Stem cells, platelet rich plasma (PRP) and prolotherapy are powerful therapies which can provide dramatic results when appropriately applied. When stem cells, PRP are not appropriately utilized, clinical results are often compromised. The correct diagnosis and an understanding of what biomechanical forces led to an injury and pain is essential. This is the cornerstone of the Centeno-Schultz Clinic. Ligament stability, muscle function and neurologic function are some of the areas reviewed when making a diagnosis.
JQ is a 79 y/o dentist who had a 15 year history of bilateral ankle pain who was interested in the Regenexx procedure whereby he could use his own mesenchymal stem cells. None of the surgical options were attractive given the extensive rehabilitation and risks associated with both anesthesia and surgery since he had multiple medical conditions including hypertension. The pain was constant in duration, 7/10 in severity and progressive in nature. JQ had strained his ankles years ago and never received therapy. As a dentist, JQ had intermittent lower back pain. Physical examination was significant for right leg limp secondary to pain, limited flexion and extension of lumbar spine, abnormal neurologic exam in lower extremities, weakness in the foot muscles and loose and painful ankle ligaments. MRI of the right ankle was significant for osteoarthritis and strain of the supporting ligaments.
An MRI of the lumbar spine was obtained given his significant findings of physical examination. The study was significant for two level disc disease, disc bulges, arthritic changes and irritation of the existing nerve roots. 
A diagnostic low volume injection of local anesthetic into the lumbar spine resolved 90% of his bilateral ankle pain. Subsequent therapies included platelet derived growth factor injections into the lumbar spine along with prolotherapy of the ankle ligaments. The patient did not require stem cell therapy into his ankle because the majority of his ankle pain arose from the lumbar spine. Bottom line: accuracy is everything.