Is an Amniotic Stem Cell Treatment Really Just a Baby Piss Shot?

By Chris Centeno, MD /

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amniotic stem cell treatment

A few weeks ago, a Colorado Regenexx provider had a funny story to tell about amniotic stem cell treatment. He had told an OB-GYN colleague about some of the crazy claims being made by medical providers that amniotic fluid contained live stem cells. What the doctor told him next will make you both laugh and cry.

What Is an Amniotic Stem Cell Treatment?

Amniotic fluid is what surrounds the baby. When the mother’s water breaks, this is the fluid that ends up on the floor. While amniotic fluid likely contains helpful growth factors and some “extracellular matrix,” it is not a stem cell product. However, when orthopedic sales reps tried to sell this stuff as what it is, it didn’t sell well. So the reps, based largely on the fact that the amniotic fluid and membrane have a low content of stem cells when fresh out of the obstetrics ward, began to tell physicians that the stuff was loaded with stem cells. Never mind that freeze drying or processing the living membrane made sure it had no remaining living cells of any type, let alone stem cells. Most doctors, who were new to the concept of stem cells anyway, bought this marketing ploy.

After I was told by a seemingly knowledgeable sales rep about the rich stem cell content of amniotic fluid, we decided to test the products of some of the companies making these claims and have found no viable stem cells in amniotic fluid. I have blogged many times over the years about the false claims regarding amniotic stem cell treatment.

So why do sales reps keep pushing amniotic stem cells? Last week, when I talked about amniotic stem cells lowering the stem cell bar, I explained the profit the amniotic stem cell treatment business generates: Given that the price this morning for gold is about $1,200 per ounce (28 grams) and a ml of fluid weighs about 1 gram, this baby piss costs about 25 times the price of gold! Also, considering that the average baby has 400–1,200 ml of amniotic fluid at term, if we use the 800 ml number, that makes each delivery worth about $800,000 retail! That doesn’t include the amniotic membrane or chorion (which make up the sac that holds the fluid). Add in an easy $200,000–$400,000 more for those tissues and we easily have a million-dollar delivery.

The Amniotic Fluid Revelation of an OB-GYN Doc

When our physician relayed to the OB-GYN specialist that people were receiving amniotic stem cell treatments despite there being no stem cells in these products, he chuckled. When asked why, he relayed, “Amazing, given the amniotic fluid in that last trimester is mostly baby piss…” My colleague was stunned. Was it really true that most of the amniotic fluid during that last trimester was in fact baby urine? Not being in that field, like myself, we both thought that we recalled this factoid from medical school, but I hunted it down this week. Here’s a quote from a text on the topic:

“By the second trimester…At this time, a fetus contributes to amniotic fluid volume and composition almost exclusively through urination.  Urine has been observed in the fetal bladder as early as 11 weeks transabdominally2 and 9 weeks transvaginally.3 Because fetal urine is hypotonic (80–140 mOsm/ liter), it results in progressively hypotonic fluid (250–260 mOsm/liter near term) that contains increasing concentrations of urea, uric acid, and creatinine as the fetal kidneys mature. By term, a fetus produces on average from 500 to 700 ml/day with a slight decline in hourly fetal urine production after 40 weeks’ gestation.4, 5, 6

Wow! The descriptions above confirm our OB-GYN colleague’s opinion. Amniotic fluid is mostly composed of baby piss. In fact, given that the average term delivery has between 400–1,200 ml of amniotic fluid and the baby produces 500–700 ml of urine a day, the amniotic fluid is, on average, 75% by volume baby piss. No wonder it contains few stem cells to begin with at term and even fewer viable cells, as urea and uric acid are not what one would consider the perfect environment for cells to thrive.

What Else Is in Amniotic Fluid if Not Stem Cells?

So what’s in this stuff that could be regenerative? It does also contain helpful growth factors and cytokines, basically similar to a much cheaper platelet rich plasma shot. It also contains collagen and other extracellular matrix proteins that may be useful as a scaffold for regenerative medicine. In the end, it’s a net positive to the growing baby. However, as far as viable stem cells that survive processing and the freeze-thaw cycle that make up an amniotic fluid product—that’s clearly not happening.

The upshot? It was interesting to hear an OB-GYN’s perspective on amniotic fluid. After all, only in America can companies bottle baby piss with no viable cells and hawk it to doctors gullible enough to believe it’s a stem cell treatment for $1,000 a milliliter! You gotta love capitalism!

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45 thoughts on “Is an Amniotic Stem Cell Treatment Really Just a Baby Piss Shot?

  1. Denis

    Seems rather ironic (to put it mildly) that these sales reps through their companies are allowed to peddle what seems like an outright fraud while at the same time patients have to go to the Cayman Islands to get certain (credible, from what I can tell) procedures done that are not allowed in the U.S. And you wonder why people get cynical about government. Has anyone reported this to whatever government alphabet agency would oversee this (e.g., FDA)?

  2. Chris Centeno Post author

    Denis, I agree. The FDA has sent letters to many of these companies, but given that 2-3 new ones pop up every month, it seems to have had little effect.

  3. Bob

    This is not really amniotic fluid but is this the same type of stuff being referred to? Does Regenexx have an opinion on this or similar products?

    http://skyebiologics.com/products/sports-med-pain-management/px50

    1. Chris Centeno Post author

      Yes, this is the same-these products have no viable stem cells. Most use what’s called gamma terminal sterilization (including PX50), which means that the cells are killed with radiation that destroys DNA before they’re released to the public. Hence, not only do they have no stem cells, but no living cells. So any doctor that is advertising PX50 as a stem cell therapy is involved in consumer fraud.

  4. Mark Conliffe

    It’s interesting. There is a Chiropractor near me who has been selling this PX50 stuff as Stem Cell, giving presentations and ads in the paper, but now that I look at it, no where on the PX50 website or on his own website does it actually mention Stem Cells. Curious…

    1. Chris Centeno Post author

      Yes, there are no stem cells in PX50. The company provided a statement that their product has no viable cells.

  5. Anita day

    Well what recourse does someone like myself that has just spent 7000.00 dollars to have this procedure done have? I have been waiting for 5 years to have stem cells put in my knees.I couldn’t go to the Cayman islands or Colorado I finally found a Dr from your Web site in birmingham, Alabama that was suppose to do it, so I go & they want to do rooster comb we did that I lost 50 lbs & I go back in a year & he says I just need knee replacement. I still don’t want that & I find another place in Canton, ga that told me they did stem cells like y’all, I get there they tell me about amonitic stems at my age 63 they would get about 1000 stem cells & with the amonitic stem cells they would get 100 , 000. I did it & now you are saying I just pissed my hard earned money away. If this is a proven lie then I should have no problem suing right. ?to say I am sick to my stomach about this is putting it mildly! I paid 2000.00 out of my pocket & paying the other 5000.00 on a care credit card. This is the worst scam that I have ever seen in my life!

    1. Regenexx Team

      Anita day,
      The issue of calling Amniotic therapy “stem cell” therapy, and telling patients that they will be receiving X amount of stem cells in these injections is a Huge issue, which is why we write about it. The good news is that there at least should be growth factors in the treatment similar in potential to PRP. While that’s certainly not what you paid for, hoping that helps your knee. Please let us know if we can be of further assistance.

  6. MItch Johnson

    Im not trying to abusive in any way. But its really hard to bring credibility to what you are doing by tearing down every other stem cell clinic in the country besides Regenexx. You are talking about stem cell weekend courses and how they are crap… Have I missed all of the university based CLINICAL Stem Cell/Regen Medicine internships?? All I can find is research based.. So that leads me to believe that you are talking about your own program.. A program that you stand to make money from. Is that correct? And since when has a large joint injection needed a three year internship?
    Basically what you are saying is that unless providers have taken Regenexx internship, then they are not properly trained?
    All I am saying is Regenexx isn’t the only stem cell center in the country who has great results with their patients.. Adipose and amniotic derived therapies have been a god send to thousands. Seems a bit disingenuous to blog about how great stem cells are but only when performed at a Regenxx location.

  7. Chris Centeno Post author

    Mitch, Interventional Orthopedics Foundation is a non-profit. All courses I have taught for IOF, I have donated my time. So no, I make no money teaching courses at this point, in fact if it involves closing our very busy clinic for a day, I loose big money.

    Yes, most patient education in this area is poor. It isn’t evidence based in any way. As an example, most still teach that a BMA is one site. We’ve know in the research based literature (not ours) that this is a great way to reduce yield. That’s just one example of many.

    Regenexx isn’t the only viable option, in fact I’ve told many a doctor that if you’re not going to do allot of this work, buy a bedside centrifuge. Could you do better, yep. But if all you’re going to do is 3-4 BMA cases a month, then having an in house lab makes little sense.

    What is different about Regenexx is that we test EVERYTHING ourselves. As an example, the OnControl drill to treat T1/T2 BMLs is a great contraption. On the other end of that spectrum, we’ve tested a device to improve BMA yield that didn’t work. We paid for that testing in our million dollar lab, as we take no money from device manufacturers. Or another example is amniotic fluid. Given that I could make several million a year just pumping this stuff to all 35 clinics and calling it stem cells, I have no incentive to slam it. In fact, if I were a pure play business guy I would be selling Regenxx branded amniotic fluid by next month. However, we paid about 10K to test it and then IOF paid another 20-30K or so and it wasn’t a legit stem cell therapy. We also couldn’t prove it actually did anything to help BM-MSCs, so we dropped it.

  8. Chris Centeno Post author

    On amniotic derived therapy being a god send to thousands-where is that data? I think it works about as well as a simple PRP shot, but costs a lot more. However, might it work to help OA pain-I have no issues believing that, just don’t call it a stem cell therapy as that’s not honest.

    Is adipose SVF helpful? We’ve used it in Cayman and I’ve been umimpressed, but can it help OA pain, again that’s likely. Regrettably FDA has classified it as a drug-a decision I don’t agree with, but having spent 500K of my own money trying to get the FDA to regulate autologous therapies appropriately, I think I’ve earned the right to say that “it is what it is”.

  9. Chris Centeno Post author

    Finally, I refer to providers outside of our network in areas we don’t have coverage, but I do make sure that these providers:

    1. Know how to do a proper BMA under fluoro or US guidance
    2. Use advanced injection techniques (i.e. use guidance to place cells in specific structures, not a blind injection)
    3. Have a good sense of the science-i.e. they know that simple things like using high dose corticosteroids or bupivicaine around cells is a really bad idea).

    On how to get good training, IOF will be offering more and more courses. This is a non-profit, so by definition it can’t make money. It will be the only non-profit in this space offering course work (that I know of), as every other venture I have seen is for profit.

  10. Mitch Johnson

    Dr. Centeno I think that we are going to have to agree to disagree. I have seen clinics use both PRP and amniotic with amniotic having dramatically better results.
    You have brought up great points, I will give you that. But on the topic of untrained doctors.. Where are they supposed to be trained? You mentioned the IOF.. That sounds like a term that you pioneered.. “interventional orthopedics”. Is this non profit something that you started? Lots of companies have non profits but most times its for tax incentives. So in an indirect way people profit. Not accusing you, just bringing light to the facts. Also do students pay to attend training at the IOF?
    The three things that you look for in providers.. absolutely.. But Im standing by the fact that amniotic and adipose derived are great therapies.

  11. Chris Centeno Post author

    IOF was initially funded by billionaire philanthropist John Malone, who continues his support. It is not financially supported by Regenexx. John has also given 100M to Yake and Hopkins as well as >40M to CSU. Nobody profits off of IOF-as I’ve said, if I add up the hours I’ve devoted to it, I’ve easily lost 100K in time. Why do it? Because it’s time that the education in this space gets cleaned up. It’s time that we all have a non-profit organization that can focus on the important in-vitro issues we all need to know. For example, right now IOF is engaged in an experiment to determine if a higher concentration of PRP negatively impacts tendons. Some prior studies have suggested this and the result of a well done in-vitro study benefits everyone.

    Mitch, if you want to engage me, let’s discuss studies-their pros and cons and things we can dig our teeth into. For example, is it ethical to call amniotic fluid a stem cell therapy? The answer is no, given our testing shows no cells, many of these companies have stated these products have no cells, most are gamma terminally sterilized. This poor woman above signed up for a stem cell therapy-was she taken? If the procedure didn’t work and she had gotten stem cells, then all procedures have failure rates. If the procedure doesn’t work and she never got any stem cells, that’s an issue.

    On whether SVF is a great therapy in orthopedics-who knows, could be. I haven’t seen direct evidence of that, but we can certainly debate the pros and cons of what’s published. Same for amniotic fluid.

  12. Chris Centeno Post author

    BTW, shutting down here for the night, so I’ll get to any other comments in the a.m…

  13. Bernadette Liberaci

    Mitch Johnson,

    Dr. Centeno’s expertise and authority in this area is clear. What is yours? Do you perform amniotic or adipose stem cell therapy? On what website or in what Journal can I find your data? I did a Google search for peer reviewed published research on stem cells outcomes and found none in your name.

  14. Charles F Mahl MD

    As a practicing physician specializing in Regenerative Medicine, I can say with authority that Dr Chris Centeno is one of the most respected and honest physicians alive now, who is advancing the field of Regenerative Medicine through hard work. His patient care is exemplary and his heart is in doing the right thing while trying to fend off the chalatans and money grabbers who use this new frontier and potential in medicine with the only intention being to make money which at times is mostly at the expense of trusting desperate patients who do not know how to scientifically evaluate the literature. I dont know Dr Centeno personally but he really is a voice of reason in this field and who better as a patient advocate? I dont see many other doctors here giving their very rare spare time to engage in these discussions and help educate the public. So, lets give credit where credit is due. I appreciate Dr Centeno’s efforts and have personally learned much from him. Charles F. Mahl MD

  15. Ross

    SickPuppet – Who are you, and why should we care?

  16. Bob

    You guys missed my point about PX50. I understand there are no stem cells in PX50 and there are no claims as such. My question is does anyone have any data or experience with PX50 and how it may help with OA. My doctor suggested adding it to a regular PRP injection to help boost the effectiveness of the PRP. It’s actually quite inexpensive, I think it costs $250 to add PX-50 along with the PRP. It is derived from placental tissue, not amniotic fluid. Just wondering if I’m wasting my money or not. From their site:
    PX50® contains the complete placental tissue matrix, including extracellular matrix components, growth factors and collagen scaffold, processed from non-aged human placental tissues.

  17. Chris Centeno Post author

    Had to get rid of another abusive poster. Interesting how the patients are generally grateful to have this information, but providers involved in using amniotic fluid and passing it off as a stem cell therapy are generally upset. On the one hand I guess we should expect that, on the other, it’s a bit upsetting as a physician. We would all expect that once a physician who has been telling patients that something is a stem cell therapy learns that the product has no living cells at all (let alone stem cells), that physician should also be grateful for the info.

  18. Bob

    I agree, typical of internet postings. So back to PX50, agreed that it is not stem cell therapy and doesn’t claim to be. However, it sounds as if it might be useful to add PX50 to a PRP injection, no?

  19. Chris Centeno Post author

    Bob, will PX50 help a PRP shot treat arthritis? First, as you’ve seen it’s not a stem cell injection, so as long as you know that and your surgeon knows that, then we’re past the first hurdle. Second, amniotic fluid generally does have helpful growth factors and collagen as well as other cytokines. There’s very limited data whether amniotic fluid will help arthritis right now, but if I had to venture an educated guess, it likely will provide some benefit in selected patients.

    On the other hand, we tested multiple amniotic fluid products with mesenchymal stem cells in culture, hoping that “young ECM” (the fact that the collagen/proteins and other cytokines in the fluid were from a young donor) would help old stem cells. This was based on other experiments done by others with young ECM and old cells (that didn’t use amniotic fluid). We didn’t see that happen along any metric we tested in culture. Hence, that was a bit of a disappointment.

    In summary, will adding PX50 to PRP help more than PRP alone? Nobody really knows. If you understand it’s not a stem cell shot and have the money, you may want to go for it. On the other hand, if you have severe arthritis, PRP (alone or in combination with PX50) may have limited longer term benefit.

  20. Bob

    Thanks. I have had actual stem cell injections as well as PRP and have seen some improvement, but still have some pain and limited mobility. Just trying to weigh the options for what might be next. Could be another stem cell treatment, PRP with or without PX50, or even synvisc. I have pretty sever arthritis in 1 hip and have avoided surgery for about 3 years now through stem cell and PRP injections. I appreciate your advice.

  21. Bob

    One more thing. You keep mentioning amniotic fluid, but isn’t PX50 different than that? It’s derived from placental tissue, it is not just the amniotic fluid.

  22. Chris Centeno Post author

    Bob, almost all amniotic products are sourced from just a few large US based tissue banks. There are a number of types: amniotic fluid, amniotic membrane, and chorion. They are all derived from the placenta, so any of these can also be called “placental tissue”. Some products out there are pure fluid or fluid that has been centrifuged to concentrate the cellular components. Some are finely chopped amniotic membrane (which makes up the “bag” that holds the fluid and the baby).

    If you look at the PX50 FDA registration located at: http://skyebiologics.com/-/media/Skye-Osprey-FDA-Registration-Validated-12.02.2015-copy.pdf, it looks like PX50 is made of amniotic membrane (although the form has no check box for amniotic fluid). The fact that the FDA 361 registration (which is not an approval) doesn’t list amniotic fluid goes back to the traditional use for these placental derived products, which was to cover a wound. Hence the membranes were always more sought after than the fluid.

    So PX50, like many of these products we’ve tested, is finely chopped amniotic membrane that may or may not contain fluid. Is it any different than what we’ve been discussing? No, it’s lumped in with a panoply of products derived from the human placenta.

  23. Bob

    ok thanks for the clarification. If I end up doing another straight PRP, I will probably add the PX50 since it’s not expensive and sounds like it can’t hurt and may help.

  24. Chris Centeno Post author

    That’s probably right Bob. If that’s the price that was quoted, given a 1 ml vial of this stuff retails for between $700-$1,200, it’s likely that the surgeon was given a sample to try this product (i.e. he wouldn’t usually be selling it below what he paid for it).

  25. Bob

    He quoted me $250. Since it’s relatively new, especially to him, it may be a sample as you say. For the retail price you quoted, I think I would skip it and stick with stem cell and PRP. Any thoughts on adding Synvisc to the mix?

  26. Chris Centeno Post author

    Synvisc is a brand of hyaluronic acid (HA), which is similar to native joint fluid. When we tested it in the lab with stem cells, the cells didn’t like it much. A recent study looked at hip arthritis treated with PRP with or without HA and saw no benefit to adding the HA. See http://www.ncbi.nlm.nih.gov/pubmed/26797697

  27. Dennis

    I for one appreciate the info that Dr. Centeno and his team post (and respond to) here, and hope these abusive posters don’t curtail this. The fact that he is willing to take time out of his schedule to blog and engage in this open forum (and publish outcome data, publish in PubMed), tells me a lot about the Regenexx company and its procedures.

    1. Regenexx Team

      Thanks Dennis! No, we’ll just deal with them as we have. Dr. Centeno’s commitment to making safe and effective stem cell treatment available to as many people as possible by educating patients through his blog, webinars, writing books and giving them away for free, training doctors (Regenexx and others), ongoing research, his time, and getting the word out about difficult issues like yesterday…is extraordinary. He amazes us daily!

  28. Chris Centeno Post author

    Thanks Dennis! Yes, waking up at 5:30 am every day to get a blog out can be tough, but it forces me to keep up with the latest and greatest literature. Our goal has always been transparency.

  29. Richard R. Clymore, D.C.

    Hi Dr. Centeno,

    My wife and I, both chiropractors in Fresno, Ca, have OA of the knee and have been gathering information on stem cell for the knee. I would appreciated it if you would shed light on several issues:

    1. Dr. Riordan of RMI (Riordan-McKenna Institute in Houston) uses the amniotic membrane from supposed new mothers along with mesenchymal cells, which he touts as providing more stem cells. But What are your thoughts?
    2. Dr. Michael Brown, M.D., states mesenchymal cells can be drawn from bone marrow, fat, and blood. I thought I read somewhere that there are many more stem cells found in the blood than in marrow or fat. What are your thoughts?
    3. Which is the most common method for gathering stem cells is used at Regenexx?
    4. I see that Regenexx has a facility in La Jolla, CA. Would the expertise at that facility be the same level and quality as in your Colorado facility? It would be much easier for us to travel to la Jolla for the procedure.

    Thank you for your kind response.

    Richard R. Clymore, D.C.

  30. Chris Centeno Post author

    Richard,

    All amniotic products are devitalized (i.e. without living cells), so adding them to a bone marrow concentrate procedure (which is done at the new RMI clinic) doesn’t add any stem cells. RMI does a single buffy coat isolation from a bone marrow aspirate, which is not a mesenchymal stem cell procedure (we perform that procedure in Grand Cayman through a licensed lab as it requires culture expansion). We tried very hard to convince ourselves using about 1M in lab equipment that adding amniotic tissue would help the stem cells in bone marrow concentrate, but it did not. I have seen no data from RMI (which doesn’t have a lab as far as I’m aware) to the contrary. I just did a literature search on Riordan and McKenna and found no published research by that clinic on their technique under either author for knee arthritis (US National Library of Medicine).

    There is no appreciable stem cell content in blood (with respect to MSCs). I know Michael and he uses a fat graft technique (i.e. the cells are not liberated from the collagen in the fat), so no stem cells would be available to the joint. We tested adding a fat graft to bone marrow concentrate and found no advantage at all over BMC alone (see our 2014 publication-http://www.regenexx.com/wp-content/uploads/2014/09/370621-1.pdf).

    We use a bone marrow aspirate, to collect stem cells. For more info about what we do and how we do it-see http://www.regenexx.com/blog/what-is-regenexx-3/ This is our published research: http://www.regenexx.com/stem-cell-research/

    Yes, the San Diego/La Jolla clinic is very experienced in our techniques and protocols.

    Chris Centeno, M.D.

  31. Neville White

    Neville White

    All this talk about amniotic fluid reminded of our story. About 10 months ago my daughter gave birth to our first granddaughter. I am not sure of all the details to this story but my daughter was apparently approached with an offer to save my granddaughter’s amniotic fluid/placenta, freeze and store it so that my granddaughter could have it if she needed it in the future. Of course there was an initial fee of several thousand dollars and a monthly/yearly fee for storage. We gave it a little thought but declined. From what I read this appears to be a completely bogus deal that plays on your emotions. Do you guys have any information about this or any similar procedures. Thanks

  32. Chris Centeno Post author

    Neville, this type of cord blood banking is different. The good news is that the cells are processed and recovered to likely protect viability (i.e there are stem cells that are viable). The bad news is that you are not permitted under current regulations to be use them to treat your child for much other than a a few cancer applications.

  33. Celeste Spoon

    I had stem cell injections for spinal stenosis in my back three weeks ago. I am still in chronic pain. How long before the pain subsides.or does this mean it did not work?

  34. Beau Barendt

    I am confused. From what I gather from your post, amniotic fluid contains “zero” stem cells…but according to research papers published by the National Center for Biotechnology Health there is.

    1. Regenexx Team Post author

      Beau,
      We can understand your confusion. The types of studies you see there are studies where fresh amniotic tissue is procured for lab experiments. What we’re writing about are Amniotic products being sold to various types of medical practices to be used to treat orthopedic injuries and degenerative conditions. Please see: https://regenexx.com/blog/amniotic-stem-cells-really-just-expensive-prp-shot/ and http://www.regenexx.com/amniotic-stem-cells-great-deception/ and http://www.regenexx.com/an-amniotic-stem-cells-challenge/ and https://regenexx.com/blog/amniotic-stem-cell-injection/ and https://regenexx.com/blog/amniotic-stem-cells-stuff-help-real-stem-cells/

  35. Aston Goldsworthy

    Dr. Centeno’s,
    I have had several patients asking about amnionic and umbilical cord blood derived stem cells in my clinic. We currently do adipose and marrow using Harvest Technologies kits. Is there any credence to Umbilical cord stem cells? My first thought is how do they survive the thawing process? Also isn’t it true most preservatives used are cytotoxic? So if these cells are not washed directly after thawing then they will be destroyed? Which since they are sold in frozen ready-ject syringes I am assuming that is not happening. So at best they are injecting destroyed stem cells into the joint along with what ever growth factors and cytokines are present? I have tried to counsel these patients but not having any factual literature to give them its tough to make them understand. Can you direct to any sources for this information?

    On an unrelated note why does Regenex and Interventional Orthopedics Foundation not accept Nurse Practitioners into to their group? I actually inquired about this a few months back and was told I could not do any training or be involved with either group because I am a Nurse Practitioner. These procedures are not that complex and I do hundreds of joint injections a month. I do US guided and Floro guided injections daily. I also on occasion do EMG guided injections for cervical dystonia on patients receiving botox treatment. A joint injection is the same for that joint no matter what is being injected, all that varies is the what we put in the injection. Procedures like these are about the amount of practice you have doing them and the amount you have done. Putting a MD or DO behind your name does not give a practitioner more experience in these procedures or give them advanced insight on how to perform them. A good portion of my patients come to our practice because a MD or a DO in the area wanted to do surgery instead of trying stem cells or even rehab on them first. At our clinic we use bracing and rehab/corrective exercise with our stem cells patients and find it to be an effective combination. For example pt 55yoa with knee pain, on further examination and imaging it is discovered he has a moderate valgus deformity and Phase 3 OA. Stem cells will help this but if the positioning of that knee remains that joint is still going to have issues. What is your opinion on using an off loading brace, stretching then strengthening the muscles around the knee in conjunction with using stem cells? Do you think this would be would be of greater benefit to the patient over stem cells alone? Obviously rehab would not start right after the injection but once they can begin to resume normal activity or before the injection occurs in the first place. I hope in future you reconsider allowing Nurse Practitioners and Physician Assistants into your groups. You might be surprised how hard someone who has to constantly prove themselves to medical hierarchy will work to be an amazing practitioner.

      1. Aston

        I reviewed the links.
        At Regenexx, we enforce strict standards on who can join our provider network. These include the following:

        Basic training in imaging-guided injections
        Extensive experience and training in treating musculoskeletal injuries
        Mandatory training and testing in core competencies
        Hands-on cadaver-based training to demonstrate skills

        If this is what is needed to qualify for membership I meet these requirements. I saw the link to the different training courses being offered on your reply. Does this mean I’m eligible to take any of those courses? I assume I would need to take the level 1 courses before I got to next levels. I try to take a course once a month right. Mainly pain management (injection courses) and aesthetics. I would love to get some of these courses on my schedule. Thank you

        1. Regenexx Team Post author

          Aston,
          No, those are requirements over and above the
          General Pre-requisites:

          M.D. or D.O. with a musculoskeletal specialty:
          Physical Medicine and Rehabilitation
          Family Practice with the completion of a Sports Fellowship
          Interventional Spine (Anesthesiology or PMR),
          Orthopedic Surgery
          Interventional Radiology accepted only with significant hands on examination experience.
          Neurology with a separate pain board and/or proof of training in interventional spine

          This can be found here: https://interventionalorthopedics.org/upcoming-education/

          1. Aston

            Also being a Chiropractor does not count toward rehabilitation and Physical medicine?

          2. Regenexx Team Post author

            Aston,
            No, not in this case. The pre-requisite is an MD or DO with a specialty (meaning residency or post residency fellowship) in Physical Medicine and Rehabilitation.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
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Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
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Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
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Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
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Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
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Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

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*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.