Should you consider it—and if so, where do you start?
The Problem
As I write this America ranks ~39th in musculoskeletal outcomes, yet we out-spend the next 25 countries combined.¹ Imagine the Yankees finishing dead-last every year despite the biggest payroll in baseball—that’s our current injury-care model. Most of the cost is front-loaded into injections or surgery because insurance makes them feel “free.” Unfortunately, the data show they rarely deliver superior long-term results, and they often leave patients chasing opioids or repeat procedures.²
I have struggled to teach patients and practitioners about when regenerative therapy should be incorporated into their care. Sometimes its obvious you have a torn tendon or muscle that isn’t surgical so it just makes sense to use regenerative therapy to heal it faster and deeper. Other times it isn’t as clear.
I find myself talking and teaching about the differences in regenerative treatments a lot so I hope this answers a lot of these questions.
The Regenerative Ladder
Think of tissue-healing as a four-rung ladder. You can step off at any level, but the higher you climb, the more powerful (and expensive) the tools become.
As I write this America ranks ~39th in musculoskeletal outcomes, yet we out-spend the next 25 countries combined.¹ Imagine the Yankees finishing dead-last every year despite the biggest payroll in baseball—that’s our current injury-care model. Most of the cost is front-loaded into injections or surgery because insurance makes them feel “free.” Unfortunately, the data show they rarely deliver superior long-term results, and they often leave patients chasing opioids or repeat procedures.²
I have struggled to teach patients and practitioners about when regenerative therapy should be incorporated into their care. Sometimes its obvious you have a torn tendon or muscle that isn’t surgical so it just makes sense to use regenerative therapy to heal it faster and deeper. Other times it isn’t as clear.
I find myself talking and teaching about the differences in regenerative treatments a lot so I hope this answers a lot of these questions.
The Regenerative Ladder
Think of tissue-healing as a four-rung ladder. You can step off at any level, but the higher you climb, the more powerful (and expensive) the tools become.
Key Idea: The higher you climb, the more skill, data, and cost are involved—but starting lower earlier prevents many trips to the top rung.
The area that I focus on the most are 2 and 3. I think this is where we find the most “bang for our buck” in terms of outcomes, time and money. I have seen multiple patients do better in level 3 because of our understanding of stacking therapies than in level 4 where we must take the hands-off approach for a while. That’s not to say that regenerative medicine isn’t going to be more powerful in certain cases. It is more to highlight that regenerative biologics can be incredibly powerful and much more affordable.
A question I get a lot is what research does any of this have?
Peptide Research and Uses
GHK-Cu — Aids in Collagen formation and nerve healing
A tripeptide naturally found in human plasma, GHK-Cu turns on hundreds of genes involved in repair:
Clinical takeaway: We stack GHK-Cu (typically as a sub-cutaneous or topical 2–3 mg/day cycle) when we need dense, high-quality scar-free collagen—think partial rotator-cuff tears, Achilles tendinosis, or thinning skin around surgical scars.
BPC-157 — Signals for Tissue Regrowth and Regeneration.
Derived from gastric juice, BPC-157 up-regulates growth-hormone receptors in tendon fibroblasts by up to 7-fold, making those cells hyper-responsive to your own GH pulses.⁶
Clinical takeaway: In stubborn medial/lateral epicondylitis, rotator cuff tears, disc injuries, partial meniscus tears, or labral frays, pairing BPC-157 (250–500 µg, BID) with GH-mimetic stimulus (heavy-slow resistance, Kaatsu, or zone-2 cardio) can accelerate healing timelines by 50+%.
Stack Smarter: We often layer laser + PEMF (improves micro-perfusion) with BPC-157 and GHK-Cu (directs cellular work) to give the body the energy and the regeneration needed to repair completely. Once healing is in action we'll add in Kaatsu Therapy to regain strength completely (GH surge without joint stress). Patients report 40-70 % faster pain-free strength return versus exercise alone.
A question I get a lot is what research does any of this have?
Peptide Research and Uses
GHK-Cu — Aids in Collagen formation and nerve healing
A tripeptide naturally found in human plasma, GHK-Cu turns on hundreds of genes involved in repair:
- Collagen & Elastin: Activates fibroblasts and cross-linking enzymes for stronger, more elastic tissue.
- Anti-Inflammatory & Anti-Oxidant: Lowers pro-inflammatory cytokines and boosts SOD, protecting mitochondria.⁴
- Angiogenesis & Nerve Growth: Guides endothelial cells to build micro-vessels and promotes nerve-growth factors.⁵
Clinical takeaway: We stack GHK-Cu (typically as a sub-cutaneous or topical 2–3 mg/day cycle) when we need dense, high-quality scar-free collagen—think partial rotator-cuff tears, Achilles tendinosis, or thinning skin around surgical scars.
BPC-157 — Signals for Tissue Regrowth and Regeneration.
Derived from gastric juice, BPC-157 up-regulates growth-hormone receptors in tendon fibroblasts by up to 7-fold, making those cells hyper-responsive to your own GH pulses.⁶
- Boosts cell proliferation & PCNA → faster matrix build-out.
- Activates JAK2/STAT signaling → stronger collagen bundles.
- Potentiates GH or IGF-1 without raising systemic levels dramatically.
Clinical takeaway: In stubborn medial/lateral epicondylitis, rotator cuff tears, disc injuries, partial meniscus tears, or labral frays, pairing BPC-157 (250–500 µg, BID) with GH-mimetic stimulus (heavy-slow resistance, Kaatsu, or zone-2 cardio) can accelerate healing timelines by 50+%.
Stack Smarter: We often layer laser + PEMF (improves micro-perfusion) with BPC-157 and GHK-Cu (directs cellular work) to give the body the energy and the regeneration needed to repair completely. Once healing is in action we'll add in Kaatsu Therapy to regain strength completely (GH surge without joint stress). Patients report 40-70 % faster pain-free strength return versus exercise alone.
NAD⁺ Repletion (NR/NMN/Direct NAD⁺) — Improves Mitochondrial Function and cellular energy
These act to improve mitochondrial function and cellular energy. The main findings that we see are:
These act to improve mitochondrial function and cellular energy. The main findings that we see are:
- Mitochondrial Biogenesis and Sirtuin activation - This means that NAD+ improves oxidative phosphorylation efficiency. NR supplemented men (1000 mg/d) increased skeletal muscle NAD+ metabolites by 2.7x in only 3 weeks.
- Stem Cell rejuvenation - NAD+ shows the ability to restore satellite cell quiescence improving muscle regeneration. Old mice given NMN for 1 week regenerated injured muscle fibers as robustly as young controls.
- Inflammation modulation - NR lowers inflammatory cytokines and improves insulin sensitivity in obese adults. 12 weeks of NR 2g/d showed a 15% drop in CRP the major marker for inflammation.
- Clinical implementation - we often use NAD+ in suppository, oral and occasionally IV. For acute recovery phases a 500-1000mg/day suppository and for baseline repletion oral 250-1000mg/day. We pair it with kaatsu training and PEA for nerve repair and quercetin for sirtuin signaling (anti-aging)
Thymosin-β4 (TB-500) — Increases angiogenesis, cell migration, promotes mesenchymal stem cell differentiation, decreases inflammatory cytokines
A master “actin architect” that accelerates soft-tissue repair and modulates scar formation.
A master “actin architect” that accelerates soft-tissue repair and modulates scar formation.
- Actin-Driven Cell Migration & Angiogenesis – TB-500 binds G-actin, freeing polymerization sites that speed fibroblast / keratinocyte migration and trigger VEGF-mediated neovascularization. In full-thickness skin wounds, topical TB-500 closed defects 25-30 % faster than placebo.
- Collagen Remodeling & Anti-Fibrotic Action – Up-regulates type I/III collagen yet down-modulates TGF-β myofibroblast activation, limiting rigid scar tissue. Rabbit Achilles models showed 45 % lower fibrosis scores vs. saline.
- Neuro- & Cardio-Protection – Activates AKT/ERK pathways and preserves mitochondrial integrity; post-MI rats given TB-500 cut infarct size nearly in half and boosted capillary density +60 %.
- Clinical Implementation – Typical soft-tissue stack: 2–5 mg sub-q twice weekly × 4–6 weeks, then 2 mg weekly maintenance. We pair TB-500 with BPC-157 (synergistic collagen signaling) plus laser or shockwave for added angiogenic stimulus.
Growth-Hormone Secretagogue Peptides (GHS)CJC-1295, Ipamorelin, MK-677 & friends
Peptides that restore youthful GH/IGF-1 pulses without exogenous hormone.
Peptides that restore youthful GH/IGF-1 pulses without exogenous hormone.
- Pulsatile GH & IGF-1 Amplification – GHS peptides bind GHS-R1a or mimic GHRH, doubling IGF-1 while preserving physiologic feedback. A 28-day CJC-1295 course raised serum IGF-1 2-fold and kept it elevated six days post-dose.
- Tendon / Ligament Anabolism – Elevated IGF-1 plus MMP-2 activity accelerate collagen realignment; rabbit partial-Achilles tears treated with ipamorelin had +32 % tensile strength at four weeks.
- Body Re-Composition & Deep-Sleep Boost – MK-677 studies in older adults added ~2 kg lean mass and extended stage-4 sleep, supporting recovery and GH output.
- Chondro-Protection – GH/IGF-1 axis reduces IL-1β cartilage catabolism; weekly ipamorelin cut OA cartilage-degeneration scores 35 % in rats.
- Clinical Implementation – Common protocol: CJC-1295 + Ipamorelin 100 µg each, sub-q nightly (5-7 nights/wk) × 3 months; or MK-677 12.5–25 mg oral daily. Monitor IGF-1 & fasting glucose; contraindicated in active malignancy.
Should we start regenerative therapy early?
If a partial-thickness rotator-cuff tear simply “rests” for 6 weeks, the body fills the gap with disorganized scar. Three months later the cuff is weaker, stiffer, and more likely to tear again. By scheduling Level 2-3 catalyst or biologics in the first 2 weeks, we give the body the building blocks and blueprints it needs to lay down near-normal collagen—often visible on ultrasound by week 6.
This is always an individualized approach. Some of my patients need to heal back to 100% or even stronger and this approach makes sense. In some of my older patients who are demanding as much on their body we make take a more conservative approach. It's not a one size fits all which is why I recommend working with someone who knows your goals, activities and ideal outcomes.
If a partial-thickness rotator-cuff tear simply “rests” for 6 weeks, the body fills the gap with disorganized scar. Three months later the cuff is weaker, stiffer, and more likely to tear again. By scheduling Level 2-3 catalyst or biologics in the first 2 weeks, we give the body the building blocks and blueprints it needs to lay down near-normal collagen—often visible on ultrasound by week 6.
This is always an individualized approach. Some of my patients need to heal back to 100% or even stronger and this approach makes sense. In some of my older patients who are demanding as much on their body we make take a more conservative approach. It's not a one size fits all which is why I recommend working with someone who knows your goals, activities and ideal outcomes.
What a Personalized Regenerative Treatment Looks Like
- Ultrasound-Based Mapping – live imaging of fiber quality, neovascularity, and fascial glide.
- Damage × Demand Matrix – how big is the tear vs. what do you need it to do (e.g., desk job vs. college pitcher)?
- Stack Design – match the lowest effective ladder-level to your biology, budget, and timeline.
Want to know more?
We’re hosting a Regenerative Healing Workshop where you’ll:
Click Register or call 337-504-5144 to reserve your seat and start your personalized regenerative roadmap.
We’re hosting a Regenerative Healing Workshop where you’ll:
- See before-and-after ultrasound of rotator-cuff and meniscus cases.
- Get a deeper dive into peptides, PRP, laser, and laser stacks (with dosage & timeline examples).
- Receive a FREE 1-on-1 regenerative consult or expedited ultrasound evaluation (limited to first 15 registrants).
Click Register or call 337-504-5144 to reserve your seat and start your personalized regenerative roadmap.
References (abridged)
- OECD Health at a Glance, 2023.
- Weinstein et al. N Engl J Med 2007;357:794–7.
- Pickart L. J Biomater Sci Polym Ed 2008;19(7):969–88.
- Hong et al. Free Radic Res 2019;53(5):555–70.
- Maiti et al. Mol Neurobiol 2022;59(1):558–75.
- Chang C-H et al. Int J Mol Sci 2014;15: 21919–34.
- Malinda KM et al. Thymosin-β4 accelerates wound closure. J Cell Sci. 2003.
- Bock-Marquette I et al. TB-4 activates integrin-linked kinase for cardiac repair. Nature. 2004.
- Smith RG et al. GH secretagogue mimetics: physiology & therapy. Endocr Rev. 2020.
- Friedlander AL et al. MK-677 increases lean mass in older adults. J Clin Endocrinol Metab. 2001.
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