An Interventional Spine and Sports Medicine specialist explains stem cell treatment’s reparative promise

By Matt Scanlon • photos by Alex Barreto

It requires only a quick walk-through Physio Logic’s second-story office space, roughly at the corner of Willoughby Plaza and Brooklyn Bridge Boulevard, to gather the sense that efforts have been made here to turn off the intimidation factor when it comes to sports and reparative medicine. The walls are not blank white, exam rooms are not the sterile adventure in “Here is Your Spine” wall chart boredom, and the rehabilitation areas are not windowless crypts. Instead, there’s bamboo flooring and floor-to ceiling windows, and palettes are an engaging counterpoint of autumnal hues and the occasional bursts of black and purple. Then there is the Saturday Night Fever poster and other homages to the ’70s highlighting the bathrooms.

Just a year old in its new location after moving from Remsen Street, Physio Logic has taken advantage of its larger space to expand treatment areas, and staff. New this year are two full-time MDs to complement practice areas of orthopedic rehabilitation, spine and sports medicine, integrative health and wellness, and Pilates and movement: Dr. Robert E. Graham, MD, Integrative Medicine Specialist, and Dr. Shady E. Hassan, who specializes in Interventional Spine and Sports Medicine.

A Board Certified Physiatrist with a fellowship in Interventional Spine and Sports Medicine, Dr. Hassan was born in Saudi Arabia but grew up on Staten Island, and completed fellowship training at Alabama Orthopedic Spine and Sports Medicine Associates and the famous Andrew’s Sports Medicine Center in Birmingham, Alabama. Prior, he completed residency training at the State University of New York, Downstate, serving as chief resident in his final year.

A treatment offered by Physio Logic that is rapidly gaining international attention is regenerative stem cell therapy, in which stem cells are applied to distressed or injured areas of the body. The National Institutes of Health define stem cells as “…having the remarkable potential to develop into many different cell types in the body during early life and growth…in many tissues, stem cells serve as a sort of internal repair system, dividing essentially without limit to replenish other cells.”

After reaching its first widespread application in Germany in 2003, stem cell treatment was first typically applied to sports injuries, often among prominent athletes such as the NHL legend Gordie Howe, then later to NFL stars such as The Jets’ Chris Johnson. This helped fuel public enthusiasm, and the therapy is now in widespread application in the United States under the guidelines of the FDA. We asked Dr. Hassan about his history with the treatment process, its advantages, and future promise.

Industry: Stem cell therapy exists under a larger umbrella in medicine referred to as “biologic treatments.” How do you define that term?
Dr. Shady E. Hassan: Biologics use the body’s natural healing power to fix what’s wrong with it, put simply. Whether it’s an injured joint, tendon, or disc, as it relates to my field. Because of its potential, biologics can extend into other subspecialties as well. Also, Biologics are not manufactured medicines; instead, they consist of live cells and growth factors, which are components that your body uses naturally when it is healing itself. The basis of this is that we are taking these isolated components and introducing them into specific areas of the body.

Industry: When did you first begin to administer stem cell treatments?
SH: Back during my training in Alabama, and since that time I’ve treated more than 1,000 patients with this kind of therapy. There is growing research to support its use and efficacy. Due to its safe application, my field in particular has had great success and exposure in the media due to its popularity and use among prominent athletes.

Industry: What leads you to the conclusion that there’s no harm in its application?
SH: Biologics are safe because they are natural treatments using your body’s ability to heal itself when introduced into areas that need repair or rejuvenation. The procedure is local. The areas that we are injecting are relatively closed, so the treatment remains locally and does not disperse throughout the body. The risks are no more than those involved with a simple cortisone injection. Transient pain may occur, which is expected since there is an intense healing response, but this quickly resolves. Otherwise, side effects of administering the injection are like any other injection procedure utilized in sports and spine medicine, such as cortisone injections, visco-injection [lubricant injections], or even a simple blood draw.

Industry: What biologic procedures are commonly used at Physio Logic?
SH: One of the treatments used here is bone marrow aspirate, which is relatively rich in stem cells. We use a technique in which we draw bone marrow from an area like the hip and then use these obtained stem cells by injecting them into a joint or tendon. The cells that have been injected have the power to regrow and repair areas that are injured in the body, and the cells also offer the additional benefit of being anti-inflammatory, which also helps the recovery process and alleviates pain. There are other biologic treatments as well, including taking blood and spinning it down to isolate its platelet-rich plasma [PRP], which has a lot of growth factors that help regeneration and repair, and then there’s also the application of amniotic fluid donated by women who have had C-sections, which is also capable of assisting in regeneration and repair. One concern with amniotic fluid is that, since it is not from a patient’s own body, might the body reject it? The answer is no. Amniotic fluid does not have an immunologic response like a blood transfusion.

Industry: What studies have demonstrated stem cells’ treatment effectiveness?
SH: Typically, what you see are case studies, in which doctors or larger practices have seen positive outcomes. There was one article that just came out in the American Journal of Sports Medicine about PRP injections in arthritic hips [“Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study,” American Journal of Sports Medicine, January 21, 2016] in which autologous PRP (patient derived PRP) was compared to hyaluronic acid (HA) and a combination of both (PRP+HA) in hip osteoarthritis, and there were very encouraging responses from the PRP patients. Randomized controlled studies are some of the best types of studies done to evaluate effectively and efficiently a drug, or in this case, a biologic treatment such as PRP— large studies without any bias. This is the type we look for to help guide our treatments. Articles like the one just mentioned, published in a major journal in a double-blind setting…those are the ones we look for.

Industry: Can you describe a recent application that you were encouraged by?
SH: We had a patient…she was a collegiate athlete, 20 years old, and had a degenerative disc in her back. She didn’t want to have surgery…couldn’t afford the downtime. Now, the mainstay of treatment would be to first stop doing what’s aggravating the condition, but athletes don’t want to do that, of course, so, she underwent bone marrow aspirate stem cell therapy for that disc. The procedure went fine, and she followed up with us at regular intervals—four weeks after the procedure to make sure everything was going well, then again at three months, six months, and a year, and she regenerated the disc in a way that allowed her to be able to participate in her athletics without setbacks.

Industry: Could that recovery have happened without the treatment?
SH: The kind of patient that comes in for stem cell treatment has usually tried other conventional modalities such as cortisone injections, physical therapy, anti-inflammatory medications, and relative rest. For this case, specifically, she had failed prior treatments and was unable to recover until we utilized stem cell therapy. This led us to confirm that it was this specific treatment that enabled her to recover as quickly as she did.

Industry: Is the therapy a reliable alternative to, say, surgery?
SH: I always tell patients to explore traditional treatments first. If a patient, say, had failed physical therapy or anti-inflammatory medications or steroids…had essentially exhausted traditional medicine and was absolutely against surgery, I would say, “There’s one more thing to try.” I would also tell them that with stem cell treatment, if we have an MRI a year from now, there is a chance you’ll have a better knee, but what I can say with 85% certainty is that your pain and symptoms will improve. That means another year of putting off surgery.

Industry: What’s on the horizon for stem cells?
SH: There are promising applications in repairing heart valves, MS treatments, even regenerating eye tissue. I have a feeling that you’ll also be soon seeing people at a younger age freezing stem cells so they can use them later on in life. The older you get, the fewer viable stem cells you have and the less strength they carry, so the earlier you get them the better. Instead of undergoing surgery, this might be a preventative. It’s expensive, but it’s like people who freeze their baby’s cord blood or sperm…there will be banks filled with people’s stem cells.

Physio Logic
409 Fulton Street / 718.260.1000
physiologicnyc.com