When You’ve Already Done the Work and the Pain Hasn’t Moved
You did the physiotherapy. You committed to the exercises, modified your activity, maybe tried anti-inflammatories or a cortisone shot along the way. For a while, some of it helped. But the ache in your knee or hip is still there when you take the stairs, still there at the end of a long day, still shaping what you say yes to.
That plateau is real, and it is not a sign that you failed or that nothing more can be done. It usually means the conservative options have taken you as far as they can, and the next conversation is about a more advanced intervention.
For people with mild to moderate osteoarthritis who have reached that point, Evidence Sport and Spine offers nSTRIDE Autologous Protein Solution, known as nSTRIDE APS. It is a single-injection regenerative therapy delivered by Dr. Todd Gash, one of Calgary’s most experienced regenerative medicine physicians.
What nSTRIDE APS Is
nSTRIDE APS is a regenerative injection made from your own blood. It is autologous, meaning nothing foreign is introduced into your body. A sample of your blood is processed to concentrate a specific group of anti-inflammatory and protective proteins, which are then injected directly into the affected joint under ultrasound guidance.
It is approved by Health Canada for the treatment of knee osteoarthritis. At Evidence Sport and Spine, Dr. Gash uses it to treat osteoarthritis of the hip or knee.
Unlike standard platelet-rich plasma protocols, which often require a series of injections, nSTRIDE APS is delivered as a single injection per affected joint. In most patients, much of the peri-articular tissue also needs to be treated. To complete the comprehensive approach provided at Evidence Sport and Spine, the surrounding tissue and complete rehabilitation plan will be reviewed.
How It Works
Osteoarthritis is not only mechanical wear. The painful joint is also a biochemically inflamed environment, with an excess of proteins that drive inflammation and break down cartilage. nSTRIDE APS is designed to address that environment directly.
The process is straightforward:
- Blood draw. A sample is taken from a vein in your arm, the same way as any routine blood test.
- Concentration. The sample is processed on-site to isolate a high concentration of anti-inflammatory and anabolic proteins from your own blood.
- Ultrasound-guided injection. Dr. Gash injects the solution precisely into the affected joint, using ultrasound to confirm highly accurate placement.
The goal is to calm inflammation, reduce pain, and help protect the joint from further breakdown, so the joint has a better environment in which to function.
Who It’s For
nSTRIDE APS is best suited to people who:
- Have been diagnosed with mild to moderate osteoarthritis of the knee or hip
- Have already tried conservative care such as physiotherapy, activity modification, or simple pain relief, and have plateaued or not gained lasting relief
- Want an evidence-based option that uses their own biology rather than synthetic medication
- Are looking for a meaningful step before considering joint replacement surgery
It is not a fit for everyone. A consultation with Dr. Gash determines whether your stage of osteoarthritis and overall health make you a suitable candidate, and whether another approach would serve you better.
While You’re on the Waitlist
Joint replacement waitlists in Alberta can be lengthy. Pain that was manageable becomes harder to tolerate, activity continues to decline and corticosteroid injections have their own risks. Steroids are considered to be detrimental for cartilage and joint stability, and repeated steroid use can weaken the surrounding tissue over time. Although they do cover the pain and have a clinical application and therefore a valid place, they should not be relied on as a sole source of benefit. Additionally, most orthopedic surgeons require a minimum of three months between a cortisone injection and a joint replacement procedure.
NSTRIDE APS does not carry that same surgical timing restriction*. As an autologous therapy using your own blood, it offers a meaningful option for managing function and protecting the joint, without compromising surgical outcomes.
*depending on your surgeons’ individual requirements
What the Evidence Shows
nSTRIDE APS has been studied in published clinical research. A single injection has been shown to be safe and well tolerated, with the most common effects being mild, short-lived injection-site discomfort that resolves on its own.
In published studies, patients have reported meaningful improvements in pain and joint function, with benefit observed in some patients maintained over a period of one to two years, and longer-term follow-up in some cases extending further. Individual results vary depending on the stage of osteoarthritis and other personal factors, which is why candidacy is assessed case by case.
As with any medical procedure, the most accurate picture of likely benefit for your specific situation comes from a medical consultation.
Physiotherapy and APS Work Together
An injection is not a replacement for the rehabilitation you have already invested in. The physiotherapy you have done is the foundation this treatment builds on, and continuing to move, strengthen, and load the joint well is part of getting the most from APS.
At Evidence Sport and Spine, your physician and physiotherapy team coordinate care, so the injection and your rehabilitation are working toward the same goal rather than in isolation. This collaborative model is central to how Evidence Sport and Spine approaches complex cases.
A Word From Dr. Todd Gash
“Most of my patients with osteoarthritis have already done everything right, by the time they find me. They’ve done the physiotherapy, they’ve put in the work, yet they’re still in pain. NSTRIDE APS gives me a tool that works with their own biology to address the inflammatory environment driving that pain, not just masking it. For the right patient, that’s a meaningful difference.” — Dr. Todd Gash, Regenerative Medicine Physician, Evidence Sport and Spine
Meet Your Physician: Dr. Todd Gash
Dr. Todd Gash is a Regenerative Medicine Physician who has practised at Evidence Sport and Spine since its inception, with more than twenty years of focused experience in ultrasound-guided interventional treatment of chronic spinal and peripheral musculoskeletal conditions.
He is Hackett-Hemwall trained in prolotherapy and works extensively with regenerative injection therapies, including platelet-rich plasma and dextrose prolotherapy. Dr. Gash completed his medical training at Memorial University of Newfoundland and a family medicine residency at McGill University, and holds a Diploma in Sport Medicine from the Canadian Academy of Sport and Exercise Medicine. He has practised in Calgary since 1998, following military service as a Battlegroup Medical Officer with NATO in Bosnia-Herzegovina.
His focus is on accurate diagnosis and precise, image-guided treatment, explained in terms patients can understand.
Dr. Todd Gash
MD, Diploma Sport and Exercise Medicine
Frequently Asked Questions
Is nSTRIDE APS the same as PRP?
No. Both use your own blood, but they are processed differently and serve different purposes. Standard platelet-rich plasma often requires a series of injections, while nSTRIDE APS is designed as a single injection that concentrates a specific anti-inflammatory protein profile for osteoarthritis. Dr. Gash will advise which option suits your condition.
Does the injection hurt?
Most patients experience only mild, temporary discomfort at the injection site, which typically settles within a day or two. The procedure is done in clinic and you go home the same day.
How soon will I notice a difference?
This varies between patients. Some notice improvement within a few weeks as inflammation settles. Your physician will discuss a realistic timeline based on your specific situation.
Is it covered by insurance?
Coverage for regenerative injections varies by plan. We recommend confirming details with your provider, and our team can help you understand the costs involved before you proceed.
Can it treat joints other than the knee?
Yes. At Evidence Sport and Spine, Dr. Gash uses nSTRIDE APS for hip osteoarthritis in addition to the knee. Suitability is assessed during consultation.
Do I need a referral?
This treatment is part of the advanced medical model at Evidence Sport and Spine. The best first step is to ask your clinician, your physiotherapist or family physician, for a referral, which begins the consultation process with Dr. Gash.
Ask Your Clinician for a Referral
If you have plateaued after conservative care for knee or hip osteoarthritis, nSTRIDE APS may be a meaningful next step. This treatment begins with a referral.
Talk to your physiotherapist or family physician and ask for a referral to Evidence Sport and Spine.
For more information about regenerative medicine at Evidence Sport and Spine, call 403.210.9969.