What Is Regenerative Medicine? A Patient's Guide to Orthopedic and Pain-Management Protocols at Hew Health
Regenerative medicine is a category of treatment that aims to support the body's own repair processes rather than mask symptoms or cut tissue out. In an orthopedic and pain-management context, that usually means injecting biologic materials (your own platelets, for instance) into a joint, tendon, or ligament that has been slow to heal on its own. The goal is to change the local biology: more growth factors, better signaling to resident cells, an environment that favors repair over ongoing inflammation.
I want to be direct about what this is and what it isn't. These protocols are not miracle cures. They are tools we consider when conservative care has stalled and when surgery feels premature or undesirable. In our practice, patients who do best tend to have a specific structural problem, realistic expectations, and the discipline to follow through on rehab afterward.
How Regenerative Approaches Differ from Conventional Care
Most orthopedic care for a cranky knee or a stubborn rotator cuff follows a predictable ladder: rest, physical therapy, anti-inflammatories, a cortisone injection, and eventually a surgical consult. Each step has a role. Each also has limits. Cortisone, for example, calms inflammation reliably but repeated injections can weaken tendon tissue over time. Anti-inflammatories blunt pain but they also blunt some of the signaling your body uses to remodel injured tissue.
Regenerative protocols sit alongside that ladder rather than replacing it. Instead of suppressing the inflammatory response, they attempt to concentrate the growth factors and cellular signals that drive repair, then deliver them precisely where the damage lives. Whether that shifts the trajectory of a given injury depends on the tissue, the patient, and how the procedure is performed.
The Main Protocols We Discuss
Platelet-Rich Plasma (PRP)
PRP is the workhorse of orthopedic regenerative care. We draw your blood, spin it in a centrifuge to concentrate the platelets, and inject that concentrate into the target tissue under ultrasound guidance. Platelets carry growth factors including PDGF, TGF-beta, and VEGF, which participate in tendon and cartilage repair.
PRP has the most consistent published evidence in lateral epicondylitis (tennis elbow), patellar tendinopathy, and mild to moderate knee osteoarthritis. It is often considered for partial rotator cuff tears, plantar fasciitis, and hamstring or gluteal tendinopathy. Response is not immediate. Most patients notice changes over four to twelve weeks as the tissue remodels.
Bone Marrow and Adipose-Derived Concentrates
These involve harvesting a small amount of bone marrow (typically from the posterior iliac crest) or adipose tissue, processing it to concentrate the cellular fraction, and injecting it into the affected joint or soft tissue. The regulatory landscape here is stricter than for PRP, and the science is still maturing. We discuss these options selectively, when the anatomy and clinical picture warrant it.
Peptide Protocols
Certain peptides are used as adjuncts in musculoskeletal recovery, generally to support connective tissue repair or modulate local inflammation. We treat these as protocols with defined start and stop points, not as ongoing supplements. Candidacy depends on your history, medications, and the specific injury pattern. We do not present peptides as cures or as guaranteed to produce a particular outcome, and we monitor patients closely while on them.
Hyaluronic Acid and Prolotherapy
Not everything regenerative involves cells or platelets. Hyaluronic acid injections can be useful in certain arthritic knees. Prolotherapy, which uses a dextrose solution to provoke a controlled healing response in lax ligaments or tendons, has a longer track record than most people realize and remains a reasonable option for select cases.
Who Tends to Be a Reasonable Candidate
The patients we see benefit most from these protocols usually share a few features. They have a clearly identifiable structural problem on exam and imaging. Their pain is mechanical (it correlates with load, position, or activity) rather than diffuse or neuropathic. They have tried and outgrown basic conservative care. They are healthy enough to mount a normal healing response, meaning reasonable blood sugar control, no active infection, no untreated bleeding disorder, and no current chemotherapy.
Age is not a hard cutoff, but biology matters. A 62-year-old runner with early knee arthritis and good general health may respond better than a 40-year-old with poorly controlled diabetes. Smoking meaningfully impairs healing. So does chronic sleep deprivation, which we ask about more than most clinicians do.
Who Is Not a Good Candidate
Some situations call for something else. Bone-on-bone arthritis with significant deformity is typically a surgical problem, not a PRP problem. A full-thickness rotator cuff tear that has retracted needs a surgeon's opinion first. Active malignancy at or near the injection site is a contraindication. Pain that does not localize, or that behaves more like a central sensitization pattern, usually requires a different approach entirely, sometimes involving pain psychology, medication changes, or a formal pain program.
Part of my job is telling you when a regenerative protocol is unlikely to help. That conversation is more valuable than any injection.
What the Process Looks Like at Hew Health
We start with a thorough evaluation: history, focused physical exam, review of prior imaging, and often a diagnostic ultrasound in the office. If imaging is incomplete or ambiguous, we order it. Only after we agree on the diagnosis do we discuss whether a regenerative protocol makes sense, and which one.
The procedure itself is done in the office. For PRP, expect roughly 60 to 90 minutes from blood draw to bandage. We use ultrasound guidance for anything beyond the most superficial targets, because placement accuracy matters more than the exact preparation you use. Discomfort during and after the injection is common and usually manageable with acetaminophen and ice. We generally ask you to avoid NSAIDs for a defined window around the procedure so we do not blunt the inflammatory signaling that drives the response.
Rehab is not optional. The injection changes the local biology; loading the tissue correctly is what turns that into durable improvement. We coordinate with your physical therapist or refer to one we trust.
Setting Expectations Honestly
Some patients notice meaningful change. Some notice modest change. Some notice none. We track outcomes with the same standardized measures used in the orthopedic literature, and we tell you at the outset what a reasonable response looks like for your specific diagnosis. If you are not responding as expected at the appropriate check-in point, we reassess rather than reflexively repeat the procedure.
These are not one-and-done therapies for most conditions. A knee osteoarthritis protocol may involve a series of injections over several weeks, with a booster considered months later. A tendinopathy protocol may be a single injection followed by a structured loading program. The plan should be individualized, not templated.
A Note on Regulation
The regenerative medicine therapies discussed here are not FDA-approved and are offered pursuant to Fla. Stat. § 458.3245. We will explain the regulatory status of any specific protocol we recommend, in writing, before you consent.
The Bottom Line
Regenerative medicine, done well, is a thoughtful application of biologic tools to specific orthopedic and pain problems. Done poorly, it is expensive theater. The difference is in the diagnosis, the technique, the honesty of the conversation before the procedure, and the rehab afterward. If you are dealing with a joint or soft-tissue problem that has not improved with conservative care, and you want a clinician who will tell you plainly whether these protocols are worth considering in your case, request a consultation with our team.
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