
Definitive guidance on biological protocols and performance recovery.
Orthobiologics is the field of medicine that uses naturally occurring substances from the body, primarily blood-derived and marrow-derived concentrates, to support the healing of musculoskeletal injuries and degeneration. The two most commonly used orthobiologic therapies at the Scheinberg Clinic are PRP (Platelet-Rich Plasma) and BMAC (Bone Marrow Aspirate Concentrate). Both are derived from your own body, which means the risk of rejection or allergic reaction is minimal. The goal is to harness your body's existing healing mechanisms and amplify them at the site of damage, whether that's an arthritic knee, a torn tendon, or a degenerating joint.
Not yet. Regenerative treatments such as PRP, BMAC and stem cell therapy are not yet FDA approved for orthopedic conditions. They are made from your own blood or bone marrow, and a substantial and growing body of peer-reviewed clinical evidence supports their use for specific orthopedic conditions. Dr. Scheinberg's protocols are grounded in that evidence, and at your consultation he will explain what the research shows for your condition.
Most insurance plans, including Medicare, do not currently cover PRP or BMAC therapy for orthopedic conditions. These treatments are classified as elective procedures pending broader regulatory endorsement, and reimbursement is not typically available. Payment is generally out-of-pocket. Dr. Scheinberg's clinic provides transparent pricing, and candidacy is determined before any financial commitment is made. For many patients, the cost of one to three biologic treatments compares favorably to the full cost, financial and otherwise, of joint replacement surgery and its rehabilitation.
The number of treatments depends on the condition being addressed, its severity, and how your body responds. For soft tissue injuries such as tendinopathy or partial ligament tears, one to two PRP sessions is often sufficient. For knee or hip arthritis, a series of two to three injections spaced several weeks apart is typically recommended. For more advanced joint degeneration treated with BMAC or the combined approach, a single comprehensive treatment session is often the starting point, with follow-up assessment at 12 weeks to evaluate response. Dr. Scheinberg will not recommend additional treatments unless the clinical picture supports them.
Most patients describe the experience as manageable. The blood draw for PRP is no different from a standard lab draw. The injection into a joint or around a tendon involves a brief feeling of pressure and mild discomfort. For BMAC procedures, the bone marrow harvest from the iliac crest is performed under local anesthetic, which minimizes the sensation at the harvest site. Post-procedure soreness for 24 to 48 hours is common and expected. It reflects the healing response being activated, not a complication.
Orthobiologics work through a biological healing process, which takes time. PRP patients typically begin noticing improvement four to eight weeks after treatment. The full benefit of BMAC often becomes apparent at two to three months and can continue improving for six months or more. This is a meaningful difference from cortisone injections, which may provide faster initial relief but fade quickly. The timeline is part of an honest conversation Dr. Scheinberg has with every patient before treatment begins.
Candidacy is determined through a formal assessment, not assumed. The best candidates are generally patients with moderate joint degeneration or soft tissue injury who have not found lasting relief from physical therapy, NSAIDs, or cortisone injections, and who want to pursue a regenerative approach before considering surgery. Patients with bone-on-bone arthritis in all joint compartments, significant structural deformity, or other complicating factors may have more limited potential benefit, though this is evaluated on an individual basis. Dr. Scheinberg will give you a straight answer about whether you are a likely responder.
PRP (Platelet-Rich Plasma) is derived from your blood and contains concentrated platelets loaded with growth factors. It is most effective for soft tissue injuries, early-to-moderate arthritis, and tendon or ligament damage. BMAC (Bone Marrow Aspirate Concentrate) is derived from your bone marrow and contains mesenchymal stem cells, cells with genuine regenerative potential, as well as a broader and more potent array of growth factors and anti-inflammatory agents. BMAC is used for more advanced joint degeneration, complex structural injuries, and cases where PRP alone is unlikely to provide sufficient support. In many cases, Dr. Scheinberg combines both treatments to maximize the biologic environment in the joint.
Yes, and this is often Dr. Scheinberg's recommendation for patients with the most significant joint degeneration or complex orthopedic pathology. The combined approach uses BMAC's stem cell and regenerative signaling properties alongside PRP's growth factor concentration to create the most comprehensive healing environment possible in the joint. Both are harvested and processed on the same day and delivered in sequence. This is the highest-intensity protocol at the Scheinberg Clinic and is reserved for patients with advanced arthritis or complex sports pathology.
Dr. Scheinberg treats a broad range of orthopedic conditions with orthobiologics, with particular focus on: Knee osteoarthritis (mild, moderate, and advanced), hip arthritis and labral tears, shoulder arthritis and rotator cuff injuries (partial tears, tendinopathy, and labral tears), patellar tendinopathy and patellar tendon injuries, Achilles tendinopathy, tennis elbow (lateral epicondylitis), partial ligament tears of the knee and ankle, meniscal pathology, and spinal degeneration in appropriate candidates. His surgical background means he also evaluates patients whose condition may ultimately require surgery, and he'll tell you clearly if that's the case.
Dr. Scheinberg is a board-certified orthopedic surgeon with 40 years of experience and a Harvard and Duke-trained background. Many PRP providers are not orthopedic surgeons. Some come from internal medicine, pain management, or other general practice backgrounds and may have limited specialized training in musculoskeletal anatomy and orthopedic diagnosis. The distinction matters for two reasons. First, accurate diagnosis requires the depth of knowledge to interpret imaging, examine the joint, and identify precisely which structure is damaged, skills built over decades of surgical training and practice. Second, procedural precision is a surgical discipline. Injecting the right substance at the correct concentration into the exact anatomical location requires the kind of expertise that orthopedic surgery demands. Dr. Scheinberg applies both to every patient he treats.
The Scheinberg Clinic is located on Chapala Street in Santa Barbara, California. It is co-located with the Pueblo Surgical Center, an AAAHC-accredited ambulatory surgical facility. The practice serves patients from throughout the Santa Barbara and Montecito area, the broader Central Coast, Bakersfield, and patients who travel from elsewhere in California and nationally for access to Dr. Scheinberg's specialized care.
The first step is a surgical-grade consultation to evaluate your condition, review your imaging, and determine candidacy. To request an appointment, call 805.682.1394 or use the contact page. You will be asked to bring any recent imaging to your first visit, or arrangements can be made to obtain appropriate imaging prior to the consultation.
Published national figures give a sense of the range. A 2024 nationwide study of top US orthopedic hospitals found PRP injection prices from $350 to $2,815, with a median of $800 per injection.1 A 2018 survey of US stem cell centers found knee stem cell injections averaged about $5,000 each.2 For comparison, a study of 58,809 Medicare patients found a median 90-day cost of $23,800 for a total knee replacement.3
These are national figures, not this practice's prices. Exact pricing is discussed during your consultation and is transparent before any treatment decision is made, so you can weigh it against the outcome you can reasonably expect.
Sources: 1. Tiao J, et al. Clin Orthop Relat Res. 2024;482(4):675-684.; 2. Piuzzi NS, et al. J Knee Surg. 2018;31(6):551-556.; 3. Courtney PM, et al. J Arthroplasty. 2018;33(8):2368-2375.
Orthobiologic treatments using PRP and BMAC carry a low risk profile because they use materials derived from your own body. The most common side effects are temporary soreness, swelling, or stiffness at the injection site, which typically resolve within a few days. There is a small risk of infection with any injection, which is minimized by the clinic's use of sterile technique and surgical-grade standards. For patients on blood thinners or with certain medical conditions, Dr. Scheinberg will assess these factors as part of the consultation. The treatment is not appropriate for patients with active infection, certain clotting disorders, or active malignancy.
Scientists and doctors have made tremendous advances to make tissue regeneration a reality in treating many diseases. Through regenerative medicine, a person can take advantage of their body\u2019s ability to heal itself by using the healthy adult stem cells that can be found throughout the body. Laboratory and clinical research has shown that it is possible to use adult stem cells to restore lost, damaged, or aging cells and effectively regenerate tissue in the body. Regenerative therapies are showing promise in the treatment of orthopedic pain.Adult stem cells were discovered over 40 years ago when researchers found that cells derived from bone marrow had the ability to form various tissues. Adult stem cells are early stage cells and under the right conditions, are capable of developing into other types of cells with the potential to regenerate damaged tissue.
In adults, stem cells are present within variety of tissues and organs, the most common sources being bone marrow and fat (or adipose) tissue.
A mesenchymal stem cell is a primitive cell with the ability to:
- Self-replicate
- Differentiate into multiple tissues
- Bone
- Cartilage
- Muscle
- Reduce inflammation
- Fight apoptosis (cell death)
Adult stem cells are the means by which our bodies naturally heal throughout our lifetime.
Adult stem cells are being used to treat many types of chronic pain and degeneration. Currently doctors are treating shoulder, knee, hip, and spine degeneration, in addition to soft tissue (muscle, tendon, ligament) and other bone-related injuries.
Stem cells are cells found in human bone marrow and adipose tissue primarily that have the capacity to transform into other types of tissue that may have been damaged and are in need of repair. We are most interested in their ability to transform into musculoskeletal tissue that has been worn away or damaged.
In adults, stem cells are present within a variety of tissues and organs; the most common sources being bone marrow and fat (or adipose) tissue.
One of the richest sources of adult stem cells is bone marrow, and the hip (pelvis) is one of the best and most convenient locations for obtaining bone marrow. In the harvesting procedure, the doctor typically removes (or aspirates) from the pelvis. A trained nurse or technician then uses specifically designed equipment to concentrate the adult stem cells in the bone marrow and provides the cells back to the physician for implantation at the site of injury.
No, since they are cells collected from your own tissue, there is little threat of rejection.
There are many potential applications where stem cell treatments can be very effective. The following are the most common:
SPINE
- Discogenic back pain
- Facet arthritis
- Degenerative disc disease (DDD)
- Sacroiliac joint pain
HIP
- Osteoarthritis
- Labral tears
- Articular cartilage injuries
FOOT AND ANKLE
- Mild to moderate osteoarthritis
- Tendon inflammation
- Partial Achilles tendon tear
- Plantar fasciitis
SHOULDER
- Partial rotator cuff tears
- Labral tears
- Mild to moderate osteoarthritis
KNEE
- Osteoarthritis
- Partial ligament tears
- Partial meniscal tears
Stem cells are used in many different medical specialties. In orthopedics and musculoskeletal medicine orthobiologics, stem cells and PRP are utilized for arthritis joints such as hips and knees in order to attempt to avoid joint replacements. That also holds true for shoulder and back problems. Rather than injecting steroid for back pain, we prefer to use a combination of BMAC (bone marrow aspirate concentrate) and PRP, which has stronger anti-inflammatory qualities and potentially long-term regenerative capacity, rather than the antimetabolic effects of corticosteroids.
The procedure of harvesting your own bone marrow and injecting the bone marrow concentrate that has been prepared by centrifugation and separation of the stem cells from the other components and then reinjection of the product takes about 90 minutes. At Pueblo Surgical Center, affiliated with our orthopedic office, we utilize a light general anesthetic so that there is no discomfort to patients, who generally awaken refreshed and without pain.
Post-injection patients can resume essentially normal activities with the exception that they avoid strenuous physical activity for 48 hours.
Utilizing adult pluripotent* stem cells in musculoskeletal problems such as arthritis has been developing for many years. However, the field of orthobiologics, which encompasses mainly the use of stem cells and blood products such as PRP (platelet rich plasma), has been popularized only in the past 10 years.
There has been some reluctance by a part of the orthopedic community to fully embrace orthobiologics as a major tool in the therapeutic armamentarium, in part because it eliminates some of the surgical procedures that are the mainstay of an orthopedic surgeon’s livelihood. There is also reluctance because it is new, and the clinical research on its efficacy is still in progress. Once those issues are resolved, I believe that utilization of biologic solutions to mechanical orthopedic problems will be well accepted and utilized extensively to avoid major surgical procedures. The insurance industry has been slow to embrace this area of medicine, which I believe will significantly change in the not-too-distant future. We are at the early stages in the evolution of harvesting the human body’s own capacity to heal itself. This area of medicine will continue to grow and eliminate more aggressive solutions to bone and joint problems such as metal and plastic implants. It stands to reason that biologic solutions are better than bionic ones.
Schedule a surgical-grade assessment to determine your candidacy for advanced biological repair.