Video Transcription

Often I get asked questions in regard to Platelet Rich Plasma because its getting a lot of press. Doctors who do a lot of Prolotherapy, who are experts in Prolotherapy can get almost every condition better by other Prolotherapy solutions. The times that we have to use Platelet Rich Plasma are actually not many. If you don’t do Prolotherapy, you just have Platelet Rich Plasma as one type of injection therapy that you can do, you don’t do the full gamut of Prolotherapy solutions, then you are just going to use Platelet Rich Plasma on everybody. Platelet Rich Plasma is a great tool to have and it’s a vast improvement over cortisone, but a Prolotherapy doctor, who has a lot of experience, will use a lot of different Prolotherapy solutions

Traditionally, Platelet Rich Plasma has been used for tendinopathy. Just so you know, before there was Platelet Rich Plasma, I can’t even remember one patient that we couldn’t get better with tendinosis with the normal Prolotherapy solution. I’m happy to use Platelet Rich Plasma and I do use Platelet Rich Plasma regularly. I probably have about as much experience as anybody in the country using Platelet Rich Plasma. But, it’s only a small segment of the chronic pain or acute pain population that needs Platelet Rich Plasma.

I want to talk about the shortcomings of Platelet Rich Plasma because a lot of people don’t realize it. First of all, most pain is not very localized. Most people who have pain have a very big diffused area of pain. Here, I’m just going to show for a model (pulls out model of pelvis), let’s just say somebody has back pain. You have low back pain, the disk area is over here (gesture to top) and this is the sacroiliac. This is a big body area. My entire hand can cover it. If you have pain up here, it’s a humongous area. Normally, the amount of Prolotherapy solution that I would inject into this area as a Hemwall-Hackett Prolotherapy doctor would be on the order of 80 to 100cc’s of solution. Most PRP kits give you about 40cc’s of solution. If an athlete, or a person with chronic pain needs 100cc’s of solution injected into them, Platelet Rich Plasma isn’t going to be enough.

Now, if you have a very small discreet area of tendon degeneration, like in your Achilles, yeah, you could do regular Prolotherapy or you could do Platelet Rich Plasma Prolotherapy. But, there are very few people who, even in the shoulder, aren’t going to say their whole shoulder hurts. The person needs the back of the shoulder treated, the top of the shoulder treated, and the front of the shoulder. So in Hemwall-Hackett Prolotherapy, this might be 40cc’s of solution. Most PRP systems give you about 4cc’s. Some of them will give you around 12cc’s of solution. Even for a shoulder, which is a much smaller joint than the whole neck, or the whole back, or the whole knee, it’s not enough solution.

Platelet Rich Plasma is good for very localized, discreet injuries like in a tendon. However, if a person has joint instability, which typically means the person has knee pain and the knee joint is loose, or the sacroiliac joint is loose. For joint instability, you have to use solutions that are very good for the ligaments and I haven’t seen Platelet Rich Plasma be that great for the ligaments. For ligament injuries, I would definitely recommend Hemwall-Hackett Prolotherapy.