Stem Cell Therapy: Acceptable Treatment or Questionable Performance Enhancer?

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Stem Cell Therapy: Acceptable Treatment or Questionable Performance Enhancer?
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UPDATE: In light of several comments, both public on this article and private through direct email, I would like to clarify the point I was attempting to make.

I am not in any way whatsoever saying that Stem Cell Therapy or PRP therapy should be outlawed by baseball or any major sport. Medical breakthroughs in sports are great, and should be encouraged.

The speculation that there is a performance enhancing effect was only speculation. I feel that more results are necessary before we will truly know the effect of this treatment on injured athletes. My opinion that it could be misused by professional athletes to gain advantage is speculation also at this point, and unproven.

The suggestion that such treatments be regulated was meant to suggest that in the event it is determined that it could be misused, then some guideline should be put in place so athletes in need are not denied the benefits of the procedure. Obviously the decision to receive the treatment belongs to the athletes and the teams, and should not be taken away as an available alternative to surgery.

The final point I would like to clarify, rather than re-edit the entire article, is that there is a difference between PRP therapy and Stem-Cell therapy. The procedure that Barolo Colon received was stem-cell injections into his shoulder, the other athletes listed below received PRP therapy.

David Epstein of Sports Illustrated wrote an informative article on stem cell therapy and PRP use in sports. If you want to receive a quick education on the topic from a credible source, I suggest you give it a read. Epstein links to a few articles at the bottom of his article that discuss the potential misuse, however as he points out throughout his article, there is thus no proof of any misuse, and there is no evidence at this point that it should be a real concern.

 

ORIGINAL ARTICLE:
Bartolo Colon's return to the Major League's has been one of 2011's early success stories.

Colon made just 12 appearances in 2009 before leaving the game with an elbow injury that threatened to end his career. He was out of baseball for the entire 2010 season.

The New York Yankees offered Colon a minor league contract with an invitation to spring training this offseason, and the 38-year-old righty has made the most of his opportunity.

In seven appearances, four starts, he is currently 2-1 with a 3.86 ERA, and appears set to settle into the Yankees' rotation for the remainder of the season.

The early success is impressive enough just based on his year away from baseball. When you take into consideration that Colon really has not been an effective Major League starter since winning the Cy Young Award in 2005—when he went 21-8 with a 3.48 ERA for the Los Angeles Angels—you have to wonder what caused the sudden resurgence?

Well, in the case of Bartolo Colon, we don't have to ask at all. Colon attributes his return to professional baseball to a stem cell procedure performed on him in the Dominican Republic last year.

According to an article on diariolibre.com, Colon had the procedure in the middle of March in 2010; by October he was pitching his way back to the big leagues.

The article states that prior to performing the procedure, the doctors and Colon sought approval from Major League Baseball, the owners and team doctors. It appears he has stayed well within the rules of Major League Baseball with the treatment, although there will be an investigation to determine if HGH was used in the procedure according to ESPN.

 

What was the procedure performed on Bartolo Colon?

Diariolibre.com described the procedure performed on Colon:

"The medical team, made up of Guzman, Liriano, Hector Rosario and an American specialist, took out bone marrow tissue and fatty tissue from Colon's hip. These were processed by special equipment and were them placed in his shoulder tissues.

Six weeks later, in the same surgery room at the Centro Union Medica de Santiago, 60 cc of blood were taken from a vein, processed and 6 cc were used in the shoulder and the elbow. This procedure is known as platelet-rich plasma (PRP).

Neither of the two procedures took more than 40 minutes, without any surgical trauma that required a long recovery period."

This PRP procedure is actually not anything new. Tiger Woods has had platelet-rich plasma treatments, and so has Milwaukee Brewer's pitcher Takashi Saito and Colon's Yankee teammate Alex Rodriguez.

Rodriguez had a PRP treatment following his hip surgery in 2009.

Saito's procedure, performed in 2008, allowed him to return to his role closing games for the Los Angeles Dodgers just two months after the procedure. He was able to avoid Tommy John surgery as a result.

When you view the procedure as an alternative to a more invasive procedure such as Tommy John surgery, there is little argument to be made against its use in professional sports.

Tommy John surgery is also a medical procedure that allows players to resume their career after injuries that were once career threatening after all. So what's the difference?

 

Can you really argue that this was not a "performance enhancer" though?

Typically Tommy John surgery is brought on by a sudden injury, not following years of decline as Colon had experienced.

Tommy John surgery allows the player to resume their career after extensive rehabilitation, this stem cell procedure seemingly does not require anything more than the players regular workout program to remain in game shape.

As I already mentioned, Colon is pitching his best since 2005, long before he left the game with a shoulder injury.

Here is a quick glance at his statistics from 2005-Present:

Year W L ERA G GS BB SO BB/9 SO/9
2005 21 8 3.48 33 33 43 157 1.7 6.3
2006 1 5 5.11 10 10 11 31 1.8 5.0
2007 6 8 6.34 19 18 29 76 2.6 6.9
2008 4 2 3.92 7 7 10 27 2.3 6.2
2009 3 6 4.19 12 12 21 38 3.0 5.5
2011 2 1 3.86 7 4 7 37 1.7 8.9

Granted, this is a very small sample size so far this season and anything could happen the remainder of the year, but his ERA is the lowest since 2005 and his SO/9 ratio is the highest since 2000 when Colon was just 27 years old.

To be fair, Colon did have to work himself back into game shape. He did not appear in a baseball game until October, seven months removed from the procedure. He was instantly effective upon his return to competitive baseball though.

 

Where it has the potential to become an abused performance enhancer

To be fair, I want to get it out of the way and say that I don't have a problem with Bartolo Colon using this procedure to resume his career. An invitation was extended to him to try the procedure, he accepted and he is a living example of its success. That is great for him, and it is a great alternative to older athletes that would not recover well from invasive surgeries.

What happens when younger athletes with a better ability to recover fast start experimenting with the procedure though?

The doctor's who performed this procedure wanted to stay away from testing its results on a younger athlete because they felt the results could be questioned:

"We did not want to do a trial on a young 23-24 year old because the effectiveness could be questioned due to his age. We did it with a veteran and we hope that Felix Sanchez and other Dominican athletes that have suffered injuries will also submit to this treatment so that they can prove what can be done with stem cells," Sergio Guzman, one of the doctors who performed the procedure, told DiaroLibre.com.

Could the use of this treatment by younger athletes with a higher fitness level be considered a performance enhancer if there were alternates to the procedure available? Personally, I think so, but I also realize there is an argument to be made that it is the better alternative to surgery in many cases.

Dr. Dennis Lox writes on his website regarding PRP-therapy:

"Platelet-Rich Plasma has received recent press as elite athletes are turning to the procedure as a means to accelerate recovery time from injuries. 

Prior to Super Bowl XLIII, two Pittsburgh Steeler players, Hines Ward and Troy Polamalu, were nursing injuries. Both turned to PRP and played exceptionally in their win over the Arizona Cardinals, despite Kurt Warner's valiant efforts (Warner has also been treated with PRP after surgery). 

Tiger Woods, the famed golfer, received PRP after his knee surgery, and twice for Chronic Achilles Tendonitis. 

Denver Nuggets basketball star Kenyon Martin swears by Platelet-Rich Plasma, after it aided in healing his ailing left knee. 

Alex Rodriguez, of the New York Yankees, received PRP after hip surgery and made a swift recovery. 

The tennis pro, Rafael Nadal, and Dodger's pitcher Takashi Saito, have each received PRP. 

Champion Canadian figure skater Patrick Chan had PRP to heal an injured calf muscle."

Each instance listed was to recover from injuries to participate in a game or event, but if it is not one of the therapies offered by the trainers in the clubhouse, is it an unfair advantage for those who partake?

Can it enhance the performances of athletes who are not injured?

Are the results more effective than the steroid injections so many ballplayers were receiving to enhance their workouts and pad their statistics?

 

Professional sports need to regulate the practice of PRP-therapy and Stem-Cell Therapy to prevent abuse

Prescribed steroids were permissible for the rehabilitation of injuries as well. They became abused as their effects became better known.

These breakthroughs in sports therapy are a great thing. They will allow players to recover from injuries, prolong their careers, provide greater entertainment to the fans and most importantly for the players, avoid surgeries that could have adverse effects as they grow older.

With any new treatment that has a performance enhancing effect, there will be those within the sport that try to exploit its benefit by receiving treatments that are unnecessary.

The treatment does not include any substances that are banned by baseball. The player's own blood goes back into their body. In other words, it is undetectable on a PED test.

The temptation to break records, boost stats in a contract year and earn mega-million dollar contracts will prompt some athletes to seek the treatment to give them an advantage in this new era of strict drug testing.

I guess it all lies within the intent of the use of the therapy; medical or for performance? There will always be gray areas to allow for arguments from both sides.

I could not begin to make an argument for how this should be regulated, but the owners and the commissioner should address the issue before another scandal sweeps the sport as more records are called into question.

Athletes such as Takashi Saito and Bartolo Colon have done nothing wrong by receiving these treatments. Tommy John surgery would likely have ended Saito's career; shoulder surgery would have ended Colon's career.

Alex Rodriguez and the other athletes who have received such treatments were also recovering from injuries and did not use the treatment as a way of enhancing their performances.

They received therapy for the right reasons, but the sport is littered with those that will choose to exploit its benefits. History has taught us this unfortunate lesson.

 

Brandon McClintock covers Major League Baseball for BleacherReport.com. You can follow me on Twitter:    @BMcClintock_BR.

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