Regenerative Cell Therapy Post-Procedure Instructions

Depending on where your regenerative cells were injected, your recovery will be tailored to provide for optimal healing. Please keep a weekly log on how you are feeling. You may or may not need additional treatments or a booster PRP to reach your goal of reduced pain and increase function. Some patients need 2 or 3 treatments to achieve complete healing, but there are no guarantees of reaching all goals.

Post Procedure Regenerative Cell Therapy Rules

Rule #1 – Set yourself up for success!

Your regenerative cells are very tender and delicate and need special care if they are going to grow and help heal your injury. Avoid twisting and compressive forces (squatting, leg presses, etc.). If you are in doubt what to do – less is best. You are your body’s best advocate.
Simple advice is:

• No pain the next day after activities – increase a bit.
• Miserable feeling the next day after new activity- you’ve overdone it, and rest 1 day
• Pain while you are doing a new activity- stop and rest for 2 days

You may experience an increase, decrease or no change in your pain level the first few weeks. You may have “up and down” days for no reason and these fluctuations are normal for healing.

Rule #2 – If it hurts – STOP! Don’t do it!

Use common sense and caution with activity. You will be sore from the procedure. The harvest site from the back of the pelvis may be numb for 2-6hours. Muscle spasms from the harvest injection site are not uncommon. You should be prepared to have some aching or discomfort the first week. Use heat for muscle spasms and ice for inflammation. You may alternate hot and cold as needed. Use a cloth barrier between the cold and skin. Use pain as your guideline and limit activity early in your recovery. Deep breathing and stretching with heat can help with muscular pain. A compressive neoprene wrap for the effected joint is recommended as tolerated. Get up and walk frequently. MOTION IS LOTION!

Rule #3 – The Anti-Inflammatory Effect

The first week after a regenerative cell injection some people enjoy the anti-inflammatory benefit of the regenerative cells resulting in a dramatic decrease in pain. You must NOT overdo it. Use caution with activity no matter how good you feel. Your original baseline level of pain may return in a few days and most likely by the second week. This original level of pain is normal and may continue for the next month or so as the regenerative cells are beginning their regeneration.

You need your body’s natural inflammatory process to start the healing process to create the matrix in your tissue/joint as the regenerative cells begin to work. Therefore, DO NOT take anti-inflammatory medication (Motrin, Aleve, Naproxen, Advil, turmeric, curcumin, Ibuprofen etc.) for 1 month after injection if possible. Boswellia is okay to use as well as other nutritional benefits to help regenerative cells such as blueberries, green tea, spirulina, Vitamin D3 and Guggul. This will help inflammation without interfering with regenerative cells. If you are on a baby aspirin regiment, you may continue that. It is safe to take Tylenol (acetaminophen) up to 1000 mg every 6-8 hrs., not exceeding 4000 mg/day. Muscle relaxants and pain medication are permissible as prescribed by your doctor. Ice for pain and swelling.

Post Procedure Regenerative Cell Therapy Activities

Weeks 1 & 2 (after regenerative cell injections)

Leave the initial bandage over the bone marrow harvest site for 48 hours. It is normal to have a small amount of bleeding during this time. Replace the bandage if the dressing becomes soaked. Remove the bandage and clean with soap 48 hours after the procedure. Apply band aids. You may shower, but do not submerge your body in water for 48 hours.

Restrict yourself to light activity of everyday living. Try not to walk or be on your feet more than 30 minutes at a time for the first 24-48 hours. You may be sore, but it is better to move than to be sedentary. You may get back to your regular routine, but avoid any strenuous activity. Be cautious to avoid overloading (excess force on the affected joint), shearing (pivoting and twisting), or compression on the joint that was injected. Use a cane or crutch(s) for a lower extremity joint. The cane or crutch (if using only crutch) should be used on the opposite side of the injected hip. It may be used in either hand following a knee injection.

Limit lifting to 5 – 10 lbs. and avoid stooping and bending. Limit stairs unless absolutely necessary, and if needed, take them one at a time. For shoulder injections, lift no more than 20 lbs. for the first 2 weeks. Avoid excessive overhead or repetitive forward activities.

In the early weeks of regenerative healing, your body’s natural inflammatory process is creating a “scaffold” for the cells to bind. Therefore, no anti-inflammatory medications are recommended so the body can use its own inflammatory process to help with healing. Analgesic creams or gels (bio-freeze, Traumeel) can help with pain.

You can get into a pool once your injection site is healed (usually after 5 days). Walking in a pool is a nice way to get some motion and can unload the joints and be soothing. Use a kickboard, a buoy, or a noodle for support in the water.

Mild to moderate pain is acceptable for a few days, but severe pain is not. If your pain becomes severe or you cannot manage your pain with the above recommendations, you may call the office at 937-415-9100, ext. 331 for Sheila. Or, we have a walk-in clinic every day from 5-8pm, and Saturday 8-12 noon at 7677 Yankee Rd., Dayton, Oh. No appointment necessary. Finally, after 8pm you can call the hospital operator at 937-723-3200, and page the Orthopedic Associates of SW Ohio physician on call.

Weeks 3-6

After a month or so, we may refer you to physical or massage therapy to provide gentle exercise and manual release. Cold laser, ultrasound, and electrical stimulation (TENS) are appropriate for pain management. You may wear a compressive brace or support during activity if it feels good, but do not wear it when sedentary.

Avoid repetitive loaded exercises such as stairs steppers, running, or weightlifting. You may walk, use an exercise bike or elliptical machine or swim/walk in the pool. These exercises have minimal compressive loading on the joints. Give the new regenerative cells time to implant themselves in the healing tissues. Proceed with caution – increase activity within pain limits.

Maintain normal range of motion with gentle exercise. Yoga, stretching, mat Pilates, tai chi, and easy walking are perfect.

Continue to manage inflammation with ice and pain medications as directed if needed. If your pain persists and doesn’t to other medication and treatments, you may begin taking anti-inflammatories, but avoid them if you can.

Most patients will notice some benefits 4 – 6 weeks out from the procedure. Shoulders, knees, and ankle feel better the fastest. Hips may take longer, so be patient. Usually the most dramatic benefits occur between 3 – 4 months, as 80% of your improvement should occur by this time. The additional 20% improvement from the procedure usually comes between 3 – 6 months.

You may initiate light running on even terrain, a treadmill, or track. Avoid shearing, uneven terrain and hiking or difficult inclines. You may continue core stabilization exercises and begin increased resistance with weight lift – but still BE CAUTIOUS! Avoid compressive exercise, such as overhead press, calf raises with weights on the shoulders, squatting and prone hamstring curls. No kettle balls or clean and jerk activities.

If you are experiencing pain, back off activities and continue to ice.

Weeks 7 & 8

As long as you’re not having pain you can slowly progress to your normal workout, but NEVER to the point of pain in the injected area. Continue to increase core and joint strengthening for optimal stabilization.

Months 3 – 6

The regenerative cells are at the peak of healing potential. Help them help you by not overdoing it. Walking, biking, yoga, stretching and light weights are appropriate. Be careful with distance running. Continue to use caution with compressive activity, twisting, planting and pivoting, and overhead activities.

If you feel very little benefit after 3 months, you may consider a booster injection with PRP.