Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) injections are used for the repair of chronic degenerative joints, ligaments and tendon injuries. This new technology is changing the way doctors and sports physicians treat injury, pain and aging. Conditions treated include: chronic overuse injuries to the ankles, knee and shoulders; arthritic joints; chronic back and spine arthritis and pain; degenerative disc disease. More specific injuries include; tennis elbow, carpal tunnel syndrome, knee ligament tears, shin splints, partial thickness rotator cuff tears, plantar fasciitis, Achilles tendonitis ,and IT band syndrome can be effectively treated with PRP.
PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins, including growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing: bone, tendon and ligament regeneration and repair, promote development of new blood vessels and stimulate the wound healing process resulting in new collagen formation. PRP is often combined with ultrasound to guide the injections to the specific pathologic tissue or joint.
How does it work?
Prolotherapy and PRP work on a very simple principle. Injecting a stimulating solution at the sites of pain, weakness and breakdown stimulates the body’s own healing mechanism to repair and rebuild injured tissue. This repair process leads to a stronger and more supportive structure.
When injuries occur, the area may not heal completely due to poor blood supply and from lack of proper treatment. For this reason, ligaments, joints and tendons heal very slowly. If left untreated, damaged ligaments become loose, allowing bones in the joint to swing out of alignment causing pain, muscle spasms, and eventually arthritis. Arthritis development occurs in the joints and spine as a result of instability in the ligaments and structures supporting them. Through years of dysfunctional movement, the joints start to wear themselves out. This is where Prolotherapy and PRP can intervene stabilizing the structures and decrease the progression of pain and aging. If left untreated, the pain will continue.
When stretched, small nerve fibers in these damaged ligaments transmit pain impulses to the brain. Through a subconscious reflex, the surrounding muscles go into a tight and painful spasm in an attempt to stabilize the joint. This causes the region to feel tight, stiff, achy, burning, tingling, numb, fatigued, and painful. The individual will often notice painful knots in the muscles. These muscles become tight and painful as they try to compensate for the weak and damaged underlying tissue structures. The spasms reduce blood flow, causing more pain. Not only are these symptoms felt locally, but they are often referred through nerve pathways into the legs and feet, arms and hands, and head (headaches). In other words, pain felt in the head, arms, or legs may be due to instability in the neck or back.
For example, weakness or injury to the ligaments in the neck may interfere with the sympathetic nervous system, causing a group of symptoms called Barre-Lieou Syndrome. This syndrome consists of one or more of the following: dizziness, visual blurring, loss of balance, ringing in the ears, runny nose, salivation, trouble swallowing, hoarse voice, nausea, vomiting, nervousness and headaches. These symptoms are caused by instability in the neck and can be eliminated.
The most basic Prolotherapy solution contains a naturally occurring sugar (dextrose) combined with an anesthetic (lidocaine). Other common, natural substances can also be used effectively. This solution does NOT contain cortisone, which is known to decrease inflammation, but will also slow or stop the healing process. Acute pain may be relieved with cortisone, but repeated use causes a weakening of the tissues and chronic pain develops. PRP uses Platelet Rich Plasma that is created from blood drawn from the patient. The blood is then put in a centrifuge machine that separates out the activated platelets, growth factors and healing cells. Rich in healing cells and growth factors, this is then injected back into the areas needed to be repaired stimulating the repair process.
PRP Frequently Asked Questions
Recently we had a patient inquire about the benefits from PRP injections. To answer the question, “What are the benefits from PRP injections,” it may first be necessary to better define what PRP is and the general procedural process.
What is Platelet Rich Plasma (PRP)?
The PRP is a blood product concentration of the growth factors and other healing cells from the patient’s own blood.
What is the therapeutic mechanism of Platelet Rich Plasma Apheresis?
The apheresis process separates the autologous blood into platelet rich plasma (PRP) and platelet poor plasma (PPP). The PPP is manually drawn off to leave PRP. This produces a product available for injection back into the patient. Included in the procedure are the venipuncture, preparation of the blood and centrifuge / separation / mixing / activation processes. This is needed to obtain a solution to stimulate the body to re-initiate the healing inflammatory processes.
How is PRP administered?
It is injected percutaneously (through the skin) into the intra-articular space and into tendon and ligament tissues. A peppering technique with the needle is used to prepare the tissue to accept the injected PRP thus using a percutaneous tenotomy procedure. The mechanism is by placing a high concentration of the patient’s own growth hormone and other healing cells in the PRP into tissue irritated by the tenotomy needling technique. The tissue is stimulated to heal itself in a manner similar to post injury without stretching the ligament tendon or joint capsule.
What tissue types are appropriate for treatment with PRP? How many injections are needed?
Chronically injured tendons(s), ligament(s), joint capsule and articular surfaces are often very positively impacted by treatment. Often a patient will receive 20-40 deep injections using the tenotomy technique described above. In addition, there are a corresponding number of superficial and deep anesthetic injections done to help alleviate the intense sensations from the tenotomy needling. Total injections may range from 40 to 80 when the deep therapeutic injections and anesthetic numbing injections are totaled.
What is the recommended frequency of treatment for PRP?
3-5 injection visits are typically anticipated. Some patients with minor issues may not require as many injections, while others with more extensive issues may require more than this average. The frequency is every 4-6 weeks ideally. Prior to initiating PRP injections, an office exam is performed and possibly imaging tests (x-rays, musculoskeletal ultrasound, CT, MRI) may be needed or reviewed if the patient already has had them performed.
What is the expected length of treatment for PRP?
Typically it is 4-5 months, but could be longer in certain cases.
What are the objective signs of successful PRP treatment?
Decreased pain, decreased use of pain medications, increased functional activities should be seen as the patient improves.
So the driving question today is what are the positive benefits of Platelet Rich Plasma (PRP) injections for you? Benefits include improving the collagen content of the ligaments, capsular tissues at the cervical facets, and improving the health of the facet joints in the neck. How is this helpful? Collagen acts as a tissue reinforcement making the tissue tougher and able to withstand more force through the structure. This allows higher levels of functional activity with less pain. Cervical instability would therefore be improved by helping to stabilize the ligaments further. While there is no cure for osteoarthritis, PRP treatment of instability should help decrease the excess motion at each vertebral segment thus decreasing the amount of irritation of the facet joints. This slows the arthritis process and should make flares of the tissue less frequent. Ultimately it treats the cause of the pain and is not just covering it up. In essence, rejuvenation from the inside out.