Where regenerative medicine and orthobiologics fit in chiropractic

Treating various conditions with orthobiologics and without surgical or pharmacological intervention

Treatment providers know that some injuries and illnesses remain unresolved even after multiple forms of mitigation are attempted. Much to the patients’ dismay, they simply may be unable to find relief through chiropractic care, physical therapy, electrical stimulation, nutrition balance and many other forms of treatment. The effects of car accidents, for example, can cause a lifetime’s worth of neck and back numbness, tingling and headaches. At this point, it is time to pose the option of regenerative medicine and orthobiologics to alleviate symptoms and help the body heal from within.1

Injection of orthobiologics

Regenerative interventional orthopedics is an emerging field, which includes the injections of orthobiologics (such as bone-marrow concentrate and platelet-rich plasma). Commonly, it is used to enhance strength, improve mobility, treat injuries and mitigate chronic conditions.

Often, when people think of regenerative medicine, stem cells come to mind. However, many forms of this treatment pre-date stem cell research. Previously-introduced methods have become more commonplace over the years.

Here are several types available today, some of which are commonplace in a musculoskeletal-based regenerative medicine practice:

  • One of the early forms of cell therapy includes blood transfusions. They are a frequently-used treatment that occurs when donated blood is introduced into a recipient’s body after large quantities of blood are lost due to surgery or as a result of trauma.2
  • Bone marrow transplants are another form of regenerative medicine wherein patients with radiation damage or certain cancers for example use donor bone marrow cells to help generate new, healthy blood cells.2
  • In 1954, the first organ transplant was performed. Since then, the process has been refined and the practice has become so common that in 2001, the number of living donors exceeded the number of organs received from those who recently passed.
  • Platelet Rich Plasma (PRP) is a form of regenerative medicine wherein the patient’s blood is extracted, placed into a centrifuge to separate the blood’s plasma, and then reinjected into the area that requires treatment. This practice is commonly used for musculoskeletal issues and enables the body to heal itself naturally.2
  • Stem cells are a well-known component of regenerative medicine and one that carries significant controversy because it has typically been derived from umbilical cord cells. Stem cells have the extraordinary ability to regenerate cell growth, are anti-inflammatory, and change the immune system’s response (immunomodulatory). Stem cells adapt to the body’s makeup and can potentially recreate any cell in the body including skin, lung and brain cells.

Benefits of regenerative medicine

As evident, there are many different types of regenerative medicine, and the applications are vast in regard to its benefits and ways in which chiropractors can integrate with this form of treatment. Furthermore, regenerative therapy and research show no signs of slowing. The benefits can mean the difference between a life of pain and one of recovery.

Some benefits of regenerative medicine that have been shown in the literature include:3

  • Potential avoidance of invasive treatment methods such as surgery
  • Decreases the risk of dependence formed from the use of narcotic pain killers
  • Helps patients avoid chronic diseases such as diabetes, nerve conditions, and heart disease
  • Faster recovery time than surgery
  • Increased functionality and improved range of motion
  • Decreased inflammation
  • Tissues that were once thought beyond repair (i.e., nervous tissue) show signs of healing

These are all tremendous benefits that extend beyond palliative care and are viable options for a chiropractor to consider working with or referring out for.

Requirements for performing procedures

While the requirements to administer regenerative medicine treatment are typically beyond the training and scope of practice of most chiropractors, there is a perfect relationship between regenerative medicine and chiropractic care. Chiropractors have the ability to refer out to a medical provider who performs regenerative medicine as well as employ providers depending on the state in which they are located and licensed.

It is important to remember and confirm with the state board in which a chiropractor is licensed regarding the scope of practice in that state and any laws or statutes regarding administering, referring, managing or hiring a provider who performs regenerative medicine. Limiting the risk of injury to patients by adhering to the laws and statutes is an important part of the patient experience and will keep your practice legal and compliant.

Additionally, clinics that often provide regenerative medicine and orthobiologics use MRIs, ultrasounds and fluoroscopy before delivering any injections, which is another step in the process to consider when arranging any regenerative medicine services in your clinic.

Health care cooperation

In addition to continually defining emerging standards, it is important that chiropractors cooperate with different health professionals when treating a variety of musculoskeletal conditions. When chiropractors partner with regenerative medicine doctors, they are able to provide a number of additional patient benefits including enhanced medical opinions regarding diagnosis and treatment as well as providing more services for the patient. This is incredibly helpful as each provider has a similar goal in mind.

Regenerative medicine parallels chiropractic medicine because both aim to treat root causes of a patient’s conditions.1 Regenerative medicine does this by replacing lost cells or organs, whereas chiropractic does so via manipulation and alignment of the body.

While some chiropractors work solo or with other chiropractors, they are increasingly integrating with other health professionals to offer a more comprehensive treatment for pain and other musculoskeletal conditions. This integration can be achieved by working together in a multi-specialty or multidisciplinary spine clinic.6

Regenerative medicine’s chiropractic fit

The goal and scope of regenerative medicine physicians and chiropractors are complementary. Both fields aim to change the way things are done in a non-pharmacological and non-surgical manner by:

  • Helping patients and clients prevent unnecessary surgeries
  • Limiting the use of steroids that have potentially long-term damaging effects on the human body
  • Limiting the regular use of narcotics
  • Limiting the use of non-steroidal anti-inflammatory drugs (NSAIDs)4

Regenerative medicines are used to replenish, strengthen and heal tissues, muscles and tendons. They also help treat injured, weakened and compromised joints. The chiropractic profession has intentionally sought to circumvent the use of non-narcotic and non-surgical care in favor of a system that improves the body’s ability to heal itself. This makes sense given chiropractors’ focus on anatomy and the self-healing capabilities of the body.

Furthermore, regenerative medicine and orthobiologics have great potential to treat several health conditions outside the scope of treatment for a chiropractor but well suited for a referral such as diabetes, heart diseases, and emphysema.

Supporting regenerative providers and vice versa

The aim of chiropractors and regenerative medicine physicians are similar. Both aim to treat conditions without surgical or pharmacological intervention.

Here is an example of how a chiropractor and regenerative medicine professional can work together: Say, for instance, a patient has a neck injury that has caused a measurable degree of instability in the cervical or lumbar spine. Intervention will be used to re-establish the patient’s comfort and range of motion. However, knowing that the tissues in the neck are damaged, the chiropractor and regenerative medicine specialist decide to take a collaborative approach by creating a plan that includes information from the MRI, examination, and patient history.

The chiropractor will conduct the manipulation of the spine and the regenerative medicine specialist will direct injections to the small ligaments and tissues that are generally damaged in injured spines. These processes complement each other and increase the patient’s long-term outcomes.

As patient care continues to evolve and patients seek additional treatment options, there are numerous ways for regenerative medicine and orthobiologics to begin integrating with chiropractic offices. Begin your search by meeting with your local regenerative medicine or pain management practitioners and discussing a collaboration as the integrative model of care is on the rise.

ANTHONY CRIFASE, DC, CNS, DACBN, LDN, is the director of professional relations of DocShop Pro. He is double board-certified in clinical nutrition and maintains an active chiropractic practice in Denver, Colo. With experience in multiple different industries and as a seasoned chiropractor who understands the ins and outs of practice management, he is on a mission to help other practitioners maximize their time, revenue and systems. Learn more at docshoppro.com.



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