What is Platelet Rich Plasma Therapy?
Platelet Rich Plasma – Prolotherapy using your own growth factors
At Caring Medical, we specialize in proliferative injection therapies, known as Prolotherapy. While these regenerative medicine treatments have been around for many decades, one of the exciting additions, in recent years, is Platelet Rich Plasma (PRP).
PRP whas been shown effective for labral tears of the hip and shoulder, as well as degenerated meniscus and meniscus tears. The scientific literature is full of reports of soft tissue injuries treated with PRP including tendinopathy, tendinosis, acute and chronic muscle strain, muscle fibrosis, ligamentous sprains and joint capsular laxity, in addition to various degenerative disorders in your joints. Especially exciting is PRP’s use for regenerating cartilage.
There is a reason researchers are trying to find ways to regenerate cartilage. The reason is regenerative medicine is the future and the days of removing tissue is clearly limited. Recently doctors found that two PRP treatments with 4-week intervals, improved the pain, stiffness, and functional capacity of patients with knee osteoarthritis. Additionally Improvements in quality-of-life were meaningful after injections.1
Researchers at the University of Washington are the latest to join in on the discussion on the effectiveness of Platelet Rich Plasma Therapy for sports injuries. In their Platelet rich plasma therapy research review they noted that “Interest in platelet-rich plasma (PRP) has skyrocketed over the last decade. . . interest from the public has fueled increased utilization of PRP for musculoskeletal conditions, particularly those that are difficult to treat such as chronic, degenerative tendinopathy and osteoarthritis.”2
What conditions are treated with Platelet Rich Plasma?
Please see research and clinical application of PRP for Knee Osteoarthritis, the page is frequently updated. If you already had a surgery and are having continued issues with joint pain, please see Platelet Rich Plasma Therapy after surgery. If you had meniscus surgery we have this article PRP after Meniscus surgery.
PRP Therapy for Knee Problems
PRP Therapy for back pain
The basic concept of blood platelets for healing
Platelets play a central role in blood clotting and wound healing. Tissue repair begins with clot formation and platelet degranulation, which release the growth factors necessary for wound repair. Platelet-derived growth factors are biologically active substances that enhance tissue repair mechanisms. After platelets are activated at a wound site, proteins are released that directly and indirectly influence virtually all aspects of the wound healing cascade. Studies have shown a direct correlation between the platelet concentration and the level of secretory proteins, as well as the amount of proliferation involved in the wound healing.
How does Platelet Rich Plasma work?
In basic terms, PRP involves the application of concentrated platelets, which release a supra-maximal quantity of growth factors which stimulate recovery in non-healing injuries. PRP causes a mass influx of growth factors, such as platelet-derived growth factor, transforming growth factor and others, which exert their effects of fibroblasts causing proliferation and thereby accelerating the regeneration of injured tissues. Specifically, PRP enhances the fibroblastic events involved in tissue healing including chemotaxis, proliferation of cells, proteosynthesis, reparation, extracellular matrix deposition, and the remodeling of tissues. Bottom line here is that tissues can heal faster with Platelet Rich Plasma treatment.
How are PRP injections performed?
PRP Prolotherapy is performed at Caring Medical by our Prolotherapy injection specialists, Ross Hauser, MD, Danielle Steilen, PA-C and Timothy Speciale, DO. The preparation of therapeutic doses of growth factors consists of an autologous blood collection (blood from the patient), plasma separation (blood is centrifuged), and application of the plasma rich in growth factors (injecting the plasma into the area.) In other words, a PRP treatment is done just like any other Prolotherapy treatment, except the solution used for injection is plasma enriched with growth factors from your own blood. In our office, patients are generally seen every 4-6 weeks. Typically three to six visits are necessary per area.
Will Platelet rich plasma therapy work for me?
This question is subject of course to many factors, the least of which is getting Comprehensive Prolotherapy that includes Platelet Rich Plasma versus getting a single, or two-treatment program. The good news is that even in research where two PRP treatments are given, without supportive Prolotherapy, results were very positive. EVEN in patients who had continued Knee Pain after knee surgery. “ PRP treatment showed positive effects in patients with knee OA. Operated and nonoperated patients showed significant improvement by means of diminishing pain and improved symptoms and quality of life.”3
Too many different ways of applying PRP Treatments causing concerns
A recent article in Orthopedics Today warns against the high degree in variability among practitioners who use Platelet Rich Plasma (PRP). The main concerns cited are a lack of standardization in treatment regimes and formula concentrations. Also mentioned are the various brands, concentrations, doses, etc that make it hard to determine the best use of PRP. Unfortunately, like many new and upcoming treatment modalities, there are good and not-so-good uses of the technique. Some physicians are rapidly jumping on the PRP bandwagon without having much injection experience or without any knowledge except for a weekend course in use of PRP. Prolotherapy is a specialized medical technique. It not only involves being able to choose the right proliferant for the patient’s particular pain complaint, but it also involves making a proper diagnosis, and then fully treating the injury. This is what we call Comprehensive Prolotherapy.
PRP is more than one injection at Caring Medical
While the concerns from this study may raise some flags for some practitioners, there are many studies proving the efficacy of PRP use. We have reported on a variety of studies including PRP for tennis elbow, knee osteoarthritis, and aging joints.
Our paper on the Platelet Rich Plasma PRP Injection Technique printed in the Journal of Prolotherapy provides the basic information on PRP’s use as an effective proliferant for Prolotherapy treatments.
An experienced Prolotherapist can use PRP Prolotherapy in a safe and effective way to heal common joint injuries. One common issue occurring in the PRP field is that a number of practitioners are performing solely PRP, and not using dextrose Prolotherapy to address the underlying joint instability that most likely lead to the injury in the first place. Comprehensive Prolotherapy involves not only providing growth factors for healing and/or cartilage regrowth, but addressing the underlying cause of the problem. Our study on the use of PRP Prolotherapy for the treatment of meniscus tears published in Practical Pain Management discusses the comprehensive approach and shows how its use lead to surgery avoidance in an otherwise typically surgically corrected medical problem: mensicus tears.
As with any medical procedure, its success is determined by the experience, compassion, and technique of the practitioner providing the treatment. Platelet rich plasma used for injection is no different. For more information on PRP Prolotherapy or for appointment information, please feel free to contact us:
1. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy – future or trend? Arthritis Res Ther. 2012 Aug 8;14(4):219. [Epub ahead of print]
2. “Platelet-rich plasma promises pain relief and healing, but remains controversial” Orthopedics Today. Web. April 2013. Accessed April 29 2013.
3. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Sports Health. 2012 Mar;4(2):162-72.
4. Harmon KG, Rao AL. The use of platelet-rich plasma in the nonsurgical management of sports injuries: hype or hope? Hematology Am Soc Hematol Educ Program. 2013;2013:620-6. doi: 10.1182/asheducation-2013.1.620.