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Expand your running knowledge, identify running misconceptions and become a faster, healthier, SMARTER runner. Let Brodie Sharpe become your new running guide as he teaches you powerful injury insights from his many years as a physiotherapist while also interviewing the best running gurus in the world. This is ideal for injured runners & runners looking for injury prevention and elevated performance. So, take full advantage by starting at season 1 where Brodie teaches you THE TOP PRINCIPLES TO OVERCOME ANY RUNNING INJURY and letās begin your run smarter journey.
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On today's episode, the science of stem cells and tendon healing. Welcome to the only podcast delivering and deciphering the latest running research to help you run smarter. My name is Brodie. I'm an online physiotherapist treating runners all over the world, but I'm also an advert runner who just like you have been through vicious injury cycles and when searching for answers, struggled to decipher between common. myths and real evidence-based guidance. But this podcast is changing that. So join me as a run smarter scholar and raise your running IQ so we can break through the injury cycles and achieve running feats you never thought possible. Chukwuike Guam joins me on today's episode. He is one of the authors of this brand new research paper titled Tendon Healing in the Era of Regenerative Medicine Literature Review. I came across this study and thought the topic itself was extremely fascinating. So reached out and I feel privileged that Chukwuike has agreed to come on and bring us up to speed on our current understanding of stem cells, how practical it is, how effective it is, how safe it is. And what the future direction is looking like around this topic of healing tendons or tendon rejuvenation. haven't covered stem cells on the podcast before, so hopefully you'll learn a lot. I know I did. Let's take it away. Thank you very much for joining me on the podcast. Thank you for having me. I want to set the stage with introducing you and your academic background and where you're from. So can we just start off with that? Okay. But first, thank you having me. Thank you for all the... uh viewers listening to this. My name is Chukwui K. Guam. It kind of be sort of a mouthful to pronounce my name, but I am a surgeon here in the United States. My academic background consists of I went to medical school at Howard University in Washington, DC. I subsequently got my PhD in molecular medicine and translational science at Wake Forest University. Also did a pit stop and got an MBA in Massive Business Administration. And then when I got tired of school, I decided to go ahead and complete a residency, a five-year residency in ortho- Right now I'm doing a fellowship in adult reconstruction as hip and knee replacements, complex injuries associated with the hip and knee. Excellent. Well, I did see in your email credentials that the business academics were in there. like, man, this guy covers a lot. So it's very impressive. Oh, thank you. The topic that we're going to discuss today is a part of the research paper that you helped publish. The title is Tendon Healing in an Era of Regenerative Medicine, a Literature Review. And we're talking mainly about STEM cells today, which is a topic I haven't yet covered on the podcast. And so for the uninitiated, those who don't necessarily have a medical background, they would have heard of the term STEM cells, but maybe haven't had a total grasp of exactly what they are. Would you mind just setting the stage by just giving people a brief explanation of what they are? So the best way to describe STEM cells is STEM cells serves as the building blocks. uh to help facilitate regeneration for all organs. As you age, typically when you're younger, most people have a large repository of stem cells, but due to aging, they tend to die out, the repository starts to dwindle a little bit. But it's really a harnessed regenerative capacity that each organ, each tendon, each tissue has. And all humans have stem cells, even when you're 99, 100%. The quality of the stem cells decreases with time, but it's certainly there. So I think that'll be the best way I describe stem cells and the most basic level is the body's repository or. cells that can replenish an organ that sits around a particular organ. Great. And so they would sit around a particular like a kidney and those stem cells are designed to if there is any kidney damage to start rejuvenating that that organ. Exactly. So it plays a critical role and there are different stem cells and different organ types. So muscles have what they call satellite cells and typically when you have a muscular injury, these cells will first of all, they'll proliferate and they end up in different pathways. So it can either create more inflammatory response to facilitate more blood vessels coming into the area to facilitate injury, to facilitate healing, or it can go a different route too and help modulate the inflammatory process. That means to kind of shut it down. It's super tightly coupled and it's very, very complex. And stem cells, when we talk more about the stem cells, I hope to explain to your listeners that's the true regenerative. potential has and really just upstart and harnesses the body's capability of healing itself. One thing that we know like me being a physio and seeing a whole bunch of people under the sun is like the younger people are they they heal really quick. Like when children break bones, it's like one thing, you know, you just like put them in a cast for a couple of weeks and they're good. Like and the older we get, the longer it takes for us to heal and get stronger, I guess. the decrease in quality of the stem cells would play a role in that? Would that be fair to say? Yes, it's more complicated, but yeah, for that specific component, that is the case. Healing, it tells multiple things. You have to, first of tell your body that there's an injury there. At a certain age, your body starts to ignore it. As you probably see, a lot of runners don't realize they have an injury until they stop running for a while. like, wow, this hurts. So just the pain receptor starts to dwindle down a little bit. Other parts too, it's just the body's ability to mobilize cells to come to the injured area. That gets harder as you age. When you have comorbidities such as diabetes, the body's ability uh to create blood vessel channels also diminishes significantly. But in speaking to the stem cells, that's another one too. So the actual number of stem cells that are available decreases and the quality of the stem cells decreases. Some of these stem cells undergo something called senescence. That means cells are incapable of divide for whatever reason. They stay there, they're loud, they're angry, they don't do anything. There's fat swabs in the organelles and just stays there. So it's a multitude of things and a lot of these things are just coupled with the overall health of the individual and also the age of the individual, unfortunately. And if we hone in on tendon healing specifically or tendon regeneration as the paper, the topic of the paper revolves around. What's the theory behind it? If we have like a tendonopathy or damage to the tendon, ah how are these stem cells collected? And then what are they injected around the area? What's the mechanism behind it? That is a good question. oh First, I'll take it back to understand there are multiple stem cells and multiple sites in which we collect these stem cells. um Some of these include things from skin stem cells that you can kind of see in the paper. Keratinocytes is what it's called. You also have uh Stem cells from fat, which tends to elicit a more inflammatory response. But for certain individuals, you can harvest it much more easily. And other ones, but it's much more painful for anyone who's had a large, bore needle uh used to aspirate bone from the iliac crest or from the hip. You can get that. That's a great site for stem cells too. The problem is with, how we create this. It's not standard. And the reason why it's called autologous stem cells, Every individual stem cells we've talked about before is different. So the capability of actually harnessing regenerative potential is associated and limited and hinged on by the individual's age, overall health status, sometimes ethnicity. Multiple things affects these things too. uh So some of the limitations in our paper, and I know we'll discuss a little bit more, we just find a way in which we can standardize how these stem cells are made and how they're delivered. Most of the studies that we looked at was to look at what we call in vitro studies or mouse studies where we control a lot of things. can control the mouse age, can control the horse age, or we can control the rat age, and we can also make sure that we're consistently getting stem cells from a certain part. But for actual humans like ourselves, like we talked about initially in beginning of this podcast, is that a repository and the quality of stem cells differ significantly and also changes too. When you're sick, it changes. Multiple reasons why it changes. And I guess if you're saying as we get, as we get older, the quality of the stem cells decreases. so probably how we're harvesting, harvesting them, where we get them from might impact our decision-making. Um, yeah, I did see that there was a bone marrow harvesting method to collecting stem cells in the paper, which does sound quite painful. Yeah. Yeah. And the yield, the hardest part is the yield and the ability to take out a large amount decreases with age. That's another one too. Okay. What about these like skin stem cells? Are they just stem cells that just are they on the surface layer of the skin like in a deeper layer and you just like put a needle in extract it and like, I'll just have it way. There are actually just skin stem cells keratinocytes on the surface of the layer. So it's really, really hard with that one to get the stem cells to function. What we have been able to see is a Nobel Prize laureate he got a Nobel Prize in 2006, Dr. Yakanama. And this is where the excitement really comes from, is he was able to take those cells and turn them into essentially embryonic stem cells. So when you think Dolly the sheep, all that stuff, that's what he was able to do. I'll go back and talk about embryonic stem cells just a little bit. That's always created large ethical concerns because in harvesting those, it usually terminates the pregnancy. It created a lot of political backlash, rightfully so, had a lot of ethical issues. The reason why this individual, Dr. Yakanama, won a PhD, because he really just opened the floodgates of what stem cells can do. In the early 2000s, we almost closed the door on that, scientists, because the ethical nature of harnessing these true stem cells, embryonic or pluripotent stem cells, that's number one. So going back to the skin stem cells, the hope is to be able to take them, harvest them in a petri dish, and also induce them back to an earlier state, so it's pluripotent, and then change them into a particular particular type of cell type that can facilitate tenocytes. We are not there yet. Unfortunately, it's a couple of decades, maybe 10 years or five years until we uh master how that is done in a consistent way that we can uh increase the economy of scale and get it out to patients. But the theory is there. The theory is developing. We just need to find a way in which we can harness this. We can find a way in which we can standardize these for patients with different types of injuries. And then once we harvest these stem cells and we're having the focus of tendon regeneration, are you just like injecting them within the tendon, around the tendon? Is that how the process works? So the hope is this. ah stem cells are not a magic bullet. oh We're all excited, but it's not a magic bullet. I like for your viewers to see it almost as an argument, as an adjunct. So typically, somebody comes in, let's say with a patellar tendinopathy. You can go ahead and try physical therapy first if that doesn't work, if you have a full patellar tendon tear. What we are thinking about what the data kind of shows is try to repair that obviously surgically and then augment it with some biologic and the stem cells. The data once again, we talk about if you're using autologous stem cells, it's very, very hard because we don't know the quality of the stem cells for each individual, but there's some promising results for that. So to answer your question succinctly, the way we try to deliver it to a particular injured organ or a particular injured tendon is to continue what we have been doing and just use it as an argument. One of the other sites that we have done too before is for, there are some clinical trials looking at ootibial band tendonitis and looking more so a PRP injection in that area and also some BMAC or stem cell injection in that area. But that's almost always supplemented or uses an adjunct to physical therapy. Stem cells at the current moment is just not capable. We're not capable of making sure that the stem cells differentiate into what we want it to differentiate into and also ensuring that the quality of stem cells for each individual person is sufficient enough to facilitate healing. I just finished reading uh a promising paper on collagen and vitamin C supplementation for tendon healing. And one of the key takeaways was Sure. It shows that there could be some improvements in tendon stiffness, tendon thickness, healing, but it needs to be paired with loading, like the timing of it 60 minutes before working out because the body needs the stimulus to be like, okay, we need to heal this tendon through load. This needs to get the adaptation signal and then time it with the said supplements. maybe like I say, it's still early days in terms of stem cells, maybe that's required, maybe that that signal is required in, you know, in line with some of these biologics. guess when you say biologic, are we referring to just injectables with the injectables obtained from a patient? And just to speak back to tendons, tendons are peculiar in every and different from every other organ in the musculoskeletal system. And that it's very, very dependent on a biomechanical environment. that is around. As you probably all know, tendons are attached to muscles for your viewers and they cross the joint most of the time. um It gets stronger by eccentric loading for your viewers is when pretty much you're contracting the muscle and you're lengthening the tendon. And that stimulates certain growth factors to get it to work and modulates inflammatory area. You have overuse disruptions when you have an imbalance. We talk about running from the posterior anterior chain. You have different tensile forces consistently in the tendon. Tendons are a little bit different as opposed to, this is a discussion about kidney regeneration with stem cells would be a little bit different because it's more so consistent. We can have the forces or the variables in kidneys or something else is more so consistent with tendons. There's so many factors associated with tendons. With tendons, how it maintains its homeostasis, how it supplies itself, for example. So it becomes a little bit more challenging to implement stem cells, but. according to the paper that we've published, there are some promises there. Just to belabor the point, the major limitation that we're seeing here is standardizing these therapies. Okay. Going back to the paper, it is a literature review. So would you mind walking people back and explaining what the design of this paper is like and how you constructed it? Yes, so in the lab that I worked in where I got my PhD, I was more so interested in utilizing biologic stem cells, all types of stem cells to address some of the mescal skeletal problems. The reason why is bringing back my MBA hat is first of all, it's cheap, you're taking your own patient cells, you're not taking anyone else's cells. It should be theoretically, once we figure it out, easy to harvest, you usually grab it, spin it down, spin it down, spin it down, and inject it back in. And it seemed like a way in which you could address a lot of these problems. In doing so, and just trying to think about it, one of my partners, Dr. Agun-Sala, who works in the same lab, first asked ourselves, first of all, what does the literature say about this, beginning? What do we know? So we limited our study from 2015 to 2025. As you probably know, science moves fast. We didn't want to get studies from prior to then because we weren't sure if they were accurate right now. And then we reviewed, all the authors reviewed 1,800 manuscripts and we identified a total of about almost 100 in... 50 manuscripts that talked about uh stem cells, particularly with tendons. What we did first of all was to try to understand the biomechanics of stem cells, how it worked, I mean, I'm biomechanics of tendons, how it worked, how it functioned. And then we started to peruse the literature on different types of stem cells and how they may be applied. So we talked about things like skin stem cells or stem cells finding your teeth, which is another amazing supply. Stem cells in the hair, which is not in the paper, stem cells in the bone. Stem cells in the actual tendon, which unfortunately is probably of limited, is usually of limited supply. And then look at some of the stuff from Dr. Yakanama's work in 2006, where he got the Nobel Prize and just seen the full potential in theory that we see in a lab of stem cells. What we saw is unfortunate, most of the studies were animal studies. We saw studies such as patellar tendon injury model for mice, horses were involved, and there were a few clinical studies that involved a rotator cuff. What we saw consistently when we look at histologically that's looking under a microscope. We saw improved collagen organization, which is amazing. That's what we want. Improved tensile strength, the ability to pull the two ends together and remain oh one component. But unfortunately, in all the mouse models and animal studies, we didn't see a consistent improvement in what we consider oh clinical outcomes. And that is for multiple reasons. Again, we talk about the tendon being a peculiar and somewhat different organelle, I like to call it organ, in that it has multiple variables that is involved in its health and in its function too. And also the overlying muscles too that are involved too that the paper didn't really talk about. Typically when you have a tendon injury, you probably know this too, the muscle tends to stiffen, you start to get fibroids, scar tissue. So even if you have an improved tendon, muscular structure you start to undergo atrophy, the whole uh muscular tendinous unit starts to change a little bit which can affect outcomes. So our study finds this, pretty much our study, uh it's pretty heterogeneous and they looked at different species and humans too and the results though promising was not consistent. So like you said there's a lot of potential in theory for where this field is going and there's the lack of standardised with like standardisation with what type of stem cells. And obviously you said there's a lot to do with animal studies as well, which can be tough. mean, you mentioned that the healing methods that they used was looking at the collagen fibres and seeing whether they're aligning or if they're still disorganised or what the tensile strength of that tendon is. But if you're doing say rat studies, you can't necessarily look at pain. and, you know, subjectively ask them. So uh it seems quite limited in that sense, because I think pain would be a lot on a lot of people's minds when it comes to an outcome. uh But like we say, can be quite complex and tendons are quite complex in nature as well. uh Was there anything that was surprised you about these studies? uh Or like, based on your prior knowledge previous to this paper? Was it, uh you know, non surprising? ah I think what surprised me most is when we were reviewing and when we decided to kind of limit the scope of the study to 10 years, you can see an almost predictable explosion in interest in stem cells. m And I think that is somewhat coupled with the interest from uh large financial institutions, investments into stem cells, into that. A lot of that thing has to do with a lot of it, think is warranted. And the studies kind of touched on it too. Again, with Dr. Yakanami, I bringing up his name, discovering that we can take any cell in the body and bring it back to almost an embryonic state. I mean, that's a huge potential. We're talking about just tendons, we're talking about full organ regeneration if we're able to truly harness it. the interest is definitely, that's the first thing. um The second thing, which I expected was more so sobering. um We're unable, even in human studies, there's one study, elective rotator cuff and shoulder improvements, but after six months, there was no difference. We're unable to consistently clinically show improved outcomes. And what's not written in our narrative review, but it's inferred from those who understand this, is that everyone's stem cells repository and efficiency is not the same. And that's what severely limits the consistency in outcomes. ah I can imagine theoretically speaking if we got the healthiest of the healthiest stem cells and we could just harness it for every individual, we start to see improved outcomes. That's just not the case. oh It's when we deliver them, we don't know the appropriate dosage, timing is important. After every injury, the body naturally goes a catabolic state, so it just breaks things down regardless. Stem cells are in a niche opportunity to regulate it at that moment and we can't control when the stem cells decide to act. So those variables, found the lack of outcomes I thought was sobering, but I expected that improved outcomes. Something else I also found interesting too is just being reminded of the science behind it. How much stem cell repository we actually have. Even as we age, we have a huge storage relatively speaking. for each individual, we have a huge storage of stem cells all over our body. Now, the quality of it, I talked about it before, we can't really speak to, but the bone marrow has quite a bit of stem cells. We have that in our teeth, we have it in our skin cells, we have it in carlis, we have it everywhere. So that's the stuff that really just opened my eyes up and makes me a little bit excited for the future. Maybe not for me, but maybe for my kids and my grandkids. They're gonna have a great life. They'll have their favorite athletes paying to play until 60 and 70. Like you say, if there's a big boom in interest and funding and studies and those sorts of things, then hopefully it just continues building momentum. When you talking before about harvesting some of these stem cells, say from your skin and almost converting it back to an embryonic state. Is that what they're doing currently? by the sound of it, you're talking that was just theoretical or are they? That is what they are doing currently in labs. It comes at risk. So when you get an embryonic stem cell, a stem cell in any state, it can transform into anything. And the biggest thing it transforms into something we're concerned about is called a teratoma. If you see a teratoma, challenge to viewers to Google it, it's very disgusting. It's a ball of just organelles, just its teeth, its eyes. And sometimes you can see in a pregnant woman in a failed pregnancy, teratoma is formed. And because we can't control the injury area, because we can't control the local environment, can't, right now we just don't know enough of the signaling processes that would direct. the it's called induced purple stem cells is embryonic cells. We don't can't control which way would differentiate. And that's where the science needs to catch up a little bit. ah But sometimes it does differentiate like sometimes it does go back to the embryonic state. uh So it always goes back to the embryonic state but in the the process of healing for an injury, gotcha, we're unable to control differentiation to the necessary cells for healing. can become cancerous and sometimes it does. That gives us a lot of pause. I did see that as one of the risks, the tumor formation, that could be uh a risk. And so when they had these studies, like you say, these human studies, when they looked at the rotator cuff, this was their attempt. They've tried um getting back to the embryonic state and then getting it to regenerate these tendons and then seeing inconsistent results. uh That's a little bit different. that one's because clinically it's somewhat unethical to use it now because of that associated risk factor of teratoma. What they did is something called adult mesocomal stem cells. So it's going back to what I saying before. We have stem cells typically just laying around in most organelles, most musculoskeletal systems. So it's using that, it's spinning that out, harvesting it, augmenting it, and then re-injecting it at the... at the time of a rotator cuff repair. that, as you saw, you probably see from our results, what we talked about in that study is that patients in the first six months did better. Stronger tendon for the rotator cuff, improved outcomes for the first six months, but going over a year and a year plus, there was no difference in outcomes. I'm just Googling teratoma now. I'm just looking at the images. It's fairly, yeah, fairly disgusting. Yeah. Okay. Thanks, Fair. You know, bring us up to speed on that one. You mentioned the challenges and the limitations of these studies. You mentioned the lack of standardization and, you know, somewhat limited to animal studies and those sorts of things. Any other limitations or challenges that you had with finding papers and articles on this? I think... The biggest one is, I would say, is obviously conflict of interest. You can tell as a scientist when a specific agenda is being pushed through a paper is usually when there's a lot of hype in the paper, certain words, that the results don't really match up. When you actually look at the numbers, not the words, but the numbers, oh it's trying to sift through that and just making sure we're giving readers an objective outcome metric. And if you see a lot of our tables, just, know, bare bones. This is what they did, and this is outcome. To be honest, mean, stem cells are exciting. I it goes back to the age old thing where, I mean, we all want to be young again. And that's ultimately what it can lead to. It's very exciting. A lot of people naturally give a lot of money to our work in the hip and knee world, where we're arthritis. And there are patients that come in all the time asking for stem cells. And you have to be my hey, it's not there yet. I mean, can charge you $3,000 for this, this is not going to work because we know the stem cells in your body is not going to be capable enough to regenerate cartilage as opposed to control setting. the lab. So I will say that'll be the most interesting trying to sift through that it's very hard. It's very hard to read and control biases, identify biases in your own biases. mean, I wanted to work. It's amazing. ah But just be able to report the literature as is and give our readers something as accurate as possible just focusing on the data. appreciate that. Like there are some studies out there where I know the authors and I know like there are, they are a surgeon that does surgery on certain types. And this is like a topic about how successful surgery is. And I'm like, there is a conflict of interest there and it's, but it's so hard. can imagine myself being a surgeon or being like have a real specialty and writing a paper on how successful my treatments are. it's gonna be extremely tough not to even unconsciously seep in some of your biases in there. And so not only for you going through those reviews, but like you kind of have to have some inside knowledge as to what might be subject to bias and not. And so yeah, I can imagine that could be extremely difficult to work through. Especially like you say, this is the hype, this is like the promising new thing. And a lot of people would get a lot of accolades for coming up and uncovering this new frontier and you know, can lead to a lot of popularity. So there are incentives there. Yeah. All right. So review. mean, it's it's when you have multiple people looking at something, then you would hope most papers before they publish have three or four reviewers. And also all the authors on our paper, you would hope that one of us steps up and says, Hey, like this looks right. This seems a little biased. And that's typically what happens in science. If you're if you're if you mentioned um So there seems to be no promising data right now about long-term effects. Did you mention something along the lines of like within six months, there was no difference? So yeah, that rotator cuff study was a clinical study that looked at mesocomal stem cells and augmented uh rotator cuff repairs. It's called single-row rotator cuff repairs uh for small tiers to medium-sized tiers and augmented with a biologic specifically mesocomal stem cell. At the first six months, the patient subjectively felt better and had better functional outcomes in the first six months. As you probably know, rotator cuff recovery, repair recovery takes quite a bit of time. It usually takes a patient to the order of a year to regain some sort of strength back in like full function or maximize their function. And while it almost sped up, and this is almost something we see consistent, and I'll explain a little bit more, but while it almost sped up the initial recovery process, the final outcomes are the same amongst all groups. And the reason why I think this is the case is that mesocompost cell cells does a really good job of policing the inflammatory state. um If more than anything else, I want your viewers to take that. It's just consider it as um almost a crosswalkers of like, when in school you had a crosswalk person um that guided you to go across the road. It almost acts that way, it almost regulates inflammatory response really, really well, turns on certain, um turns on certain cells, certain white blood cells turns out certain white blood cells, and helps to regulate the whole healing process. So our theory behind it, my theory behind it is it helped to do that a lot quicker, as opposed to those who didn't receive it. uh But the body eventually figured out what to do. It just helped like sort of accelerate that those initial phases those initial inflammatory phases. Yeah, exactly. Which could be a good outcome for people. if they had a method, sure, it might be quite pricey at the moment, but just say you have like an elite athlete who wants to uh have the first six weeks being less painful and more function that might lead them to be doing their rehab more effectively, which might lead to, I guess, yeah, better outcomes. don't know. Most of the athletes that I'm aware of. from the sports that's hanging out now, get some type of supplemental biologic for that reason. They gotta get them back quicker. I would say when it comes to like, I know we're not talking about PRPs, play-liverage plasma, for certain tendinopathy's they work really well, help you get back. So, and it's one of the things like, it can't hurt you, right? If it's your own stuff, it can't hurt you, can only possibly make it better. So most people get, most of the wealthy athletes will get that, but it is pricey and the literature is... like this right now. So that's why a lot of us don't recommend it. Most patients are, don't have a $50 million contract a year. get cell therapy. So yeah, the, uh, yeah, when you're talking about the cost effectiveness of it, of like getting this stem cells, just extracting it from the body, you know, uh, spinning it around, extracting out those and harvesting those cells and injecting it made me think of the PRP as a method because that's exactly what they do. They spin it, they extract it. And then they inject it back in. Are ah you, you've sort of just mentioned that there, if we talk just briefly on PRP, are you up to date on the, well, the general consensus is around PRP. Cause like based on my understanding, it's stumps some studies show some promise, but if we sort of grab the whole literature that's out there, it seems a bit hit and miss and not exactly promising. I'll be cautious, but more. And PRP works in certain groups of patients. There's one study that compared PRP to placebo in patients with mild to moderate neontylphritis and saw an improvement in placebo when compared to placebo group. The problem is we have something better than PRP, and that's the cortisone injection. PRP is expensive, but it does work better than placebo. Tennis elbow, you probably heard. It works pretty well with tennis elbow. It doesn't work better than physical therapy, but if somebody doesn't want physical therapy or wants physical therapy and PRP, it does work. And another big thing is too, chronic tendonitis. It helps pretty well, especially chronic patellar tendonitis when you supplement it with physical therapy. Again, the problem with this is PRP, when we talk about stem cells, that's one thing. When we talk about platelets, platelets are, if you sneeze funny, platelets act differently. platelets are highly variable. The coagulation cascade, it changes for, and there's multiple studies that show like when you're sick, platelets become more inflammatory than when you're in a healthy state, determined by your mood, how you sleep. And I'm not exaggerating what I'm saying. It becomes very, very difficult. But as a whole for those three groups, it works pretty well. The problem is that for most of them, we have other therapies that are cheaper. It works either just as well, or it works marginally better. It doesn't really justify the cost. I did have a question written down about, okay, what are the practicalities of stem cells right now, as we understand it, like a people like doing this in practice. You sort of mentioned that it is being done around the world, but it seems like mainly for the elites because it's extremely expensive and maybe not that regulated in certain countries. Like, do you, do you know like what, what the current practicalities and protocols are for stem cells? Well, outside of musculoskeletal injury, obviously, is treatment of cancer, particularly like bloodborne cancers. There's some promise with that. um There's some evidence that stem cells may play a role in individual sickle cell disease in which you have to almost do a transfusion, take all the sickle cells and replace it or do some type of genetic therapy. Maybe it would help with that. um In musculoskeletal injuries, most of all muscle injuries. I would say there's more evidence to that, that it can help there too. So stem cells do a great job of releasing growth factors. The problem with growth factors is some parts of the body doesn't know what to do with that. It doesn't know what to do. It just creates more inflammation. But a part of the body that loves anabolic factors is skeletal muscle. So there is some evidence, particularly with muscle belly injuries, that it may be able to facilitate and help a little bit more. And that is still very preliminary. There's other things too you probably heard is associated with this too, like blood restriction therapy, et cetera, et All of that does is really just activate and harness the effects of stem cells and vascularity. So there is some evidence that it may help with musculoskeletal, I'll say more so when dealing with the muscle as opposed to the muscular tendinous unit or even joints. That there may be some potential for stem cells there. Okay. So it is being done. in certain nations, certain specialties around the world? ah Yes. So I know Europe, for example, uh more people are starting to explore with that. Even the United States, unfortunately, it's just very cost prohibitive. the results, the problem is the results are not reliable. So I know one big one recently was the use of a neon streptoesthetics and it was somewhat promising results. don't want to say the manufacturer's name, but they did, uh, they took fat from the belly, from adipose tissue and they did it in clinic. I was part of this when I was a medical student. You just take a large syringe. It almost looks like you're doing a BBO. Take a large syringe, you spin it down and you mix it in the clinic and you pop it in the knee. And surprisingly, a lot of patients say they would be feeling a lot better. The problem is that costs about $5,000. A cortisone injection costs us about $200. It's just It didn't make any sense, but there is some, there's some useful, I don't want to say there's not any use that would be disingenuous. It's just, it's very cost prohibitive and we have equally good or maybe slightly worse, but equally good alternatives. Um, use the word like potential a lot in this conversation, cause it seems like while we have something that can be just as effective. and more consistent and more reliable and more studied, I guess, um of like other injectables like PRP or cortisone. um The potential that stem cells can lead us down, like once we get, learn more, get more consistency, um seems like it has the potential to far exceed PRP and other cortico steroid injections once we know more. Would that be fair to say? Yeah. Yeah, I will say that. And for your viewers, I want everyone to understand like the stem cell market and the understanding of stem cells. So at least in the United States, there was a very strong political push against all stem cell treatments from the late 90s to early 2000s. This really exploded in 2006. So I'll say it's really only 20 years old. I know we're all like really pushing this, but if you even look at the plane, for example, with the Wright brothers in 1914, 1916, people were working on it. 50, 60 years before the eye drops and then they kind of like get this thing up and moving. So with kind of the stuff we have going on with AI, for example, allowing us to process more information quicker with more proteins being coded, more DNA, understanding of DNA codons and how it translates as proteins and other things. Once you understand human physiology a lot better, we finally have the machinery in which we can tinker with these cells. It's almost like play putty, tinker with the cells. created into anything. And I was listening to uh one of the scientists out of Harvard, and he talked about we're one or two generations away from longevity, from living forever for these reasons. the basic work, the science is there. It's just very, very, very young. I know we're all excited about it, but it's about two decades, I will literally say it's about really two decades, where the scientific community, two or three decades, scientific community started putting a lot of effort into this. Yeah, I think that's good to know. um And just so, uh viewers aren't too confused when you're talking about the steroid injections and those sorts of things just being more effective. uh Is that around osteoarthritis? You mentioned like knee osteoarthritis for a few of these cases, because to my understanding, like injectables like a steroid into the tendon itself, instead of someone who has like uh inflammation around the tendon or a Tino sinusitis or something that they inject around the tendon when there's inflammation instead of into the tendon. uh My understanding is like into the tendon isn't really that effective and can have some risks like tendon rupture and those sorts of things. Do you know much about that? Yeah. So, that is correct. And thanks for, I'll just clarify a little bit. So when I talk about cortisone injection, I'm talking more so about joints. There is a very real risk, especially in the lower extremity with uh cortisone injections with tendon rupture. And that goes back to the biomechanics of the tendon and also that the natural eccentric force that it naturally feels. uh Cortisone, what it does, it increases catabolism or breakdown and then quiets the diseased tissue area. When you don't have that pain regulator and you also have a weak tendon, you can imagine someone saying, I feel great. They get up and do an eccentric load, trying to jump, trying to run, then you hear a pop. So it's certainly associated with that. And for that reason, there are other things. I think the biggest thing you probably know as a physiotherapist is literally physical therapy. The eccentric loading. after you try to heal, if you have like a partial tear, eccentric loading helps that a lot um in a controlled manner. And that has to do with this really just opening up or waking up the stem cells around it, the certain growth factors that stimulate blood vessels to grow into the tendon. oh And for right now, it's very, very hard to say definitively where stem cells will play a role into that. But when we talk about in the role of regenerative medicine, we know if we can regenerate anything, oh certainly uh tendons are one of them. And that's the theory behind it. Great. Appreciate you sharing that. Cause I get a lot of emails about, Oh, I want to do my tendon rehab. know I should be loading it, but scans show that I have very small mild tears and you know, I do I need surgery and those sorts of things. I like to remind people like if it's a small tear, like it's treated exactly the same as a tendinopathy without a tear because the tendons do have the ability to get really strong and really functional if you just put it through a strengthening protocol. So I appreciate you highlighting that. And you're obviously extremely knowledgeable on all things, biologics and injectables and um very up to date with the current understanding of the stem cells. Are there any? final takeaways or things we may not have touched on any misconceptions we haven't yet discussed that you think listeners might need to be aware of? ah Yeah. So when it comes to stem cells, I, I'm really optimistic for stem cells. I don't want to be a cynic about it. I know it's very sobering and as a scientist, you just kind of have to not be biased and just give it as it is where we are now. But I the viewers to know there is a lot of promise into this and uh what typically happens is First is the scientists in the laboratory have to kind of figure it out. And then once you get that there, the scientists have to be able to figure out a way to translate it. And we're at a point where we're trying to figure out the two parts of that is first of all, how do we make this work? How do we make this work consistently? How do we control what it turns into? And even if we do that, who are we getting this from? How do we make sure to standardize this? How do we monitor this and post surveillance once we get this stuff out? How our federal government or how our institutions are gonna monitor its work? For your viewers to know that it's not just the medicine or the science that has to be up to date on par and we're getting there, we're moving as fast as we can, but it's other bodies too that has to understand how we're gonna watch this and prevent people from marketing it the wrong way and making sure that it's standardized. And that takes a larger community outside of just the scientists. We'll keep our finger on the pulse and see what emerges the next couple of decades, but. Right now it's good to get a honest recap on what our current understanding is and the fact that you can speak so candidly and it seems come across as very unbiased and very honest. It only just puts more trust to your word and your level of expertise. So I appreciate all the work you're doing in the field. And I didn't bring this up with you prior to recording. So um one thing I want to ask is Are there any like, are you active on social media? Like if there's audience that want to learn more about you or anything that you're putting out there, are there anything I can add in the show notes for people to learn more? Oh yeah. So, I, if can find me on Instagram, uh, it's Chukwui KG. Sometimes I highlight some of my studies on there. It's my first name, underscore G. Um, I highlight some of my studies on there and I also have a link to some of the stuff I'm working on. Uh, a lot of the stuff I'm interested in is in two realms is in healthcare equity. ah Just making sure that people get the best that medicine has to offer, all groups of people. And the other part I'm working on too, speaks to the words of my degree, Molecular Medicine Translational Science, is finding a way we can take some of the insights, some of the things that we learn in the bench, in the scientific bench, in the laboratory, and translate it in a way that's meaningful uh for patients, and also just make sure that everyone who needs it can get access to it. So that's... That's kind of my two things that I do outside of just being a surgeon. I'll be make sure to leave that link, your Instagram link in the show notes for people to follow you. um Like I say, thanks for coming on. Thanks for your time. Thanks for the great work that you're doing and appreciate you coming on. Thanks for having me. If you are looking for more resources to run smarter or you'd like to jump on a free 20 minute injury chat with me, then click on the resources link in the show notes. There you'll find a link to schedule a call plus free resources like my very popular injury prevention five day course. You'll also find the Run Smarter book and ways you can access my ever growing treasure trove of running research papers. Thanks once again for joining me and well done on prioritising your running wisdom.