’s. MRI is a wonderful and useful tool, however the results can be misleading. The problem is that at least 40 or 50% of the general public have abnormal discs on MRI, and many of them have no backpain at all. Just because you have a disc abnormality detected on MRI does not mean this is the real root-cause of the pain. So, what might be the real cause of the pain? As a regenerative orthopedic specialist for the last 22 years I have seen and treated thousands of patients with serious back pain. In my experience, by far the most common cause of low back pain is micro-tears in the attachments of the large ligaments and tendons of the low back and pelvis. These attachments are highly innervated and can become huge pain generators. Unfortunately, MRI’s, ultrasound and X-ray all miss these abnormalities, and hence, the true diagnosis may be  missed. So, if all these standard imaging tests miss the diagnosis, what testing do we need to make the correct diagnosis? Since the micro-tears are too small to be seen on MRI or ultrasound, the only reliable way to pick them up is with a specialized physical exam technique called palpation interrogation. With this tried and true technique I carefully palpate all the major structures in the low back and pelvis. If I find the “jump sign” and reproduce a patients pain, I have actually demonstrated the pain generators and diagnosed the true root-cause of the pain with a high degree of certainty. Once we have made this diagnosis, how do we fix it? In essence we are treating chronic strains and sprains in the low back and pelvis. These connective tissue problems may sound minor, but believe me, they can cause huge pain and can easily mimmic true sciatica and cause debilitating back pain. Once we have diagnosed the precise regions where the microtears are located, the best and fastest way to heal them is by precisely injecting stem cells from a patients own fat, mixed with  growth factors from a patients own blood (PRP). By using DNA- matched, fresh stem cells with the PRP growth factors, you optimize the regenerative healing power. The whole procedure is minimally invasive and extremely safe. It takes about 3-4 hours and is done in the office setting. Patient comes in, we take about 60-100 ccs of abdominal fat with a gentle liposculpting technique with just local numbing. Then we take some blood like a routine blood draw. After this, the patient rests for 60-90 minutes while we prepare the stem cell/PRP combo. Then we inject the stem cells precisely where they are needed. Best of all there is minimal downtime and patients can return to activities of daily living within 24 hours.  The success rate of this procedure is of course totally dependent on the skills and experience of the doctor to correctly diagnose and inject the precise cause of the problem with properly prepare the stem cells and PRP.  When it comes to healing, there can be no guarantees. All you can do, is use the best techniques possible and give patients the greatest chance of success. If I examine a patient and confirm they are a candidate for this protocol, My own success rate is 80-85%. Once we have successfully healed the root cause of a patient’s pain, the results are long-lasting and may easily last 5 or 10 years or more. If, God forbid the pain recurs several years or more down the road. we can always repeat the stem cell procedure. What’s the downside? Since the procedure is so safe and uses the patients own tissues, the main risk is you may pay your money and not get the results you hope for. Unfortunately, the costs of stem cell procedures are not yet covered by medicare or any other insurance company. The average cost of a stem cell procedure is $7,000-$10,000. depending on how many areas are involved. Although, these costs are substantial, for many the returns in terms of quality of life, are totally worth it!  After the procedure I like to follow patients carefully and make sure they rehab correctly. Usually, patients will show improvement in the first few weeks (sometimes much faster!). The stem cells remain alive and active for at least 4 to 5 months so If for some reason the results are sluggish, I may recommend a PRP booster about week 6-10 to reignite the stem cells and improve results. In short, the stem cell/ PRP combo is an elegant and powerful non-surgical approach to heal back pain (and many other conditions as knee or hip arthritis, rotator cuff etc.) Due to the minimal risk and downtime, I believe that this approach may eventually become the treatment of choice for many orthopedic problems. As you understand (and experience!) the power and application of regenerative orthopedics, you may agree that this approach really should be primary care orthopedics. This truly is the medicine of the future! About Dr. Walter: Mark Walter MD, CM, CCFP has pioneered the field of Regenerative Orthopedics for the last 22 years and is considered one of the top Stem Cell Orthopedic specialists in Florida. Dr. Walter is author of Stem Cell Orthopedics (now avail on amazon) and is a leading expert in myofascial pain generators and ligament and tendon regeneration. He received his M.D. degree from McGill (1980) and went on to do five years of post-doc fellowship work in Regenerative Orthopedics with the world-renowned Hackett-Hemwall foundation, in association with the University of Wisconsin. During that period Dr. Walter was mentored by and worked with some of the top regenerative orthopedic teachers in the world.  For more information please visit us at Regenortho.com. To schedule a personal consultation with Dr. Walter (by phone or in-person) or to sign up for a free seminar, please call Stem Cell Orthopedics in Sarasota, FL at (941) 955-4325 or email us at stemcellortho@gmail.com.

by Mark Walter M.D. | Apr 23, 2023 |  As a physician, I have specialized in regenerative orthopedics for over 20 years. With advances in stem cell science we now have a viable nonsurgical alternative for a whole host of orthopedic problems. In fact, as you understand the full power of using your own stem cells and growth factors from your blood (PRP), you may agree that this safe, minimally invasive and easily applied technology should be considered as primary care orthopedics. If you have persistent joint, back or neck pain that lasts more than a month or two and significantly affects your quality of life, I should be the first doctor you consult with, not the last. In about 85% of cases stem cells, properly prepared and injected correctly, will be able to solve the problem or at least improve the issue significantly within a month or two. Some of the more common issues that stem cells can address are knee or hip arthritis, degenerative disc problems or pain involving the low back or neck region, rotator cuff or shoulder arthritis and ankle or thumb arthritis. In addition, since stem cells address cartilage, ligament and tendon damage of all sorts, stem cell orthopedics is often the treatment of choice for all types of musculoskeletal injuries or degeneration. In medicine, as in any other field, critical to solving any problem is correctly diagnosing the root cause of the issue. When I evaluate a patient’s problem I use a technique called palpation interrogation. If I palpate a specific structure and region and reproduce a patients pain i.e. “the jump sign”, we have correctly identified the pain generator and damaged region that requires regenerative injection therapy to resolve. As simple as this technique sounds it is an immensely useful tool to identify and prioritize the root cause (s) of a patients pain. As useful as MRI and ultrasound can be for certain types of problems, they fail to identify the micro tears in ligaments, tendons and joint capsules which are often the root-cause of pain. Hence, in my opinion, palpation interrogation skills are critical to the correct diagnosis and resolution of almost all orthopedic problems. Once we understand where a patients pain is actually coming from, we can apply ourselves to fixing it. In my own stem cell orthopedic center, the protocol I use is as follows, all of which is done in the office setting in a few hours. First, we take about 8-12 small vials of blood with a standard phlebotomy technique. Then we take about 60-100cc of fat, usually from the belly, with a gentle lipo-sculpting technique.  Then the patient, rests comfortably for an hour or two while we isolate the stem cells from the fat and the growth factors from the blood. Then we inject the stem cells/PRP mixture into the affected joints and carefully pepper the affected ligament and tendon attachments that are often such big pain generators. Patient rests for a few minutes and we are done. The real beauty of such a procedure is there is only minimal downtime. Patients walk in and walk out. They can return to activities of daily living the next day. Also, if the stem cell/PRP combo is prepared and injected correctly, as previously mentioned. we have about an 85% chance of long-term resolution of the issue. Since healing times vary on a patients healing capacities, severity of degeneration of the tissues and the area or region involved, it is hard to predict if a patient will notice improvement in a week or two or if it will take 4-6 weeks before patients notice significant improvement. If a patient’s healing is delayed, we may elect to do a booster PRP treatment at about the 6-8 week mark. The stem cells remain alive for at least 4-5 months, if they are sluggish they may benefit from a booster PRP session to reignite their activity. Importantly, if we are successful at rebuilding and healing an issue (or issues) this a long-term solution. Once we are successful at structurally rebuilding the damaged tissues that are causing the pain and debility, we would expect the improvements to last for at least five or ten years.  OK, sound too good to be true? What’s the downside? Since, if properly done, it’s so safe, the main risk is you’ll pay your money and you may not get the results you hoped for. God forbid, you elect to do a stem cell treatment and it doesn’t work, you can always resort to surgery as your last option. The average stem cell treatment is 7-10K all in. (Unfortunately, to date, medicare and insurance companies do not cover regenerative treatments since the field is still too new and not yet standardized). Nevertheless, for many, stem cells may be a God send and solve issues faster and more safely than any other approach. In the end, it’s about quality of life. This is the medicine of the future!   About Dr. Walter Mark Walter MD has pioneered the field of regenerative orthopedics for the last 22 years and is considered one of the top stem cell orthopedic specialists in Florida. Dr. Walter completed his MD degree at McGill University (1980) and went on to do five years of post-doc work in regenerative orthopedics with the world famous Hackett-Hemwall foundation (in association with the University of Wisconsin). Dr. Walter has collaborated with the top teachers in the world and is a leading expert in using a patient’s own stem cells to heal joint, back and neck pain and avoid the need for invasive surgery. Dr. Walter is author of Stem Cell Orthopedics- A New Way to Fix Joint, Back and Neck Problems  (available on amazon). To book a consultation or reserve a seat at an upcoming free seminar (given bi-monthly) please call Dr. Walter’s office in Sarasota at 941-955-4325 or email stemcellortho@gmail.com. For additional information and background, please visit us at regenortho.com.

by Mark Walter M.D. | Jun 6, 2022 | Back pain is a huge problem in the U.S. Most of us will experience it in our lifetime. For a small percentage, but a substantial number, of cases the problems can become persistent and severely debilitating. Unfortunately, the conventional orthopedic approach based on MRI’s and invasive back surgery has largely failed to resolve these problems. Thankfully, there have been two major advances in technology in the last few years that have led to better, more effective, more elegant ways to heal persistent back pain. The first is the Discseel approach, invented by Dr. Kevin Pauza. The second important advent comes from the exciting new field of stem cell orthopedics. Good medicine starts with the right diagnosis. The more precise the diagnosis of the root cause of the problem, and the more focused the treatment, the better the chance for a successful outcome. In the case of Discseel, the key understanding is that pain doesn’t come from disc bulges and herniations but rather from disc leaks. It is the chemical irritation of the disc leaks, not just the mechanical pressure of a disc herniation, that produces the pain. This explains why MRI findings may correlate poorly with the clinical picture. Some patients have significant herniations with minimal or no symptoms while others have a fairly benign appearing MRI and severe symptoms. According to Dr. Pauza, a key factor is whether the disc is leaking or not. Unfortunately, MRI is unable to pick up disc leaks. To make a more precise diagnosis of the pain generators, Dr. Pauza’s Discseel system calls for an annulogram that has fewer adverse effects than a discogram yet is more detailed and able to identify disc leaks. With this guidance, he is then able to pinpoint and fix the disc leak by injecting fibrin into the damaged disc. Pretty cool if you ask me. In stem cell orthopedics, the key understanding is that instability of vertebral segments (and shear force) may be the root cause of discopathy in the first place and that by correcting and tightening the ligaments and tendons that hold the vertebrae in place, you can improve symptoms (and even help protect a Discseel repair from reinjury). Also, in regenerative orthopedics, we are aware of and look for tears and microtears at the attachments of stabilizing ligaments and tendons. These attachments are highly innervated and can often become major pain generators. Since these tears are often too small to be seen on ultrasound or MRI, the only reliable way to verify and prioritize pain generators at the attachments of key structures is by a specific technique called palpation interrogation. Using your thumb, if you palpate a specific structure with 20-30 pounds of pressure and elicit the “jump sign” you have diagnosed and confirmed a specific pain generator and a source of the pain. One needs to bear in mind that the myofascia connects the whole body and should be considered as a whole. For example, if a patient has discogenic pain due to a leaky disc, the whole myofascia of the low back is under stress and muscles go into spasm to splint the damaged area. Therefore if a patient has significant back pain it is worthwhile to check the whole region for primary and secondary pain generators. There are about 40-50 common trigger points in the major ligament and tendon attachments in the lower back. Key structures include the supra-spinous ligaments, facet joints, transverse process, sacroiliac, gluteal attachments in the pelvis, hip capsules and the IT bands. It takes an experienced regenerative specialist about 15 or 20 minutes to test all of these structures and identify and prioritize any major “epicenters” of pain generation. Any structure that is positive for the “jump sign” can then be earmarked for repair which is done by peppering the attachments with injections of prolotherapy (dextrose), PRP or a PRP/stem cells combo depending on the severity of the degeneration and the particular case. As we saw with the Discseel approach, MRI also misses key details for the stem cell orthopedic system. In this case, MRI gives a “still” picture and is unable to gauge instability of joints under movement or stress. It is this subluxation of “loose” joints (and pulling on the capsular attachments) that can often be so painful. In addition, connective tissue damage at the site of attachments of supporting ligaments and tendons is often in the form of micro-tears which are too small to be seen on MRI. Once again, MRI misses critical details and we can readily understand why an over-reliance on MRI findings alone can be dangerously misleading. Now that we have a basic understanding of the Discseel and the stem cell orthopedic systems, we can begin to appreciate why conventional back surgery approaches such as fusion have been so unsuccessful. It’s not that the surgeons are technically lacking. It is a basic misdiagnosis and misunderstanding of the primary pain generators. The problem starts with an over reliance on MRI and an assumption that, in a patient with significant back pain who also has significant MRI abnormalities such as disc herniations, that those abnormalities must be the root of the pain. Don’t get me wrong. They may be causal, but to proceed to a very invasive surgery without fully exploring simple, minimally invasive testing is a mistake and can lead to serious consequences. It is a relatively easy thing to do an annulograms on suitable candidates or to evaluate major structures in the low back with a basic palpation interrogation scan. It is vital that these simple yet detailed tests are not overlooked as they may often yield critical information regarding the true root-causes of the back pain. I should add a caveat to the principle of striving to make the most precise diagnosis possible. First, do no harm! Always start with the safest, least invasive approach first. When it comes to human beings and medicine, nothing is a 100%. If, for any reason, an approach fails to resolve a problem, the potential adverse effects and risks are directly proportional to the invasiveness of the approach. I therefore recommend that patients only consider the option of invasive back surgery if all other reasonable, nonsurgical options have been fully explored and have failed. Now that we understand the limitations of basing a diagnosis and treatment plan solely on MRI findings, and have additional tools to evaluate the root-causes of back pain more precisely, we can develop a less invasive and much better approach. If patients have severe symptoms that appear discogenic, I would recommend that they explore the Discseel option (and potentially be evaluated with annulograms for discseel repair if indicated). In addition, as an adjunct to Discseel, I would recommend that all patients with significant pain consider the option of evaluation and potential treatment by a good regenerative orthopedic specialist. An experienced regenerative expert can evaluate all the key structures for weakness with a basic palpation interrogation scan that takes less than 20 minutes. If the scan yields positive “jump signs”, the affected structures should be properly addressed with regenerative injections of prolotherapy, PRP or a PRP/stem cell combo. If we choose to use stem cells, only autologous tissues are used i.e. from the patients own blood or tissues, as this is safest and DNA matched stem cells are most effective. The regenerative injections can be started as a primer prior to Discseel treatment or given as boosters in the weeks/months after treatment. (Note* Depending on the severity of the damage and how fast patients heal, cases may require two to four sessions of injections for complete resolution of the back pain.) Improvements can sometimes occur very quickly because tightening can occur almost right away although other improvements based on tissue regeneration can take 6 weeks or more. Discseel and regenerative orthopedics, together, present a minimally invasive yet powerful approach to back pain. If used properly I believe these strategies can be synergistic and yield a success rate in excess of 85%. Importantly, I believe these approaches can improve the quality of life for many patients and help many avoid the need for back surgery altogether. In addition, since both approaches are regenerative and structural in nature, there is every reason to believe that positive results would likely be long-lasting. Downtime for both approaches is minimal and patients can return to activities of daily living almost immediately.

by Mark Walter M.D. | Jan 27, 2020 |  The most common condition that I treat as a stem cell orthopedic specialist is arthritis or degeneration of the knee. The knee is the largest joint in the body and arguably the most prone to degeneration. We see the whole gamut from mild degeneration to full blown bone-on-bone osteoarthritis. Our goal is to help patients avoid knee arthroscopy /replacement. Even with severe cases we have about an 80% success rate. Our intention is not to just postpone surgery but to heal the knee so that patient will be able to avoid surgery for the long term. To me, surgery should always be the last resort and my intention is to do everything possible to find a nonsurgical way to return the patient to full and active life (and use of the affected joint or structures). Knee arthritis is not just a loss of cartilage but also involves loosening of the capsule and damage to the surrounding ligaments and tendons. This loosening and instability of the joint is very important. If the femur is not held firm on the tibial plateau the joint can shift or subluxate. This displacement is a serious problem. First, it pulls on the highly innervated capsule, a mechanism that may actually produce much more pain than the commonly referred to “bone-on-bone” mechanism. Secondly, nothing will accelerate damage and degeneration of the joint faster than repeated subluxation. The articular cartilage is grooved to hold the joint in place, sliding out of place will cause tearing etc. of the cartilage. In stem cells orthopedics, one of our first goals when we inject stem cells in and around the knee is to tighten and stabilize the joint. This initiative in itself may greatly lessen the pain from the joint. Further improvements can occur over time as the stem cells regrow cartilage. The safest and the most effective stem cells to use are those from your own fat, mixed in with PRP (growth factors from your own blood). It is very important to not only inject in the joint but also to pepper the surrounding ligamentous capsule. I also highly recommend that you check your wheel alignment and make sure you have optimal orthotics to minimize the strain and keep everything in alignment. Prior to the procedure patients are weaned off anti-inflammatories as they interfere with the body’s healing systems. Following the procedure patients are encouraged to return to activities of daily living and start walking immediately (with corrective orthotics please!). The knee needs movement to heal optimally. Things like cycling etc. can be introduced as tolerated. Sporting activities such as golf or tennis may take a little longer depending on how severe the problem was to start with. It can take up to 4-6 weeks before the joint is strong again. About Dr. Walter: Mark Walter MD, CM, CCFP has pioneered the field of Regenerative Orthopedics for the last 20 years and is considered one of the top Stem Cell Orthopedic specialists in Florida. Dr. Walter received his M.D. degree from McGill (1980) and completed his residency in Family Practice and Sports Medicine in 1982. He went on to do five years of post-doc fellowship work in Regenerative Orthopedics with the world-renowned Hackett-Hemwall foundation, in association with the University of Wisconsin. During that period Dr. Walter was mentored by and worked with some of the top regenerative orthopedic teachers in the world. Dr. Walter is a leading expert in Myofascial pain generators and ligament and tendon regeneration. For more information, to schedule a personal consultation with Dr. Walter (by phone or in-person) or to sign up for a free seminar, please call Stem Cell Orthopedics in Sarasota, FL at (941) 955-4325 or email us at stemcellortho@gmail.com. Also, please visit us at StemCellOrthopedics.com

by Mark Walter M.D. | Aug 11, 2022 |  Many of us are excited about stem cell orthopedics and its potential. After all, who wouldn’t be interested in a very safe, minimally invasive treatment that uses your own stem cells and growth factors (from your fat and blood) to heal many painful and troublesome orthopedic problems? Yes, this treatment can help many avoid the risks of invasive surgery and in fact, for certain types of problems, may be much more successful. And yes, the benefits can be long-lasting. Our goal with stem cells orthopedics is to actually heal the root-cause of the pain. Because of its safety profile and ease of use, regenerative orthopedics really should become primary care orthopedics. If you have some persistent orthopedic problem, stem cell orthopedics should be the first thing you try, not the last! Can it fix everything? Of course not, but it can fix at least 80% of orthopedic ailments. The treatment is minimally invasive and super safe. In my own practice, my protocol is done in a single day as an outpatient procedure. You walk in, we take a little blood and about 60-120ccs of fat in a painless harvesting procedure (with only local anesthesia). You take a break and relax while we prepare the stem cells. Then we inject the stem cells and PRP in and around the specific area involved. And you walk out. The whole thing takes 3-4 hours, start to finish. Yes, you’ll be a little sore for a day or two but downtime is minimal and you can return to activities of daily living within 24 hours. What’s the downside? The main risk is you may pay your money (stem cells are not yet covered by any insurance!) and it may not work as hoped. Sound too good to be true? Actually, it’s not, but there is a big caveat. Results can be truly amazing, but are only possible if you do the treatment properly. The field of stem cell orthopedics has grown rapidly over the last decade and unfortunately, as with any new field, there is no standardization and much misconception and misinformation. It is also true that many doctors who are attempting to do these treatments do not have the right training or background to do it properly. I call them dabblers! They may mean well but their lack of knowledge, training and experience in regenerative orthopedics can greatly jeopardize the outcome. If someone has had a stem cell procedure and if the outcome of the treatment was poor, the first question is: who did it? and what type of stem cells did they use? Certainly, when it comes to healing, there can be poor biologic outcomes, but far more common is poor diagnostic and injection technique, improper selection or preparation of the stem cells or regenerative solution, and failure to educate the patient properly for follow-up and rehab. There are three major determinants of the outcome of any stem cell orthopedic procedure. First and of prime importance, you need to make the correct diagnosis of the primary pain generators and inject them properly. Good medicine starts with the right diagnosis! For this, you need the right doctor with the right background and skill set. Make no mistake, regenerative orthopedics is a highly specialized field that is a totally different specialty than conventional surgical orthopedics. The outcome, as with any skilled procedure, will totally depend on the training, skill and knowledge of the practitioner. The best regenerative doctors will have had training in a highly effective technique called Prolotherapy. It is a little known fact that the majority of pain actually comes from micro tears in the attachments of ligaments, tendons and joint capsules. These loose attachments and the resultant joint instability, are crucial concepts to understanding the pain picture in a patient. Unfortunately MRI and ultrasound are not sensitive enough to make these distinctions and really the only way to make a precise diagnosis and prioritize the primary pain generators in any given patient, is with a technique called palpation interrogation. If I palpate a specific site on a specific structure and it reproduces the pain, we call this the “jump sign”. The bigger the jump sign the more important that specific structure is in the pain picture and the more crucial that we address that exact spot with injections. Second, you need to use the right kind of stem cells and prepare them properly. For our purposes, autologous tissue (from your own body) is far safer and more effective than any other type of stem cells. In my experience, freshly prepared, DNA-matched stem cells are far more effective than umbilical tissue from a donor. There are two sources of autologous stem cells- fat and bone marrow. I prefer fat since it’s easier to get and fat has a higher concentration of mesenchymal stem cells, which are the precursors of ligaments, tendons, cartilage and bone. Finally you need the right follow-up and rehab program to give the stem cells the best healing environment to work optimally. After the stem cells are placed they live and continue to grow for at least 4-5 months. If, for any reason, a patient is slow to respond and fails to progress after 6-8 weeks, we usually suggest one or two PRP boosters over a month or two to reignite the stem cells. The treatment plan for any given patient needs to be individualized depending on the severity and urgency of the problem, number of joints or regions injected, timeline and availability/willingness to come for several visits etc. If the problem is severe, I usually recommend to start with a stem cell/PRP combo to all affected joints, since this gives us the best chance for a rapid and substantial improvement. After all, I only get one chance to make a first impression. I want to turn every patient into a huge success case- and as quickly as possible! Proper rehab is also important for optimal healing. The patient needs to use and move the areas involved without over-loading the attachments. Painkillers such as tylenol and tramadol are fine but pharmaceutical anti-inflammatories are to be avoided as they interfere with healing. Good nutrition, reducing stress and sleep hygiene also help the healing process. If you optimize all the above factors, your chances of success are 80-85% for a long-lasting, great result. The goal of stem cell orthopedics is to relieve pain and restore functionality. In the end it’s all about quality of life. This is the medicine of the future!

by Mark Walter M.D. | Jun 6, 2022 |  Back pain is a huge problem in the U.S. Most of us will experience it in our lifetime. For a small percentage, but a substantial number, of cases the problems can become persistent and severely debilitating. Unfortunately, the conventional orthopedic approach based on MRI’s and invasive back surgery has largely failed to resolve these problems. Thankfully, there have been two major advances in technology in the last few years that have led to better, more effective, more elegant ways to heal persistent back pain. The first is the Discseel approach, invented by Dr. Kevin Pauza. The second important advent comes from the exciting new field of stem cell orthopedics. Good medicine starts with the right diagnosis. The more precise the diagnosis of the root cause of the problem, and the more focused the treatment, the better the chance for a successful outcome. In the case of Discseel, the key understanding is that pain doesn’t come from disc bulges and herniations but rather from disc leaks. It is the chemical irritation of the disc leaks, not just the mechanical pressure of a disc herniation, that produces the pain. This explains why MRI findings may correlate poorly with the clinical picture. Some patients have significant herniations with minimal or no symptoms while others have a fairly benign appearing MRI and severe symptoms. According to Dr. Pauza, a key factor is whether the disc is leaking or not. Unfortunately, MRI is unable to pick up disc leaks. To make a more precise diagnosis of the pain generators, Dr. Pauza’s Discseel system calls for an annulogram that has fewer adverse effects than a discogram yet is more detailed and able to identify disc leaks. With this guidance, he is then able to pinpoint and fix the disc leak by injecting fibrin into the damaged disc. Pretty cool if you ask me. In stem cell orthopedics, the key understanding is that instability of vertebral segments (and shear force) may be the root cause of discopathy in the first place and that by correcting and tightening the ligaments and tendons that hold the vertebrae in place, you can improve symptoms (and even help protect a Discseel repair from reinjury). Also, in regenerative orthopedics, we are aware of and look for tears and microtears at the attachments of stabilizing ligaments and tendons. These attachments are highly innervated and can often become major pain generators. Since these tears are often too small to be seen on ultrasound or MRI, the only reliable way to verify and prioritize pain generators at the attachments of key structures is by a specific technique called palpation interrogation. Using your thumb, if you palpate a specific structure with 20-30 pounds of pressure and elicit the “jump sign” you have diagnosed and confirmed a specific pain generator and a source of the pain. One needs to bear in mind that the myofascia connects the whole body and should be considered as a whole. For example, if a patient has discogenic pain due to a leaky disc, the whole myofascia of the low back is under stress and muscles go into spasm to splint the damaged area. Therefore if a patient has significant back pain it is worthwhile to check the whole region for primary and secondary pain generators. There are about 40-50 common trigger points in the major ligament and tendon attachments in the lower back. Key structures include the supra-spinous ligaments, facet joints, transverse process, sacroiliac, gluteal attachments in the pelvis, hip capsules and the IT bands. It takes an experienced regenerative specialist about 15 or 20 minutes to test all of these structures and identify and prioritize any major “epicenters” of pain generation. Any structure that is positive for the “jump sign” can then be earmarked for repair which is done by peppering the attachments with injections of prolotherapy (dextrose), PRP or a PRP/stem cells combo depending on the severity of the degeneration and the particular case. As we saw with the Discseel approach, MRI also misses key details for the stem cell orthopedic system. In this case, MRI gives a “still” picture and is unable to gauge instability of joints under movement or stress. It is this subluxation of “loose” joints (and pulling on the capsular attachments) that can often be so painful. In addition, connective tissue damage at the site of attachments of supporting ligaments and tendons is often in the form of micro-tears which are too small to be seen on MRI. Once again, MRI misses critical details and we can readily understand why an over-reliance on MRI findings alone can be dangerously misleading. Now that we have a basic understanding of the Discseel and the stem cell orthopedic systems, we can begin to appreciate why conventional back surgery approaches such as fusion have been so unsuccessful. It’s not that the surgeons are technically lacking. It is a basic misdiagnosis and misunderstanding of the primary pain generators. The problem starts with an over reliance on MRI and an assumption that, in a patient with significant back pain who also has significant MRI abnormalities such as disc herniations, that those abnormalities must be the root of the pain. Don’t get me wrong. They may be causal, but to proceed to a very invasive surgery without fully exploring simple, minimally invasive testing is a mistake and can lead to serious consequences. It is a relatively easy thing to do an annulograms on suitable candidates or to evaluate major structures in the low back with a basic palpation interrogation scan. It is vital that these simple yet detailed tests are not overlooked as they may often yield critical information regarding the true root-causes of the back pain. I should add a caveat to the principle of striving to make the most precise diagnosis possible. First, do no harm! Always start with the safest, least invasive approach first. When it comes to human beings and medicine, nothing is a 100%. If, for any reason, an approach fails to resolve a problem, the potential adverse effects and risks are directly proportional to the invasiveness of the approach. I therefore recommend that patients only consider the option of invasive back surgery if all other reasonable, nonsurgical options have been fully explored and have failed. Now that we understand the limitations of basing a diagnosis and treatment plan solely on MRI findings, and have additional tools to evaluate the root-causes of back pain more precisely, we can develop a less invasive and much better approach. If patients have severe symptoms that appear discogenic, I would recommend that they explore the Discseel option (and potentially be evaluated with annulograms for discseel repair if indicated). In addition, as an adjunct to Discseel, I would recommend that all patients with significant pain consider the option of evaluation and potential treatment by a good regenerative orthopedic specialist. An experienced regenerative expert can evaluate all the key structures for weakness with a basic palpation interrogation scan that takes less than 20 minutes. If the scan yields positive “jump signs”, the affected structures should be properly addressed with regenerative injections of prolotherapy, PRP or a PRP/stem cell combo. If we choose to use stem cells, only autologous tissues are used i.e. from the patients own blood or tissues, as this is safest and DNA matched stem cells are most effective. The regenerative injections can be started as a primer prior to Discseel treatment or given as boosters in the weeks/months after treatment. (Note* Depending on the severity of the damage and how fast patients heal, cases may require two to four sessions of injections for complete resolution of the back pain.) Improvements can sometimes occur very quickly because tightening can occur almost right away although other improvements based on tissue regeneration can take 6 weeks or more. Discseel and regenerative orthopedics, together, present a minimally invasive yet powerful approach to back pain. If used properly I believe these strategies can be synergistic and yield a success rate in excess of 85%. Importantly, I believe these approaches can improve the quality of life for many patients and help many avoid the need for back surgery altogether. In addition, since both approaches are regenerative and structural in nature, there is every reason to believe that positive results would likely be long-lasting. Downtime for both approaches is minimal and patients can return to activities of daily living almost immediately.

by Mark Walter M.D. | Jan 27, 2020 |  The most common condition that I treat as a stem cell orthopedic specialist is arthritis or degeneration of the knee. The knee is the largest joint in the body and arguably the most prone to degeneration. We see the whole gamut from mild degeneration to full blown bone-on-bone osteoarthritis. Our goal is to help patients avoid knee arthroscopy /replacement. Even with severe cases we have about an 80% success rate. Our intention is not to just postpone surgery but to heal the knee so that patient will be able to avoid surgery for the long term. To me, surgery should always be the last resort and my intention is to do everything possible to find a nonsurgical way to return the patient to full and active life (and use of the affected joint or structures). Knee arthritis is not just a loss of cartilage but also involves loosening of the capsule and damage to the surrounding ligaments and tendons. This loosening and instability of the joint is very important. If the femur is not held firm on the tibial plateau the joint can shift or subluxate. This displacement is a serious problem. First, it pulls on the highly innervated capsule, a mechanism that may actually produce much more pain than the commonly referred to “bone-on-bone” mechanism. Secondly, nothing will accelerate damage and degeneration of the joint faster than repeated subluxation. The articular cartilage is grooved to hold the joint in place, sliding out of place will cause tearing etc. of the cartilage. In stem cells orthopedics, one of our first goals when we inject stem cells in and around the knee is to tighten and stabilize the joint. This initiative in itself may greatly lessen the pain from the joint. Further improvements can occur over time as the stem cells regrow cartilage. The safest and the most effective stem cells to use are those from your own fat, mixed in with PRP (growth factors from your own blood). It is very important to not only inject in the joint but also to pepper the surrounding ligamentous capsule. I also highly recommend that you check your wheel alignment and make sure you have optimal orthotics to minimize the strain and keep everything in alignment. Prior to the procedure patients are weaned off anti-inflammatories as they interfere with the body’s healing systems. Following the procedure patients are encouraged to return to activities of daily living and start walking immediately (with corrective orthotics please!). The knee needs movement to heal optimally. Things like cycling etc. can be introduced as tolerated. Sporting activities such as golf or tennis may take a little longer depending on how severe the problem was to start with. It can take up to 4-6 weeks before the joint is strong again. About Dr. Walter: Mark Walter MD, CM, CCFP has pioneered the field of Regenerative Orthopedics for the last 20 years and is considered one of the top Stem Cell Orthopedic specialists in Florida. Dr. Walter received his M.D. degree from McGill (1980) and completed his residency in Family Practice and Sports Medicine in 1982. He went on to do five years of post-doc fellowship work in Regenerative Orthopedics with the world-renowned Hackett-Hemwall foundation, in association with the University of Wisconsin. During that period Dr. Walter was mentored by and worked with some of the top regenerative orthopedic teachers in the world. Dr. Walter is a leading expert in Myofascial pain generators and ligament and tendon regeneration. For more information, to schedule a personal consultation with Dr. Walter (by phone or in-person) or to sign up for a free seminar, please call Stem Cell Orthopedics in Sarasota, FL at (941) 955-4325 or email us at stemcellortho@gmail.com. Also, please visit us at StemCellOrthopedics.com

by Mark Walter M.D. | Jan 27, 2020 |  The most common condition that I treat as a stem cell orthopedic specialist is arthritis or degeneration of the knee. The knee is the largest joint in the body and arguably the most prone to degeneration. We see the whole gamut from mild degeneration to full blown bone-on-bone osteoarthritis. Our goal is to help patients avoid knee arthroscopy /replacement. Even with severe cases we have about an 80% success rate. Our intention is not to just postpone surgery but to heal the knee so that patient will be able to avoid surgery for the long term. To me, surgery should always be the last resort and my intention is to do everything possible to find a nonsurgical way to return the patient to full and active life (and use of the affected joint or structures). Knee arthritis is not just a loss of cartilage but also involves loosening of the capsule and damage to the surrounding ligaments and tendons. This loosening and instability of the joint is very important. If the femur is not held firm on the tibial plateau the joint can shift or subluxate. This displacement is a serious problem. First, it pulls on the highly innervated capsule, a mechanism that may actually produce much more pain than the commonly referred to “bone-on-bone” mechanism. Secondly, nothing will accelerate damage and degeneration of the joint faster than repeated subluxation. The articular cartilage is grooved to hold the joint in place, sliding out of place will cause tearing etc. of the cartilage. In stem cells orthopedics, one of our first goals when we inject stem cells in and around the knee is to tighten and stabilize the joint. This initiative in itself may greatly lessen the pain from the joint. Further improvements can occur over time as the stem cells regrow cartilage. The safest and the most effective stem cells to use are those from your own fat, mixed in with PRP (growth factors from your own blood). It is very important to not only inject in the joint but also to pepper the surrounding ligamentous capsule. I also highly recommend that you check your wheel alignment and make sure you have optimal orthotics to minimize the strain and keep everything in alignment. Prior to the procedure patients are weaned off anti-inflammatories as they interfere with the body’s healing systems. Following the procedure patients are encouraged to return to activities of daily living and start walking immediately (with corrective orthotics please!). The knee needs movement to heal optimally. Things like cycling etc. can be introduced as tolerated. Sporting activities such as golf or tennis may take a little longer depending on how severe the problem was to start with. It can take up to 4-6 weeks before the joint is strong again. About Dr. Walter: Mark Walter MD, CM, CCFP has pioneered the field of Regenerative Orthopedics for the last 20 years and is considered one of the top Stem Cell Orthopedic specialists in Florida. Dr. Walter received his M.D. degree from McGill (1980) and completed his residency in Family Practice and Sports Medicine in 1982. He went on to do five years of post-doc fellowship work in Regenerative Orthopedics with the world-renowned Hackett-Hemwall foundation, in association with the University of Wisconsin. During that period Dr. Walter was mentored by and worked with some of the top regenerative orthopedic teachers in the world. Dr. Walter is a leading expert in Myofascial pain generators and ligament and tendon regeneration. For more information, to schedule a personal consultation with Dr. Walter (by phone or in-person) or to sign up for a free seminar, please call Stem Cell Orthopedics in Sarasota, FL at (941) 955-4325 or email us at stemcellortho@gmail.com.Also, please visit us at StemCellOrthopedics.com The field of Regenerative Orthopedics is extremely useful for sports injuries of all kinds. Almost all of these injuries involve connective tissue structures i.e. ligaments, tendons and joint capsules. Sometimes there is a history of sudden trauma although, in many cases, there may be a repetitive strain “overuse” pattern, where the structure has been weakening over a period of time. Since these connective tissue structures have very little blood flow, healing can often be problematic. If the problem is chronic or fails to heal itself in about 3 to 4 weeks, the fastest and indeed the best way to fix the damage is to target the damaged structure(s) with injections of stem cells, PRP or other regenerative solution. Some of the more common areas we can treat with stem cell therapy and regenerative injections are the knee, shoulder, elbow, wrist and low back, but we can pretty well inject and help the healing in almost any joint in the body, from the bottom of your foot (plantar fasciitis) to the neck and sub-occipital area. With a skilled and experienced doctor our success rate is better than 80% for long-term resolution. If done properly, this therapy is very safe and has very little chance of adverse effect. Patients have almost no downtime and can return to activities of daily living almost immediately. For athletes this is by far the most effective treatment to allow the quickest possible return to the sport they love.  There are several keys to optimize a stem cell therapy. The first key is make the right diagnosis of what specific structure(s) are the root cause of the problem. In many cases there may be multiple structures that are contributing to the pain and loss of function so it is important to identify and prioritize the pain generators.  As useful as imaging techniques such as MRI and ultrasound are, it is a mistake to rely on them too heavily. Results can be misleading and only give part of the picture. Not every structural abnormality is a pain generator. Also, they often miss the micro-tears in connective tissue structures that are so often the root cause of the pain. In order to get a clear picture of the problem and properly identify pain generators it is crucial that patients have a thorough palpation exam of the areas in question from a skilled regenerative orthopedic doctor. Stem Cell Orthopedics is a “hands-on” specialty and a palpation methodology is the only reliable way to properly identify and prioritize the specific structures that are causing the problem. If direct palpation of a certain structure produces the “jump sign” and reproduces the pain, it is virtually diagnostic that you have identified the root-cause(s) of pain. In medicine it is said that half of solving a problem is correctly diagnosing what’s causing it. Once identified and prioritized accordingly, we can inject stem cells and regenerative solutions with specificity and have an excellent chance of solving the root cause(s) of the issue. The second key is the type of regenerative solution we select for a given patient and the particular problem. Stem cells freshly prepared on the spot from your own fat combined with PRP (growth factors from your blood) is the most powerful and safest regenerative solution we have – I call it the Mercedes-Benz of injection solutions. It has about 10 times the regenerative power of PRP alone. Stem cells with your own DNA and genetic code are intelligent and as long as you deliver them to within a dime of the damage, they have an amazing ability to detect tissue disruptions at a cellular level, become the right type of cell and regenerate the damaged tissue. The two sources of autologous stem cells (from your own body) are your fat and bone marrow. The stem cells from fat are more powerful to rebuild orthopedic structures and it is far easier and more pleasant to collect a little fat with a gentle liposculpting procedure than to do a bone marrow aspiration.  Particularly if there is severe degeneration in a region, I generally prefer to use a stem cell/PRP combo over PRP by itself. One reason is I usually can fix a problem with a single treatment whereas with PRP or other regenerative solutions such as dextrose (Prolotherapy) we may need 3-6 sessions. I like to say that I only have one time to make a first impression; my intention is to try and have the biggest impact and resolve orthopedic problems as quickly and directly as possible.   Third, the right rehab is important to a great outcome. We need to get movement in the affected joint(s) as soon as possible. This helps get more circulation in the area and is necessary for the correct regeneration of tissues. As patients feel stronger they can incrementally add load to the healing areas. If the activity produces pain, they need to back away and allow more healing time. In addition, If the problem involves feet, ankles, knees, hips or low back I want to make sure that patients have optimal orthotics. If a patient’s wheel alignment is not perfect when they walk they will continue to break down the area in question. Once we inject an area, it is important that we try and optimize the biomechanics. Finally, since stem cells are really part of the body’s healing process, I recommend to all my patients to boost their healing power by eating a low inflammation diet and getting plenty of sleep. Let’s review the pros and cons of the stem cell option¾ 80-85% success rate, minimally invasive, no downtime, effectiveness in addressing micro tears in the connective tissues, very safe if done correctly. The only real potential downside to a stem cell procedure is you have to pay for it and it may not work. Your stem cells have an innate intelligence and if applied correctly, can be an immensely powerful healing force. Stem cells are the power that built you in the first place, they certainly have the ability to heal and rebuild a small part of you. Modern medicine is only beginning to understand the full potential of stem cells and in many cases the results may be far superior than what you might get with surgery ¾ and far safer! This is the sports medicine of the future! About Dr. Walter: Mark Walter MD, CM, CCFP has pioneered the field of Regenerative Orthopedics for the last 20 years and is considered one of the top Stem Cell Orthopedic specialists in Florida. Dr. Walter received his M.D. degree from McGill (1980) and completed his residency in Family Practice and Sports Medicine in 1982. He went on to do five years of post-doc fellowship work in Regenerative Orthopedics with the world-renowned Hackett-Hemwall foundation, in association with the University of Wisconsin. During that period Dr. Walter was mentored by and worked with some of the top regenerative orthopedic teachers in the world. Dr. Walter is a leading expert in myofascial pain generators and ligament and tendon regeneration. For more information, to schedule a personal consultation with Dr. Walter (by phone or in-person) or to sign up for a free seminar, please call Stem Cell Orthopedics in Sarasota, FL at (941) 955-4325 or email us at stemcellortho@gmail.com. Also, please visit us at StemCellOrthopedics.com

by Mark Walter M.D. | Jan 27, 2020 |  As an MD specializing in stem cell orthopedics I often get asked what stem cells are best to help heal orthopedic problems like knee/hip arthritis, shoulder problems, back pain and other common problems. This is part of a larger question which is what regenerative solution is best and where and how do we place it to best help the body repair the particular damaged structures that are causing pain and disability. Stem cells are only one type of regenerative solution and are generally used with PRP (platelet rick plasma) from your blood. The type of stem cells or solutions we use and how we use them have a huge impact on the success of the procedure. The field of Regenerative Orthopedics has been around a long time and includes many different kinds of solutions. For many years doctors used a dextrose solution to help heal joints (Prolotherapy). About a decade ago we started to use PRP (platelet rich plasma) which was the first biologic regenerative solution and greatly enhanced our regenerative power. In the last 6 years or so we have added stem cells to the choices available. Stem cells are the cells that built us in the first place- they are immensely powerful and can rebuild virtually any tissue in the body. For orthopedic applications the most common types of stem cells used are either umbilical (from newborn umbilical cords) or autologous from your own body, either bone marrow or from your fat. For most cases I do not recommend umbilical. Although the idea of  using the stem cells of a newborn is compelling, it actuality doesn’t work that well. Recent studies have found that the cells are mostly dead and there is always the risk of contamination. Also, I don’t like the idea of using foreign genetic material. Lastly, to properly treat most orthopedic conditions you need much more volume than is commonly provided by umbilical stem cell companies. Autologous stem cells (from your own body) on the other hand, are freshly prepared and have much greater amounts of growth factors. Also, since the cells are from your own body, you can harvest however many stem cells you need for a given application. In addition, cells from your own body contain your own DNA and genetic blueprint of how best to rebuild you.  When choosing between bone marrow and fat, such factors as how much body fat the patient has available for harvesting is important. For orthopedic applications fat cells have more potency than bone marrow and are easier (and more pleasant!) to harvest. Ideally for any given patient, a doctor might use a combination of dextrose, PRP and autologous stem cells, properly apportioned and injected on a priority basis at the root cause of problems. In addition, since many pain generators are contained in the myofascia, it is important that the doctor has proper palpation skills in order to properly identify and prioritize the primary pain generators (with the jump sign) and to ensure that the patient gets all his pain generators attended to. Properly used, stem cells are very powerful healing agents that have the potential to heal most common orthopedic problems in a very efficient and elegant manner. The procedure is minimally invasive and done in 3-4 hours in the office setting with only local anesthesia. Patients walk in and walk out a few hours later, returning to activities of daily living almost immediately. If properly done there is a better than 80% success rate, very little downtime and it’s very safe. If you have a significant orthopedic concern, I would highly recommend that you fully explore the stem cell option prior to considering surgery. In many cases there may be a simple and safe solution that obviates the need for surgery. This is the Medicine of the Future! About Dr. Walter: Mark Walter MD, CM, CCFP has pioneered the field of Regenerative Orthopedics for the last 20 years and is considered one of the top Stem Cell Orthopedic specialists in Florida. Dr. Walter received his M.D. degree from McGill (1980) and completed his residency in Family Practice and Sports Medicine in 1982. He went on to do five years of post-doc fellowship work in Regenerative Orthopedics with the world-renowned Hackett-Hemwall foundation, in association with the University of Wisconsin. During that period Dr. Walter was mentored by and worked with some of the top regenerative orthopedic teachers in the world. Dr. Walter is a leading expert in Myofascial pain generators and ligament and tendon regeneration. For more information, to schedule a personal consultation with Dr. Walter (by phone or in-person) or, if you live in the Tampa-Sarasota region, to join us for a free seminar, please call Stem Cell Orthopedics in Sarasota, FL at (941) 955-4325 or email us at stemcellortho@gmail.com. Also, please visit us at StemCellOrthopedics.com