Full Transcript Inflammation as a Systems Problem 0:01 For years, providers are taught to think 0:02 about inflammation as something to 0:04 suppress. Inflammation is not the enemy. 0:07 It's unresolved inflammation. That's 0:10 where the problem lies. According to the 0:13 CDC, in 2023, 76.4% 0:17 of US adults reported at least one 0:20 chronic condition and 51.4 0:24 reported multiple chronic conditions. So 0:28 that means providers are seeing the 0:29 downstream of expression of chronic 0:32 inflammation every single day. Even when 0:35 the word inflammation is not even in the 0:37 chart, modern inflammatory load is being 0:40 fed from multiple directions all at 0:42 once. You have obesity, insulin 0:45 resistance, poor sleep, sedentary 0:48 behavior, chronic stress, gut barrier 0:51 dysfunction. This is why so many 0:54 patients feel inflamed everywhere. It 0:56 isn't just one joint. Their knee is 0:58 hurting, but the biology is systemic. 1:00 Inflammation is not something we should 1:02 automatically fear. It's something we 1:05 need to understand. Redirect the 1:07 inflammation and then resolve especially 1:11 the chronic lowrade because once you 1:14 resolve that, then you allow the body to 1:17 actually do what it's made to do. 1:22 So everything you were taught about 1:24 inflammation is wrong. I love that title 1:26 so much. We are focusing on systemic 1:28 inflammation, the current landscape in 1:31 this country, and why regenerative 1:33 medicine is changing the paradigm. 1:36 Remember, a paradigm is how you think of 1:38 something. It's how you view the world, 1:40 whether it's you or your patient. So 1:42 next slide. So we're going to dive right 1:44 into that. All right. First off, 1:48 for years, providers are taught to think 1:50 about inflammation as something to 1:51 suppress. If a patient hurts, you want 1:54 to calm the inflammation. If symptoms 1:56 flare, reduce the inflammatory response. 1:59 You can see this when we look at our
Chronic Disease and Unresolved Inflammation 2:01 statistics for this country. When you 2:02 look at NSAIDs, for example, uh 15th 2:05 lead, well, it used to be 15th leading 2:07 cause of death in this country. That's 2:10 much higher on the the level now. And 2:13 also opioids. Opioids used to be the 2:15 third leading cause of death in this 2:17 country behind heart disease and cancer. 2:19 It's now second. Our own health care 2:22 system is the second leading cause of 2:25 death in this country. So when we take a 2:27 step back and look at how did 2:29 inflammation the thought process about 2:32 controlling inflammation 2:35 um how is that connected here or is 2:37 there a correlation? So the having a 2:41 greater understanding about this 2:43 inflammation is not the enemy. It's 2:45 unresolved inflammation that's where the 2:49 problem lies. So when you're thinking 2:51 through cases, when you're thinking 2:53 through medical history, you want to be 2:56 looking at it's unresolved inflammation. 2:59 Acute inflammation, we need it. We want 3:01 it. It's part of the healing process. 3:04 The problem is the chronic lowgrade 3:08 disregulated 3:10 inflammation. That's what causes tissue 3:13 breakdown, metabolic dysfunction, 3:14 chronic pain, and accelerated aging. 3:18 So thinking of it from that paradigm, 3:21 chronic lowgrade disregulated 3:24 inflammation is what's driving tissue 3:27 breakdown, metabolic dysfunction, 3:28 chronic pain, and accelerating the aging 3:31 process. reviews. And just so you guys 3:34 know, I've got 17 peer-reviewed articles 3:37 on the back of this that you'll be able 3:39 to take a picture of that and reference 3:41 everything. All right. Reviews in recent 3:44 years describe how this lowgrade 3:46 persistent state as a shared mechanism 3:49 across cardioabolic disease, obesity, 3:53 frailty, and age related decline. 3:56 Inflammation is not something we should 3:58 automatically fear. It's something we 4:00 need to understand. d redirect the 4:04 inflammation and then resolve especially 4:08 the chronic lowgrade because once you 4:11 resolve that then you allow the body to 4:14 actually do what it's made to do. So 4:16 this is not a French concern it's 4:18 actually the clinical reality of modern 4:20 American medicine. According to the CDC 4:23 in 2023 76.4% 4% of US adults reported 4:28 at least one chronic condition and 51.4 4:34 reported multiple chronic conditions. 4:36 That's half. 4:39 That's crazy. Multiple chronic 4:41 conditions. And I think it's just 4:43 continuing to get worse every single 4:44 year. Another CDC summary notes that an 4:48 estimated 4:49 129 million people in this country have 4:53 at least one chronic major disease. 4:56 Chronic pain is also very widespread. A 4:59 quarter of adults reporting chronic pain
Systemic Drivers of Inflammatory Load 5:01 in 2023 and 8.5% 5:04 report reporting high impact through 5:07 chronic pain. So that means providers 5:10 are seeing the downstream of expression 5:12 of chronic inflammation every single 5:15 day. Even when the word inflammation is 5:18 not even in the chart. So as a provider 5:20 when you take a step back and look at 5:22 this systemic inflammation is the most 5:26 important thread tying modern chronic 5:28 disease together. 5:31 We've got to So people come in with knee 5:33 pain, they come in with autoimmune, they 5:34 come in with all these conditions, 5:37 chronic, multiple. It's thinking through 5:40 it with systemic inflammation. How do I 5:44 control inflammation on a systemic 5:47 level, on a cellular level? That's the 5:50 question we need to address here. 5:52 Modern inflammatory load is being fed 5:55 from multiple directions all at once. 5:57 You have obesity, insulin resistance. I 6:00 know Dr. Maryanne Martin talked about 6:01 this last week and she had she had a 6:04 phenomenal presentation that she really 6:06 explained some of this. Poor sleep, 6:10 sedentary behavior, chronic stress, gut 6:13 barrier dysfunction. This is something 6:15 that people are becoming more and more 6:17 aware of as well. Processed foods, 6:20 microbiome 6:22 biome disruption, and aging itself. 6:26 So these are the things we want to look 6:28 at. How do we get control of this? 6:31 Recent reviews continue to describe 6:33 obesity as a state of chronic lowgrade 6:36 inflammation. 6:38 Western style diet. Look at how people 6:41 are eating in this country. Look at what 6:43 foods are available to us and all of the 6:45 chemicals that are in the foods. And 6:47 again, there's more awareness now um 6:50 from a regulatory standpoint, but 6:53 there's so much damage that's already 6:54 been done on this that's actually 6:57 producing that chronic inflammatory 6:59 disease state and increases risk 7:01 significantly. 7:03 More attention is being put on the gut 7:05 barrier dysfunction in the microbiome as 7:08 contributors to the systemic 7:10 inflammatory signaling. They're the 7:12 gatekeepers. When the gate's broken, 7:14 things get through the gate that 7:15 shouldn't be there. And that really 7:17 increases inflammation significantly. 7:19 Okay. So, um this is why so many 7:23 patients feel inflamed everywhere. It 7:25 isn't just one joint. Their knee is 7:27 hurting, but the biology is systemic. 7:29 Inflammation is not just about the pain. 7:31 It's about failed resolution. A key 7:34 concept for this with providers is that 7:36 chronic disease is often less about 7:39 dramatic inflammatory storm 7:42 and more about failed resolution of 7:44 inflammation. The body initiates a 7:46 response to injury or stress but does 7:48 not efficiently transition back to 7:51 tissue homeostasis. 7:53 So when you're looking at regenerative 7:54 medicine and orthobiologics, the goal is 7:57 to look at what inflammation is going 7:59 on. Is it systemic? Is it local? Or is
Failed Resolution and Osteoarthritis 8:02 it both? Because if I just go straight 8:04 to injecting that knee without handling 8:06 the overall inflammatory components, how 8:10 good is that knee injection going to be? 8:12 I've got to handle the big picture first 8:15 because then I can look at getting a 8:18 better patient outcome potentially. The 8:20 body initiates a response to injury or 8:22 stress but not efficiently transitioning 8:25 back to that homeostasis. Over time, it 8:27 creates a biologic environment favoring 8:30 fibrosis, degeneration, altered immune 8:33 signaling. We're seeing more autoimmune 8:36 now than ever before. mitochondrial 8:38 dysfunction and sensitized pain 8:41 pathways, 8:42 major pain issues with the patients that 8:45 are harder to actually handle more now 8:48 than ever before. It's especially 8:50 relevant with aging or inflammaging. I 8:54 heard that term a few years ago and that 8:56 is chronic lowgrade systemic 8:58 inflammation associated with frailty 9:01 frailty and age- related diseases. So 9:04 the issue isn't just inflammation turned 9:06 on. It's it doesn't actually turn off 9:10 and get to the place of homeostasis. 9:13 So osteoarthritis is the perfect example 9:16 of the outdated model. Uh OA wear and 9:19 tear that is definitely part of it but 9:22 that's not all of it. Current literature 9:25 actually describes osteoarthritis is a 9:27 joint as a whole um active roles for 9:30 synovium subcchondrial bone innate 9:32 immunity inflammatory mediators and 9:35 tissue cross talk. So we have the um 9:38 wear and tear and then we have the 9:40 immune theory when you're looking at 9:42 cytoines and a cytoine storm and that 9:45 cytoine storm is actually upregulating 9:48 your M1 cytoines that are causing it to 9:51 be a more uh pro-inflammatory 9:53 environment resulting in tissue 9:55 breakdown 9:57 versus creating homeostasis 10:00 getting cytoines in there that are 10:02 controlling the environment. 10:04 So recent literature argues that OA 10:06 should be approached in many patients 10:08 having systemic features, not just local 10:10 mechanical degeneration. So if you still 10:13 think osteoarthritis is just cartilage 10:15 wearing out, you're already behind what 10:19 is actually going on. 10:22 Because when we know exactly which 10:23 cytoines are being upregulated and 10:26 downregulated in those different cycles, 10:29 then we know more of okay what type of a 10:32 product or nutrition like what do I need 10:34 to do for this patient specific to this 10:37 patient to modulate this and the goal 10:42 create homeostasis. 10:44 That's what we're trying to go for. It 10:47 isn't just putting in um a product 10:50 that's got certain types of collagen or 10:53 got cloth though or HA like how good 10:56 those can those things actually do if we 10:58 don't regulate inflammation in their 11:01 whole body first. Why conventional care 11:03 often stalls? Traditional care often 11:05 focuses on symptom based care, 11:06 suppression, escalation, NSAIDs, 11:09 steroids, activity modification, more 11:12 medication, and then a scope, and then a 11:15 total joint replacement. These tools 11:18 absolutely have a place, but they often 11:21 do not address the broader inflammatory 11:24 micro environment or support tissue 11:29 signaling in a way that promotes 11:31 restoration of function. That's the 11:35 goal. How do we support tissue signaling 11:38 that promotes restoration of function, 11:41 restoring, repairing, things like that? 11:44 So this is one reason so many patients 11:47 cycle through temporary relief without 11:49 that more uh durable biologic 11:52 improvement. Newer regenerative 11:54 discussion is gaining traction because 11:56 it's trying to shift from blocking 11:58 symptoms to influencing the healing
Why Conventional Care Often Stalls 12:01 environment. Framing this is supported 12:04 through recent reviews on immuno 12:07 modulatory strategies. 12:10 I can't stress that enough how important 12:12 that is to understand you are modulating 12:15 the immune system. That's upregulating 12:18 certain pathways, downregulating other 12:20 pathways with your cytoines and your 12:23 proteins because you want to stimulate 12:25 that homeostasis that will assist with 12:28 cartilage regeneration and whole joint 12:32 restoration. We're moving not just out 12:35 of the pain management mindset but 12:37 actually into a tissue environment 12:40 mindset. It's completely different when 12:43 you think of it from a tissue 12:44 environment mindset. Okay. So what 12:47 regenerative medicine is really changing 12:50 it is changing the paradigm because it 12:52 isn't just built around suppressing the 12:54 inflammation. You want to be looking at 12:57 modulating the inflammation which will 12:59 help with cell signaling. 13:03 support, repair and assist to restore 13:07 homeostasis in the tissue environment. 13:10 That is absolutely the key here. Um so 13:12 that's why terms like imunom modulation, 13:15 signaling, secretone, cytoine balance 13:18 and tissue micro environment have become 13:21 so important to understand. 13:24 Reviews on mazinkal stromal cell biology 13:26 and tissue engineering repeatedly point 13:29 to anti-inflammatory 13:31 immuno regulatory and repairerative 13:33 mechanisms as the key reasons the 13:36 approaches are under such intense study. 13:39 So like I said, the future is not just 13:41 anti-inflammatory. 13:43 It's how do we create that 13:45 pro-resolution, pro repair, and that's 13:49 through modifying, upregulating, 13:51 downregulating those different um 13:54 pathways. All right, PRP is a good 13:57 example providers can understand. So PRP 14:00 has become one of the most clinically 14:02 practical examples of this shift. It's 14:04 simply not a growth factor shot. So 14:07 before I go into this anymore, I want to 14:10 preface this. I am a firm believer as a 14:14 provider, it is so important to 14:16 understand 14:18 everything in the regenerative umbrella. 14:22 as and you as a provider, you can choose 14:24 what you want to provide for your 14:26 patients, but understanding and versus 14:31 being able to speak to it, understanding 14:34 the science, understanding how it 14:36 affects the body, understanding who is a 14:38 good candidate and who is not for 14:40 different treatments of everything, 14:43 whether it's autotogus, anything from 14:45 your own body, PRP, um, PRF, A2M, 14:49 autotogus, bone marrow, autotogus 14:52 atapose or something allergenic like an 14:55 umbilical cord derived Wharton's jelly 14:57 or an exoome. Regardless of the source,
Regenerative Medicine and Immune Modulation 15:01 there are pros and cons to everything. 15:04 But as a provider, understanding every 15:07 single one of those treatments, how they 15:09 work, and why, and then making a 15:12 decision on what is best for that 15:15 specific individual. It's okay to have 15:17 preferences, but understanding who's a 15:21 good candidate for this or that um and 15:23 who is not, that's half the battle. But 15:27 as a provider, that's your job. Like 15:30 take that level of understanding to a 15:33 new level. Okay. So um current 15:36 literature describes PRP as exerting 15:38 effects through inflammatory modulation, 15:41 cell recruitment, angioenic signaling, 15:44 matrix effects and support of tissue 15:46 repair. Recent reviews and metaanalytic 15:49 summaries continue to report benefits 15:51 for pain and knee function in knee OA 15:55 compared to placebo and in many analyses 15:58 HA there is side note HA doesn't repair 16:02 it is cushion it I call it jelly in the 16:05 donut it does not have anything that 16:07 will actually help restore or repair 16:09 anything it doesn't stimulate any um 16:12 type of event it's simply jelly of the 16:14 donut cushion Okay, there's also growing 16:18 attention on the importance of PRP 16:20 composition and dose. So, how much blood 16:23 am I drawing? Is it a single spin or a 16:26 double spin? What is their platelet 16:28 count coming into this? Concentration 16:30 does matter, especially if you're 16:33 looking at aesthetics or osteoarthritis 16:37 or soft tissue partial tear. Um, so 16:40 those are all things that you definitely 16:42 want to be thinking about of what is 16:44 best for that specific individual. 16:46 So here we have peer helped open the 16:48 door because it taught providers that 16:50 biological signaling matters and 16:53 preparation. 16:54 How what kit do I use? Is it at 510k 16:57 cleared? Not pieces, the actual kit. Is 17:01 it um what's the dosage? What is the 17:04 most robust evidence supporting that? Um 17:08 I really like to give this super fast 17:09 example of not everything is for 17:12 everybody all the time. There is no one 17:15 recipe that fits best. If I have a 17:17 patient who's highly uh systemic um 17:20 systemic inflammation, 17:23 is it a good idea to give them something 17:26 from their own body that's going to 17:28 upregulate that inflammation more? And 17:31 can their body create the teeter totter 17:33 effect to get it back into homeostasis? 17:37 Something to ask yourself and that's a 17:39 great question. If I have somebody who's 17:41 super healthy, um they're not on a lot 17:44 of medications, they eat healthy, they 17:46 exercise daily, and they are, you know, 17:49 younger, do I have a better potential 17:52 outcome with the PRP for that person 17:55 versus somebody in their 70s, a horrible 17:58 diet, on a lot of smoking, drinking, and 18:00 on a lot of medications 18:02 definitely will have two different 18:04 outcomes within 48 to 72 hours. I've 18:07 seen it for years. So things to take 18:09 into account why the field is expanding 18:11 beyond simple injection thinking. The 18:14 regenerative conversation is broadening 18:16 because providers are asking better 18:18 questions. What pathology is present? 18:22 Is what type of cartilage defect am I 18:25 looking at? Is it tendon? Is it 18:28 ligament? Is it cartilage? Like it isn't 18:30 just I have knee pain here. Let's put 18:33 something in it. No, let's address what 18:36 specifically is going on. What type of 18:38 tissue is involved 18:41 and what type of product has the ability 18:46 to potentially help restore 18:49 the that restoration within those types 18:52 of tissues. Cartilage for example, type 18:54 one, type two, type three, right? Um or 18:57 a tendon or a ligament or a soft tissue 18:59 tear like in a muscle.
PRP and Patient-Specific Treatment Selection 19:02 What inflammatory phenotype does the 19:04 patient have? Is the issue mechanical 19:06 overload, cynitis, 19:09 atipost driven inflammation, metabolic 19:12 dysfunction, immune disregulation, huge 19:17 t failed tendon healing or combination. 19:21 The field is moving away from 19:22 oneizefits-all 19:24 and towards strategic protocols that 19:27 match the biology of the individual 19:30 patient and the tissue. That's the 19:33 mindset you want to be using when you're 19:35 looking at what type of product am I 19:38 using. Is it autotogus, allergenic, why, 19:42 how often? What's my dose? What's my 19:44 frequency? What is my goal that I'm 19:47 looking to solve here? 19:49 That direction is reflected in the newer 19:51 muscularkeeletal and cartilage 19:52 regeneration literature emphasizing 19:55 patientspecific 19:57 and really looking at how do we immunom 20:00 modulate uh immunom modulatory 20:03 strategies. So the question is no longer 20:06 what can I inject the question is what 20:10 biology or pathology 20:12 am I looking to influence? 20:16 What am I looking to upregulate or 20:18 downregulate and why? 20:21 All right. The connection between 20:22 systemic inflammation and 20:24 muscularkeeletal outcomes. 20:26 This matters especially in 20:28 muscularkeeletal and pain medicine 20:30 because joints do not exist in 20:32 isolation. I love that joints do not 20:35 exist in isolation. 20:37 Obesity related inflammation, poor 20:40 metabolic health, microbiome 20:42 dysfunction, aging, chronic stress, all 20:46 influence pain sensitivity, tissue 20:49 quality, and the healing response. 20:53 So the more you address these other 20:56 things before you look at the joints, 20:59 are you potentially going to have a 21:00 better outcome? Recent reviews connect 21:03 chronic low-grade inflammation with 21:05 metabolic disease, aging, chronic pain, 21:07 and some literature highlights 21:09 microbiome and gut mediated contribution 21:13 to pain and inflammatory signaling. So 21:16 if the patient is systemically inflamed, 21:19 which is very common in this country 21:21 especially unfortunately 21:24 um your outcomes may plateau unless you 21:27 address the whole patient. Why patients 21:30 are seeking this now? Patients are 21:32 absolutely more open to this now and 21:34 they are looking for options. The old 21:37 ladder of medication, repeated steroids, 21:39 and waiting until surgery feels 21:42 unavoidable. That demand is growing 21:44 because they want treatment that is 21:46 personalized and biologically 21:49 intelligent. 21:51 I love that personalized biologically 21:55 intelligent. 21:56 Regenerative medicine speaks to that 21:58 desire, especially when it's presented 22:00 responsibly. As a provider, it's so 22:03 important to not be saying that you're 22:05 curing and you're treating and um it's 22:09 not magic. This is evolving framework 22:12 for supporting tissues for healing and 22:16 improving function in appropriately 22:19 selected patients. 22:22 Patients are not just asking for pain 22:25 relief. They're asking, "Can you help my 22:27 body heal better?" All right. The field 22:30 is promising, but it is not a 22:32 freeforall. 22:34 So, this is where it's so important to 22:36 have um your provider credibility 22:40 matters, getting the mentorship, asking 22:43 the right questions, looking for 22:46 peer-reviewed articles that support your 22:48 decision-making process. Regenerative 22:51 medicine space is exciting, but it is 22:54 not a license to overpromise. 22:56 The FDA continues to warn that many 22:58 products marketed as regenerative
Systemic Inflammation and Musculoskeletal Outcomes 23:00 therapies, including stem cells, 23:02 exoomes, are being promoted without 23:03 adequate approval or evidence of wide 23:06 range orthopedic and other conditions. 23:08 This is why it's so important to be part 23:11 of FDA approved IRBs 23:14 and part of documenting patient outcomes 23:18 on a big scale. The FDA pages updated 23:21 through late 2025 show ongoing 23:23 regulatory activity and warning letters 23:25 in this space. So the winning long-term 23:28 approach is not hype. It's disciplined 23:31 science, patient selection, informed 23:35 consent. I cannot stress that enough. 23:38 Informed consent, good documentation, 23:41 and responsible clinical communication. 23:45 Do not promise rainbows and unicorns. 23:47 It's responsible clinical communication 23:50 from provider to patient. The providers 23:53 who win in regenerative medicine are the 23:55 ones who combine innovation with rigor. 23:59 And that's why I love being part of FDA 24:02 approved IRBs, part of this ongoing 24:05 mentorship, communication, and how do we 24:08 advance this field? Talking with 24:11 experts, discussing what's up on the 24:13 horizon. 24:15 What I'm going to challenge all of you 24:17 to do differently, 24:19 I'm encouraging each of you to stop 24:21 reducing inflammation to a symptom 24:23 problem and see it as a systems 24:27 issue. That means evaluating the 24:29 patients joint, tissue, metabolic 24:32 health, inflammatory load, stress 24:36 patterns, nutrition, sleep, and recovery 24:39 capacity. 24:41 You know, so often people are looking 24:43 at, oh, this is functional medicine 24:45 side. Oh, this is orthopedic side. This 24:48 is I'm challenging each of you to 24:51 combine that because that's where you're 24:54 going to see the best patient outcomes. 24:56 Regenerative medicine becomes far more 24:58 powerful when it is integrated into a
Responsible Regenerative Medicine Practice 25:00 broader precision care model rather than 25:04 treated as a standalone procedure. It 25:07 drives me nuts when people do the one 25:10 and done here. Let's do a super maybe do 25:13 a quick exam or not. Let's inject you 25:15 one time and off and you don't ever 25:18 follow up with the patient. Like I have 25:21 a lot of opinions on that type of care 25:22 and I'm very much not I think of this 25:26 regenerative medicine is far more 25:28 powerful when it's integrated into 25:30 broader precision care model. Let's all 25:33 be part of that model. Regenerative 25:36 medicine is changing the paradigm 25:38 because it forces us to ask better 25:40 questions. Not just how do we suppress 25:42 symptoms, how do we restore a healthier 25:46 healing environment? That's the key here 25:49 as a provider. All right. In closing, 25:52 everything we were taught about 25:53 inflammation is wrong. Even if we think 25:55 the answer is simply to shut it down, 25:58 the real opportunity is to understand 26:00 the inflammation, the inflammatory 26:02 pathways. How do we upregulate, 26:06 downregulate, and why? 26:09 Identify when it has become chronic and 26:11 maladaptive and use smarter strategies 26:14 to help patients move from breakdown to 26:18 repair. This is why regenerative 26:21 medicine is not just a trend. It is part 26:23 of a larger shift in how we think about 26:26 healing. And this paradigm shift starts 26:29 with each and every one of you, the 26:31 providers.
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