What are orthobiologics, and why does a back clinic use them?

Orthobiologics are treatments built from your own blood, bone marrow or fat. We concentrate the parts that carry repair signals and place them, with imaging, into the tissue that is failing. Nothing is grown in a lab. Nothing comes from a donor.

A back clinic uses them for a simple reason. Most of the people we see have already had the usual round. They took the pills. They went to therapy. They had two or three steroid shots, and each one wore off sooner than the last. Some have been told surgery is next. Orthobiologics sit in that gap. They aim to help the tissue heal, not just to quiet it for a few weeks.

They are not for everyone, and they are not a first step. A back that went out last Tuesday does not need them. A joint that has hurt for a year and has been proven to be the source might.

Which three orthobiologics do we use?

• PRP, or platelet-rich plasma. We draw your blood, spin it, and keep the platelets. Platelets release growth signals that tell tendon, ligament and joint cells to rebuild. PRP is the workhorse. It suits most facet, sacroiliac and tendon problems.
• Bone marrow concentrate. We take a small amount of marrow from the back of the pelvis through a needle, then spin it down. It carries repair cells as well as signals. We reach for it in a worn hip joint or a damaged disc, where the problem is bigger.
• Microfragmented fat. We take a small amount of fat, usually from the belly or flank, and break it into tiny clusters. Fat holds its own repair cells and acts like a cushion. It is a choice for a joint with more advanced wear.

The choice depends on the tissue, how badly it is worn, and what you have already tried. We explain why we picked one over the others before anything is drawn.

Where do the injections go?

Placement matters as much as the product. A good treatment in the wrong spot does nothing. Every injection here is guided by ultrasound or X-ray, so we see the needle reach the target.

• Into the joint. Facet joints, the sacroiliac joint and the hip joint all have a lining that can take PRP or a cell product directly.
• Into the tendon or ligament. The gluteal tendons at the side of the hip, the hamstring tendon at the sit bone, and the ligaments that hold the pelvis together are treated at the frayed spot itself.
• Under the cartilage. In some hip joints the bone just beneath the cartilage is swollen and sore. This is called subchondral placement. Treating that bone as well as the joint space can matter in more advanced wear.
• Into the disc. When testing points to a damaged disc, the product can be placed inside it.

Conditions we treat with orthobiologics

Each page below explains one condition in full, including whether orthobiologics fit and which one we use. They are grouped by where the pain sits.

Spine and pelvis

• Lumbar facet syndrome: PRP into a facet joint that a numbing block has already proven.
• Sacroiliac joint pain: PRP inside the joint when steroid relief keeps getting shorter.
• Degenerative disc disease: PRP or bone marrow concentrate when testing points to the disc.

Hip and buttock

• Hip arthritis: PRP, bone marrow concentrate or microfragmented fat for a worn hip joint.
• Hip bursitis: PRP into the worn gluteal tendon at the side of the hip.
• Hamstring tendonitis: PRP into the tendon at the sit bone, the pain often called sciatica.

Dr. Padda has directed regenerative care since 2004. You can read about his training on the About Dr. Padda page.

Who is a good candidate?

The best results come from people who meet most of these points:

• The pain has lasted at least three months.
• A test has proven the source. For a facet or sacroiliac joint, that means a numbing block that took the pain away.
• Steroid shots helped for a while and then stopped helping.
• There is no red-flag sign, such as new leg weakness or loss of bladder control.
• You are ready to do the strength work that follows.

Some things lower the odds. Smoking slows healing. So does blood sugar that runs high. We check your metabolic labs at the first visit, and we treat those numbers as part of the plan, not as a side note. Read more on metabolic health and back pain.

If a full tendon tear or a pinched nerve with weakness is the real issue, we tell you that. Orthobiologics will not fix a problem they cannot reach.

What are the visit and the recovery like?

Orthobiologic procedures are done at our regenerative clinic, 4477 Woodson Rd in St. Louis. You check in at the front desk, and our staff walk you to the right room from there.

You stay awake the whole time. We numb the skin and the path of the needle with local anesthetic, so most people drive themselves home. A PRP visit takes about an hour, including the blood draw. A marrow or fat procedure takes longer because of the harvest step.

Plan on being sore for about 48 hours after PRP, and a bit longer after marrow or fat. That ache is part of the repair starting. We ask you to avoid pills like ibuprofen and naproxen for a while, since they can blunt the platelet signal. Walking is encouraged from day one. The number of treatments follows how you respond, not a set package.

PRP is not covered by insurance. HSA and FSA funds can generally be used.

Why do dose and rehab decide the result?

Two people can both say they had PRP and mean very different things. One got a small tube spun in a desk machine, with few platelets. The other got a measured, high-platelet dose placed under imaging. Research on joints shows the higher dose gives clearer and longer relief. That is why we count what we deliver.

The second half is load. The injection starts the repair. The tissue then needs graded work to grow back strong and in the right direction. A tendon left to rest after PRP heals weak. We give you a written plan for the weeks after, and our team checks your progress.

Over 90% of our accepted case-study patients see significant improvement. These are practice-reported figures from our own population, not trial outcomes, and individual results vary.

Pick your guide

Each guide below is a short, plain-English read sent by email. Pick the one that matches where you hurt. The back guide is also right on this page.

• Back and spine: Your MRI report translated, disc and facet findings in plain English.
• Hip and knee joints: What your joint X-ray does and does not mean, grade by grade.
• Tendons, including the outer hip and hamstring: Why the shot wore off and what to ask before tendon surgery.

Frequently asked questions

Do PRP injections work for lower back pain?

They can, when the source is a facet joint, the sacroiliac joint or a disc that testing has pinned down. A 2026 review found PRP gave better pain relief than steroid at three and six months for facet and sacroiliac pain. PRP is not a cure for back pain with no clear source.

How is PRP different from a steroid shot?

A steroid shot calms pain fast but does not rebuild tissue, and repeated shots can weaken it. PRP works slower. It aims to help the tissue repair, so relief tends to hold longer.

Is bone marrow concentrate the same as a stem cell shot?

It is your own marrow, taken and spun the same day. It holds some repair cells along with growth signals. Nothing is grown or changed in a lab.

How many PRP injections will I need?

Many people need one. Some need a second or third, spaced weeks apart. We decide after we see how you respond.

Can I get orthobiologics if I already had back surgery?

Often, yes. Pain after a fusion can come from a joint above or below it, or from the sacroiliac joint. If a test proves that joint is the source, it can be treated. See pain after back surgery.

Where do I go for the procedure?

Orthobiologic procedures are done at 4477 Woodson Rd in St. Louis. Check in at the front desk and staff will route you.

If your back or hip pain has outlasted the usual fixes, the next step is a proper look at where it starts. Ask for an orthobiologics evaluation below, or call us.