Stem cells for joints: my back, and the knees I’ve seen since

This page is about the one stem cell treatment I had for pain rather than for age: a single injection into my back in Bangkok after a gym injury. It’s also about the knees, shoulders, necks, elbows and ankles I’ve watched go through the same thing since. Some went better than mine did. Some didn’t move at all. Both kinds are here.

Jump to: My back · Knees · Shoulders · Back and neck · Elbows · Ankles · The two clocks · What I’d check before anyone touched my joint · Questions I get asked · What I was told it does

Why I tried it

I hurt my back in the gym. It wasn’t dramatic, which is part of the problem with injuries like that. It never finished. For weeks at a time it kept me out of the gym, then it let me back in, then it took me out again. Off and on, off and on.

I had it scanned. I honestly can’t tell you now what the scan said. What I remember is what came next. I had steroid injections, and they did what they’re meant to do: they quietened it down. They didn’t end it.

The rule I’ve run this business on is that we don’t offer anything we haven’t tried on ourselves first. My back was the obvious place to test the joint side of it.

What actually happened

The day itself was quick. It barely hurt, and I walked out on my own.

I did what I was told afterwards and stayed out of the gym for the first stretch. That was harder for me than the needle.

Then it followed the pattern I’d been told to expect, almost exactly. Something changed fast, within the first few days. After that it kept getting better slowly, over months, not days.

Today my back doesn’t hurt. I had the injection once, a few years ago, and I’ve never needed to repeat it. I go to the gym consistently now, which I couldn’t say before.

I’ll add one thing to that. The explanation I was given is that people with milder problems tend to respond better, and mine was a gym injury, not twenty years of wear. I was fine is not the same sentence as you’ll be fine. Everyone is different, and the rest of this page is proof of that.

The two clocks

This is the most useful thing I was told, and nobody else I spoke to beforehand had said it.

The explanation I was given is that there are two clocks running after a joint injection:

The nerve clock is fast. Pain and irritated nerves can change within hours, up to about three days.
The structure clock is slow. Cartilage, discs and tendons change over months, with the fuller picture showing around the third month.

Once you know that, a lot of the stories people tell me make sense. There’s the neck that got feeling back in its arm inside 48 hours. There’s the knee that “doesn’t grow new cartilage overnight”, as one man put it, and kept improving week by week. And there’s the person who felt a big change on day 17, lost it the next day, and only really settled in the third month.

What nobody told me about steroid injections

Mine helped. Then each one helped a little less. Later I heard people describe exactly the same thing, and one of them called it “the steroid cycle”. The name stuck with me.

The explanation I was given:

Steroid injections calm inflammation, and often bring real relief. But they treat the inflammation, not the wear underneath.
Repeated or high-dose steroid injections into a joint can weaken tendons, damage cartilage, and raise the risk of joint infection over time.
Long-term use of anti-inflammatory painkillers (NSAIDs) and steroids, without proper supervision, has been linked to kidney damage.
Hyaluronic acid (a lubricating gel injected into the knee) has conflicting evidence. The 2013 guidelines of the American Academy of Orthopaedic Surgeons strongly recommended against it for knees with symptoms.

Knees

Knees are what most people write to me about.

The explanation I was given is that the knee is a hinge that carries your whole weight while letting the leg move in several directions. When you jump, the force through it is many times your body weight. Even sitting with the knee bent loads it. Knees usually go wrong in one of three ways:

Injury: a torn ligament or tendon, a torn meniscus (the cushion inside the knee), or a fracture
Wear and tear: osteoarthritis, where the cartilage cushioning the joint wears away
Autoimmune disease: such as rheumatoid arthritis, where inflammation destroys the joint

What people describe: loss of flexibility · a grating or crackling feeling · bone spurs · swelling · pain during or after movement · stiffness, worst on waking or after sitting still · tenderness when pressed.

What I was told raises the risk: age · trauma · muscle weakness · loose joints · mechanical load · repeated knee injuries · kneeling · squatting · meniscus injuries · genetics · being overweight · being female. A past knee injury raises the risk several times over.

The list I was given for keeping a knee going. I’m passing it on as I got it:

Keep a healthy weight. Extra weight presses on the cartilage, and extra fat makes the body release cytokines (signalling proteins that drive inflammation).
Keep blood sugar in check. High blood sugar affects cartilage, and diabetes raises the risk of cartilage loss.
Exercise regularly — walking, gardening or swimming, 30 minutes at a time, five times a week. If you haven’t exercised in a long time because moving is hard, ask a medical professional how to start.
Reduce injury risk: shoes that fit, protective gear in sport.
Avoid overuse. Jobs and sports built on squatting, kneeling or regularly lifting heavy loads raise the risk. Vary the activity and rest between.

How I was told the options line up:

Prevention: the weight, muscle and posture list above. It’s the best option, and the one nobody sells.
Supportive treatment: most procedures sit here. They treat the inflammation. Once the cartilage has broken down and bone rubs on bone, the relief is usually temporary.
Joint replacement: like a chair with a leg too broken to fix, you replace it. The problem is that no artificial joint yet works in sync with the body the way the original did. Complications depend on the surgeon and the setting, and include infection, nerve injury, restricted movement, persistent pain and dissatisfaction.

The knees I’ve seen:

A man with a torn ACL (a knee ligament) and a torn meniscus came hoping not to need an operation. What he wrote afterwards was that nobody was pushy and everyone was realistic.
A man had twenty-plus years of knee pain from old ligament damage and hadn’t run in three years. By three months the pain was gone, and at six months it hadn’t come back. He’s running again.
One man ran a week after his injection, for the first time in six years.
An old football injury had stopped one man squatting for twenty years. He told me the knee felt better than in his twenties.
An older man with stage 4 arthritis in both knees had IV cells, not a joint injection. His shoulder settled in a week or two. His knees kept improving week by week. His words were that cartilage doesn’t grow overnight.
A basketball knee walked out of the room unaided and barely felt the injection in the days after.

Shoulders

Most shoulder stories I hear are about the rotator cuff, the group of tendons that holds the shoulder together.

The explanation I was given:

Causes: overuse and repetitive strain (from sport and certain jobs), age and wear, and trauma such as falls or direct blows.
How the damage happens: during overhead movements the tendons get pinched between the top of the arm bone and the bony point of the shoulder. Over time they wear down, and tears follow, sudden or slow.
What it feels like: pain moving and at rest, trouble reaching up or behind the back, trouble lifting and dressing, and difficulty sleeping on that side.
Surgery and its limits: surgery aims to repair the torn tendon. Studies keep reporting a high failure rate for repairs where tendon meets bone, even with better techniques. The reason given is biological. That transition zone doesn’t regenerate after standard repair. It forms scar tissue that’s mechanically weaker.
Where research has moved: it has shifted from purely mechanical fixes to improving the biology around the repair, using growth factors, bone morphogenetic proteins (signalling proteins that help bone and tendon form) and stem cells. The hypothesis is that these could help rebuild the normal tendon-to-bone structure while limiting scar tissue. Growth factors and platelet-rich plasma alone have given variable results. Stem cells are thought to help grow new blood vessels and calm inflammation during healing.

The shoulders I’ve seen:

One man had tendinopathy (tendon wear) and bursitis (an inflamed fluid sac in the joint) after a bad strain. Years of pain, and steroid injections that did little. Before anything was done, he was told which of his other pains were unlikely to respond. Early weeks were modest. At around eight months he put the shoulder at 80 to 90% back, and he’s swimming again.
A man who had torn his rotator cuff playing football at 18 re-injured it and was about to consider surgery. A week after the injection he said he had full range of motion and was back in the gym.
A tennis player in his forties still had shoulder trouble after keyhole surgery, and was facing a second operation. His result from the cells went beyond what the first surgery had given him.
One man came a week after rotator cuff surgery, for IV cells, and said he could already notice the shoulder.

Back and neck

This is my section, so it’s the one I read most carefully.

The explanation I was given about backs:

The lower back is five vertebrae. They carry the upper body and join the spine to the pelvis, so they take constant load and movement.
Damage can come from a sudden injury, and it doesn’t have to be a big one. A small twist on an unlucky day can do it.
More often it comes from gradual wear of the spinal joints. As cartilage breaks down, the tissue around it becomes inflamed and the friction increases.

Discs. The disc is the shock absorber between vertebrae. Each disc has two parts:

A tough outer ring: nerves run through its outer part, so a tear there hurts.
A soft jelly core: it contains proteins that inflame whatever they touch if they leak out.

Discs have very little blood supply, so once damaged they can’t repair themselves. A disc starts out mostly water and dries out with age, losing its cushioning. By around sixty, most people have some disc degeneration, though not all of them have pain.

What disc pain is described as: often in active people who are otherwise healthy, in their thirties or forties. Common signs:

It’s easier walking than standing or sitting, and better lying down.
It comes and goes in bouts lasting days to months.
It’s worse sitting and worse lifting or twisting.
There’s tingling or numbness in the arms or legs.
There’s leg weakness or foot drop (trouble lifting the front of the foot).

The list I was given for looking after a spine, passed on as I got it:

Keep good posture.
Get up from sitting every 30 minutes.
Carry loads in a backpack with both straps, not a sling bag.
Stop smoking. It’s believed to reduce blood supply to the discs. I smoked heavily for most of my adult life, so I’ll let that one sit.
Do back-strengthening and stretching, like yoga, at least twice a week.
Lift with a straight back and bent knees.
Stay active and eat well.

What the usual options are, as I was told them:

Non-surgical care: physiotherapy, painkillers and anti-inflammatories, weight management and less sitting.
Procedures: epidural steroid injections, facet joint injections, and radiofrequency ablation (using heat to switch off pain signals).
Surgery: discectomy (removing part of the disc), spinal fusion (joining vertebrae), and artificial disc replacement.

Look closely at what surgery does. The surgeon trims the cushion to fit, removes bone to make space (laminectomy), or takes the cushion out and fuses the vertebrae. That manages the symptom rather than the cause. Once a level is fused, the levels next to it take the extra work. This is called adjacent segment disease.

What the research says, with sources:

A 2023 review of lumbar fusion in The Spine Journal found about 36% of patients developed degeneration in the adjacent segment. About 11% developed symptoms from it, within two to seven years.
A community study of treatments for disc-related back pain (Mirza, Deyo and colleagues) found that only a third of surgical patients achieved a successful outcome. Surgery was linked with more restrictions and more opioid use.
A 2022 study in Frontiers in Surgery reported disc herniation rising in adolescents and young adults, driven largely by sitting, inactivity and poor posture.

The possible complications of spinal surgery I was told about: infection · bleeding · nerve injury · a tear in the covering of the spinal cord with fluid leakage · screws or plates breaking or loosening · blood clots in the legs or lungs · a fusion that doesn’t take · pain that persists or gets worse · complications from anaesthesia · problems with implanted rods or screws · sexual dysfunction if pelvic nerves are affected. Any surgeon who suggests a procedure will talk you through these risks.

Cells and discs. The explanation I was given:

Researchers have been looking at whether disc degeneration can be slowed or reversed, not only cut out.
In a 2019 review in JOR Spine, 78 people treated with mesenchymal stem cells across six studies showed better pain and disability scores overall. The improvement was limited to about two thirds of them. Disc height on MRI mostly didn’t come back, although one study reported improvement in eight patients at twelve months.
A 2023 systematic review in the International Journal of Molecular Sciences also looked at this. So does a trial now testing umbilical cord cells in lumbar disc disease, measuring MRI at 3, 6 and 12 months.
Not all back pain comes from the disc, and pain can ease without the disc getting taller. That makes candidates hard to choose and results hard to measure.
For my back the cells went into the muscle. The explanation I was given is that cells “home” towards where the pain and inflammation are.
Injecting straight into the disc carries its own risks: damage to nearby tissue and nerves, pain that doesn’t resolve, needing more surgery, infection, and damage to the disc itself.

The backs and necks I’ve seen:

One man with ten years of sciatica (nerve pain running down the leg) from the L5/S1 level had tingling and numbness most of the time. Four weeks after the injection he was walking daily without pain, with the numbness at least 90% gone. The part he cared about most was sleeping again.
One man’s neck had two slipped discs pressing on a nerve, leaving his arm numb and weak for three months. He wrote to me just under 48 hours after the injection. The feeling in his arm and hand was back, and his strength was returning. That’s the fast clock.
A woman with a narrowed spinal canal in her neck had headaches from the nerve pressure. She had tried cells somewhere else a year before without much change, and specialists had told her surgery was the only option. Five months after an injection in her neck, the headaches were down to a minimum. Her follow-up MRI showed less pressure on the spinal cord.
A man with wear in three levels of his neck said it was early days. He felt his mobility was better.
A woman with an old ankle infection from childhood had five bulging discs in her lower back. She had IV cells rather than injections, because the problem sat in more than one place. Within 72 hours she put the pain at 60 to 90% better. She’s waiting on the slow clock, because discs and cartilage take longer.
A man with a degenerated lower spine had his pain spreading to his hip. He could walk about 30 metres before sitting, and his surgeon had recommended spinal surgery. He had IV cells instead: two weeks of nothing; on day 17, something, then gone again the next day; weeks six to eight into the third month, a dull warm ache; then, for more than a month, almost no pain. He now walks about four miles a day. He told me he’d thought the reviews he’d read were written by AI.
A man with eleven years of rugby and a couple of car crashes behind him had IV cells. He slept 8 to 9 hours for the first time in twelve years. At six weeks his back was nearly pain-free and his neck about 70% better. I’d told him three months is about what discs take.
A desk-bound executive with mild arthritis in her spine felt about half the pain a day after treatment. She has slept through the night since.
The counterweight. One man reported at five weeks, item by item: lungs clearer, nerve pain in his feet about 20% better, arthritis in his hands maybe 10%. His lower back, nothing at all. I keep that report next to all the others on purpose.

Elbows

The explanation I was given about tennis elbow (lateral elbow tendinopathy):

It’s tiny repeated injuries to the tendons on the outside of the elbow, which slowly wear them down.
Despite the name, most people who get it don’t play tennis. It’s common among mature amateur players, though. It’s also common in sports that repeat wrist and forearm movements, and more likely after forty.
It causes pain, weaker grip, and trouble with everyday tasks.
Inside the tendon, the cells that maintain it die off, collagen production drops, and the tissue degenerates.
Most people get better within a year, even without treatment. I’d want that sentence on this page even if it cost me an enquiry.
The usual route is physiotherapy and anti-inflammatories. Steroid injections give temporary relief, and long-term use may weaken the tendon and raise the risk of rupture.
When nothing else works, the thinking is to use biology to break the cycle of tearing: heal the tendon, limit scarring, restore strength. Lab and animal studies suggest mesenchymal stem cells may speed tendon healing and improve its quality.

One man had both his elbow and his shoulder done and was happy with the early results. That’s as far as his story has gone so far.

Ankles

The explanation I was given:

Ankle injuries are extremely common in active people, mostly sprains and fractures.
A bad one damages the ligaments and cartilage, changes how the joint moves and carries load, and makes it unstable. Over time that becomes post-traumatic arthritis: the cartilage breaks down, the joint becomes inflamed and its structure changes.
The joint-saving operations (clean-outs, joint distraction, bone realignment) have given variable results, with better outcomes when the damage is limited.
In the early stages the breakdown may be partly reversible. That has pushed research towards biological treatments that delay the end stage.
Mesenchymal stem cells are thought to calm the destructive environment inside the joint and help repair cartilage. Cells transplanted from bone marrow have also shown promise.
For the ankle, the cells go into the joint.

The ankles I’ve seen:

A young man had lived with a lasting ankle injury for so long he’d stopped noticing he was in pain. Before, he couldn’t walk or drive for more than five minutes. A year after the injection he was doing seven-hour treks and long road trips. What he said to me was that he’d got used to pain he shouldn’t have accepted.
A former martial artist had given up all sport after a severe ankle injury that became arthritis, and had put on weight. His pain eased within a day, and he’s gradually gone back to sport. He believes earlier is better, and asked that his story be shared for that reason.
One man had wanted to try cells for years and couldn’t find the right place. He sat down with me and we made a plan for the pain and movement in his ankle. The procedure was swift and simple, and he felt a big difference early on.

Injection or IV

People ask me this a lot. The explanation I was given:

Target — Joint injection: One joint or area · IV: The whole body
Typical use — Joint injection: Osteoarthritis, tendon injury · IV: Immune, lung, general ageing
Time — Joint injection: 10–15 minutes · IV: 1–2 hours
Downtime — Joint injection: Minimal to none · IV: Minimal
Cells — Joint injection: Fewer, concentrated at one site · IV: More, given through the body

When the problem is in several places at once, like an ankle and several spinal levels, IV cells travel through the circulation towards inflammation. After IV they’re first held in the lungs, then redistribute. So it’s a whole-body approach, not a guaranteed single target.
For one isolated joint, a direct injection may be the better choice. You can have both in the same plan.
For the joint injection, the doctor uses ultrasound to guide the needle into the joint capsule. Local anaesthetic is used, not general.
The people I’ve seen do best with an injection are: people with localised joint pain or stiffness · people diagnosed with grade 1–3 osteoarthritis · people who want to avoid or delay a joint replacement · people who want faster recovery in one specific joint.

What I’d check before anyone touched my joint

This part comes from ten years of hearing what goes on in this business.

Is it actually cells? Some places sell PRP (platelet-rich plasma, spun from your own blood) at a high price and call it stem cells. The two are very different things: cells grown in a laboratory versus platelets from your blood.
Who is doing the injection? An article on stem cell fraud in Thailand in Thailand Medical News described clinics in high-end areas like Sukhumvit offering stem cells in luxury settings without a certified doctor on site. It also described some using doctors who graduated outside Thailand, such as in the Philippines, or even just a nurse. That’s against Thai law. If something goes wrong in a place like that, nobody takes responsibility. Many places save money by having a general practitioner do the injection. Mine was done by a US-educated orthopaedic surgeon. Getting the cells to the right place in a joint is not something to hand off casually.
A beautiful room proves nothing. Look past the marketing.
More cells don’t mean a better result. The explanation I was given is that route, number and above all quality decide the result. Good-quality cells can multiply in the body. Poor-quality cells die quickly and leave millions of dead cells for your body to clear, which may itself make you unwell.
Where the cells come from. Mine were adult mesenchymal cells from umbilical cord tissue. The explanation I was given: there are three broad types of stem cells. Embryonic cells are used mainly in research and have been linked with tumours. iPS cells (made by genetic engineering) are still in research and have shown some links to cancer. Adult cells are the ones used in treatment. Your own cells age with you. Umbilical cord cells start at age zero, they’re collected without surgery, and they have “immune privilege”, which makes them a universal donor. The cells I was given were live cells that had never been frozen. They came from a lab working to EU GMP rules with a class 100 cleanroom (an environment controlled like a pharmaceutical plant), using animal-free, phenol-red-free culture media. There was a certificate for the batch that went into me.
The conversation before the needle. I still talk to people myself, before anything is decided. Everything after that comes from the medical team.

Questions I get asked

Does it hurt?
Mine barely did. Local anaesthetic is used for joint injections, not general. The most common things people report afterwards are mild pain at the site, swelling and some stiffness, for a few days.

How long before anything happens?
That’s the two clocks. What I was told to expect: some people notice less pain and inflammation within the first few days, most notice real change between 4 and 8 weeks, and function keeps improving over 3 to 6 months. Mine was fast first, then slow.

How many sessions?
I had one and never needed another. What I was told is that some people benefit from one, and others need two or three. It depends on the problem.

Can I train afterwards?
I stayed out of the gym for the first stretch, as I was told. The advice I was given: rest for the first 24 hours and walk only if you need to. Normal daily life can usually resume after 24 hours. Avoid jumping, jogging and anything that risks injury (skiing was the example) for a month. The reason given is that the cells should be repairing what’s there, not chasing a new injury. If you pick up a gym injury later, I wrote about what I use for that on the BPC-157 page.

Is it better than steroid injections?
They do different things. Steroids calm inflammation quickly and the relief can fade. Cells are aimed at supporting repair of the tissue. I had both, in that order.

Is everyone a candidate?
No. It depends on the cause, how severe it is, the scans and your general health. I’ve watched people be told plainly which of their pains probably wouldn’t respond.

What I was told it does

The explanation I was given is that the cells:

can develop into cartilage cells
produce cytokines (signalling proteins) that slow cartilage breakdown and reduce pain
damp down the inflammation that makes arthritis worse
support repair of tendons, cartilage and the other parts of the joint
work largely through a “paracrine” effect, releasing signals that tell your own joint cells to start repairing — including switching immune cells from an inflammatory state to a healing one (from M1 to M2 macrophages)
help protect cartilage from further breakdown
home towards injury and inflammation

What the research says, with sources:

Toronto knee study (Stem Cells Translational Medicine): researchers at the Krembil Research Institute gave 12 patients with moderate-to-severe knee osteoarthritis cells from their own bone marrow, at one of three doses. After a year there was significantly less pain, better quality of life and less inflammation in the joint.
Stem Cells International, 2020 (Yin and colleagues): a meta-analysis found significant improvements in pain and function compared with controls.
American Journal of Sports Medicine, 2022 (Freitag and colleagues): a randomised trial reported less pain and better cartilage quality in knee osteoarthritis treated with umbilical-cord cells.
Other reports: single-knee studies found the injected knee in better shape years later than before treatment, while the other knee kept wearing. Longer follow-up has suggested injections may delay the need for a joint replacement.
World Journal of Orthopedics, 2017 (Paschos and Sennett): a review of cartilage disorders. With a collagen scaffold, knee scores improved significantly at 30 months. A randomised trial found better cartilage quality, pain and quality of life than with hyaluronic acid.
The overall picture: the research is most encouraging for early-to-moderate osteoarthritis. Cartilage is one of the few tissues that barely repairs itself once damaged, which is why it’s studied so much.

References

Yin W. et al., Stem Cells International, 2020
Freitag J. et al., American Journal of Sports Medicine, 2022
Jo C.H. et al., Stem Cells Translational Medicine, 2017
Vega A. et al., Transplantation, 2015
Paschos N.K. & Sennett M.L., World Journal of Orthopedics, 2017
Soufi K.H. et al., International Journal of Molecular Sciences, 2023
Loibl M. et al., JOR Spine, 2019
Mirza S.K., Deyo R.A. et al., one-year outcomes of surgical versus non-surgical treatment for discogenic back pain
Lumbar adjacent segment degeneration after spinal fusion, The Spine Journal, 2023
Risk factors for lumbar disc herniation in adolescents and young adults, Frontiers in Surgery, 2022
Immunoregulatory paracrine effect of MSCs in osteoarthritis, Frontiers in Cell and Developmental Biology, 2024
MSC therapy for osteoarthritis: the role of the secretome, Frontiers in Bioengineering and Biotechnology, 2019
Mesenchymal stem cells home to sites of injury and inflammation, Journal of Inflammation Research
American Academy of Orthopaedic Surgeons guideline, 2013

Keep reading: The stem cells overview · What to expect on the day · Safety questions I get asked · People I have met

My back was one injection, a few years ago, and I haven’t thought about it since. If you want to tell me about yours, I read these myself.

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I’m George. Thirty years in business, then ten years trying this whole field on myself before offering it to anyone else.

This is where I write down what I use, what I stopped using, and what I’d never do again. More about me →

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