The Role of Physiatry in Regenerative Medicine: The Past, The Present, and Future Challenges

Abstract

Historically, the foundation of physical medicine and rehabilitation training has provided the capabilities to optimize nonoperative treatments of a variety of musculoskeletal conditions, including acute and chronic muscle, tendon, ligament, and cartilage disorders. Such treatments include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic modalities (eg, thermal and manual therapies), and corticosteroid injections in conjunction with specific rehabilitation exercises. Although NSAIDs, modalities, and corticosteroids may be helpful for short-term pain reduction and early recovery of function, they do not typically reverse the structural changes associated with degenerative conditions and may contribute to worse long-term outcomes by potentially interfering with tissue healing. Regenerative interventions, including platelet-rich plasma and mesenchymal stem cells, recently have been used to treat refractory painful conditions such as chronic tendinopathies because of the potential of these interventions to facilitate tissue healing. The future development of these regenerative techniques will require a variety of conditions to be met, including determining the most appropriate procedures based on the disease being treated; establishing the optimal preparations of these regenerative techniques; and providing clinicians, patients, and regulatory agencies with high-quality evidence demonstrating the safety, effectiveness, and long-term results of these treatments. Clarification of current regulatory uncertainty, improved access for all patients, proper training for clinicians who incorporate these techniques into their practice, and determination of the most appropriate postinjection protocols will allow physical medicine and rehabilitation specialists to play a unique role in the long-term management of patients with musculoskeletal and sports injuries. This article will also address the role physiatrists should have in the inevitable growth of regenerative medicine applications.

Musculoskeletal and Sports Medicine Physical Medicine and Rehabilitation Curriculum Guidelines

“…iv. Be up to date on the evidence-based medicine research and appropriate usage regarding orthobiologics [14][15][16][17][18]. c. Asthma medications.…”

The Evolution of Physical Medicine and Rehabilitation in Sports Medicine

“…A recent review in PM&R stated that “Prolotherapy, PRP [platelet‐rich plasma], and mesenchymal stem cells are being used in the treatment of tendinopathies, ligament injuries, and degenerative joint disease, with an increasing number of both animal and clinical studies to support their use. Some evidence indicates that these treatments may be superior to the traditional treatment interventions from the ‘past’” [17]. That observation highlights the need for PM&R and other sports medicine specialists to be fully aware of the scientific evidence for such novel techniques and to continue to optimize the success of nonoperative treatment outcomes.…”

“…Various sources of stem cells have been used to treat a variety of medical conditions. Research is beginning to demonstrate that via an induced pluripotent stem cell technique, mesodermal cells such as chondrocytes can be generated by reprogramming a patient's own dermal fibroblasts, adipose tissue, or bone marrow [17]. Centeno and Faulkner [18] have suggested that recent advances in regenerative therapies include clinical trials for anterior cruciate ligament, rotator cuff, cartilage, and intervertebral disk defect repair and for the healing of meniscal tears.…”

The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review

“…The primary goal of physiatrists is to optimize the pain management of their patients with various MSK conditions, including acute and chronic muscle, tendon, ligament, and cartilage disorders. The traditional management of MSK pain involves control with conservative “Rest, Ice, Compression, Elevation” treatment and physical therapy to corticosteroid injections coupled with specific rehabilitation exercises [ 5 ].…”