A Sports Medicine Doctor Explains Cortisone, PRP & Stem Cell Injections

[0:00] All right. If you’ve ever had a doctor say, “Let’s try a shot,” and you thought they were talking about tequila, this episode’s for you. Kathy: Today, we’re talking about joint injections, what works, what’s hype, and when you should actually consider one. Jason: And we brought a real life expert. Dr. Liam Vu from Samaritan Athletic Medicine joins us to break down everything from cortisone to PRP to stem cells. Kathy: Stick around because by the end of this episode, you’ll know when to roll up your sleeve and when to roll your eyes. Jason: All right, this is the PTCH.

[0:30] What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Kathy: Chiropractors and physical therapists don’t like each other. Jason: Oh, think again. Kathy: I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Kathy: Welcome to the PTCH Podcast. Jason: Remember, there’s no I in PTCH. All right, welcome back to the PTCH Podcast. I’m Dr. Jason Young. Kathy: I’m Dr. Kathy Lynch.

[1:00] Jason: Oh, are you? Yeah. Did we catch you by surprise there? And I’m really excited to introduce our guest today, Dr. Liam Vu. Dr. Vu is a doctor of osteopathy and he works at Samaritan Athletic Medicine with Samaritan Health here in town, and also one of the doctors for the Oregon State Athletic Department. Kathy: Yes. Go Beavers. Okay. And that —

[1:31] that’s where I — that’s where I know Dr. Vu from, and I was like, “Hey man, you got to be on my podcast.” And he said, “What?” And now look, here he is. Yeah. So, no, we’re really glad to have you here. Dr. Vu: Glad to have you. Your specialty is sports medicine. Dr. Vu: It is. Jason: And we hear that you know a lot about injections. You do them. Dr. Vu: Yes. Yes, we do. It’s a big part of our practice. Been part of my practice. And so happy to come here and speak with you guys about it. Jason: Sweet. Love it. Because we get questions about it all the time. Yes. But first, let’s talk about this podcast

[2:02] that we’ve been doing. Yeah. Things are going pretty well. Yeah. So, we want to thank all of you who’ve been tuning in, clearly from all over the world. Yeah, we love you everywhere all over the world. We really love our local people. So, no, but yeah. Did you know there’s this weird feature on YouTube where it will actually dub our voices into different languages? Kathy: I did not know that. Jason: Yeah. It does. Yeah. I think — yeah. So, I’ve heard the PTCH Podcast in

[2:32] Dutch. Kathy: Serious? Jason: Yes. I’ve heard it in German. And so, yeah, if you’re really, really bored — Kathy: Yeah. Jason: — like, it’s a great thing to listen to, change your life. Kathy: Jason: So, and then as always, feel free to hit us up on our swag store, right? The — I’ll put the link up here. It’s ptchpodcast.shop/swag. You can get yourself a sweet shirt. The holidays are just right around the corner. We’re not running any Black

[3:02] Friday specials, and so you should definitely get yourself something. All right, that’s enough of that. Kathy: Okay, back to business. Jason: Yes, Dr. Vu. Dr. Vu: Yeah. Jason: Why do you do what you do? Dr. Vu: No, it’s a lot of fun, Dr. Young. So, my interest in sports medicine kind of evolved, right? As a young child, you know, teenager, I was involved in high school sports and stuff like that, and saw the benefit of

[3:34] what sports could do to an individual. Jason: Yeah. What was your main sport? Dr. Vu: Yeah, I did football and baseball. Jason: Okay. Man, I thought that you were like a basketball — Dr. Vu: No, no, they breed them taller for that. So, Jason: All right. But yeah, so the interest started there, right? And then as I went through school, you know, got interested in medicine. And as you guys know, there’s different types of fields that you can go into, and I was really drawn to the tactile part of

[4:05] medicine, things that you can touch, feel, and see. So, as opposed to more of the cerebral types of specialties. So, I kind of gravitated towards the orthopedic side and the sports medicine side. Jason: Did you go to — do school because you couldn’t get into PT school or chiropractic? Dr. Vu: Pretty much every time. Kathy: Yeah. No, in all honesty, actually, as

[4:36] I went through school, I was like, “Oh my gosh, the part of osteopathic medicine that was about looking at anatomy and function, the interplay of the two, and getting a lot of education early about anatomy and function really probably catapulted my career to go into sports medicine.” So, I think that had a lot to do with it. Jason: Well, I think a lot of people don’t understand that because these days, when you see DOs and MDs working, a lot

[5:07] of them are in mainstream medicine. Dr. Vu: Absolutely. Jason: And those degrees are kind of interchangeable. Like, we had Tyler Early on — he’s a cardiologist, he’s also a DO. So people are like, “Well, why didn’t you become an MD?” And it’s not because like you weren’t smart enough to become an MD or anything like that, but it is a bit different focus. It’s a little more physical medicine and everything like that. So, Dr. Vu: and you hit it on the head — a lot of MDs and DOs are now working alongside each other. You know, the curriculums are

[5:40] becoming more and more similar, but there is from the osteopathic side a stronger emphasis on anatomy and structure and function like I talked about. So, Kathy: you’re going to give me an adjustment later. Dr. Vu: Yeah. Jason: Yes. Kathy: Not as good as you could do. Jason: Okay. Shoot. I wanted to see that. Oh goodness. Jason: So, a real common question that we get is about injections.

[6:10] Jason: Yeah. Kathy: Right. We see patients who have knee pain and shoulder pain and stuff like that. And all the time we have patients who are coming, they’re like, “Hey, my doctor thinks that I should get an injection.” And for some stupid reason, people are asking us, “Are you — What should I do?”

Jason: Yeah. So I’m really excited for this episode because I’m excited to learn from you about some of these things. So now I know what to tell patients. I’ll probably just show them the episode. But yeah, so it’s a very, very common question. Sometimes people are

[6:42] coming to us because they want to avoid an injection. Kathy: Sure. But there’s other times when it’s probably the best thing that they could do, right? Jason: No doubt. So how did you get interested in doing injection therapies? And I want to be clear — the injection part is just part of the, you know, one tool in the toolbox. And I think that the services that you guys are doing is

[7:12] as important if not our first line. We said, “Hey, let’s emphasize the importance of doing the rehab, right? Empowering yourself in doing the exercises to really address the pathology where you have direct power and ability to improve your condition.” Kathy: Yeah. You’ve got to freaking move, people. Jason: Right. Speak my language. Yeah. So a

[7:44] lot of times the injection part is another tool, and I use it really as a way to get you to be able to do your rehab. Kathy: Yes. And that’s kind of funny because that’s maybe something that you and I have in common — both of us are doing things that help them to get to what she does. Jason: Right. Right. Right. Yeah. Exactly. Like when people come in and they’re like, “Oh, you know, I’m stiff and I can’t move.” I tell them, I’m like, “Listen, I’ll give you an adjustment.” The adjustment is not going to last you — like, this is not a cure for your life. You’ll get adjusted, and my purpose in adjusting you is so that you

[8:15] can then rehab, right? So same kind of thing with injections. Like, you can get all the injections you want, but an injection — maybe, kind of, my understanding of it at least — is it provides a window where you can now rehab and develop stronger muscles, more stable joints, and everything like that, so that you can avoid having to do the next step, which is eventually we have to find somebody who cuts people open. Kathy: I haven’t said this before yet. Jason: Yeah. No. I think you’re hitting it on the head right there. Right. So I generally tell people that

[8:46] we have to look at it as: what’s the purpose, right? They’re coming in just asking for an injection kind of willy-nilly. Why? Because you hurt. I say, well, let’s get granular. Let’s say, what is the purpose right here, right? So if it’s — I hurt too bad, I can’t do my rehab, I can’t function — okay, I think that’s a good reason. Another one is like, hey, I have this event

[9:16] in X number of weeks, whatever, and I want to be really functional for that. I have this game or I have this competition, whatever, right? And so once you look at it through that lens, then it kind of makes sense, and you kind of tailor the different types of injections for the purpose that the patient’s trying to achieve. Right? And so again, this is just a part of what we do, but focusing on the musculoskeletal side of

[9:46] non-surgical medicine — it’s a big part of what we do. Kathy: Yeah. That’s usually how I’ll try to sell it to the patient, too. Like, should I get it? Jason: Yeah. Kathy: And I say, “Well, you’re probably going to be able to do your home exercises better.” Jason: Right. Right. Kathy: Right. That’s usually like, “Oh, really?” Yeah. Jason: Yeah. But you still have to do your exercises. Kathy: Exactly. I’m usually trying to tell them to hold out for the surgery. Jason: No, let’s see. Let’s cut that knee out. Yeah. I mean, the knee’s the problem. Let’s just cut it out. Give me a robot. Kathy: Let’s just wait for it, right?

[10:16] Jason: Get the model with Bluetooth, right? And the hotspot. Yeah. Kathy: Yeah. And so, well, should we go over the different types of injections? Jason: Let’s start with cortisone. Okay. And so, cortisone has probably been around the longest and is still the most frequently used.

[10:47] And so when you look at cortisone, right, it is the strongest anti-inflammatory that we have. Kathy: Mm-hmm. Jason: So it’s delivering a steroid, or a strong anti-inflammatory, locally to the area of pathology. Kathy: Right. So that’s the benefit. Jason: So I tell people: if you have an inflammatory condition that would benefit from taking that anti-inflammatory locally right there, I think a cortisone injection is not a bad

[11:18] place to start. Kathy: Okay. It’s one of the fastest things that acts, right? So we usually mix it with either a local anesthetic or some saline, right? Jason: I like to mix mine with honey butter. Kathy: Yeah, how’s that going? Jason: Delicious. Kathy: So you get a numbing effect from the anesthetic, and then cortisone — in terms of onset of action, sometimes it’s almost immediate. Sometimes it takes a couple of weeks to

[11:49] really kick in. Jason: Where does cortisone come from? Kathy: Well, it’s synthetically made, but — if you guys remember, the whole inflammatory cascade, right? And so it is a synthetic hormone that blocks the inflammatory cascade fairly high up. Jason: It’s like synthetic cortisol, right? Kathy: Exactly. Straight from the — what? The adrenal glands. Jason: Oh gosh. Yeah. Right. Let’s go through the whole HPA axis right now.

[12:21] Kathy: Impressive. And so it’s strong, right? The benefits: it’s fairly quick-acting on average. You know, different studies will say different things, but I generally tell patients — I look at it as a bell curve, right? Most patients, if you look at the peak, or the middle of the bell curve, is that they’re getting about 2 to 3 months of relief. Jason: Yeah. Right.

[12:51] Kathy: On the ends, on the tail ends, outside of the standard deviation, right? You get months to years, you know, or months to years, and then weeks to months on the shorter end. Jason: And that’s because some people just need to break that inflammatory cycle, and once they do, they’re just going to complete that healing process. Kathy: But to your — to your really salient statement, Lynch — it’s the big thing is that I tell people: you utilize this time that you feel good.

[13:21] Jason: Yeah, to do your rehab, Kathy: to do your exercises, to be active, to achieve what you want to do. Don’t say, “Oh, I feel good now,” and kind of put that to the wayside. Jason: Right. Yes. Kathy: Oh, he fixed it. He fixed it. Jason: Fixed. Kathy: Yeah. That man with his needles, he did it. Yeah. So the negative part is that — and this is mainly Jason: in vitro and animal-based research Kathy: — that it can be

[13:51] chondrotoxic. Jason: Okay. Kathy: Right. So wearing down of the cartilage, Jason: and then wearing down of the tendon if you’re injecting into a tendon. Kathy: Dang it. I knew it. No free lunch in life. Of course. Jason: And so you have to weigh the risks and benefits of each of those, right? And so once again, it’s no free lunch. Kathy: Right. Well, and I thank you for sharing that. I think that’s really good. It’s important for people to hear because sometimes people come in and they’re like, “My doctor wants to give me a

[14:21] cortisone shot and I don’t want that poison in my body.” And I’m like, “Well, bad news, bad news.” Right? And then also, you know, especially in the world of like menopause, people are like cortisol is the enemy, and it’s like it’s a very important hormone. And I think that it’s kind of the case with — well, I’m looking at all these and it’s really Jason: redirecting mechanisms that already exist in our body and deploying them at a specific problem, which is

[14:52] kind of cool. Um, so yeah. I slipped one in there that maybe isn’t in that category, but like the gel injections. Can you talk about that? Kathy: Because that’s — I think I’m seeing that more and more with patients who are like, “Yeah, they shot some gel in my knee.” And they’re like, “What’s the gel?” And I’m like, Jason: “So, how’s your dog?” Kathy: Because yeah, honestly, this is probably the one that I know the least about, but it’s really fascinating. So break it

[15:22] down for us. Jason: So, it’s not hair gel, number one. Just get that clear, off the bat. Kathy: I can’t move. I can’t move my knee. It’s because you got hair gel in there. Yeah. It’s got amazing hold. Jason: Yeah. But it’s got so much body Kathy: and sheen. Jason: Um, so gel is what we like to call it because it’s easy to remember, right? But it is hyaluronic acid — the other term that you’ll hear thrown around is viscosupplementation, right?

[15:54] Kathy: I like that. Jason: But hyaluronic acid is the protein, and it’s a protein that is found Kathy: in the synovial fluid, or the fluid inside your joints. Okay. Jason: So it’s already there — so we are taking stuff from the body again — but this is also synthetically made as well, right? Kathy: And so the idea — Jason: so poison — but no, no. Um, so the idea is that it is a protein that is found within the

[16:24] synovial fluid around your knee to help lubricate Kathy: the joint. Jason: Mm-hmm. And that’s where we think the benefit comes from — the lubrication. Okay. And studies — you know, we thought when it first came out it was going to be the holy grail, right? Oh my gosh, this is going to be like anything else Kathy: that comes through the scientific process, right? Everyone’s excited about it, and then Jason: like no honey butter required. Kathy: Yeah. And then but we found that

[16:54] the efficacy in it isn’t probably as great as what we thought we were going to see. So it is beneficial in the fact that it probably gives you a little bit longer relief than corticosteroids or cortisone shots. It takes a little bit longer to kick in, Kathy: okay? A couple, two to three weeks to kind of kick in. Jason: But it doesn’t have the negative effect of breaking down your cartilage or your tendon or the structures around a joint.

[17:25] Kathy: Cool. So you’re kind of limited on the number of cortisone shots that you might get in a joint. Jason: Yes. Yes. Kathy: But I can do gel for days. Jason: Yeah, if you wanted to. But so the typical thing we say is — this is sort of dogma — but in a weight-bearing joint like your knee or your hip or something like that, we want to limit cortisone to three to four times a year. Now, that’s quite a bit. And that was something that we Kathy: kind of said way back in the day. I’ve become a lot more conservative

[17:55] with it, because of the effects that we’re finding, right? But the gel injections don’t have that effect. And so really what it comes down to is, unfortunately, like Jason: other things in American medicine, is insurance, right? Kathy: So yeah. Jason: We never talk about insurance on this show. Kathy: Right. So right now the coverage — Jason: or even FDA approval — and insurance only

[18:27] cover the gel injection for your knees. Kathy: It’s not covered for your hips, your ankles, or anything like that. And that’s partly because the data isn’t as Jason: strong for those joints. And so right now it’s just for knees, and Kathy: the vast majority of insurances are allowing it once every six months Jason: as the most frequent, Kathy: which probably is pretty good, right? Because I think I see people get

[18:57] about that much mileage out of it. Jason: Yeah. Yeah. And so we always got to take that into account too. Kathy: So asking for a friend though — like if I wanted gel injections in my ankle, could I get gel injections in the ankle, and how much would it run me? Jason: Good question. Kathy: I mean, you don’t have to speak for Samaritan Athletic Medicine, but give me a ballpark. Like is somebody looking at thousands or hundreds? Jason: Yeah, that’s probably — you know, if you’re talking about buying it from the distributor and

[19:28] Jason: Oh, man. And and Kathy: I get mine behind Dairy Mart. Jason: There’s a guy, there’s a guy. Kathy: Wait, is that lactose or lactose-free? Jason: Yeah. Kathy: My contact, his name is Bandit. Yeah. So, Jason: no. And that’s that’s the challenge that we have. And so, you know, in some of my colleagues from other countries, you know, they they’re saying, “Hey, it’s so much cheaper,” let’s say in Canada or Kathy: something, you get the spicy injections right?

[19:58] Jason: So it is, it’s it’s one of those things — the unfortunate part of our system, right, is is the cost. Kathy: Yeah, it’s funny, I I’ve always thought about that because usually in my practice I usually see the gel in the knees, and I didn’t realize it’s of course this insurance Jason: but also so we don’t have a lot of data on like shoulders. I’ve seen some pretty old children that Kathy: could they think it would benefit, right? But but you know, I’d say that the data there, the the just the data is not strong.

[20:28] Glenohumeral joints and shoulders and ankles, you know, it’s just — and then again, right, it was something that we thought the data initially was was pretty strong for for the knee, but then as more comes out it’s like, “Oh man, is it is it as beneficial as we thought it was?” Okay, Kathy: maybe placebo. Jason: Yeah, Kathy: we should do an episode on that. Jason: Oh, wait. It’s one of our most popular episodes ever, Kathy. So, but I will say though that there are some of these

[20:59] injection therapies where, you know, there is a significant placebo effect, ‘cause this is an easy one to do placebo with — like, I can stick you with a needle and in a test situation you don’t have to know what’s necessarily in there. So there is a bit of placebo effect that’s associated with any of these. Kathy: Oh, absolutely. And like with any therapy — I mean, I’ve seen cortisone is a very powerful steroid, very powerful anti-inflammatory. Jason: I noticed that people who have the worst

[21:29] attitude Kathy: about having to go get a cortisone injection, they tend to be the ones who have the worst outcomes with it. So, Jason: I think that goes along with a lot of medicine, right? It’s it’s the — it’s sort of the — what was — we always call it the pretest probability, right, coming into it. If if patients are like, “Hey, I I I don’t want this,” or, you know — well, plus we we don’t force anybody to get it, right? But if they’re like, “Oh, this is this is—” right.

[22:00] They’re like, “This is not going to work, whatever.” Then chances are — I mean, it probably won’t, right? But so much of it — because you were measuring Kathy: a subjective outcome, right? We’re measuring it by how much pain relief have you gotten. Jason: Well, that’s a subjective measure. Yeah. So, Kathy: totally. Totally. Part of cortisone too — like if it doesn’t work, it’s kind of diagnostic for you too, right? Jason: It can be, and so I actually think that the anesthetic is probably more so, right? Because it’s so quick,

[22:30] Jason: but so I tell people this a lot of times. I said, “Hey, listen, like this injection is both diagnostic and therapeutic. Kathy: We could just do the anesthetic, right? But then if it comes in and gives you longer relief, right? So since we’re there, like Jason: just do it. Kathy: Do — which one would you rather, you know, which one do you want to try, you know?” So, Jason: well, and and it limits the risk, too,

[23:02] because I mean, the only thing safer than two injections is one injection. Kathy: Yeah. Jason: Good point. And and again, just like I said with placebo is in everything, you know, there’s risk in everything too. So it’s not like — injections tend to be very safe, right? Very good safety record, but you know, there’s there’s always like weird things that can happen. So yeah, you want minimum intervention for maximum effect. Kathy: There you go. Jason: Well put. Um okay, so I think my favorite on the

[23:32] list is probably PRP. Kathy: The platelet-rich plasma. And I say it’s my favorite because it’s one that’s made a big impact for me. Jason: Yeah, Kathy: guys, I’m a survivor of PRP. I am. Tell us more. Yeah. Um, Scott, is there like violin music that we can cue? No, we don’t have that. Okay. Yeah, we didn’t buy that package here. Um, Jason: did you tear a hamstring? Kathy: No. No, no, no, no. Okay. Here’s — now, here’s the story. So, Corvallis, Oregon is a very bike-friendly place. And so, at one point in my practice when I was

[24:03] like, “You know what? My life is just so uncomplicated, I’m gonna start adding a level of difficulty and I’m gonna start biking to work every day,” right? And so I was biking back and forth and then one day I biked home for lunch and then I was biking back to the clinic Jason: and I see dangling from my handlebars a spider — like a big fat spider — and I decide in that moment one of us is going to have to die, right? And it wasn’t

[24:33] going to be me. So I’m doing combat with this spider. I finally kill it. By the time I look up, the curb is like Jason: 3 feet away from me. And so I’m like, “If I hit this curb, I won’t be able to practice.” And so I decided I’m going to bail. There’s a nice like soft embankment of grass. So I bailed, aimed for that, landed on it on my shoulder, sprained my AC joint, Kathy: okay? Which is maybe one of the worst joints that you can sprain if your job is to push into other people’s spines

[25:04] all day long. Jason: Yeah. So I had a pretty good AC joint sprain Kathy: and um and yeah, it didn’t feel great at all. It was horrible. And um but it didn’t need surgery. What it needed was rest. You know, you just got to let that joint heal up. But I couldn’t do that. You know, I was hustling — I own a business, that business requires me to be in it working. And so I was just going through, banging my AC joint all day and suffering. So

[25:35] Kathy: I had a really good friend who she does a lot of injection therapy up in Portland and she was like, “You know what? Come on up. I’ll get it taken care of.” So she did some PRP injections into my shoulder. Jason: She said, “You know, here’s the injections. Now you need to take about two weeks to really let this set up.” And so I was like, “Cool. Thanks.” And I went back to work the next day. So Kathy: Jason: But Kathy: Mandy said, “Get back.” Jason: Yeah. Yeah. Despite the fact — despite the fact that I’m a horrible patient, it really was effective for me. And so,

[26:06] Kathy: Can you tell me why? Jason: Can you tell me what she did to me? And can you tell me like why that was — why that was useful? Kathy: Absolutely. So, Jason: that’s — that’s awesome, by the way, that experience. And yeah, it’s probably not advised to start working, you know, less than 24 hours afterwards, but so PRP stands for platelet-rich plasma, right? And so what the — the idea is isolating the platelets

[26:38] that — and we’re beginning to understand more and more, right? And for the listeners, platelets are just very small plates Kathy: that are in our body. Right. Right. Jason: Yeah. So, what’s a platelet? Kathy: A platelet is a — it is one of the cells in your blood that is primarily — its function is to help clot and stop bleeding. Sticky. They’re sticky. Exactly. Jason: But one of the other really awesome things about them is that it is a great

[27:10] recruiter. So, it releases a lot of these little molecules Kathy: that recruit all these different types of cells that come here and help with inflammation, help with healing. Okay. Jason: So, the football team could use some platelets. Kathy: Yeah, they — Jason: Yeah, they have a lot of NIL money. So, no. So, yeah. Wow. So the thing is that it

[27:41] — it’s, you know, at first the big — like I was talking about — the big excitement before was that, okay, this is going to help regenerate, and this is in this umbrella of what we call — what we call regenerative medicine. But really, one big take-home point is that I want our listeners to know that PRP and other things — we’ll talk about stem cells later. Right. Right now, the data

[28:12] is not — I mean, the science isn’t there that we’re actually regenerating tissue. Kathy: Mm-hm. Jason: Okay. So, this is what we call — there’s a term a lot of us use — this is symptom-modifying. So, it’s improving symptoms Kathy: and — sorry — function-modifying. Jason: So, pain and function modifying, but not structurally modifying. So, you’re not — am I saying this right? You’re not making a joint or a tendon become 18 years old again. Right. Right. Right. So, you’re

[28:43] not regenerating things. So, Kathy: it’s like a guided healing process. Jason: It is. It is. And I’m also careful about the term “healing” because people hear “healing,” they say, “Okay, well, you’re regenerating.” No, it is Kathy: a guided curing process. Jason: Yeah. It’s changing the environment Kathy: around that tissue Jason: to facilitate — to change the environment so that it is less

[29:14] painful and more functional. Let’s just say that. Okay. So the process is: you take your blood — usually it’s just from your elbow or somewhere, a vein that’s easily accessible. You take whole blood out. Kathy: Okay. Jason: You then put it in a centrifuge — a machine that spins — and you separate the platelets. So you really want to get a concentration of the platelets itself. Okay? And then with that

[29:44] separated platelets, you inject that into the area that is giving you issues, right? Or where you have disease there. Okay? And again, I think the big thing that people need to know is that it then recruits all these other cells that help with the healing process. And another term that we use a lot of times — because a lot of people do this for chronic issues, right? Kathy: Yeah, Jason: you’re trying to make a chronic

[30:17] process more acute, meaning that after a tendon — or let’s say a joint — has been chronically diseased, right? The milieu — or the environment there — is not conducive to healing, right? So you want to kickstart sort of an acute process again. Kathy: Your body’s like me — Jason: yeah, Kathy: we’re done. Jason: I give up, right? Kathy: Shut up. We’re done with you. Yeah. Jason: And so that’s the whole idea from a

[30:47] 30,000-foot view. Kathy: Yeah. That’s helpful. Jason: Yeah. What conditions do you think — oh, this is going to be — PRP is going to be perfect for this? Jason: Yeah. So if you want to look at sort of the science and how it evolved, right? I think one of the places that it started is looking at tennis elbow. Kathy: Okay. Yeah. So lateral epicondylitis — for others that know — that’s the — that’s Jason: how you say it. Kathy: Yeah. Mm-hm. And so but you know, even that’s —

[31:18] lateral epicondylosis, because there’s very little inflammation there, right? Kathy: Yeah. Jason: So anyway, tennis elbow is the common term. And it’s been well studied for that, right? And then initially the data came out, it’s like, oh my gosh, PRP is very effective for this, right? Kathy: This is it. Jason: Right? And as more data has come out, it’s a little bit more tempered, but it’s still seen as a good option, especially compared to — let’s say — cortisone injections, right? Okay. Um,

[31:48] other places I think it’s really helpful — there’s been a lot of data on knee arthritis. Kathy: Really? Jason: Yeah. Yeah. Specifically, knee mild-to-moderate osteoarthritis. Okay. So the data has been fairly — it’s been robust. So a lot of studies out there, and it’s been pretty effective. Okay. Especially looking at it head-to-head with cortisone. Right. It’s not as — it doesn’t Kathy: — it doesn’t kick in as fast as cortisone. Jason: Like I said before, cortisone is one of the fastest we have.

[32:18] But you look at 6 months, 12 months, 2 years, Kathy: PRP generally outperforms Jason: corticosteroids. Kathy: Nice. Jason: Yeah. I’m not saying that it’ll last that long, Kathy: but looking at it head-to-head in this — Jason: and I would add anecdotally — it is great for AC joints injured by spider death, right? Yeah. How fun was it going in though? Kathy: Darn near here. What? Oh, the —

[32:48] injections. Okay. Yeah, I will say PRP injections do not feel great. No, they the best part of it was the blood draw. That was fairly painless. But yeah, the injections — well, and a lot of these therapies, like prolotherapy, we’ll just kind of skip over that. But, you know, it’s like one of the values of prolotherapy where you’re injecting like sugar water. Sugar. Yeah. So I guess we’re getting into it now. But one part of the value is that you’re

[33:19] creating some irritation and inflammation. You’re causing a healing crisis. That’s the word that they love to use with us in chiropractic. Oh, I’m causing a healing crisis. It’s great. But our body has a mechanism for healing and it basically consists of drawing attention to something, and you see that with an acute injury. You also see that with a virus, right? Because your body’s response to a virus is, I’m going to mark

[33:50] this and draw attention to it. And then the rest of these functions, they just go and they attack it. And I think that bodies are really pretty amazing because there’s lots of little ways that you can kind of tweak this principle that ends up working in a person’s favor, right? So yeah, really neat. So going back to your AC joint, right? The hard part there is like — you know, is that

[34:20] Kathy: because of that system that you’re talking about — our bodies being amazing and taking care of it — the question, you know, we always like, again, like I said about injections, say, hey, what’s the purpose, right? Yeah. Is it — you know, are we trying to get Dr. Young back to work faster, or by doing the PRP is it going to help with the healing process so that you’ll get a better, more complete outcome, let’s say, a more stable joint.

Jason: Yeah. And that part has been — it’s been difficult to kind of say, okay, well PRP speeds up, you know,

[34:52] whatever disease process we’re talking about, especially if it’s acute, as opposed to just letting the body do what it naturally does. And so that’s that’s one that has been a tough one to outperform, right? But we do it frequently for that reason too.

Kathy: And I think a lot of these things go that way because you start with your initial studies and they tend to be smaller studies, and then that treatment gets deployed and then you get much more data just by

[35:23] seeing how it exists in the real world. So, and I think that, you know, with evidence-based medicine, it doesn’t mean that just because something has moderate evidence that it can’t be effective for an individual, right? Or just because something has pretty strong evidence that it is definitely the answer for —

Jason: Exactly.

Kathy: Yeah. It’s an N equals one, right? Everybody is their own study. So, all right. What about stem cells? What

[35:54] can you tell us about that?

Jason: So stem cells is also an umbrella term, right? And we’ll hear stem cells and they — and once again they think about regeneration of tissue. And what we have found — again, the science isn’t there yet, right? So let me just — first of all, what is a stem cell? So the whole idea of stem cells, right, is taking a cell that is

[36:25] not quite differentiated, meaning it hasn’t been destined to become a certain cell type yet, with the thought of injecting it into a certain location and then making it become that type of tendon or cartilage cell, right? And we have found that — at least where the science is right now — that is not what’s happening. Got

[36:56] — right — we are finding that these stem cells — and you know I don’t like calling them that because it has that connotation — these cells are having a similar effect as the PRP, in that these cells have the ability to recruit other cells to help with changing the environment and with helping with the healing process of that location. And so, you know, you hear a lot about the marketing about,

[37:26] okay, you know, you get these stem cell injections and, oh my gosh, you’re going to be back and you’re going to be flying and whatever, you know, and so we have to be careful. Yeah. And so we have to be really careful about that, right? I think that’s one thing — that’s probably another take-home point — is really looking closely at what people are saying the objective is of what they’re injecting.

[37:57] Kathy: Yeah.

Jason: There are a lot of different types, right? They can get it from your fat cells. They can get it from —

Kathy: I have a good supply of stem cells actually. So if anybody’s interested in stem cells, just hit me up after the show. Okay. Anyway,

Jason: so then — and umbilical cord, and so — I just caution our audience to be a little wary and be really critical, and just ask the questions about where you’re getting this from and what you’re saying is the expected outcome.

[38:27] Kathy: Yes. Yeah. Gotcha. Yeah. Because like, could you use stem cells to grow an extra arm? Because I could use an extra arm sometimes.

Jason: Yeah.

Kathy: Like if you just get enough of them close enough to an arm, it’ll be like, look at that arm. Yeah. Let’s do that.

Jason: Why stop at a third?

Kathy: Yeah. Right. I know. Well, I just want

[38:58] to try out a third one, see if it’s useful, then you know, go from there. Yeah. It’s kind of like that movie Multiplicity, right? Such a great movie — who was that with? Batman. Michael Keaton. Yeah. Uh-huh. Hey, Steve. So it looks like he’s already busting some myths for us. Yeah. Should we — PRP and stem cells? Are you ready?

Kathy: Yeah, we could do — go do that and then I’m going to find the game.

Jason: Come back. I’m going to find the game. Yeah.

[39:28] Kathy: You already kind of talked about PRP — stem cells or regrowing cartilage. That’s not —

Jason: That’s a myth.

Kathy: False.

Jason: False. We talked a little bit about cortisone destroying joints. That’s not 100% true. I think “destroy” is a pretty strong term there. Is it healthy for the joint? I think —

Kathy: No, right?

Jason: It is — that’s why you want to limit the number

[39:59] of injections into a joint —

Kathy: But it can definitely be useful.

Jason: Yeah, it can. Yes. Yes. Definitely. Right. And so — “destroy” is a strong, strong term.

Kathy: It’s not great for the joint. It’s not healthy for the joint. And is it useful? Yes, it can be — in the right context. And just be mindful of how many times you’re doing it.

Jason: Right. Right.

Kathy: Let’s see.

Jason: But of course, cortisone’s always

[40:29] approved by insurance, isn’t it?

Kathy: For the most part.

Jason: Yeah. It depends where you’re injecting, but —

Kathy: Well, and I think it goes back to the very first thing that you said about cortisone, which is that it’s been used for a very long time. So there’s a lot of data out there, and the cost of producing cortisone — you know, it’s not a super expensive process. And so I think that probably explains that.

Jason: And we’ve only talked about the injectable type. There are, you know, oral types that treat a

[41:01] myriad of conditions, and it’s extremely powerful. It really is. And so I think I’d be doing a disservice to say, “Oh gosh, this is terrible.” No, that is not the case.

Kathy: So what’s your favorite flavor of cortisone? It’s watermelon, right? It’s watermelon.

Jason: Depends on the season. Yeah.

Kathy: Well, I want to ask this next one for you, Kathy. You should try injections before physical therapy.

[41:31] Jason: Definitely —

Kathy: I would say myth. Well, so again, if we are making a conscious effort of understanding what we’re doing and why we’re doing it, I don’t think there’s a wrong answer out there, but — right, for the right situation. So if you want to talk about a blanket statement — “you should try injections before physical therapy” — I don’t do that. I generally like to start with

[42:01] therapy, or even, you know, chiropractic and other modalities first. With that said, if you’re in so much pain that other modalities are going to be ineffective for you, then let’s try this so that you can get into and do your rehab.

Jason: Well, and I think it’s a good selection process for who that’s going to be good for. For a couple of reasons — number one, I don’t think it’s just because exercise is what physical therapists do or adjustments is what chiropractors do. The thing is, if you can find something that you know is low risk — especially with exercise that’s self-directed and so empowering —

[42:32] that’s huge, because it’s not just helping you through this problem, it’s giving you tools for how to live your life. And then if you can’t get it done that way, I think those are the people that are going to tend to have a better outcome with an injection,

Kathy: Right.

Jason: And that’s because of all the reasons — what the science says, the placebo, the “I have confidence that I’ve done everything that I can for myself and this is the next step.”

Kathy: And I think all those things go into it. So

[43:03] I want to say too — the whole stem cell thing, you know, it’s a hot-button topic right now. I don’t want to say that — yes, I said that

[43:34] the data is still emerging. I think that it is sort of the future, and when we find that — I think it’s going to take off, and it actually already has, and there are some applications for it right now. I don’t do a ton of it, but I’ve seen some benefit. And so I

Jason: I guess I want to be fair to —

Kathy: Yeah, you busted the myth. The next one

[44:04] we were asked, which is “stem cells are useless” — but stem cells and PRP are not always covered by insurance either, right?

Jason: It is not. Well, when I got PRP — I heard that, and gosh, I’ve got to look back at it again, but I think one insurer might be starting to cover it. But for the most part, it is not covered — it’s out of pocket, which is really unfortunate.

[44:35] Usually my compass for knowing if something actually works or not is: does insurance cover it? Oh, it does. It doesn’t. Oh, okay. Then that’s useful. You should get that.

Kathy: Definitely.

Jason: They are behind quite a bit.

Kathy: I’m just going to make a statement — what I just said is not true. Okay. Insurance covers —

Jason: For entertainment purposes, by the way. Yeah. Disclaimer. We’re so bad about that. Yeah. Nothing that we’re saying here is true. Go talk to your doctor. No. No — the thing is, we’re talking about real stuff, but definitely

[45:06] we’re not your doctors. Well, some of us aren’t your doctors. And so, yeah.

Jason: But I do think it’s time for a game.

Kathy: Okay.

Jason: Now, we’re going to call this Vu Sports Trivia. The reason that we’re calling it Vu Sports Trivia is I just think your name’s fantastic to say. I love it. I love it. So, yeah. Congrats and thank you to Mom and Dad Vu.

Guest: I’ll make sure to tell them.

Jason: Yeah. So, because you work in the arena of sports medicine,

[45:36] it’s just going to be sports trivia. You’ve talked to us a lot about medicine. We appreciate that. So let’s do some sports.

Guest: Okay. All right. All right.

Jason: Very simple. I’m going to give you a question. You just give me the answer. Okay.

Guest: All right.

Jason: So what sport, originally called Mintonette, was invented in 1895 — which I will say is also the same year that chiropractic was invented.

Guest: Oh, 1895. Mintonette.

Jason: Mintonette. I’ll give you a clue. The net

[46:07] is kind of a clue. Jason: Yes. Pickleball. Kathy: Pickleball. Jason: Pickleball. Kathy: Um, okay. Jason: And I’ll tell you, it was created as a lower impact alternative to basketball. Kathy: So, it was a joint friendly sport Jason: to basketball. Okay. Okay. Kathy: Gosh. Lower, lower impact than basketball. Jason: Mhm. Oh,

[46:37] okay. Gosh, you’re getting pickled. Okay. Jason: I’ll give you a clue. And I came up with this one. I was also thinking of doing sports trivia that all — and calling it V-U sports trivia because all the answers started with V. Kathy: Was it volleyball? Jason: It is volleyball. Very good. Okay. Yeah, that’s the only one that starts with V. That’s why we didn’t go with that. Okay. Next question. What animal is the official mascot of the Olympics? Kathy: I didn’t know they had — I didn’t either. Jason: That is correct. There isn’t one.

[47:08] Jason: Yeah. So, each host city gets to pick its own mascot. So, Kathy: I didn’t even know there was a mascot in — Jason: Yeah. So, like in the 80s, the Russians had a bear named Misha, right? Kathy: Thought it was Flavor Flav. Jason: Yeah. Kathy: Yeah. You know, in the last one, it was a dog. I think it was Snoop Dogg, right? Yeah. So, Jason: Oh god. Yeah. He was — he was there a lot, Kathy: dude. He was — He’s great on the Olympics. Oh my gosh. Yes. I’ll sign up for that. Jason: All right. In golf, what is the term for

[47:38] scoring three under par in a single hole? Kathy: Oh, I know. Okay. Jason: Is it albatross? Kathy: Yes. Killed it. Yes. Yeah. I get lots of albatrosses, so I get that one. Yeah. Um, Tiger Woods golf. Um, so which sport includes the terms axel, lutz, and salchow? Kathy: Figure skating. Jason: Yes. Very good. All right, you know your sports. And if you don’t get this

[48:10] next one correctly, I don’t know if you are a true Beaver. In what sport might you perform the Fosbury Flop? Kathy: The Fosbury Flop. Jason: The Fosbury Flop. Kathy: Oh no. Oh no. Jason: Oh. Oh. Um, it is — Kathy: Yeah. Um, diving. Jason: Ooh. Well, it’s kind of a similar motion, but Kathy: it’s named after Dick Fosbury, Jason: who was an Oregon State Beaver, and it

[48:41] was — it is the high jump. Kathy: It’s the high jump. Jason: Yes. The Fosbury Flop is the backwards jump over the bar. So, before that, everybody was like doing kind of a scissor kick. Yeah. Kind of rolling. Scissor kick. Right. Kathy: Yes. But Dick Fosbury made it popular because he was breaking records by going with the extension through the lumbar spine, to what we know now, right? All the techniques. Jason: Everybody’s doing the Fosbury. Kathy: There’s a statue in front of — Jason: There is. There is. Kathy: Yeah. I did not know that. Wow. Jason: Yeah. And he just passed away, I think,

[49:12] like a year or two ago. Yeah. But awesome guy. Great ambassador for Beaver Sports. Kathy: Wow. Jason: All right. Here’s an easy one, I think. Which athlete famously said, “Float like a butterfly, sting like a bee?” Kathy: Muhammad Ali. Jason: All right. Very good. What is the only major sport that has been played on the moon? Kathy: Golf. Jason: It is. All right. Very good. Yeah. Alan Shepard made his own like six-iron out of some equipment. Yeah. Kathy: Um, which piece of equipment was originally made from a pig’s bladder?

[49:46] Jason: The football. Kathy: Very good. That’s why we call it the pigskin. Very good. Jason: And I think that you’ll get this one just because I read some of your hobbies. Which two sports are combined in the Olympic event called biathlon? Kathy: Oh, um, it’s cross-country skiing and then shooting, right? I mean, Jason: Very good. Yes. Uh-huh. Because you are a skier. Yes. Kathy: Yeah. Yeah. Jason: All right. Very good. All right. Well, man, he killed it. Kathy: He did. Jason: Yeah. I was writing this stuff up and I was like,

[50:16] those are hard questions. Kathy: Those are hard questions. Jason: No, this — you prove that this is V-U sports, right? It’s a whole category of sports trivia now. Kathy: No. Well, hey, I really appreciate you being here. This is — I think this is a real treat. Jason: Yeah, there’s — I mean, most of the time we’re talking about this stuff, it’s just stuff I already knew. We’re so — me and Kathy are so freaking smart. So freaking smart. But this was like — I’m going to count this as continuing education. No doubt. Kathy: Submit it.

[50:46] Jason: See what they say. Kathy: Yeah, exactly. There we go. This — this was really informative. You gave us some stuff that I’m definitely talking with patients about tomorrow. Because — we have to go to work tomorrow. Jason: Um, but yes, if anybody is interested in getting in touch with you or anything like that, like how do people locally get in touch with you, or how do they get in at Samaritan Athletic Medicine? Kathy: Usually — I mean, like you — we’re on the

[51:17] Samaritan website. I’m on there, too. And so, happy to see anybody that wants to talk about any of the stuff that we talked about, or anything else, right? And so, that’s probably the easiest way, and I can share my contact info with you, too. And so, Jason: awesome. Yeah, the man’s got a lot of needles and they’re all full of good stuff. So, Kathy: full of the good stuff. Jason: Yes. Kathy, take-homes. Kathy: Take-homes. Yeah. Um, I was going to ask the question why I don’t see the viscosupplementation in other joints.

[51:47] And you kind of answered that. So now I know, because Jason: there’s definitely some shoulders that I see are just Kathy: so much in there and just super painful, and I think, gosh, there’s got to be something other than cortisone. Jason: Exactly. Kathy: But right now, no. Jason: Yeah. I’m not covering it. Kathy: And I learned something about cortisone shots, actually. I was misinformed, or maybe misremembered, but I thought that people shouldn’t get over three — period — but you said it was more than three in a year, which, you know, I

[52:18] think that’s good, useful information, because I’ve been lying to people apparently. It’s not a lie if I just didn’t know, right? No. But yeah, this is awesome. I think it’s one of our best episodes yet. Um, yeah. When we get that platinum YouTube plaque, I’m going to have to have you come sign it. Okay. Jason: Could talk about this for hours. Kathy: Yeah, totally. Yeah, we might have to have you back. Jason: Oh, happy — happy to come back. I appreciate the invite, guys. Kathy: Yeah. Um, and, speaking of our platinum YouTube plaque, make sure to

[52:48] Like and subscribe. We love your comments. We’d love a great review on Spotify. We want you to share this with all of your friends who are hobbling and limping around, or who have questions about this, because it’s a really useful thing to know about. There are people whose quality of life sucks right now because they’re afraid of this thing just because they don’t know about it, right? And so there’s people who have decided that I’m not going to play with my kids anymore. I have to

[53:19] quit my job. I’m going to give up my sport. No more pickleball for me. And it’s because they don’t understand some of these options that are out there. And so hopefully this is going to make somebody’s life better by hearing about it. So thank you very much.

Kathy: Thank you very much.

Jason: Yes. And I think that there’s one really important thing that we cover every single week though. Maybe the most important point that we can make is that there’s no “I” in PTCH.