In recent months, renowned footballers have been forced to stay out of the squad due to bone edema. Portu, forward for Girona, or Joselu, from Real Madrid, are just some of the elite athletes who, for various reasons, have suffered from this pathology. But regenerative medicine is advancing at the speed of light: the combination of focal shock waves (the most effective solution for bone edema) and platelet-rich plasma makes First Division soccer players take to the field like new ones and in record time. . We spoke with Dr. Freitag, an international reference in the application of this technique.
Sports medicine. In Spain, do we lack to understand the importance of this branch?
It is becoming increasingly important in our country for two simple reasons: the increase in sports activity at any age and the technological revolution that it is experiencing, which helps specialists to further personalize treatments.
What is bone edema?
It is a finding on an MRI, which translates into an inflammatory pattern in the bone. Let's say that it is like a “bruise” in the bone, which can arise from multiple causes such as sports injuries, degenerative (osteoarthritis) or ischemic injuries.
How does an athlete identify who suffers from bone edema?
The most characteristic symptom is acute pain that increases with physical activity and only decreases when you rest.
It is usually treated with physiotherapy and rest, why do they opt for focal shock waves?
For us, and for our athletes, the most important thing is to shorten recovery times so that they return to activity as soon as possible. Shock waves do that. They act as a very powerful anti-inflammatory, facilitating bone repair and reducing pain. It also protects cartilage against new injuries. This multilevel effect makes this technique a star indication. In athletes, shock waves were introduced a long time ago to demonstrate their high regenerative potential by attracting stem cells to the focus of injury.
How long does shock wave treatment last?
First of all, a warning: focal shock waves for this type of pathology can only be applied by a certified doctor. There are many patients who come to us because they say they have been treated with shock waves without success, but they are not the waves we use here, nor has a doctor performed the treatment. There are other types of waves that physiotherapists apply in other ailments, which is why it is very important, in bone pathology, to follow the protocol of the International Shock Wave Society, of which I am a member of the board of directors. In total, a total of 3 half-hour sessions are applied at 7-day intervals. It is very important to use a high-energy focal wave with ultrasound or fluoroscopic guidance to direct the wave to the focus and thus obtain a powerful biological effect. No side effects have been described with this technique, so we can ensure its effectiveness and safety.
What is the success rate of this treatment?
In our patients treated to date, success is around 80%. One of the most notable benefits is that the athlete can maintain training with gradual loads. The “return to play” times accelerate; a great advance for athletes who are in the middle of a season. That is why many elite athletes treat themselves to us.
It usually combines shock waves with platelet-rich plasma, why?
At Clínica DKF we have not only been pioneers in shock waves; Our way of applying Platelet Rich Plasma (PRP) is unique. We work with a Madrid laboratory authorized for its manufacture. Nobody takes into account that PRP was considered a medicine in 2013, and that we must be very diligent when infiltrating it. As PRP can enhance the effect of waves on bone edema, thanks to the biological effect of the growth factors contained in the platelet concentrate, at DKF we always apply this combined technique, ensuring short-term success.
What is PRP?
It is obtained by taking blood from the patient, which is then centrifuged to separate blood cells, platelets and plasma. PRP is the fraction of blood with a concentrate of platelets that, when activated, release growth factors and other biomolecules. These particles encourage the multiplication of cells that repair tendon, muscle and degenerative joint injuries.
We see an 'explosion' of PRP to treat hernias, alopecia, surgeries… Why?
Due to the regenerative capacity of PRP and its rich biological content, it is a technique that is being applied in many fields, such as reproductive medicine and aesthetics, with good results.
Will it be therapy for everyone?
I am sure that the development of PRP will continue an upward curve with new applications. For all? It is my wish.
What other biological treatments will we see in the future?
Early and personalized biological treatments. In the nearest future, we will see the administration of a specific growth factor for each tissue, be it tendon, muscle or cartilage. Furthermore, I also hope that our regulatory agencies will soon allow cell therapies, which will not only completely regenerate lesions, but will even form tissues identical to the injured one.
Profile
The elite sports doctor
He has been practicing medicine for more than 45 years. He began his career in rheumatology and later discovered his passion: biological regenerative medicine. Founder and director of Clínica DKF in Madrid, she is a specialist in shock waves, rheumatology and regenerative medicine. Beyond our borders, it has become a reference in the application of shock waves and in the treatment of degenerative diseases, through biological treatments and infiltrations in tendons and joints.