When planning to cook a big meal you may begin with a trip to the grocery store for ingredients. But what if you discover your kitchen already contains everything you need? Bonus, right? That’s kind of the idea behind a medical practice called Regenerative Orthopedics & Sports Medicine, or ROSM.
Rather than surgery (that’s the “going to the grocery store to find what you need” part of the analogy), the doctors at ROSM use what’s currently inside in your body to heal you (that’s the “it’s already in your kitchen” part of the analogy).
With minimally invasive procedures the doctors at ROSM treat a range of orthopedic conditions traditionally slated for intensive surgery. These include acute and chronic injuries to muscles, nerves, ligaments, tendons and joints, including injuries to the back/spine, elbow, foot/ankle, hand/wrist, hip, knee and shoulder. For regenerative treatments, the ROSM doctors can use a patient’s own bone marrow, platelets or fat.
Dr. Nathan Yokel says, “We also treat the treatment gap of injuries or chronic dysfunction that is not severe or deranged enough—or not effectively treated with surgery—but is also not getting better with conservative therapy or medications.”
The treatments have names like autologous microfragmented adipose injections, bone marrow aspirate concentrate, platelet rich plasma, prolotherapy, extracorporeal pulse activation and more.
Dr. Yokel says, “These treatments stimulate your body to heal itself. We are stimulating an inflammatory cascade that re-sparks the body to try and heal wherever we inject.”
ROSM has offices in Annapolis, Columbia, D.C., North Bethesda, Reston and Tysons Corner. The practice includes 10 doctors, three physician assistants and a support team. Dr. Yokel, plus Dr. John Ferrell, III, Dr. Imran Siddiqui and Dr. David Wang are partners in the practice. Their specialties vary but they are all experts in musculoskeletal ultrasound, a key tool at ROSM.
After a physical exam, the doctors often use ultrasound to get an exact diagnosis. “We get immediate data,” Dr. Yokel says, “rather than send somebody for an MRI.”
Also, since ultrasound is a dynamic tool, the patient can move their elbow (or knee, etc.). “I can see if something is damaged or not moving correctly. You can’t see that in a static picture. And I can show the patient so it’s an education tool and that’s very helpful,” says Dr. Yokel.
In most cases, neither x-ray guidance nor palpitation are as effective as ultrasound. “When doing an injection to treat a very specific part of a knee ligament I use ultrasound to guide the treatment exactly into the area of injury,” he says, and adds that knee pain is often driven by weakness or bad movement patterns elsewhere.
“So, if I’m doing a treatment for lateral knee pain, I may also treat gluteal tendons or the sacroiliac joint; areas that are providing weakness that put stress on the knee. We see quite a few patients unfortunately who have had surgery and still have pain or discomfort. We try to get them back on track.”
The phases of healing, Dr. Yokel explains, include, “The inflammatory phase for a couple days where things are inflamed and angry. Then comes the proliferative phase for three to four weeks where things are healing at a rapid rate. And then the remodeling phase for six to 12 months where things are healing much slower. And then after that it’s kind of stagnant.”
He adds, “These treatments can be effective for helping to heal a chronic injury and also to shorten the time the patient is sidelined or missing out on things they love to do.”
Treatments offered at ROSM, Dr. Yokel explains, “Result in the spark of this healing so most patients are seeing relief in the three-to-six-week range,” he says, drawing a distinction between this ideally long-lasting relief, and the immediate but short-lived relief a person might feel from a traditional cortisone injection. “When you’re having that relief from a regenerative treatment, it’s because there is healing taking place so it takes little time for that to happen. And so, coaching the patient about expectations is important.”
Patients sometimes refer to ROSM doctors as miracle workers. In testimonials, they say things like, “They gave me my life back.” “I was skeptical but now I’m cured.” “Fantastic team.” “Great listening skills.” “Would not go anywhere else.” “Exceptional experience.” “The perfect embodiment of what a doctor should be.” And so on.
In addition to this anecdotal data, Dr. Yokel says, “It’s clear to me that the data is there showing the effectiveness of the plasma, prolotherapy and cellular treatments, but there is a lack of movement as far as getting reliable approval from the FDA about what it can be used for, which I think will then dictate what insurance will cover.”
Most of what Dr. Yokel and his colleagues do is covered by insurance, including exams, ultrasounds, muscle injections, diagnostic injections, nerve-entrapment release and more.
However, with few exceptions, he says, “The regenerative treatments are not covered by insurance.” He adds, “We continue to build data about the effectiveness of these procedures. We work with data-collection groups to try to have national data registries so we can go back to insurance companies and say, ‘These treatments are effective. You need to cover these.’”
Collectively, the ROSM doctors and PAs have treated athletes at every level, from recreational athletes to college athletes, professionals and Olympians, as well as members of the nation’s Special Operations and other military branches. Their work has been widely published in a variety of journals. The doctors are also athletes themselves, as well as instructors, lecturers and presenters at many national conferences. Their website, ROSM.org includes detailed explanations of what a patient may expect before, during and after treatment. It also includes links to their research, webinars, podcasts, invitations to participate in clinical trials and much more.
Dr. Yokel says, “All of the physicians in our practice teach nationally, go to conferences, teach ultrasound, teach regenerative medicine. By bringing together these experts, it really drives our improvement.”
Please visit ROSM.org or call 855.720.2491.