Dr. Roddy McGee and Joe Rogan explore regenerative medicine, where placental tissue—donated by screened C-section mothers via AATB—avoids surgery for injuries like Rogan’s shoulder. Bush-era stem cell debates targeted embryonic cells, not placenta-derived mesenchymal ones, which repair cartilage but lack FDA-validated clinics. PRP (e.g., Regenikine, used by Manning and Bryant) shows promise over steroids, though trials remain pending. McGee warns against rushed returns post-treatment, citing ligament risks in sprains or dislocations, while advocating diet (collagen, anti-inflammatory foods) and tailored rehab to bypass scar tissue. The shift from thermal capsulography’s failures to safer Zahiri techniques highlights evolving, but still experimental, approaches—suggesting biologic therapies could redefine recovery if rigorously proven. [Automatically generated summary]
For folks who have heard me rant and rave about the fantastic results that I have had getting treatment on my shoulder where I was that close to getting surgery, it's this gentleman, Dr. McGee, who has fixed me up out of Las Vegas, Nevada.
Well, I just want to tell you that I feel super fortunate to have met you and to have been treated by you and to be able to have these conversations with you in your office, which is why I wanted to have you here to talk to you because, I mean, I was having some really significant shoulder issues before you treated it and it's amazing the results and what, you know, I mean, what I've avoided, avoided in shoulder surgery.
Yeah, I mean you've had a tremendous result so obviously we're very thankful that you're able to get that benefit and I think we're in my community of orthopedic surgery and sports medicine you know we're very excited about the possibility and eager to continue to learn about it and see what it can be and how it can help and what it does best for what.
Well, a lot of the stuff that we're using is not new in terms of the tissue or that type of thing, but it's actually the application for orthopedic sports medicine.
So you could go back decades to when it's been used in plastic surgery for corneal ulcers is one of the original applications of placental tissue.
So the idea of it isn't necessarily new.
It's just that as we've gained more understanding in our community of orthopedic surgery, now we're starting to see what the applications can be.
You said a couple of different important things there, so let's start breaking that down a little bit.
So the first thing is...
Where does it come from?
It comes from a young, healthy mother.
In this case, what we're talking about, this particular category of biologic treatment or cellular tissue.
This comes from a young, healthy mother that's having an elective C-section and prior to the delivery has agreed to make a charitable donation.
And then they have been screened.
And there's a process that must be followed by the American Association of Tissue Banks.
And they have a series of blood tests that they have to go through.
And so you're checking to be sure that there's no communicable disease, for example, hepatitis or HIV, things of that nature.
And so once that has been cleared and they're an acceptable donor, then they go through the delivery, the tissues collected, and as you said, this is stuff that typically would go in the garbage.
So essentially the ethical and the moral dilemma shouldn't exist for that portion of it because otherwise it's just garbage.
Now, that's taken by the company that has harvested And they have their processing center, which also has to be evaluated and approved by this AATB, American Association of Tissue Banks, to be a facility that is up to their standards.
So they have a sterilization process.
The tissue is not contaminated.
Their packaging is appropriate.
Their shipping is not causing problems with the tissue.
So you have to meet all these standards.
It's very stringent.
And so if you have that, if a company has that Approval, then, you know, they meet the standards allowed so that that stuff can then go either to an office or to a hospital.
So, now, the next thing of what you said...
Let's talk a little bit about President Bush and that whole discussion.
So first of all, that is about embryonic stem cells.
An embryonic stem cell, and that doesn't have anything to do with what we're doing.
An embryonic stem cell is when the sperm and the egg join and begin to form the beginning cells of life.
And there's initially two cells, and then it divides into four, eight, etc.
In the first five days of life, that's called a blastocyst.
And those cells can be harvested.
And they are what we call totipotent.
That means they can become anything.
They have the ability to transform into any line of tissue or organ.
Or, in the case of that first five days of life, those individual cells can actually become a complete organism.
So that's where we had the cloning of the sheep.
So that's what happened.
So they took the cells in that first couple of days, and then they had a process to allow it to continue to grow.
And so you had two different, from a single sperm and egg, you had two organisms, complete mammals, created.
So, now when they have like frozen embryos and people do things like that, when they decide they want to have kids later in life and they freeze their embryos, how the hell are they doing that?
My understanding of it would be that if you're, you know, you're freezing it with the intention of maintaining the cell viability, and so somebody has demonstrated that you could then thaw that cell and it still has the opportunity to divide, produce, and, you know, become a living thing.
Well, okay, so let's back up on that, because I think there's a lot of misconception about that, and I hear very strange comments made about it all the time in the media.
So, the thing that George Bush signed in 2001 stated that the federal government was not going to supply money for embryonic stem cell research.
That's it.
It was not a ban on The application?
On stem cell research.
So for all of that time, I mean, private equity companies and any private investor could have and probably has been spending the money to continue to research that and develop it and find it.
So I always find it interesting when I hear on TV, oh, like...
Our country has been set back a decade because they signed this bill.
So what is the difference in terms of the viability of placental stem cells that you would get from a woman in a cesarean section versus something that you would get from a blastocyst?
It's actually to our benefit in orthopedics not to be using that line of cells because those cells, starting from that time point, have the ability to have teratogenic potential.
So what that means is they can potentially form tumors.
So that makes it obviously a big disadvantage because now we're adding our risk to what we're doing.
Once they've gotten to the point where it's a part of the whole, you know, we call this like a human placental stem cell or mesenchymal stem cell.
And that includes the placenta, the umbilical cord, the Wharton's jelly is a mucus type substance that's around the arteries of the umbilical cord.
The amnion or the amniotic sac, which is the inner layer around the baby, and then the outer layer is called the chorion.
Now, all of that has cells in it that we would put in the category of mesenchymal stem cell or mesenchymal stem cell.
Now, what that means is they have a specific line of tissues that they can become.
So, now, back to when I was explaining the formation of the The blastocyst becomes a morula, becomes an embryo eventually.
So in that process, you have this ball of tissue, and then it starts to kind of fold in on itself, and then it starts to layer out into these three layers.
So you have endoderm, ectoderm, mesoderm.
Each of those kind of is directed towards a certain line of cells and tissues.
The mesoderm and what the mesenchymal stem cells can become are all of the things that we care about in orthopedics.
So cartilage, bone, muscle, ligament, tendon.
So we have that whole line of cells that this particular cell has the potential to become.
So when we talk about a stem cell, By definition, what it means is, one, it can divide and become another stem cell.
So it can duplicate itself so that now you have another cell that can divide and become another cell.
Or it can divide and differentiate into a cell that then has the characteristics of the things that you're hoping it will become.
Now that's a directed and ordered approach in embryology.
And in the case of treating an injury, what we're hoping is that that can differentiate into the injured tissue.
Well, studies on that have been going on for at least 10 years.
So I want to say maybe back as early as 2007. Now, we've been...
If you go way back to the early days of...
Arthroscopy, and that would be like the late 70s and early 1980s.
And I don't know exactly what year, you know, he would have started doing this, but Dr. Stedman in Vail, Colorado, and he was in Reno and Lake Tahoe area before that, they would...
He's the one that developed the microfracture procedure.
Well, the main difference in what's applicable is that it doesn't have the same structural properties.
So it was more easily able to kind of come off with a sheer force.
So just picture, like, your knee bending.
Yeah.
You could kind of flake off, or in some cases just didn't form as well as, you know, you would want.
Hmm.
So that experience, and having conversations with the guy that I trained with, his name is Larry Lemack in Birmingham, he noted just over his career that he always felt like patients that had worse arthritis, but they would do this microfracture procedure on in knee arthroscopy, actually would do better than patients with less arthritis, but that they didn't do the The procedure.
And so it had always been in his mind that somehow that marrow stimulation was providing something that was helping with either healing or pain relief.
And it's only now that we start to understand, you know, because the bone marrow has some of these mesenchymal stem cells available also.
And we'll kind of talk about the differences and stuff like that.
Well, in orthopedic sports medicine, I don't think I started to hear about it until around 2012. So that was the first year that I was in practice, and I attended a conference in Las Vegas, and it was called the Emerging Techniques in Orthopedics.
So they were kind of talking about what's the newest and most forward-thinking ideas that are coming through.
So a company presented and one of the physicians presented information showing that they had harvested fat tissue from patients' abdomens and injected into their knee for patients that had knee arthritis.
And they were showing new growth of cartilage.
and an actually improvement in some of the x-rays So when you look at an x-ray, there's some characteristics that we look at that define what arthritis is.
So if the patient has narrowing of the joint space or they have bone spurs, things like that.
They were actually seeing more space between the bones on some of these serial x-rays.
So, you know, I saw that and that was just like so incredible and something that I never heard about, read about, or, you know, had encountered before.
And that's really what kind of sparked my interest.
A physician friend of mine in Memphis, Tennessee, her name's Dr. Laura Lenderman, she has utilized that quite a bit and she's been very happy with the patients that she's treated.
And naturally some people do better than others, but...
You know, the rigorous study of this, though, is still yet to come.
So, essentially, you did mine, I think, how long ago was it?
I think it was July of 2015. Yeah, so I kind of came in pretty early.
Because Jeff Davidson, the doctor from the UFC, he was the one who told me about it because he had shoulder surgery and...
He was very stiff and had real problems after the shoulder surgery and was just very unhappy with his range of motion and the pain that he's experiencing and then he got some stem cell treatments and it just all went away.
I was pretty impressed with, you know, what he told me about how he was, what he was able to get back to after, you know, he had been treated with that type of injection.
Yeah, so he told me, and then I was like on the fence.
I mean, I'd seen an orthopedic surgeon, and the only thing that was keeping me from getting surgery is, you know, he put me through all these stress tests where he pushed down on my arm and all this stuff, and I resisted all of them.
And he's like, this is, it's kind of odd that your injury's this bad, but you have so much strength in your joint still.
So, and that's another reason, and I probably would have been in the same boat as the first guy, in terms of trying to make a decision about surgery.
Because, you know, if your physical exam doesn't, you know, show that somebody has some significant deficit, it's hard to make the jump to take somebody to surgery.
So in that case, that was one of the reasons why I was thinking, because I don't want to walk around with a compromised body.
I'm like, if I have to just get surgery and then take six months of rehab or whatever, what is the, for a type of shoulder injury that I had, what is the rehabilitation time?
With some patients, they've never even lifted weights, for example.
So for them, the recovery and rehab, we're introducing things to them that they've never seen or done.
And they don't understand the difference between being sore and pain that they should be conscious about.
And it's challenging.
It's hard work.
And it's uncomfortable.
And so some patients, you know, they're, they struggle to get through that part of it.
Um, and it naturally will take longer to improve.
So it's harder for them to get their motion.
It's longer, much longer for them to return their strength.
Now you already have like a significant baseline level of strength.
So, you know, much easier in your case to bounce back.
And then also the things that you would do in rehab, they're so rudimentary, you know, you would move through that very quickly.
And then, uh, Once you're at the point where you have had enough tissue healing and it's safe to progress you, you know, through higher level exercises, then you could really push it.
And you would.
I mean, you would be committed to it, dedicated, diligent.
One of the lines that I say to all my patients regularly is, you've got to respect biology.
You have to allow the healing to happen.
I know you feel good, I know you're moving good, and you're ready to go.
You want to be back on the court, on the field, things like that.
we risk having you re-injure and then you're right back in that same boat we don't we only want to have you miss the most limited block of time that you can so i never want to i don't want people to miss one more practice game you know match workout or whatever then they have to uh but same time we don't want to put them in a situation that's unsafe so it's always a it's a balancing act So in your time of doing this, have you had people that didn't respond to this particular type of therapy?
So, you know, I would have to go back and look and kind of critically evaluate each case.
Certainly, you know, we worry about the patient that has lower, like, baseline fitness, like their overall health is poorer, you know, and what their response might be.
But I think that's information that is still, you know, to come.
But definitely, I mean, some of the people that have responded the most dramatically, like, for example, you and John Dudley, I mean, you guys are...
Fanatical about your nutrition.
You're working out regularly.
You're doing all kinds of things to optimize your chance to not, you know, in this case, heal, but in other instances, perform.
And I have to believe that that has, you know, that's a huge factor.
Yeah, I would wonder how much of a factor it is if your body is conditioned in a way to constantly generate muscle tissue and breaking down and rebuilding and it's always constantly under stress.
You know, I think it's not the typical realm of my specialty to be looking at all those other factors, but I think with all of the information that's becoming available...
One of the cool things for me has been it's forcing me to have to learn about it.
It's forcing me to have to take a look at, you know, how can we do better?
You know, what are we ignoring?
And I think if you're not looking at every aspect of that wheel, then you're missing a chance to do as good as you can for each patient.
And it might be things that we have to do before somebody even has treatment.
We might have to bring them up to some baseline level with a number of different things.
And the other side of it, too, is we're in a system now where there's so much information.
One person can't be your source for everything.
So you really have to have a good team all around you.
I think that's really important.
I find myself more and more seeking help and just saying, hey, I don't know enough about this.
Can you help me with this or explain it better?
Can I have the patient talk with you and maybe get some more information?
And I think that may give them an even better chance to do well.
One of the things I thought was interesting, you were telling me that there's been really good results with people going into a sauna directly after treatment.
Well, I don't know that there's been good results.
I think it's interesting.
And the things that you've talked about for other applications in terms of heat shock proteins, you know, there's some belief that that may either assist the cells in proliferation or their ability to, you know, have as robust a response as possible.
That's hypothesis.
But I think it's interesting.
And again, it falls into the category of a lot of these things that we're talking about where the science, the basic science is there.
We understand how it happens in the embryo, in the developing child.
We know what it does in a lab.
We can add these things to a Petri dish and watch these changes happen.
But nobody has demonstrated this in a human, in a clinical trial where we're treating an injury.
So we have to be very careful about that.
In fact, the FDA is very clear that, you know, we cannot be making those claims.
Companies can't be making those claims about their products and physicians cannot be making claims and marketing their practice to drive people to them stating that these things are happening.
Now, when you talk about heat shock proteins, I don't know if you can answer this question, but is there a difference between the heat shock proteins that you receive from, say, like a steam shower, like a steam room, versus a sauna, versus even a hot bath?
I've heard people saying that you get heat shock proteins from a very hot bath.
But the whole idea is just Being involved in an environment that's extremely hot where your body is like what is this guy doing?
And then it produces the heat shock proteins to try to compensate as a protective mechanism So, just the knowledge of this, I mean, this is really interesting because people have been using saunas forever, and it was all sort of anecdotal.
Oh, the sauna makes me feel great, and I would look at them like, what are these assholes doing?
They're going to go in there and sweat?
I always thought it was people that were just, like, lazy and they didn't want to lose weight, and so they went in the sauna and they thought they lost weight in the sauna.
But talking to Dr. Rhonda Patrick, and she was explaining the benefits of sauna, where there was one study where mortality decreased 40% from all causes through daily use of the sauna.
I think at the same time, one of the things that we have to be conscious of is being responsible about how we use this information and what we're telling patients.
I think there's a lot of misinformation and a lot of people taking advantage of that.
And so, you know, we want to try to avoid that.
We want to try to give people good information so that they can ask the right questions and they can evaluate places where they're going to see if they're comfortable with what they're being told and what's being offered.
So I think there's something like 200 plus regenerative medicine clinics that have popped up in the last couple of years.
which is a common treatment for an attempt to give pain relief.
In the particular study that I'm thinking of, they had, you know, 73% of the patients that received PRP had relief of their pain compared to about 50% of patients with a steroid injection.
So that's a head-to-head study comparing treatment, and, you know, the advantage seemed to be to PRP.
Yeah, Dana White did, too, the president of the UFC. He went in there for tinnitus, you know, and found through intramuscular injections there's a deep relief of tinnitus.
And again, there may be great applications for all of the different things that fall into this category of biologic treatment.
Time is going to tell us what things pan out clinically to be best.
I mean, you can look at all kinds of factors, and we can draw conclusions from that.
But ultimately, you know, the proof is going to be when we have You know, robust clinical studies that compare treatment and, you know, we have follow-up physical exams and we have follow-up imaging to see exactly what's happening.
So we know what we are hoping for.
We know what we want to see.
We want to see that, yeah, we have this cell that has the potential to differentiate into other tissue and actually causes healing.
But nobody has demonstrated that yet.
There are some studies.
I mean, there's 35 studies.
29 are animal.
There's six or seven that are human trial.
I just saw this review paper, and I didn't know if the review paper had been written before one of the more recent clinical trials was published.
So one was on knee arthritis, and the others were on mostly foot and ankle stuff.
The most recent is from USC and in combination with a doctor that's in Indiana.
And they looked at patients that had a knee arthroscopy and they resected part of the meniscus.
So we call that a meniscectomy.
And part of it was essentially cut out.
So there was a tear, they cut out the bad tissue, they left the remaining healthy tissue.
And they did an MRI and they measured on the MRI the volume of meniscal tissue.
Then they injected the patient with a bone marrow aspirate.
So in this case, it was the, you know, BMAC or bone marrow aspirate.
In the middle of a jiu-jitsu class, it was really bad.
So I had to get it scoped.
And then once I got it scoped, it was functional.
But it would provide me with...
Maybe every couple weeks, it would be painful.
There would be something going on.
There would be an ache.
It would be a problem.
You shot some stem cells in there a year ago.
I've had zero problems with it since.
Zero.
Nothing.
I don't even acknowledge that I have a knee that's weaker than the other knee anymore.
It doesn't even feel like that anymore.
My left knee feels exactly like my right knee now.
It's crazy.
I mean, for a decade plus, I had pain in that knee.
One injection, a year later, nothing.
And it was almost...
Within two months within two months after the injection, I felt like a significant difference I was like waiting for those days because those days when I pushed it hard particularly after kickboxing There's something about those like hard pad work like kicking the pads I was gonna say any particular things that you were doing that made it feel the worst that was the big one is Striking because striking is just jarring and there's just so much and I just think there's just there was Laxity in the knee is that a word?
So for a young person that has the tear, we want to preserve that meniscal tissue for as long of their life as we can.
So certainly you are willing to risk it and even you sometimes might attempt to repair something that you think even has a lower chance just because they're young and you want to preserve that.
Why you want to preserve it is we know that if you even resect a small amount of the meniscal tissue, like say up to 25%, it will change the contact pressure in the knee.
So they do these, you know, color pressure studies where it shows you the amount of force and its distribution.
And with a normal meniscus, it's evenly distributed into the, you know, the medial femoral condyles, the end of the femur, and then the tibial plateau is the top part of the shinbone.
So when those come together, with a normal meniscus in there, The pressure's even.
If you resect part of that, now you see this point loading.
So you see these hot spots where there's a much greater amount of pressure.
So I think what I was trying to get to and I was taking the long path to get there was that, you know, in the past what we might have said is, you know...
They're trying to find an easy solution so that you don't come back into the office and complain about something that we don't have an easy solution for.
Well, when they do replacements now, because I know a guy who's got a knee replacement, and one of the things he was saying, actually, I know quite a few people.
One of them was on the podcast.
His name is Dan Pena, and he was saying that the problem is, with his knees, is they only bend this way now.
They don't move side to side.
There's no lateral movement in the knee.
There's no wiggle room.
He can't go side to side.
The knee just goes straight up and back, like this.
It's really kind of a terrible story, but he lived near a golf course, and the golf course used these horrible pesticides, and it leaked into the groundwater, and all the people in his neighborhood got cancer, like a huge epidemic of cancer in his neighborhood, and he got bone cancer, and they replaced one of his femurs with a metal rod, and, and they replaced one of his femurs with a metal And it causes them significant discomfort.
So that would be in case of infection and, you know, there's the cases that we had were usually multiple fractures below a hip replacement and then and then below A longer stem, hip replacement.
Finally, you've got just no bone.
The other, you know, reason would be infected bone that you had to resect.
And then still another reason would be in the case of tumor where you have to, you're doing limb salvage.
Yeah, but isn't that what they said when, if someone came up to the person that had the telegraph and said, hey, do you think one day I'll be able to send dick pics from this thing?
This is an embarrassing story to admit, but when I was about 13, I went next door to my neighbor's house and he was kind of a computer nerd at the time.
But, you know, computer nerds at the time were playing with like Commodore 64. Right.
And he's like, dude, look at this.
I can hook my computer up to the phone and I can type on the screen and my friend down the street will see what I wrote.
And I was like, that's the dumbest thing I've ever heard, dude.
Can we, like, go play football?
Like, what are you talking about?
So, apparently I'm not a very forward-thinking guy, because, obviously, we're doing that quite a bit now.
I just, I think that is one of the most infuriating things.
It's fucking terrible.
It's like, you're going 60 plus whatever miles an hour, the amount of distance that you cover in a glance where you are not looking at the road and things can happen at any moment.
If you truly have an injury and we're trying to recover you, then what also comes along with that is...
The appropriate rehab protocol.
And none of those are defined yet for what some of these things that we've done.
But we're trying to develop that and dial it in and hone it down.
For me right now, the easiest thing is to try to adapt it from a surgical rehab.
And I'm not a physical therapist, obviously, so I try to collaborate with those guys and girls that are smarter than me in that avenue.
But The principles are the same, right?
So you have an injury that you're trying to heal.
Now, in some cases, it's, you know, we've created the injury or we've done the thing that the patient has to recover from.
In the case of an injection, you have an injury, you've done the injection, and now we need the effect to happen, whatever it is that we're hoping that will be.
But then you can't ignore the fact that if somebody has a bad shoulder, well, we may decrease the pain, but if their motion is poor, if their strength is poor, if it's not functioning correctly, then how can we be achieving the best result if we're not also attending to that?
And then the more that we're learning about all these other factors, I mean...
Like, again, for you, I mean, you're paying attention to your sleep, you're paying attention to your nutrition, you're on a variety of supplements that are meant to help a lot of these processes.
It's pretty much universally agreed that rest, ice, compression, elevation, all those different things that people have said in the past, that there is benefit to particularly icing things.
So, you know, I think one of the interesting things about this whole topic and the possibility of healing from utilizing this type of treatment is how It allows you to go through the process of healing without this fibrovascular response.
So the typical healing cascade has an inflammatory phase, proliferative phase, and the maturation phase.
So in the inflammatory phase, you have neutrophils and white blood cells and these enzymes that are present that are trying to start the process.
Then in the proliferative phase, you're having what's called angiogenesis, and that means the development of new blood vessels and vasculature to the area.
And your body's producing fibroblasts, and you're laying down tissue in this sort of haphazard manner.
So it's just kind of piling on in there.
Then the maturation phase is when you have remodeling.
So that scar tissue is changing over time and developing into tissue that's more like or is the native tissue.
So that occurs over a period of time.
And then a lot of times during that process, before you're fully matured in the healing, you're back to activities.
So, let's just take an example.
Like, when you sprain your ankle, and then you, you know, you start feeling better, and maybe you go back to basketball within a couple weeks.
At that point, if you've actually torn one of the ankle ligaments, you don't have native ligament tissue that's the same structural properties.
It's not as strong.
I mean, you might be developing the strength around it, but it's not like the native tissue.
Now, the hope is that we can demonstrate.
Now, we know that this is the science.
This is what it's supposed to do.
This is what it does in the developing fetus.
We see it in kids.
You know how, you know, when your daughter was real young, she scratched her face.
So healing without scar is, you know, has to do with not forming this fibroblast disease.
We're fibrovascular response and fibrotic phase.
Now, the cool potential of this to me is if we can skip that and we can have more complete healing and quicker resolution to the native tissue, then you're going to have the same properties.
You're going to be stronger.
You're going to be better.
You know, technically and hopefully, you know, clinically this pans out that you would be more resistant and lower risk for repeat injury.
Because that's really our goal is in treating patients is get them back to their activity.
And decrease the chance that they have to miss more time.
This is one of the big questions that will be discovered with, again, rigorous studies where we can look at what should the dosing be, what should the frequency of the treatment be, and what should the protocols before and after be.
It's not defined.
And anybody that's telling a patient that they have exactly what it should be, I mean, be wary of that.
Because that has not been discovered yet.
So we're trying to take, you know, we're taking the information from our experience and applying it that way.
It's not the best way to go about this.
And it's one of the things that PRP suffered from is that all of the things, everybody was using it for so many different things and just kind of hoping that it was the magic bullet that it was going to...
Treat all the things that we had difficulty treating.
And even all of the studies that were coming out, people were using different centrifuges and applying it for different reasons, different protocols.
So it has growth factors and cytokines, and the platelets release proteins and things, and those things help mediate that inflammatory response and help the healing process.
So some cellular treatment, like bone marrow fat or the placental tissue, and that line of treatment can help expand the cells.
So that gets us to an important point, which is expanding the cells has been done and is not currently legal in the United States.
So there was a place, and they do it in other countries, but here...
If you more than minimally manipulate the tissue, then that is not under the guidelines of the FDA for use of human cellular tissue products.
So they were taking, for example, bone marrow and plating it and growing more cells, bringing the patients back two weeks later and injecting them with this super production of cells, which probably is great.
But we don't know.
We don't know if that's safe.
And that has to be taken through the appropriate process.
So if someone gets that injection and does PRP, they would have to essentially get that done within those 7 to 21 days to have some sort of a benefit of what you're saying?
Well, so we just, I thought it was important to talk about the, it's called Section 361 of the Public Health Service Act, and this is the definition from the FDA on the use of human cell tissue and cellular tissue products.
So it has to match these criteria.
So you have to have minimal manipulation.
That means you can't add things to it.
You can't combine it with other stuff.
You can't, like I was saying, you can't put it in the lab and grow it and add things to it and then bring the patient back and treat them.
This isn't part of it, but you can't treat patients on a different day.
It has to be at the same time, whenever you're harvesting the cells or utilizing the Whatever it is you're using.
It has to be something called homologous use.
And what that means is whatever tissue you're taking has to have the intention of the purpose of that tissue for when you put it into somebody's body.
So, for example, if you have a fracture that's not healing, and I take a bone graft product, so cadaver bone, and we're going to use that to help heal your fracture that hasn't healed, that's homologous use.
We're taking bone, we're using it to become bone, or to be the scaffold for bone to heal and grow.
So, it can't be combined with something else.
And it can't be intended to have a systemic effect.
Now, all of these things that I'm explaining, these are rules for manufacturers and what the rules are for them to be able to market their product.
So, for example, you can't take amniotic fluid and say, this is a product meant for IV infusion, for treatment of...
Well, what I'm interested in, what I was thinking before you threw me off there, is he going with a specific intent of treating something, or is he just looking for the fountain of youth?
So, patients like yourself that have had a number of injuries and a number of treatments, one of the things that's got me enthusiastic about the potential of all this...
Is when somebody tells me, look, I've had this, this, this, and this, and then I had this, what we're talking about, and that it was just completely different.
When you're focusing on that shot, you literally have no room for anything else.
It requires so much concentration.
You're concentrating on the front hand position, front shoulder position, where the string touches the tip of your nose, the corner of your mouth, and John is just an amazing coach.
But what they were able to demonstrate was that when they've actually introduced bacteria, like literally injected bacteria onto these membranes, and then they come back and check, and it has destroyed the bacteria.
So ability to resist scar formation.
Move through the fibrotic phase of healing and then also the antimicrobial properties.
The important stuff is that you get the strong kombucha.
This is the brand that I really like.
I don't work for them.
They're not a sponsor.
GT's Kombucha.
GTS. This stuff is awesome, but you have to be over 21 because it has more than one half of 1% alcohol by volume because the fermentation process is so strong.
One big question I wanted to talk to you about was something that I had a discussion with Dr. Davidson about recently.
Jeff was telling me that the most recent procedure with stem cells is injecting them directly into the discs for people that have degenerative disc disease and that there's some really promising results.
Again, our whole training is based on we need to do things that have an evidence base for our patients.
I mean, this is kind of the...
The foundation of what we do.
But we're in a unique situation.
So we have patients that...
One, this stuff is available.
And it's legal to do.
And it's there.
And people know about it now.
So they're seeking the information.
They come to us.
And even before we started talking about it, it started to be here and there.
And then all of a sudden, it's like two, three patients a day now.
Even more are saying, well, what about stem cells?
Can I have stem cell?
And, uh, like, okay, well, you know, then we have to back up and like have the whole discussion, like, okay, well, let's talk about what that is and what maybe it can do.
And, um, So, people are seeking the treatment.
It's available.
But we don't know.
We don't have a lot of information.
So, we just have to be forthcoming and say, look, this is experimental.
We've had encouraging early results.
I can tell you anecdotal stuff.
We've even seen images where somebody had, you know, full thickness rotator cuff tear.
Eight months later, what looked like a healed rotator cuff on an MRI. Now, did that happen on its own?
Well, we know that that happens at a lower percentage, but it is possible to heal.
It's just a lower percentage.
Did it happen because of the treatment?
You know, that hasn't been established.
So I have to really explain all that.
And the other category, too, that patients will come and they'll explain an injury...
And, and I've had to turn away a lot of people that were, they were fully ready to come in and have treatment and, and they were fine with paying out of pocket because of course it's not covered by insurance.
Because it's experimental, because there's, you know, no data yet.
And that's not true.
There's not no data, but there's not enough data to support treatment for, you know, certain conditions.
But, you know, I've had to tell people, I don't think this is appropriate even to try, even if you want this.
And usually the category is...
Excuse me.
If it's something mechanical.
So I think this makes intuitive sense to people.
So for example, had you come to me and you said, Hey, you know, I dislocated my shoulder seven times.
And can you just put an injection in there?
Well, the problem with that is that the in that case, in this example, the ligaments of the shoulder have been stretched and disrupted.
And in the case of a dislocation, there's oftentimes a labral tear that comes with that.
Now, I don't believe, and I could be proven wrong over time, but I just don't believe that an injection on its own would magically decrease the volume of the capsule, you know, tighten the static structures in the shoulder and resolve the pain for that patient.
I believe there was something that came up a few years ago where they were doing something where they were heating up the inside of the capsule and shrinking it.
So when someone has had, like, if you talked to some dude who played football or something, had multiple shoulder dislocations, like, what would you do to him?
So the, you know, the typical course for recurrent instability of the shoulder would be a stabilization procedure.
Now, a lot of that's based on the exam and what you see on imaging.
Some people can do well with a simple shoulder arthroscopy, and then you pass a couple stitches, you repair the labrum, you can tighten the capsule at the same time, and young patients progress really well through that.
When there is more complicated problems, such as there's bone loss on the front of the socket, so when you have a dislocation, the head goes forward, it It goes out the front.
That's the typical and anterior shoulder dislocation is the usual one.
And then as it tries to come back into place, the head bangs into the glenoid or the socket.
So you can, you'll tear the front of the labrum, you'll stretch the front of the capsule, but then you can also get a dent in the back of the humeral head.
So one of the guys that we trained with in my sports medicine program in Alabama showed us this, and it was like one of the first things that we reviewed at the beginning of the year.
So basically, you have the person lying flat on their back, and I would hold your wrist, Loop my arm under your arm and then grab onto mine for for leverage.
And then I literally just sort of lean back and I'm using the muscles in my back.
So I'm not pulling with my arms.
So a small person can do this on a very big athlete and you're fine because you're you're using all the strongest muscles in your body, right?
So you literally just Lean back and you hold traction in that position.
So you've got the arm is positioned like this.
Yeah, you got to describe to people that are listening and The arm is in front of the person while they're lying on their back.
And again, I have my right hand on your right wrist if it's a right shoulder dislocation.
I don't remember exactly your MRI, but if you had a tear of the front of the labrum, and you had any evidence of that little dent in the back of the humeral head, then that would be consistent with that injury.
The strong first protocol, I think what they're trying to say is, in order to have really powerful shoulders, you should be able to do 90% of your max kettlebell press.
If it requires sound mechanics and you're doing it with load, it's bad to do that to failure because what happens as you fatigue is your mechanics are going to break down.
Well, what Pavel talks about is that strength is a skill and that all these different things, think of them as a skill and then don't do things to failure.
And if you're looking for, you know, endurance or something along those lines, you want to do light weights and you want to do multiple repetitions.
It's not what you're doing when you're trying to get stronger.
Right, but they even believe that when you're doing chin-ups, like if you're doing pull-ups or chin-ups, that when you're doing it, you shouldn't go to failure.
You should just stop, like, close to it or halfway there, and then take a long time off and then do another five reps.
Like, say if your max is ten reps, get to five, stop.
Take a break.
Do another five.
Stop.
Take another five, ten minutes.
Do another five.
Keep going.
And just you're working on form and your muscles are performing these actions in a very clean, smooth delivery and that this is the best way to recover or to build strength and that you just do it more often.
Don't do it to failure once a week and then be a wreck for like three or four days afterwards.
Because you know that feeling when you lift weights and you lift weights for a week, or you lift weights and you lift weights to failure rather, and you're sore for so long.
You can't get anything done.
This idea is you do more frequent workouts and you don't go to failure.
Yeah, so I try to emphasize with, and we have to really talk about this with our ACL rehab, because that's a group that they're so eager to get back.
If they're a competitive athlete, you've got to remind them that, look, we have steps to go through.
And I always say you've got to work smart, not hard.
We have a plan, and there's a reason why this week may not be a whole lot of work.
Your body needs rest and recovery in order to put stress on it again so that we can continue to make your progress.
Otherwise, at some point, you're either going to plateau, you're not going to be making changes, you're going to get frustrated, or you're just going to get hurt.