The role of physiatry in regenerative medicine: the past, the present, and future challenges

Historically, the foundation of physical medicine and rehabilitation training has provided the capabilities to optimize nonoperative treatments of a variety of musculoskeletal conditions, including acute and chronic muscle, tendon, ligament, and cartilage disorders. Such treatments include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic modalities (eg, thermal and manual therapies), and corticosteroid injections in conjunction with specific rehabilitation exercises. Although NSAIDs, modalities, and corticosteroids may be helpful for short-term pain reduction and early recovery of function, they do not typically reverse the structural changes associated with degenerative conditions and may contribute to worse long-term outcomes by potentially interfering with tissue healing. Regenerative interventions, including platelet-rich plasma and mesenchymal stem cells, recently have been used to treat refractory painful conditions such as chronic tendinopathies because of the potential of these interventions to facilitate tissue healing. The future development of these regenerative techniques will require a variety of conditions to be met, including determining the most appropriate procedures based on the disease being treated; establishing the optimal preparations of these regenerative techniques; and providing clinicians, patients, and regulatory agencies with high-quality evidence demonstrating the safety, effectiveness, and long-term results of these treatments. Clarification of current regulatory uncertainty, improved access for all patients, proper training for clinicians who incorporate these techniques into their practice, and determination of the most appropriate postinjection protocols will allow physical medicine and rehabilitation specialists to play a unique role in the long-term management of patients with musculoskeletal and sports injuries. This article will also address the role physiatrists should have in the inevitable growth of regenerative medicine applications.