Vibration Plates, PRP & More: What REALLY Helps Your Joints? Ft. Leading Orthopedic Surgeon

0:00 What can people do to prevent joint degeneration?

0:03 Yeah, so let's define a joint.

0:04 A joint is just where two bones come together.

0:07 The The ones we think about most are our shoulder joint,

0:11 our knee, our hip, especially in midlife women and men.

0:15 So, when two bones come together, bones are actually pretty fragile.

0:19 And so, every bone is coated on the end with a layer of cartilage.

0:23 Cartilage is is white.

0:26 It's glistening.

0:27 It's smoother than ice.

0:29 It has a coefficient of friction that's less than ice.

0:33 So, it's so smooth, you don't even perceive it

0:35 moving in your joints until it starts to break down.

0:39 Cartilage itself is a matrix with some few scattered cartilage cells in it.

0:44 So, it's mostly scaffolding.

0:46 And the thing that makes it healthy is joint fluid.

0:50 Joint fluid that is not filled with inflammatory cytokines.

0:55 Joints are healthy when the cartilage do not

0:57 hasn't been worn down like a food grader.

1:00 Why would the cartilage matrix be worn down?

1:03 Well, there's so many reasons.

1:04 It could be due to high steroid use.

1:07 Maybe you had asthma.

1:08 Maybe you had cancer and have to have high steroids.

1:11 That's really bad for cartilage.

1:12 Maybe Or you abuse steroids.

1:15 Or you abuse steroids.

1:16 How about that?

1:17 Anabolic steroids.

1:18 Or maybe you were pre-Ozempic and carrying

1:22 around a couple of hundred extra pounds.

1:25 Joints bear 7 to 10 times body weight.

1:29 So, imagine 100 extra pounds,

1:32 it's like 1,000 extra pounds of pressure across a very delicate structure.

1:37 [snorts] And in the laboratory, when you want to damage cartilage,

1:39 you drop a marble on it.

1:41 It's very sensitive.

1:43 And so, maybe it was due to wear and tear of weight.

1:48 Maybe it's due to trauma.

1:50 Athletes twist and bend and bang.

1:53 And we get one sheet of cartilage on every bone for our entire life.

1:57 Once it's gone, it it can repair with a patch,

2:02 but it will never be the healthy cartilage we have again.

2:05 So, these are all reasons why people

2:07 end up with joint degradation, aka arthritis.

2:12 Before 50, men have more arthritis than women, a higher incidence of arthritis.

2:19 After 50, women will have can have a rapid progression in their arthritis.

2:25 In fact, get this.

2:27 There was a paper published in 1925, 100 years ago,

2:33 by a a researcher named Noble, documenting the arthritis of menopause.

2:39 100 years ago, That's insane.

2:42 someone started asking,

2:43 "Why do all these women in menopause have so much more arthritis?" Well,

2:47 it's because every musculoskeletal tissue, tendon, ligament, muscle, bone, fat,

2:55 muscle-derived stem cells, they all are cousins,

2:59 and they all have estrogen alpha and beta receptors.

3:02 So, if estrogen is not sitting in the receptor on the cartilage matrix,

3:07 it cannot maintain its integrity as well.

3:10 And therefore, lo and behold,

3:12 we have a rapid progression of arthritis in women in midlife,

3:17 of course, during a time when they're putting

3:18 on weight that they never wanted to have.

3:21 And so, we have that added pressure.

3:23 Maybe they're still not eating because they're

3:25 trying to diet their way to feeling better.

3:27 Maybe they hurt so much because

3:29 of arthralgia that they're not exercising because becoming

3:33 strong and moving your joints is one of the cures for my joint pain,

3:37 but it's counterintuitive.

3:39 If it hurts, don't move it.

3:40 Not true.

3:41 All the reasons that all of a sudden

3:43 women in midlife have this rapid progression in arthritis.

3:47 And then it slows them down.

3:49 And it's just one thing leads to the next.

3:51 Is it inevitable?

3:53 I mean, because we're living longer.

3:54 Is it inevitable that you will have joint pain and joint issues as you age?

4:01 [snorts] I think it's common, but not inevitable.

4:03 And I think it goes in degrees.

4:05 I mean, I I think having an ache and pain once in a while,

4:10 maybe that's inevitable.

4:12 Having pain that's so debilitating they have to sit in a chair,

4:15 I don't think that's inevitable.

4:17 But it cannot start when we're 60 or 70.

4:20 We have to be mindful from a very younger age and do

4:25 all the things that we've talked about in terms of keeping,

4:29 for instance, let's talk about the knees.

4:30 When people come to me with knee pain, I never just address their knee.

4:35 We always, one of the steps in my plan

4:38 for them is always to become strong as a bull.

4:42 The The The muscle support above and below the knee

4:47 has a critical effect on the impact that the knee sees.

4:50 So, they're always very surprised when I'm like,

4:52 "We're sending you to physical therapy,

4:54 and then we're getting you in a gym." Because

4:56 we are going to get you strong as a bull, and your knees will benefit.

5:00 So, to answer your question,

5:02 I don't think debilitating joint pain is inevitable,

5:07 but we have to start early on all the things we talked about.

5:11 Will we have aches and pain as we age?

5:13 Yeah, but not so much that they make us sit in a chair usually.

5:18 Right.

5:19 Well, also, I mean, you're you can damage your joints from overuse, too, right?

5:24 So, where is the balance then of Obviously,

5:26 you want to strengthen your muscles to maintain joint

5:29 health and do all the other things we've talked about,

5:31 but also avoid sort of, you know,

5:34 really minimizing that that joint fluid and and space

5:38 that kind of that cushion there in the joints.

5:40 You know, what's interesting is there there is

5:43 clear literature that even the impact of running,

5:47 long-term chronic running, does not speed up arthritis progression.

5:51 Running does not cause arthritis.

5:54 Yes.

5:54 That's good to know.

5:55 Yes, because that is a very common fallacy.

5:58 "Oh, you got to stop running." Well,

6:00 if you have trauma and your cartilage is damaged,

6:04 then the repetitive nature of a thousand steps a mile can make you feel worse.

6:08 But, long-term runners, running itself doesn't cause arthritis.

6:13 Probably for a lot of reasons,

6:15 one of which is is they're tend to be lighter people.

6:18 Mhm.

6:18 Right?

6:19 Mhm.

6:19 So, generally speaking, we don't need to worry about that.

6:22 If you're doing all the right things, If we're doing all the right things,

6:26 you don't need to worry that you're actually like wearing out your joints.

6:28 I would not know.

6:29 I would not stop being mobile because

6:31 of being afraid of wearing out your joints,

6:33 because what am I sentencing you to then?

6:36 If I say, "Why don't you sit still and don't wear

6:40 out your joints?" I am sentencing you to sedentary death syndrome.

6:44 We know that it's kind of like a societal mantra,

6:47 "Sitting will kill you." It's like smoking.

6:49 It's like smoking.

6:51 Yeah.

6:51 Yeah.

6:52 I want to talk about a couple things that are

6:53 sort of novel and interesting and people are talking about them.

6:58 What about vibration plates?

7:00 So, power plates, vibration plates, there is some small study data that it

7:06 can stimulate impact and build bone density.

7:10 Not as much as lifting, not as much as jumping.

7:14 Vibratory plates are great for engaging the lymphatic system.

7:19 They're great for involving your core strength in big compound lifts, right?

7:25 If your feet are firm on the ground and you're doing compound lifts,

7:30 even though it's hard, it's not as hard as doing those squats,

7:34 for instance, on a power plate,

7:37 because then you must engage all your small muscles to stay upright.

7:40 So, there's there's great value to it.

7:43 Value alone in building bone is not as strong from a research perspective.

7:48 Okay.

7:49 And what about PRP?

7:51 So, PRP is platelet-rich plasma.

7:55 We know that platelets, when you cut your leg shaving,

7:58 platelets rush to the s- scene of the crime in your bloodstream,

8:02 and they plug the hole.

8:03 But they're not just bricks in a wall.

8:05 They're sacks full of a variety of growth factors

8:08 that your body use to initiate the healing cascade.

8:12 So, what we've learned,

8:13 I started doing research on on platelet-rich plasma in 2000 in 2000,

8:18 when I was in the lab.

8:19 I know.

8:20 And I would just draw my own blood, spin off my platelets, cuz I had blood.

8:25 Why not, right?

8:26 Since that time, researchers have found that platelet-rich plasma

8:31 in a musculoskeletal system can be very effective for chronic tendon problems,

8:37 for rotator cuff tears, for moderate arthritis, for tendon and ligaments,

8:44 as I've said, like patellar tendonitis, tennis elbow, Achilles tendonitis.

8:50 But it is dose-dependent, and you have to know how many platelets you're giving.

8:55 So, the current literature points to needing 10 billion

9:00 platelets to to mount an effective anti-inflammatory and healing response.

9:05 10 billion.

9:06 So, that means wherever you're getting it

9:07 done needs to have the ability to count.

9:10 Otherwise, you don't know what you're getting,

9:11 and you don't know why it's not working, right?

9:14 And the science is evolving.

9:17 And but we do have enough papers to have meta-analysis,

9:20 with meaning a lot of randomized controlled trials,

9:22 then you compare them all in a meta-analysis.

9:26 [snorts] When I first started using platelets clinically,

9:27 we were doing 5 billion in three injections.

9:31 Well, the data evolved.

9:33 Now we know one injection of 10 billion is as effective.

9:38 My patients get about 80% relief for more than a year,

9:42 sometimes up to two years.

9:44 So, when we put the platelets into the knee joint, for for instance,

9:48 they burst, they release their growth factors,

9:51 start initiating an anti-inflammatory cascade.

9:55 And we believe that they call the stem cells from the synovium

10:00 into the milieu to start working because to heal a tissue you need cells,

10:06 you need scaffold, and you need growth factors.

10:09 So, the platelets are providing growth factors.

10:12 They're calling in the cells, and the knee has its own structure, right?

10:18 Yeah.

10:17 Are we to the end of the road

10:19 with research knowing how everything works precisely?

10:23 No, actually not.

10:25 But does it offer an amazing option if we don't want to go do surgery,

10:30 which most of my patients aren't looking for surgery?

10:33 Yeah.

10:34 And I've had great success with it.

10:35 So, I offer it.

10:37 right?

10:37 Like instead of an injection for pain,

10:39 which is just relieving the pain or inflammatory markers potentially,

10:43 it's actually creating more response.

10:46 Well, let's compare that, right?

10:47 So, I just told you that a dose of 10 billion platelets in my patients

10:52 and in the literature has an 80% efficacy

10:56 in relief of pain and can last durably.

11:01 A steroid injection, which is the go-to knee-jerk reaction,

11:05 which I rarely give, in the literature lasts 3 weeks.

11:10 And we don't really know what's 3 weeks.

11:12 Now, some people get a 6 months out of it,

11:15 but that is the exception, not the rule.

11:17 Yeah.

11:18 And so, the only time I use steroid injections is when people

11:22 do not want platelets or their joint is so damaged it's bone-on-bone.

11:28 We're just trying to buy some time getting them out of excruciating pain.

11:32 And then I'll do it cuz I'm not inhumane.

11:34 Right.

11:36 [laughter] Yeah, and I think the interesting thing about PRP is one,

11:39 there's definitely this lack of counting of platelets, you know?

11:43 And two is it's a blood product, and so there's no right you don't have to go

11:47 through the same regulation as like a pharmaceutical injection.

11:50 And so, anybody can really give it.

11:52 Anybody can I'm glad you brought that up, right?

11:55 And so, I I do worry and I tell my patients this too.

11:58 I think for for so people do this PRP for erectile dysfunction, however,

12:02 the data is mixed and because I think

12:04 we don't know the right amount of platelets, we don't know that you know,

12:07 there's still some some things that need to be figured out.

12:09 And so, yeah, could it work for the same reasons, right?

12:12 It's bringing growth factors and things like that.

12:14 Yes, it could.

12:15 I'm not convinced yet that I know exactly what to do, right?

12:18 And so, I'm not offering it.

12:19 But I think the issue is that yeah, anybody can do it.

12:21 At like anyone can give you PRP

12:24 without really even necessarily being trained on it.

12:27 Well, that's true.

12:29 And so, patients need to know who's treating them.

12:32 Are they board-certified doctors or licensed

12:35 clinicians at the very least board-certified?

12:38 There's a You know, there's all kinds of letters after names out there.

12:43 Lots of letters.

12:43 Lots of letters, and there are legitimate letters and there

12:47 are letters that I don't really know where they came from.

12:50 And I think if I don't know where

12:51 they came from that the public definitely doesn't know.

12:54 So, I just think people need to be careful.

12:57 Yeah.

12:57 Ask for the data.

12:59 Don't be sold.

13:01 People are very good sales people.

13:02 We were just talking about this at lunch before we

13:05 before we started that we're not good at selling things.

13:09 We're not taught in school.

13:10 There are so there are so many schools [laughter]

13:14 Well, that's not our vision that's not our mission.

13:16 Doctors are not um Not all doctors,

13:19 but we are not certainly looking to sell anything.

13:22 But yeah, I would say look, if I was getting something injected in my joint,

13:25 I would want it from an orthopedic surgeon or a PM&R physician.

13:30 Primary care sports medicine.

13:31 Yes, primary care sports medicine.

13:33 That's who I would look for.

13:34 If I had something injected in my penis, I would go to a urologist.

13:37 I don't have a penis, but you know what I mean.

13:38 So, you know, all those things I think it's really important to bring that up

13:42 because this is this is one of the things that's not regulated and won't be.

13:47 And there's going to be more in the future.

13:49 So, it's really important now, especially in the time of social media,

13:51 to be informed and to look at who you're who's

13:54 talking to you on the other end really really critically.

13:57 I Do you see this?

13:58 I see a little bit of turn where audiences want

14:03 to know what the qualifications are of the people speaking to them.

14:07 I've always seen it, but I think now it's more so like,

14:10 okay, just because you have the qualifications, they want a little more.

14:14 They want to know like, well, what does that even mean?

14:16 Which is good.

14:17 I think it's important for people to be discerning.

14:21 Um but also, I see the other side of it where they just see someone

14:24 who has a big following and is very eloquent and charming and they just say,

14:30 well, this person said this and Well, what's interesting Oh,

14:33 I'm I'm glad you were I'm going to sound all hateful and spiteful.

14:37 I'm not.

14:38 But I see a real difference between the challenges

14:41 that happen with female doctors and men online.

14:46 Mhm.

14:46 Doctors are not who who I I don't think there's as much scrutiny, frankly.

14:51 And I'm not trying to start anything on your podcast, but I observe it.

14:55 I'm on there every day observing who's who's being questioned and who isn't.

15:00 So, I don't think questioning is bad, frankly.

15:02 I think questioning is good.

15:03 I want to be questioned.

15:05 I want people to call me I've I've been wrong before,

15:07 I'll be wrong again, right?

15:08 I'm certain I will.

15:09 I'll misinterpret something.

15:10 I'll I'll not be you know, I'll mess up.

15:13 And it's the nature of medicine to do more research and to change.

15:17 Yes.

15:17 And I think the other thing is how you present information, right?

15:20 It's I think if you guys have listened to me

15:22 for a while or you listen to even this conversation,

15:24 we've not said things in absolutes unless

15:26 they were truly absolute and not harmful, right?

15:29 Like exercise is good for you.

15:31 It's not harmful, right?

15:32 We can say that in absolutes.

15:34 But there are certain things where like, yes, there are some data on this.

15:36 This is the data.

15:37 This is what we know right now and this is how we're practicing because of it.

15:40 And I think that's where you need to think there should be nuance.

15:43 Um because people are vying for your attention in such a way

15:48 where if you say a negative I just I actually just heard this.

15:52 Um if you say a negative thing,

15:54 if your title is negative, if you start with a negative,

15:57 people are like almost four times more likely to It

16:00 depends on the the topic or how you're doing it,

16:02 but they're significantly more likely to listen.

16:05 And so, it makes sense that people will find that pattern and say, oh,

16:08 if I say someone didn't tell you this or you're doing this wrong or you know,

16:13 something negative, people pay attention.

16:16 It's a survival instinct, right?

16:17 We want to know the things we should look out for.

16:20 The bad.

16:20 Yeah.

16:20 Yeah, that makes sense.

16:22 Mhm.

16:22 You actually on the PRP, you did a study on this.

16:25 You looked at using PRP before rotator

16:28 cuff surgery and that it actually improved outcomes.

16:32 It does.

16:32 It does.

16:33 And so, why do we think that is?

16:35 Well, it it was observing data.

16:37 It wasn't a causation study.

16:40 But what we observed is that by adding an adequate dose of platelet-rich

16:46 plasma to a milieu where you have put the tissue back together.

16:50 So, what if the rotator cuff This is the rotator cuff.

16:55 This is the bone.

16:56 What if the rotator cuff was still

16:58 torn and I dumped platelet-rich plasma in there?

17:01 Well, actually, there there is an anti-inflammatory pain relief

17:05 effect of that, but it does nothing to the tissue.

17:08 Cells don't jump.

17:10 And so, that paper showed that with repairing the tissue,

17:16 so we have the structure, right?

17:18 The scaffold we've talked about.

17:20 Adding the growth factors in the form

17:23 of platelets bursting and expressing their growth

17:26 factors helped the bone heal to the tendon

17:29 better because that's the direction of healing.

17:31 The bone sends out fibers to heal the tendon.

17:34 And that was augmented by the addition of growth factors to the milieu.

17:40 And so, in a repair where some data shows

17:44 that up to 40% of rotator cuff tears retear.

17:47 Mhm.

17:48 It's a lot and it's not due to surgical technique.

17:50 It's due to the fact that rotator cuffs have no blood supply.

17:54 And blood is key for bringing growth factors and cells to an area, right?

17:59 So, in an event where 40 a surgical response that 40% of the time it can retear,

18:06 the fact that we can simply add your own biologics

18:10 back to the system and see better outcome, that's a bonus.

18:14 That's a huge bonus.

18:16 Do you think Do you foresee a future where this becomes standard of care?

18:19 In many sports practices, in elite sports practices, it is standard of care.

18:25 Right.

18:25 It's not a standard of care of everywhere,

18:27 but almost everybody I know does it just cuz I come from a big

18:31 academic center and those are the the clinicians that I practice at that level.

18:38 It might not be available in some small space without a centrifuge,

18:42 not because it can't be.

18:44 Yeah.

18:45 It's just not.

18:47 Well, I mean, I I don't know I don't know the orthopedic training.

18:49 Is it something that everyone's trained on in in orthopedic training?

18:53 Um you know what?

18:53 I would say in the big fellowships there they see it, absolutely.

18:57 Yeah, but maybe a general orthopedic surgeon who's like

19:00 in a community taking care of everything would not necessarily see it.

19:02 If you haven't done a fellowship in orthopedics,

19:05 you can still go practice as a generalist.

19:07 You might not have seen it.

19:09 But if you've done a sports fellowship,

19:12 you are likely to have seen it because it's

19:14 a concentrated year of how to best take care of tendons,

19:18 ligaments, bones, that kind of thing.

19:20 If you guys like that clip with Dr.

19:21 Vonda Wright, make sure to check out the full episode right here.