Platelet-Rich Plasma (PRP) Therapy is a nonsurgical procedure which utilizes platelets from an individual’s own blood to rebuild damaged tendons or cartilage. Not only does PRP successfully relieve pain, it’s also reported to speed the healing process.
There’s been much in the news recently, about PRP Therapy and its potential effectiveness in the treatment of injuries, particularly sports injuries. A number of famous athletes, among them Tiger Woods, have reportedly been injected with PRP for various problems, including sprained knees and chronic tendon injuries. Typically, these conditions were treated with medication, physical therapy, or sometimes surgery.
Blood is primarily a liquid called plasma. It also contains some solid components– red cells, white cells and platelets. Platelets are essential to clotting. They also contain proteins called growth factors which are important to the healing of injuries. PRP is plasma, but with many more platelets than are typically found in blood. The concentration of platelets, and therefore the concentration of growth factors, can be five to ten times richer.
How is PRP Therapy Performed?
A PRP preparation is created by first drawing blood from the patient. The platelets are then separated from the other cells. Next their concentration is increased through a process called centrifugation. Finally, the increased concentration of platelets is combined with the remaining blood.
The injury site can be treated by injecting PRP into the injured area. PRP may also be used to improve healing after surgery. This requires preparing the PRP in such a way as to allow it to be stitched into the damaged tissue.
Clinical studies show that PRP injections have improved function and decreased pain in elbow, wrist, shoulder, hip, knee, and ankle tendonosis. Research with osteoarthritis is also encouraging. Side effects of PRP injections are rare as the patient is utilizing their own blood, to which there should be no reaction.
Prolotherapy is a pain relief procedure that involves the injection of an irritant solution into a tendon insertion, joint space or weakened ligament. Commonly used solutions are hyperosmolar dextrose, lidocaine, glycerine, sodium morrhuate or phenol.
Prolotherapy injections are administered at joints or tendons where they connect to bone. The treatment sessions are usually given every two to six weeks for several months until treatments are rarely required, if at all.
Bone Marrow Aspiration
What is Bone Marrow Aspiration (BMA)?
It is well established that a significant population of our bodies’ stem cells are contained within our bone marrow. By harvesting blood and tissue from the bone marrow space of the hip, an injectable product can be produced by concentrating platelets and cells withdrawn through a simple outpatient needle aspiration procedure, done with local anesthetic and light sedation. BMA contains all of the growth and healing factors in PRP, along with concentrated “pluripotent” or stem-like cells which further contribute to the regenerative process.
What conditions can be treated with PRP and BMA?
• Tendon Injuries (Patellar Tendonitis, Quad Tendon)
• Muscle injuries
• Ligament sprains or tears (MCL, LCL)
• Muscle pain or injury
• Pyriformis syndrome
• Greater Trochanteric Bursitis
• Tendon Injuries
• Sacroiliac joint pain
• Hamstring tendonitis or tears
Shoulder and Arm Pain
• Rotator Cuff tendonitis, tendonopathy or partial tears
• Bicipital tendonitis
• Medial and Lateral epicondylitis (golfers & tennis elbow)
• Ulnar Collateral Ligament sprain or tear
Lower Leg and Foot Pain
• Plantar Fasciitis
• Shin Splints
• Peroneal tendonitis
• Ankle sprains/ligament injury
• Achilles tendonitis or partial tears
Following a formal evaluation and diagnostic workup, an individualized treatment plan will be discussed with you. A full explanation of the procedure including risks and benefits will be reviewed. Once written consent is obtained, blood is drawn from your arm or from a bone marrow aspiration in the back of your hip region, and placed in a special processing unit, which separates platelets, white blood cells and serum from red blood cells. The platelets and white blood cells (including stem cells) are then concentrated and collected into a sterile syringe. Some of the blood is used to create an “activator” of the PRP/BMA. The skin and soft tissue is anesthetized with local anesthetic, followed by injection of both the PRP/BMA and activator into the tissue targeted for treatment. Depending on the size of the injured tissue, one or several needles are inserted to optimize placement of the product.
Depending on the severity and duration of your injury, one to three injections are suggested. Following the initial treatment with PRP or BMA, a follow up visit occurs 3-4 weeks later. At this visit an evaluation of your response to the initial therapy is performed and a decision is made regarding the need for additional PRP treatments. In general, chronic injuries often require more than one injection. In both acute and chronic injuries, injections may be combined with an exercise or physical therapy program to enhance the success of the treatment.
Are PRP and BMA injections safe?
Research and clinical data show that PRP and BMA injections are extremely safe, with minimal risk for any adverse reaction or complication. Because the injectable products are produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Of note, recent research suggests that PRP may have an anti-bacterial property which protects against possible infection (4).
What to expect after your treatment:
Often, following the initial injection, an “achy” soreness is felt at the site of injury. This “soreness” is a positive sign that a healing response has been set in motion. This effect can last for several days and gradually decreases as healing and tissue repair occurs. It is important that anti-inflammatory medications such as Ibuprofen, Naproxen and Aspirin be avoided following PRP treatments. These medicines may block the effects of the intended healing response facilitated by the injection itself. It is acceptable to use over the counter pain medication, such as Tylenol and in some cases a prescribed analgesic, which does not have anti-inflammatory properties, to control discomfort as needed. Pain management options will be discussed with you by the physician managing your treatment plan. You will be permitted to resume normal day to day activities and light exercise following injection. We suggest that you avoid strenuous lifting or high level exercise for at least several days after injection.