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WillBrink
06-23-09, 19:06
GH therapy and possible applications to connective tissue/joint degeneration in active populations.


By Will Brink

A common issue for athletes and other active populations (e.g. SWAT, SOF, etc.) is joint and connective tissue pain with various causes and diagnosis such as tendonitis, bursitis, cartilage degeneration, to name a few.

The use of various anti-inflammatory drugs, as well as nutritional supplements (e.g., Glucosamine, fish oils, etc,), and other therapeutic modalities are of value, but are far from a cure at this point.

A topic I have been researching for some time is the use of GH and other growth factors as a possible treatment for joint/connective tissue degeneration.

The causes of joint pain are multi factorial, but in active populations are often training related: over training, lack of proper warm up, loading and exercise choices, and other variables.

That’s the first place people should look when having chronic joint issues, but not everyone has a choice in the matter as to how much exercise they do and or the types of exercise they perform; various athletes, special operations soldiers, SWAT operators, etc.

I have written in prior articles that I think the use of GH and other growth factors (IGF-1, etc) was a promising way to treat connective tissue/joint problems, and studies are starting to support that conclusion.

There have been impressive developments recently in the use of growth factors for accelerated healing of sports related injuries, overuse syndromes, improved healing after some plastic surgery procedures, as well as studies finding success in the area of orthopedics.

More controversial, my hypothesis has also been that many people who suffer from chronic connective tissue problems and chronic back problems are often found to have low IGF-1, and reversing that state of low IGF-1 as a treatment for these pathologies is a viable treatment. It appears the former concept – using growth factors to treat joint pathology - is getting greater attention with the scientific/medical community. The latter concept - that a deficiency in these growth factors may be the cause of their joint related problems - a much more controversial idea.

But hey, I don’t mind being ahead of the curve and waiting for the scientific and medical community to catch up to me! Remember, Growth factors (e.g., IGF-1, bFGF, PDGF, EGF, and others) are the mediators that control the biological processes necessary for repair of soft tissues. After hitting the gym or the road with 60-80lbs of stuff on your back, and having muscles and joints in need of repair from micro trauma caused by those activities - or in the case of traumatic injury to muscles, tendons and ligaments - these growth factors are responsible for healing the injuries, with animal studies showing clear benefits in terms of accelerated healing and repair.

Regarding research on the issue of using growth factors to treat sports related injuries, a recent review in the British Journal of Sports Medicine entitled “Growth Factor Delivery Methods in the Management of Sports Injuries: The State of Play” examined the issue. The review covered a wide range of topics that examined the use of growth factors for treating various sports medicine related injuries. However, the report also noted,

“The use of growth factors in Sports Medicine is restricted under the terms of the WADA* anti-doping code, particularly because of concerns regarding the IGF-1 content of such preparations, and the potential for abuse as performance-enhancing agents.”

So, as hormones such as growth hormone (GH), IGF-1, as well as others may have performance benefits in athletes, they are banned by the International Olympic Committee (IOC) and are on the WADA list of agents.

It’s important to note that this review is talking mostly about directly delivering, via injection, the growth factor in question into the injured joint, which results in a much higher concentration to the injured area while reducing whole body/systemic exposure.

The IOC and WADA are concerned with athletes taking these hormones for performance enhancement vs. treating an injury. However, WADA has what they refer to as a “Therapeutic Use Exemption” which states:

“Athletes, like all others, may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption may give that athlete the authorization to take the needed medicine.”

There are various ways of delivering higher doses of growth factors to injured tissue, but each has in a reliance on the release of the aforementioned growth factors which are released upon injection at the site of an injury. This means you get a high therapeutic dose at the site of the injury with a low whole body/systemic exposure of these growth factors.

So what about athletes and other active populations using GH who are not subject to IOC or WADA rules? Many athletes using low dose GH report improved joint function and less pain from GH therapy. Of course, not injecting it into the joint (and that should NEVER be attempted without medical supervision), which is how most athletes use GH, means a greater whole body effect and a lower concentration at the site of injury, which opens up additional areas of concern.

Regardless, it still appears to help with joint problems. I also recommend people who have chronic joint problems have their IGF-1 levels checked via blood tests. Healthy young people who have adequate diets and protein intakes don’t generally suffer from low IGF-1 levels, though I find it’s more common than some might realize, and not uncommon in older adults.

Finally, the use of GH for joint problems has to be done in the context of legality. I do not recommend people use illegally obtained GH for this use and need to find a medical doctor willing to work with them on their medical/joint related problems, but physicians using GH for this use is becoming more common as additional research and clinical feedback becomes available.

Creaney L, Hamilton B.
Growth Factor Delivery Methods in the Management of Sports Injuries:The State of Play. Br J Sports Med. 2007 Nov 5

* = The World Anti-Doping Agency

Source:

http://www.brinkzone.com/blog/general-health/post/gh-therapy-for-joint-degeneration-and-back-pain/

WillBrink
05-08-13, 12:56
Follow up:

I find those suffering extensive connective tissue pathology always low in igf-1 when tested. My general hypothesis on that above. Cause and effect, not clear, but it's not rocket science to see the obvious connections regardless in my opinion.

I have currently worked directly with a handful retired SOF with spinal issues, and or other musculoskeletal pathology, who got no help or relief from treatments offered and tried, and were on heavy pain meds.

Correcting their hormonal status ( As indicated by their blood work) - working in conjunction with their doctors - resulted in immediate (several weeks in some cases) improvements with continued improvements ongoing.

I have now spoken to hundreds of vets - via forums like this, email, in person, etc - who experienced minor to major improvements in pain by just getting their testosterone levels up (if indicated by blood work showing low T levels), which is about as far as their docs will go with them in most cases I find.

Note one:
TBI may also be greatly improved (https://www.m4carbine.net/showthread.php?t=94780&highlight=TBI), via similar treatments and recently communicated with that doc since my post and he's having great success with TBI. And med professionals here who deal with TBI, should consider contacting him.

Note two: One person in particular, an ex Army medic with severe spinal issues and pain regardless of treatments tried, should have some of his first hand experiences regarding the above written up, and I'll post it when I get it.

More new on this to come...

NOTE: I'm not a doctor, don't play one on TV, and no one should take the above as medical advice. I confer with medical professionals regarding any of this, and you should too if the topic is of interest.

Self diagnosis and self medicating based on any info here, would be a very bad idea and not recommended by me.

Study of interest RE above:

Eur Spine J. 2008 Dec;17 Suppl 4:441-51. doi: 10.1007/s00586-008-0749-z. Epub 2008 Nov 13.

Biological repair of the degenerated intervertebral disc by the injection of growth factors (http://www.ncbi.nlm.nih.gov/pubmed/19005698).
Masuda K.

Source

Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, 9500 Gilman Dr, Mail Code 0630, La Jolla, CA, 92093-0630, USA. koichimasuda@ucsd.edu

Abstract

The homeostasis of intervertebral disc (IVD) tissues is accomplished through a complex and precise coordination of a variety of substances, including cytokines, growth factors, enzymes and enzyme inhibitors. Recent biological therapeutic strategies for disc degeneration have included attempts to up-regulate the production of key matrix proteins or to down-regulate the catabolic events induced by pro-inflammatory cytokines. Several approaches to deliver these therapeutic biologic agents have been proposed and tested in a preclinical setting.

One of the most advanced biological therapeutic approaches to regenerate or repair a degenerated disc is the injection of a recombinant growth factor. Abundant evidence for the efficacy of growth factor injection therapy for the treatment of IVD degeneration can be found in preclinical animal studies. Recent data obtained from animal studies on changes in cytokine expression following growth factor injection illustrate the great potential for patients with chronic discogenic low back pain. The first clinical trial for growth factor injection has been initiated and the results of that study may prove the usefulness of growth factor injection for treating the symptoms of patients with degenerative disc diseases. The focus of this review article is the effects of an in vivo injection of growth factors on the biological repair of the degenerated intervertebral disc in animal models. The effects of growth factor injection on the symptoms of patients with low back pain, the therapeutic target of growth factor injection and the limitations of the efficacy of growth factor therapy are also reviewed.

Further quantitative studies on the effect of growth factor injection on pain generation and the long term effects on the endplate and cell survival after an injection using large animals are needed. An international academic-industrial consortium addressing these aims, such as was achieved for osteoarthritis (The Osteoarthritis Initiative), may further the development of biological therapies for degenerative disc diseases.

Ericstac
05-19-13, 08:52
Interesting.. You never really stated at what levels IGF1 would need to be at? I know a baseline has a wide range based on each person but in general?

I'm guessing it is very beneficial to run GH along side steroids when used in excess to help prevent the decrease in collagen decrease that occurs?

Is this something we could see added to a normal HRT protocol in the future and it be covered by insurance?

WillBrink
05-19-13, 11:05
Interesting.. You never really stated at what levels IGF1 would need to be at? I know a baseline has a wide range based on each person but in general?

In theory, high range of normal physiological range, but there's no data on that per se. That is, maybe in some cases, for some period of time, levels above normal physiological range would make sense, but long term, safety wise, within physiological range makes sense until more data exists.



I'm guessing it is very beneficial to run GH along side steroids when used in excess to help prevent the decrease in collagen decrease that occurs?

I'm not aware of an actual decrease in collagen production from AAS use, but the effect may be specific to the AAS. It's tendon ruptures and such seen with high dose AAS users is due to the muscle outpacing what the connective tissues can support, vs disruption of the connective tissues per se. But, I have not looked at latest data on that specific topic as focus is HRT, not athletic/bbing uses.

Using GH and AAS combined, not for HRT but at higher doses above physiological ranges, usually without medical supervision, can be problematic and not recommended.



Is this something we could see added to a normal HRT protocol in the future and it be covered by insurance?

Depends, but as a rule, getting insurance to cover GH is very difficult as it's only indicated for limited medical uses and expensive. Per the review posted above, I think think use of GH and other growth factors will be a treatment of the future for connective tissue pathology and if I'm right in my hypothesis, low IGF-1 levels, accepted as a known risk factor (and possible cause) of connective tissue pathology.

BTW, raising T will also raise IGF-1, which again, I suspect a major reason why many note a big reduction of aches and pains, etc when they are put on HRT/TRT even without any GH.

WillBrink
01-06-14, 13:06
Although not an exact fit to info above, I thought a good more recent review to bump this thread with. It's a review of various biological based treatments for disc pathology being explored, tested, and hopefully approved if one more more shows real value.


Intervertebral disk repair by protein, gene, or cell injection: a framework for rehabilitation-focused biologics in the spine.
Zhang Y, Chee A, Thonar EJ, An HS.
Author information
Erratum in

PM R. 2011 Aug;3(8):783.

Abstract

Low back pain carries an enormous socioeconomic burden. Current treatment modalities for symptomatic intervertebral disk (IVD) degeneration have limited and often inconsistent clinical benefits. Novel approaches with the potential to halt or even reverse disk degeneration and restore physiologic disk function, such as biological treatments, are therefore very attractive. The following barriers are impeding the development of successful therapeutic interventions: (1) the biology and pathophysiology of disk degeneration are not well understood, and (2) the precise relationship between IVD degeneration and low back pain remains unclear. This article reviews the structural changes that take place during IVD degeneration and their relationship to diskogenic back pain. It also presents treatment modalities that currently are under laboratory investigation and are being studied in clinical trials. The authors of recent studies have shown that the content of large proteoglycans, such as aggrecan and versican, decreases with aging and IVD degeneration, whereas the content of certain small proteoglycans, such as biglycan, increases. Proinflammatory cytokines such as interleukin-1 and tumor necrosis factor-α also are associated with IVD degeneration and are potential biomarkers of IVD degeneration and repair. Our group of investigators and others have developed in vitro models of IVD cell and explant culture in addition to in vivo animal models to study IVD degeneration and repair. With the use of these models, we have tested candidate therapeutic agents to assess their therapeutic potential for matrix restoration. When a rabbit annular puncture model of IVD degeneration was used, injections of either bone morphogenetic protein-7 (also known as osteogenic protein-1) or bone morphogenetic protein-14 (also known as growth differentiation factor-5) were shown to be effective in restoring IVD structures. On the basis of these data, the Food and Drug Administration has recently allowed the initiation of Investigational New Drug clinical trials on osteogenic protein-1 and growth differentiation factor-5 in the United States. Protein therapies such as other growth factors, inhibitors of degradation enzymes or cytokines, and cell therapies also are being investigated in laboratory settings with the goal of restoring disk function and alleviating back pain symptoms. These therapies may be used by physiatrists with the skills required to administer intradiskal injections and supervise a comprehensive rehabilitation program after the procedures. Ultimately, the clinical use of any biological treatment discussed in this article would require the collective efforts of clinicians and researchers.

WillBrink
02-23-15, 07:48
Bumping this thread vs adding a new one on the topic. This is written by a buddy of mine and shows a changing attitude toward HGH and possible medical uses for healing injuries, etc.


Mark Cuban: Changing the Game on HGH?
By Rick Collins

Dallas Mavericks owner Mark Cuban says he intends to fund research on human growth hormone (HGH) to see if it might help NBA athletes to recover more quickly from injuries. To be clear, he's not advocating a rules change to permit HGH use in pro basketball -- at least, not yet. But with a rash of NBA players on the disabled list, he proposes studies to find the truth about the restorative potential of HGH in the recovery process.

Cuban's remarks last month at NBA's Board of Governors meeting in New York could lead to a new way of looking at HGH in sports... and beyond. While anti-doping crusaders and some sports executives might tremble at the very notion that a banned substance might be just what the doctor ordered for injured players, some athletes, particularly in baseball, have recently begun to question the status quo. After missing a season recovering from Tommy John surgery, Los Angeles Angels reliever Ryan Madson suggested that MLB consider a rules change to allow rehabbing players to take HGH in limited cases. "If HGH were legal, just in the process of healing, under a doctor's recommendation, in the right dosage, while you're on the [disabled list], I don't think that's such a bad idea -- as long as it doesn't have any lasting side effects, negative side effects," he told MLB.com.

While adverse side effects have been linked to high-dose, long-term HGH use, such concerns might not be relevant to the low-dose, short-term therapy proposed for healing injuries. Of course, the possible side effects -- and the long-rumored potential benefits -- can only be determined if controlled safety and efficacy studies are performed. If the results are favorable, Cuban believes that the stigma attached to HGH's status as one of the banned "performance-enhancing drugs" can be overcome. "I mean, think of it this way: Any drug that's been FDA approved that has medical benefits, there's going to be a non-sports population that benefits from it," Cuban said. "If you've got every recreational athlete using it to recover, then it's becomes kind of the Tommy John surgery equivalent."

Cont:

http://www.huffingtonpost.com/rick-collins/hgh-mark-cuban-changing-the-game_b_4380189.html

WillBrink
08-02-15, 17:02
Instead of starting a new thread, figured I'd add this recent study. As you can see from the OP date, I have been looking into this topic a while and (to me at least) makes perfect sense why it should help and should be offered as a viable treatment in conjunction with other modalities:


Use of localized human growth hormone and testosterone injections in addition to manual therapy and exercise for lower back pain: a case series with 12-month follow-up
Pain Res. 2015; 8: 295–302.

Abstract

Objective

The objective of this case series was to investigate the feasibility and safety of a novel method for the management of chronic lower back pain. Injections of recombinant human growth hormone and testosterone to the painful and dysfunctional areas in individuals with chronic lower back pain were used. In addition, the participants received manual therapies and exercise addressing physical impairments such as motor control, strength, endurance, pain, and loss of movement. Pain ratings and self-rated functional outcomes were assessed.
Study design

This is a case series involving consecutive patients with chronic lower back pain who received the intervention of injections of recombinant human growth hormone and testosterone, and attended chiropractic and/or physical therapy. Outcomes were measured at 12 months from the time of injection.

Setting

A community based hospital affiliated office, and a private practice block suite.

Participants

A total of 60 consecutive patients attending a pain management practice for chronic lower back pain were recruited for the experimental treatment. Most participants were private pay.
Interventions

Participants who provided informed consent and were determined not to have radicular pain received diagnostic blocks. Those who responded favorably to the diagnostic blocks received injections of recombinant human growth hormone and testosterone in the areas treated with the blocks. Participants also received manipulation- and impairment-based exercises.

Outcome measures

Outcomes were assessed at 12 months through pain ratings with the Mankowski Pain Scale and the Oswestry Disability Index.

Results

Of the 60 patients recruited, 49 provided informed consent, and 39 completed all aspects of the study. Those patients receiving the intervention reported a significant decrease in pain ratings (P<0.01) and a significant improvement in self-rated Oswestry Disability Index scores (P<0.01). In addition, in the Oswestry Disability Index results, 41% of the patients demonstrated a 50% or greater change in their disability score. Of the subjects who withdrew from the study, one was due to the pain created by the injections and nine were for nonstudy factors.

Conclusion

The intervention appeared to be safe and the results provide a reasonable expectation that the intervention would be beneficial for a population of individuals with chronic nonradicular lower back pain. Due to the design of the study, causality cannot be inferred, but the results do indicate that further study of the intervention may be warranted.

Full Paper HERE (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487155/)