The Clinical Coach: Stem Cells as Injury Prevention for Achille's Ruptures

Happy Friday !!

What a week! Originally, I had a much different topic to share with you this Friday, but here we are talking about stem cells, injury prevention and blown Achilles tendons.

This is the tweet that encouraged this newsletter.

Before you keep on reading.

Let me know what you think about this tweet… Don’t scroll down yet.

Can you see what my issue might be with his message?

What is…. stem cell treatment?

Stem cell therapy is also known as regenerative medicine. It promotes the repair response of cells that otherwise are considered to be dead, dysfunctional or damaged to a greater degree than a normal healing response.

It’s not a “new treatment” but it definitely shows promise treating a large variety of musculoskeletal conditions like tendinopathies, joint pain, muscle strains and even some spinal cord related injuries for patients who’ve tried all conservative approaches.

How is it done?

Stem cell therapy comes from the extraction of mesenchymal stem cells. It’s usually a quite painful procedure as the cells are taken from the patient’s bone marrow or fat tissue (less painful).

Then they are concentrated and injected at the treatment site. These cells then specialize into specific types of cells needed for repair. The body is remarkably smart.

Most Common Use in MSK

Stem cell therapy offers a promising approach to a variety of injuries in the musculoskeletal world. After all it promotes tissue regeneration, and reduces pain and inflammation in the areas of treatment.

Overall it’s been used in the treatment of injuries in:

• muscle

• tendon

• cartilage

• meniscus

• ligament

• spinal cord

You can see how it could be promising to help avoid some injuries correct?

Looks great on paper… but

What about injury prevention

Here’s my biggest issue.

Injuries are NOT 100% preventable.

I’ve said this before, and I will always stand by it.

We may be able to mitigate the risk of unnecessary injuries like tendinopathies from overtraining, or muscle strains from poor recovery.

We will not (at least not in our lifetime) be able to 100% prevent an Achilles tendon from blowing up.

Back to the tweet

The premise of his response to most comments was:

“Why let the tendon continue to tear if you know its slightly torn. Just inject it with stem cells.”

If you know the tendon is slightly torn, why is the athlete still practicing at 100% and playing in a sport that requires over 100% of their tendon’s ability?

I would consider this medical negligence.

Wouldn’t you?

This is no longer about “preventative care” it’s about treating the damaged tissue to give it the best chance to heal and recover.

If that is the case then yes. NBA players (and other athletes) should consider stem cell therapy to help repair damaged tendons.

But even then… the therapeutic effect is inconsistent.

The evidence

As a treatment for pain and inflammation it’s one that I have used in several occasions for some patients dealing with tendon, meniscus and cartilage related pain. We simply set up an appointment with a trusted ortho and they will take care of the rest.

It’s been super helpful for those patients who just need a little more boost in their rehab.

But should it be used as a preventative measure?

As of today there’s no clear evidence that stem cell therapy can prevent injuries from happening.

It is also not covered by insurances so the cost to the patient can be anywhere from $350.00-$1000 per treatment.

Also, could this be considered as using performance enhancing treatments?

Treatment for Achilles Tears

Now, I wasn’t aware, but the original tweet was sparked by Jayson Tatum’s Achilles blow out.

Could his Achille’s injury have been prevented?

By now you’ve seen and heard about Achille’s Tendon Tears in the NBA, NFL and even in MLB.

But this type of injury doesn’t just happen to professional athletes. There are videos where non-professional athletes blow up their Achille’s tendon by simply warming up.

Should they have had stem cell therapy? Was there a sign someone missed?

Conservative Care

Uhhh — not primarily.

Conservative care will come afterwards and will consist of:

• Progressive rehabilitation of ankle mechanics and gait (12-16 weeks)

• Progressive strengthening of the lower extremity

• Dry Needling of muscle and scar tissue. (8-12 sessions)

Non-Conservative Care

It shouldn’t be a surprise that I’m going to tell you this is a surgical case.

Though I have had patients who’ve just “let it heal.” But this approach comes with significant muscle atrophy, decreased range of motion and overall function of the ankle complex.

The surgery requires the re-attachment of the Achille’s tendon to the calcaneus. Want to see how it gets done? Animation. In Real Life

And the recovery will be dependent on various factors including physical and mental health.

Clinical Pearls

Stem cells for complicated musculoskeletal complaints can be a game changer in your patients rehab, but it must be part of a tailored rehab program. At this point there’s no specific timeline of when you should consider stem cells therapy for your patients. However, if your patient is not improving and you’ve been working diligently with them for 6 week (or more). It’s probably time to consider stem cells. Specially with tendon and cartilage complaints.

Conclusion

What do you think? I’d love to hear your stance on stem cells as injury prevention for tendon ruptures.

My apologies if this one felt like a rant… but oh well.

Until our next issue!

In health and strength,

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