Are Stem Cells Snake Oil?

Stem cells make for great discussion of the modern day marketing of medicine.

For some, stem cell injections are a broad and exciting field of scientific inquiry and pain relief. For others, they are pure snake oil sold for approximately $2000 per vial.

So which one is it?

Whatever the case, the advertising gives an easy “tell.” Is the doctor or medical facility making unreasonable claims and guaranteed promises that play off fear, desperation, and the plain realities of aging? Being more realistic and careful with promises makes for ho-hum marketing. But what kind of outfit would you really want to work with?

When a product or procedure is marketed as a  -new- -miracle cure-  -for everyone with…-  you should be skeptical. This includes physical therapy! A local colleague of mine (rhymes with Schmadden) has built a large profit margin and entire team of physical therapists in part through the advertising slogan “Pain Free [Back/shoulders/knees/feet].”

Either his entire team of physical therapists, including all the new graduates, have far superior clinical skills than I, or there are a LOT of people walking around central PA who are a bit disenchanted because the treatment didn’t live up to the promise of pain free.

People with joint aches and pains frequently ask whether or not stem cells may help their condition.  I’m rarely optimistic about these types of treatments, and I have yet to hear from anyone who has experienced significant or long lasting benefit. That doesn’t mean they are worthless, or that all marketing is bad.

Shouldn’t we be asking some questions first. Why are we doing this? How does it work? How much and for how long is it likely to help? Are there side effects?

Stem cells have been claimed to help cartilage, bone, tendon, and ligament problems. That’s a lot of different tissue, with different metabolism, and different response to hormonal factors and mechanical loading, to begin with. A person with knee pain may not care if the target tissue for treatment is ligament or cartilage, or if the injection is placed inside or outside of the joint capsule. But to scientists, doctors (and physical therapists) this is basic and essential information to define before making any recommendations.

Some literature shows that stem cells can help with specific issues, such as mild to moderate cases of knee osteoarthritis and elbow tendonitis. But when you look closely at the studies, they show much variety in terms of what exactly is being injected, how the formula is produced, and where and how often it is being injected.

If you don’t believe me, that’s what people like this team of researchers in that “bizz” are saying:

We still do not know exactly how and why the injected cells -may- aid in recovery. Are the stem cells integrated into the damaged tissue? Do they provide support or stimulate the existing cells to heal? The research does show that milder the arthritis, the more likely the benefit. Multiple injection into one site leads to increased risk of adverse reactions. When and where the injections are effective, the benefit usually lasts for six to twelve months. One study showed that stem cells are slightly more beneficial than corticosteroid injections.

All that being said, I would like my skepticism to be proven wrong. I have a stiff and sometimes painful arthritic hip. I’m certainly in favor of finding new ways to help people feel and function better. As a physical therapist, my primary problem with Stem Cell injections is that it’s just…so…

Passive.

Joint wear and tear, whether over a day or a lifetime, never exists in isolation. But passive and less-than holistic solutions seem to be the American way.

Imagine two very real scenarios.

34 year old patient suffered a knee sprain 10 years ago, and now shows mild knee arthritis and a tear of the meniscus. He has good alignment, strength, and range of motion at the other joints and is reasonably active, neither an exercise addict nor a couch potato. His pain persists despite refraining from high impact exercise.

54 year old diabetic patient with knee pain is 35 pounds overweight, has inflexible and weak hips, has minimal great toe extension and walks with his feet turned outward which places a twisting force at the knee joints with every step.

Which of these patients has a greater likelihood of experiencing a year of modest benefit from stem cell injections? Doctors and medical centers can and should address these types of challenges when recommending this type of treatment. Some may be realists, and others will advertise like stem cells will fix everything.

As usual, the actual science makes for less than stellar marketing. Until more is known regarding the particulars of stem cell injections, you should probably try to identify and address postural issues and movement dysfunction ; ). If you do, I guarantee health, happiness, fame, and fortune ; )

— – — — — — — —

Further reading-

Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses.
Campbell KA1, Saltzman BM2, Mascarenhas R3, Khair MM2, Verma NN2, Bach BR Jr2, Cole BJ

Arthroscopy. 2015 Nov;31(11):2213-21. doi: 10.1016/j.arthro.2015.03.041. Epub 2015 May 29.
Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses.

World J Stem Cells. 2014 Nov 26; 6(5): 629–636.
Published online 2014 Nov 26. doi: [10.4252/wjsc.v6.i5.629]
PMCID: PMC4178263
PMID: 25426260
Stem cell application for osteoarthritis in the knee joint: A minireview
Kristin Uth and Dimitar Trifonov

J Knee Surg. 2018 Nov 13. doi: 10.1055/s-0038-1675170. [Epub ahead of print]
The Use of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis.

Stem Cell Res Ther. 2016 Sep 9;7(1):131. doi: 10.1186/s13287-016-0394-0.
Secreted trophic factors of mesenchymal stem cells support neurovascular and musculoskeletal therapies.
Hofer HR1, Tuan RS2.

Published by

bonnylane

I'm a husband, father of five, and physical therapist. I do sports performance physical therapy and personal training at Full Reps Training Center in Camp Hill, and in my basement and backyard. I have been in the game for over 18 years and attempt to find time to type out my ideas and experiences! Thanks for reading.

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