PRP and Stem Cell Injections for Sports Injuries Explained

Welcome to the Performance Place Sports Care podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, how's it going? This is Dr. Sebastian Gonzales with Performance Place Sports Care. And today, I have the pleasure of interviewing Dr. Goswami. He's a regenerative cell therapy doctor in Newport Beach. We're going to go over some topics that you guys probably have not heard about yet. A lot of my patients have not heard about PRP and stem cell or these regenerative types of injections that you can get that can really be a good substitute for doing surgeries on multiple different types of conditions.

So, I'll tell you a little bit later how I met Dr. Goswami, but Dr. Goswami's right here. And would you like to introduce yourself? Tell us a little bit about yourself. Hello, Sebastian. Thank you for having me over. And I'd love to answer any questions and talk more about this new and innovative treatment that I think is going to revolutionize how we treat sports injuries. I remember when we first met, you were telling me about you used to do more procedures or you did more surgeries, right? Yes. I started off my medical career as a surgeon and then super specialized in minimally invasive treatments because even within surgery, the trend has been towards less and less invasive procedures.

So, my focus kind of shifted from open surgery, which usually comes with a lot of collateral damage, to figuring out how we can treat some conditions with less surgery or minimally invasive techniques. So, the last 15 years of my career has been devoted to minimally invasive procedures. Would you, I know we haven't gone to quite what PRP and STEM are, but in regards to percentage of like an open surgery, would you say like what's a rough percentage of success rate of an open surgery versus like a minimally invasive one like we're talking about now? Well, it is different for different conditions.

You know, open surgery or even arthroscopic surgery does have a role to play in certain conditions. You know, I mean, if somebody had a complete ACL tear, it's an acute injury and they have an unstable knee, it still requires that somebody goes in and either fixes that ACL or stabilizes the knee. But for a lot of other conditions, especially chronic joint damage or even partial ACL tear or rotator cuff injuries, if you look at the surgery literature, the outcomes are not very good, especially in terms of people returning to playing their sport or the level of activity they had prior to injury.

And that's why there's always been this search for what can we really do to help those patients who, after an injury, want to really get back to playing the sports that they like or would like to continue to perform at a higher level. Well, you mentioned the return to play. I actually did quite a bit of research on rotator cuff tears in pitchers, and I want to say that the rough estimation of a complete tear pitcher ever coming back was like 8%. It was so low. Yes. And even re-tightening the areas, it gives different mechanics and whatnot. So tell me what you do, PRP, PPP, stem cell, explain all these to me.

So basically, there's a whole spectrum of treatments. I mean, the fundamental concept of regenerative treatment is that, and this is where it gets exciting, is that unlike any other treatment in mainstream medicine, which is basically designed to suppress pain, but really not address the actual healing process, these treatments are designed to repair and regenerate cells. And they are based on a very fundamental concept of our life, that if we are alive, our body cells are constantly regenerating. That's why we recover, even after surgery or even after an injury, when our body tries to heal us, it happens because of the regenerative capacity of our cells.

And what regenerative medicine is trying to do is harness that regenerative capacity and make sure that we could have enough cells to complete that repair job at a much faster pace, but not just to suppress the pain, but also to repair the damaged tissue. And that is where the return to the muscle and that is where the return to the regenerative capacity, because if you have the ability to regenerate what was damaged and get it back to how your tissue used to be or as close to it, then you've got a very good chance of being able to perform at a higher level. Well, you mentioned before we actually had a discussion before we started this podcast, and you had mentioned that, and I was actually not aware of this, that some of these regenerative therapies, I was under the impression that the cell that we're putting back into the body in the region of an injury actually becomes the tissue we're trying to regenerate.

But you corrected me, so can you explain a little bit about that? So, and you're not totally off the cuff because a lot of us and a lot of us who practice this field until recently believe that that's how this treatment was working, but, you know, we're trying to understand, as we do more treatments, the actual what's happening at a cellular level. So, and so what we're really finding is that it's not so much about that you need cells, because you already have cells, you know, if you're alive, you have cells, and there are live cells even at the site of the injury, but what has happened is that because of the injury and damage to those local cells, the local environment is not conducive, and it's kind of suppressing the cells to really perform well.

So, and the whole lot of these cells go in and they try to calm down the environment, they try to change the environment, which promotes faster healing, so that the local cells can do the job, you know, sometimes I give an example of a crime taking place in a town, and, you know, you have got a hundred, a force of hundred cops, they're having a hard time, and you send in about a thousand cops, which just help them finish the job. If they're not going to necessarily stay there, they will return back, and the city will be fine, just like it was functioning before, but because there was an increase in crime, you send some additional forces.

So, I mean, I don't know how good an analogy that is, but that's how I like to look at it and explain it to my patients. I was thinking the sheriffs would be a good one, OC sheriffs, or when they had, actually, you know, they hear about that big fire they had in Central California? Yes, absolutely, right. So, I guess the fire ones would work. I know they go back to where they came from afterwards. Right, that's true. Yeah, yeah, so that was, I thought that was really interesting to me about the, the cells really don't make too much of the new tissue, because I know that, like, some of the, some of the feedback that I've heard from patients, at least in regards to, like, their concerns about the, the types of procedure was, we're talking about, like, embryonic stem cells, or, they're like, well, won't this grow, like, a tumor inside me?

Or, is it going to stop growing, or whatever? But, good to know. And, and, and, that's why it's also important to understand that there's a whole spectrum of stem cells, you know, and, and, a lot of the early debate on stem cells, as you know, was based on embryonic stem cells, and this whole idea that one cell is capable of literally growing anything, and in theory, that sounds all good and well, but that's not where we want to go, because, a, embryonic stem cell is banned in the United States, and secondly, their moral and ethical implications to using those cells, and more importantly, I feel on a scientific level, it's foreign DNA, and why would I want to play with that?

So, our practice, and our current focus is solely based on utilizing patients' own cells, you know, so, another thing I like to make clear to my patients is that I'm not trying to turn the clock back and make a younger version of you. I mean, your knee or your hamstring is, is going to be what age it was. All we're trying to do here is naturally help heal your injury, with the focus on getting you back to playing at the level that you were playing before, without introducing anything foreign into your body. So, there's no downside, there's no risk of rejection, there's no risk of rejection, I mean, this is even safer than a blood transfusion, because the cells, and that's why there are a lot of other subtle things that come into play when we do this treatment, you know, we do same day treatment, I do the entire treatment in the same sitting, because I don't want to shelf the cells, I don't want to mix any chemicals, I don't want to freeze them, I don't want to store them.

Because all of that then brings other variables into play, and we don't know what the outcome, because of those variables would be. It's got a lot of subtle things, but here the entire focus is using patients' own cells, just helping the area where the injury is, so that the healing is rapid, it's natural, and brings the original tissue back. I've had quite a few patients ask me to describe what I feel about the whole, these types of procedures, and I can never explain them really well, because it's not my expertise, but I always just tell them, look, it's just a catalyst, I'm actually going to speed things up, would that sound?

Absolutely. Okay, I want to make sure I'm not saying the wrong thing. No, no, you were right on it. Now, I did have this question this week, where I actually had a patient who had a, he had a, probably a grade one hamstring tear, or a strain, it was very minor. His dad hit the panic button, and he wanted to have a bunch of PRP done, an MRI, and he wanted everything done. He's in season now, is the reason why. But, so the patient asked me, well, what's the difference? Like, why, which one would I need? Because I explained PRP versus STEM, I didn't know about PPP. Right. Is there certain types of situations where one would work better than another?

So, basically, in the spectrum of regenerative medicine, I apologize, I started to answer this earlier when you asked me, but there's a whole host of things, because there's a whole host of sources from which we can derive cells, you know. So, when we talk about, say, stem cell treatment, just to use the word, because it's easier to understand, we're basically trying to isolate the cells from the same organ systems that belong to the same family of cells. So, let me explain it a little bit more. Yes, we all grew from one cell, stem cell, and then, as we grew and became older, those cells specialized into different organs.

The brain was formed, the kidneys was formed, liver, similarly, bone, joints, muscles were formed. Now, as we specialized, each organ system still has a seed of that stem cell. But, as we specialize, that stem cell is only capable of regenerating that organ system. So, that means the brain stem cells heal brain, and the liver stem cells heal liver. What is lucky for us is that fat, bone marrow, blood belong to the same family that form the muscle, ligament, cartilage, meniscus, bone. So, these are belonging to the same family. So, what we can do is, because fat is easily dispensable, bone marrow is easily collectible, blood can be easily collected.

That's why this area is really one of the first areas where the clinical applications came along so quickly, because you just have to isolate, harvest enough cells from these areas, and use them to heal. Now, so you have fat cells, you have bone marrow. Bone marrow, as you know, is literally a factory of cells, because all it does 24-7 is make cells. And then you've got blood, and within blood, we have three kinds of cells, which is red blood cells, which carry oxygen, white cells that fight infection, and then platelets. These are the cells that really have about 10 to 11 growth factors in it.

So, and that's why we call it platelet-rich plasma, because once you remove the red cells and the white cells, you're left with platelets suspended in plasma. So, it's platelet-rich plasma that we use. And then if we remove some of the plasma, then you really got a rich concentrate of platelets. Having said that, platelets, by themselves, do not have as much regenerative capacity. They do have some healing power, and they can help with healing by suppressing some inflammation. But if the injury is significant, then adding some cells from the fat and bone marrow really helps to get the job done much more quicker and a more thorough job.

In minor injuries, minor sprains, I mean, I'm not sure what the extent of this hamstring injury was. Simple PRP can work. But, and then again, sometimes even with PRP, the other thing is, how is PRP made? And that's where this whole field, you know, starts spinning on its head right now, and it becomes very hard for people to understand. You know, I have patients coming and saying, oh, I've been told I'll have to have a PRP injection every week for the next three weeks or every month for the next three months. Because all PRP is not the same. How PRP is made is critically important to the concentration of platelets you're going to get.

So, the lack of standardization, even as we discuss these things about PRP and PPP and fat cells and bone marrow cells is, it's not so much the title, it's how it's being done. More than art. Right. How the cells are being isolated. How are the cells being delivered. So, so that just further adds to the confusion because it's not a standardized procedure. There are 20 different ways of making PRP. And, and each one will have a different concentration of platelets. So, so there's a lot that goes into it. Usually, I, and that's where my approach is. If it's a soft tissue injury, if there's a joint injury, it's probably going to read cells along with PRP and PPP and some other stuff too.

A little bit of everything. Right, because generally speaking, those damage tend to be involving multiple tissues within the joint. It's a little bit of damage on the cartilage, the bone, the meniscus, the cartilage, the labrum tear. It's hard to really damage a joint, just have one side of injury. Usually, it's going to be. Even the example that I gave you of a complete ACL tear, that patient happened to have a meniscal tear along with it. Because, you know, to tear your ACL completely, it has to be a pretty violent injury. So, it's unlikely that other sites would not be damaged. And so, for joints, 90% of the time, it's going to require, you know, you can buy some time with just a PRP injection.

It's still a major upgrade from getting a steroid shot or something else, because at least it won't cause further damage. But if you're really serious about addressing it, it has to include cells. Soft tissue injuries, if they are to a minor grade, PRP is a wonderful option. If done correctly, if made correctly, you need only one injection. And you don't need to be off of your activity for more than a week. And then you can slowly get back into doing things. So, suddenly, that's there. So, I've had, like, full spectrum of patients. I've had some hamstring sprains that haven't healed from conservative treatment.

And just a single injection of PRP speeds up things. I've had a patient come to me with a bicep tear. It was old, a bicep tear. Like a complete one? He had a partial tear. And obviously, was offered surgery. But given the complexity of the procedure, she was not to undergo surgery, but still had pain. And so, we use cells, a combination of cells there, because we want to repair the tendon and also take the pain away. And, you know, this is an amazing gentleman. He's going to be part of our police force very soon. A young guy then, right? A young guy. And that's why he was crazy enough to try to be lift 300 pounds towards his bicep.

Hopefully, he didn't. He wasn't in the middle of the academy doing it. No, no. I know they don't like to talk about it. Yeah, but so, you know, but you have the whole range and whole spectrum, and the goal is to match it to the extent of damage we're trying to repair, basically. Well, you brought up some things that actually, I know that, so everyone here in the podcast, hopefully people will hear it across the U.S., and we'll see how popular it gets. But if someone is seeking out someone who does regenerative therapies, is there certain questions that they would want to ask to make sure that that's the right person for them?

Because I know in my profession, there's a handful of questions I would probably want them to ask, because not everyone's able to reach me. Absolutely. And I really, you know, I appreciate the opportunity, because one of the goals I've had since I got involved with this treatment is being education. You know, I mean, I have these consultations with patients, sometimes patients call from other cities, other countries, and I do take the effort to spend at least talking to them, even over the phone. And my main emphasis is, wherever you choose to get the treatment, make sure you don't just go for a title that you're getting a stem cell treatment.

It's very easy to throw that name out there. The most important thing is, what exactly are you getting? You know, what are the sources of cells? How many cells are you going to get? How is the process going to work? Is it being done in one setting? Or are your cells going to be shipped out? Or, you know, they're going to be frozen or mixed with? Because those things should raise some questions as to whether you're really getting the scientific protocol of this treatment. So that's the main thing. And this is a treatment that does require a certain level of skill set, because it's the first time in my career where I'm not putting something that a pharmaceutical or a device company gave me and I'm putting into your body.

This is your own cells going into your own body. So it basically comes down to good collection techniques, good isolation techniques, and good delivery techniques to make sure the cells get to the right spot. And all of that has to be done in a certain time window, because as you know, when we pull cells out of our body, they start to die. So every step of the procedure has to be defined to do correctly, and that's when we can expect results. There should be like an e-book on regenerative cell therapy and what patients should know. We have put together an educational guide, so if anybody goes to the website, they can have within seconds an e-book delivered to their inbox.

I'm working on completing, and I feel embarrassed because every six months I say I'm about to complete this book, but it's a very simple Q&A book that I'm wanting to put together. And just based on the questions, just like you've asked me over the years, the last five, six years of my involvement with these procedures, there have been some very, very interesting questions that patients have. And so I'm trying to see if I can put together, you know, those questions and answer them in a manner where, you know, every lay person can understand. So when they have this treatment or consider this treatment, at least they are educated and informed on the fundamental principles of the treatment.

And so that's my aim with it. Hopefully we'll have that out soon. Yeah, you got to get a, maybe dictate it or something. You can borrow this microphone. Yes, I have actually, you know. I'm on to, I want to get to about 100 questions. I'm thinking they'll make it worthwhile people's time. And I've kind of been hovering around 65, 66 questions. So let's see if I can find enough to pull another 30 questions. I'll try to make some. Hey, okay. Yeah. So if you listen to this podcast, then feel free to email your question. Well, hopefully it wasn't one that's been answered already. Oh, by the way, so you mentioned your site.

I know we got a couple more questions to go through for sure. But what is your website and where can they reach all of the informational stuff that you're talking about? So precisecare.com is the website address. And there is some educational guide. If you put in your email address, you can get it. But I've written quite a few educational articles. So if you go in the patient resource section, it will give you access to articles that I've written, but it will also give you access to peer-reviewed articles that have been published in the journals. So I try to post them so people can see that it's not just me talking about this treatment.

There are other people who have done studies and have published data on that. Within the educational articles, we address a lot of the things that common injuries and what are the options and where does this treatment stand in relation to traditional treatments. So just to kind of give a good overview of where it is. I always emphasize it's new. It's just with anything new. We obviously can't claim to have, you know, robust data of how this is going to work in the long run. But having done a substantial number of patients now over the five years, I've seen that the amazing part is that if people take care of their bodies, if athletes are careful not re-injuring themselves, if they focus on their techniques, if they work with the right trainers, they can really enjoy their sport for many, many years to come, which in essence is the most gratifying part of doing these treatments.

Well, you mentioned earlier that there's not an age window for this. So what is the youngest person that you've ever worked with? My oldest patient was a 20-year-old basketball player with a partial ACL tear. And we treated him in three months of good follow-up. He was back playing basketball at the same level, a spree injury level. My oldest patient has been an 86-year-old, which I reluctantly admit because I was very reluctant in accepting her as a patient because at some point the regenerative process will stop. That's how we leave this planet. But she was also a patient who had really taken good care of her body.

She was a dancer all her life. And, you know, obviously it's taken a toll on her joints. So both knees and ankle were severely arthritic. And obviously she had never considered surgery. She lived through her pain, but would have liked to have some relief so that she can travel the world. And that's exactly what she's doing now three years out, traveling the world and really enjoying. And so as I do these procedures, I think we're using patients' own cells, right? So those cells are coming from a patient's own body. So my message is that if your body is healthy, if we take care of our bodies, our cells are likely to be healthy.

And when we need them, they're likely to perform much better. So the patients that worries me is not so much the age of the patient, but I'm more concerned with their overall health and how they're taking care of their body. Because if that's not in place, and that's true for surgery too. I mean, I've done surgery for many years and doing the same procedure, using the same graft or the same device and doing it exactly the same way, the outcomes would be so different in two patients. Because ultimately, it's our cells that try to heal us even after surgery. So your own body, your own cells, I tell patients, and if you take care of your body, and that's the other exciting part.

I mean, we're just, I think, scratching the surface of these treatments. And the potential, especially for some other conditions that people suffer from, will be tremendous if we could figure out a way of harvesting cells and different organs and try to heal those organs. Yeah, you mentioned that Dr. Goswami brought up a graph that we were looking at a little bit earlier. And there was heart and pancreas and lungs. Those would be really interesting for, I guess, heart attacks, smokers, and then diabetics. Is that what we're looking at? Correct, correct, correct. That's the, and then there is some other research going on on some other organs or some other conditions, too.

Just, but yeah, most of it is heart disease, diabetes, COPD, some form. But clinically, there's not enough data. And sometimes, you know, I feel people suffering from MS or Parkinson's disease. And these are conditions which really take a toll on the patient and also on their caregivers and their family. And I often get calls, people asking, oh, could you treat? And I try to educate them. We still don't have any clinical data on this. You know, unfortunately, there are some clinics here and abroad that try to claim to offer treatments for these conditions. But there are some clinical trials that go on in the United States and we keep a list of those and we are happy to hook patients that we don't think, we're not going to accept because we are a clinical place.

You know, we only do treatments that have been scientifically proven. But patients certainly can seek, you know, some trials. Well, that'd be awesome. So they can contact you at Precise Care and just contact you? Sure. So we'll be happy to guide them or at least bring them up to speed with what's happening in those areas. Cool. That's awesome. So, well, there's just a couple more questions probably, but I know that I want to tell Elise's story that the reason why I actually met Dr. Goswami was that I had a, we have a patient in common and I can't mention his name. I'll tell a little bit about his case anyways.

I met him about two years ago or so. He came into my clinic and I did a real quick exam on him and I don't typically, or when I see someone I know I can't help, I usually tell them straight away and don't charge them and just guide them somewhere else. And he had, God, I think at the time, I don't even know, was it, did it end up being a labral tear? Was it? So, a labral turn in the hip, which is more of a cartilage injury and he had a very, he had a very bony or like pinching end feel that you couldn't like push past. It wasn't a flexibility issue in the hip. And, uh, so he's about a 60 year old guy, I think.

Um, anyways, I had to turn him away and he found Dr. Goswami and, uh, he actually came back to my office and it was amazing to see the difference that he had. And even now working with him, like he surprised me all the time, actually, like he, he was on the table and he was talking about like why he can't squat below a certain degree. And I'm like, well, you probably saw some pinch in there. And so he brings his thigh all the way up to, actually his knee is extended. So straight leg all the way up to the ceiling. And I'm like, okay, so do you feel a pinch there? He's like, no, I actually feel a stretch on the backside.

I'm like, you feel absolutely no pinch in the front side of the hip here. It's amazing because hip labrums, at least in our field, are really hard. Um, they're very frustrating for the patient and the clinician. Actually, between seeing you and seeing me, obviously, went down the traditional route and saw a couple of orthopedic surgeons and was generally, you know, told that he might be looking at either arthroscopic or maybe even replacement surgery in a few years. And, but the concern is, obviously, this is a gentleman who really wants to be physically active. And, and I think it's, it's critically important to a lot of us to continue to be able to play the sports and, you know, he's both a tennis player and, and a rider.

And he really caught my attention because I love riding motorbikes too. And he said, he kind of do it because every time he sits on his bike, his hip, you know, his labrum acts up and so much pain. So, it was really a pleasure to, you know, help him out and really see his results. He was equally committed and more importantly he's in good hands with you because a lot of time this is not surgery so the post-treatment rehab is not where you're trying to fight scar tissue but it still is an important part of it because in the end as you know an injury is a very focal problem but there's muscle and joints above and below the sites that need to be kept active and invariably I see it in a lot of the patients that because of pain the whole, you know, they try to freeze their muscles because any motion causes pain so it's just it's an inherent component of having injury and you start to see some disused atrophy and other things set in so I tell patients even though this is not surgery but you still need to continue to work with your trainer your physical therapist with whosoever you have been to really make sure that you get back to really using the full function of your muscle and your joint and so I'm glad you know you're being able to help him further down he's a lot of fun I mean he is he is a hard worker so I mean and he really does understand that you know the way he moves is going to affect it too in the long run so so I think that's all the major questions we have obviously we can keep going down many different roads of questioning for the good doc here but we'll save that for a second podcast so we're about the 30 minute mark doc how can they get a hold of you give us your personal cell phone number sure and actually I don't have any problem I love to hear from my patients but you know obviously the website has a little info form one can fill out there is other information on the website if one doesn't want to commit for our local folks I do conduct a free workshop once a month in the evening I think our next one is on February 22nd and you can come in and you know we just it's a good group of people just wanting to learn more I mean this is not where we're just trying to sign up this is not a sign up clinic where you just walk in and you have to commit to something but the whole goal is to educate and answer questions that people may have so that's one avenue certainly calling the office 949-387-9991 9991 so that's the number they can call my email address is very simple Dr. G just three initials D-R G as in Goswami at precisecare.com so you can reach me via email send me your queries and just to make your efforts special I'll give you my cell phone number too it's 949-734-9381 oh we might have to clip that away one day you might get random text messages in case too the spelling on the website is P-R-E-C-I-S-E care.com okay thank you so much for being on the podcast and I'm sure I'll have you again we'll maybe go and do a specific topic I appreciate really I appreciate the opportunity it's been really enjoyable you know the conversation with you and working with your patients yeah I think I learned a lot so thanks everyone and make sure to like and subscribe to the podcast if you have questions go on to my site it is P2 as in the number sportscare.com and there is a button there on the side which you can just leave a voicemail right on your computer or your phone you don't have to have cell reception at all you can just have wifi just talk straight to your computer and just leave your question and we'll try to answer something so everybody can learn from what you got going on so take care