PRP Therapy (Platelet-Rich Plasma)
Although PRP (Platelet-Rich Plasma) Therapy has been around since
the mid-1990s many people are still unaware of this beneficial
Various fields of medicine, including dentistry, neurosurgery,
wound healing, and orthopedics, have only just begun to scrape the
surface of the long-term and ongoing benefits that can result from
employing this valuable therapy.
is it? A Quick Lesson on Blood
In a nutshell, a PRP injection delivers a high concentration of
endogenous (your own “home-grown”) platelets to an area of injury.
To understand the therapeutic value of PRP injections, you need to
have a basic understanding of the make-up of blood. Blood is composed
of plasma, red blood cells, white blood cells, and platelets. It’s
these platelets that are the injury’s “first-responders” and
help revascularize an injured area, construct new tissue, and stop the
Because platelets play a significant role in the healing of tissue,
reintroducing a high concentration of platelets directly into the
injured area may enhance the healing process.
The physiological effects include:
• Increase tissue regeneration (tendon, ligament, soft tissue)
• Decrease inflammation
• Decrease pain
• Increase collagen (base component of connective tissue)
• Increase bone density
• Increase angiogenesis (development of new blood cells)
In the world of high-stakes sports, many stars swear by it. Tiger
Woods received PRP injections in his left knee following surgery, and
L.A. Dodger’s pitcher, Takashi Saito was able to return to the mound
for the 2008 playoffs as a result of this little-known therapy.
Studies have seconded these testimonials. A recent study published
in the American Journal of Sports Medicine (2006) reviewed the
effectiveness of PRP therapy in patients with chronic elbow pain.
Fifteen patients were treated with PRP therapy. The results documented
a 60% improvement at eight weeks, 81% at six months, and 93% at final
follow-up (12-38 months). There were no side effects or complications
The Trouble with Tendons
Tendon injuries often become chronic because of the poor blood supply
to these areas. Athletes and active people tend to have these issues
and sometimes a whole career or hobby can be ruined by this ongoing
complication. A PRP injection allows a quick and focused action to the
area of injury, which allows it to heal more effectively and rapidly.
A patient’s blood is drawn and placed in a centrifuge which
separates the platelet-rich plasma from the rest of the blood. This
plasma is then injected into the area of injury. It’s a quick
procedure with little, if any, downtime. It’s also safe because the
platelets are derived from the patient’s own blood, so there is no
risk of rejection or reaction.
Not every patient is treated with PRP.
We do not treat every patient with PRP, most often, Dextrose
Prolotherapy is used instead of PRP, because of the extra step in
drawing your blood, the extra expense in purchasing the PRP kit, and
extra time it takes to prepare the platelets. The injections are
exactly the same way, but the proliferant, or solution injected is
different. For many years we have had great success in healing
1000’s of patients’ and having them avoid surgery with dextrose
Your decision to have PRP should be discussed with us to determine
which type of Prolotherapy, (Dextrose, platelets, or another
proliferant) is best for you.
Not every doctor is proficient in PRP Therapy
Platelet Rich Plasma Therapy has become very popular. Physicians who
do not do traditional Prolotherapy are now offering PRP.
Unfortunately, these untrained doctors are injecting the platelets in
a way that is often painful, debilitating for weeks, and can leave
hematomas (collections of clotted blood) in the area injected. We
believe that PRP is best delivered by a physician already experienced
and well versed in Prolotherapy.
Platelet alpha granules contain potent growth factors necessary to
begin tissue repair and regeneration at the wound site. Concentrated
autologous platelets contain large reservoirs of growth factors that
have the potential to greatly accelerate the normal healing process,
naturally. The use of concentrated growth factors is considered by
many to be a “new frontier” of clinical therapy
Excerpts in this article from Harvest Technologies Corp
1. Marx, R.E. , et al,“Platelet-Rich Plasma Growth Factor
Enhancement for Bone Grafts”, Oral Surg Oral Med Oral Patrhol,
2. Antonaides, H.N., et al,“Human Platelet-Derived Growth
Factor: Structure and Functions”, Federation Proceedings,
3. Pierce, G.F., et al,“PDGF-BB,TGF-ß1 and Basic FGF in
Dermal Wound Healing: Neovessel and Matrix Formation and Cessation
Repair”, Am J Pathology, 1992;140:1375-1388.
PRP is an autologous blood therapy that stimulates your body’s
natural healing process through the injection of its own growth
factors into injured areas. Research and clinical data show that PRP
injections are extremely safe, with minimal risk for any adverse
reaction or complication. Because PRP is 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. Some research suggests that PRP may have an anti-bacterial
property which protects against possible infection.
Your body naturally recruits platelets and white blood cells from
the blood to initiate a healing response. Under normal conditions,
platelets store numerous growth factors which are released in response
to signals from the injured tissue. Special PRP devices concentrate
platelets from whole blood. When the PRP is injected into the damaged
tissue growth factor release is enhanced so that natural healing is
accelerated. Desired results include by enhancing the body's natural
healing capacity, and a more rapid, more efficient, more thorough
restoration of tissue to a healthy state.
PRP was initially developed in the 1970s. It enjoyed increasing use
in hospital and outpatient surgical settings in the 1980's and began
to be utilized in physician offices for musculoskeletal procedures in
the 1990's. Technological advances have enabled the administration of
PRP to become more popular among musculoskeletal physicians
(physiatrists and orthopedists) since 2000. Much of the original PRP
use centered around orhtopedic surgical procedures, such as spinal
fusions and joint replacements,however PRP has also enjoyed extensive
use among maxillofacial and plastic surgeons and dermatologists.
After an injury, the repair response of musculoskeletal tissues starts
with the formation of a blood clot and degranulation of platelets,
which releases growth factors and cytokines at the site. This
microenvironment results activation of inflammatory cells and
proliferation of local progenitor cells. In most cases, fibroblastic
scar tissue is formed. In some settings, however, such as in a
fracture callus, these conditions can also facilitate the formation of
new bone tissue.
Transforming growth factor beta (TGF-b), platelet-derived growth
factor (PDGF), insulin-like growth factor (IGF), vascular endothelial
growth factors (VEGF), epidermal growth factor (EGF) and fibroblast
growth factor-2 (FGF-2) are growth factors that can be found at injury
sites during wound healing. In addition to soft tissue repair (muscle,
tendon, ligament and supporting joint structures), PRP has been shown
to enhance one or more phases of osteogenesis, early angiogenesis and
Studies also recognize the possibility that the effect of the clot
microenvironment or concentrates of PDFGs on fracture repair might be
either positive or negative. The nature of this effect, like that of
many graft materials, depends on the clinical setting, particularly
the graft site’s local environment of cells in which PRP or
associated factors are placed.
In summary, available data suggest that PRP is valuable in
enhancing soft-tissue repair and in wound healing. The clinical role
of PRP in bone repair remains controversial however. PRP is not
uniformly successful as an adjuvant to bone grafting procedures. PRP
may promote or inhibit bone formation, depending on the setting in
which it is used and the quality of the PRP.
musculoskeletal conditions and symptoms treated with PRP
* Sports injuries
Fibulo-Talo Ligament Strain
- Joint pain associated with arthritis
- Ligamentous strain
- Tendionosis, Tendinopathy
- Reflex muscle spasm
- Recurrent swelling or fullness involving a joint or muscular
- Popping, clicking, grinding, or catching sensations with
- Spinal pain (musculoskeletal; non neurogenic in origin)
- Distinct tender points and “jump signs” along the bone at
tendon or ligament attachments
- Sclerotomal numbness, tingling, aching, or burning, referred
into an upper or lower extremity
- Recurrent, referred headache, face pain, jaw pain, ear pain
In most instances PRP is not the first treatment employed. Other
traditional interventions such as restorative therapies, medication,
anesthetic injection and [Prolotherapy] are frequently employed first.
Most musculoskeletal physicians will use Prolotherapy prior to PRP
when considering regenerative treatment for muscle, tendon, ligament
or supporting joint structures, however individual considerations
exist. Examples where PRP might be utilized first include professional
athletes that need rapid wound healing time, more severe cases and
instances where multiple problems exist.
PRP is an effective alternative to invasive arthroscopic surgery,
including those cases that have failed or that simply are not remedial
to arthroscopy. When contraindications exist for joint replacement
(obesity, age, medical co morbidity)PRP is a beneficial alternative as
The PRP process involves drawing blood, spinning it down to
separate out growth factor rich platelets, then injecting the platelet
rich plasma into the injured area. To make the injection more
comfortable, local anesthetic (numbing medicine) or nerve blocks are
performed first. To help ensure accuracy of placement, Ultrasound
guidance is employed (see [Diagnostic musculoskeletal ultrasound]).
Most patients don’t require anything more then acetaminophen for
pain from the procedure. Often, following a PRP injection, an
"achy" soreness is felt. This "soreness" is a
positive sign that healing has been set in motion. The soreness can
last for several days but gradually decreases as healing and tissue
repair occurs. It is important that anti-inflammatory medications such
as Ibuprofen, Aleve and Aspirin be avoided following PRP treatments.
These medicines may block the effects of the PRP injection. While
many patients find it best to rest the area for several days after PRP,
as long as you are responsible you can resume normal activities
following I treatment. You should avoid anything other then light
activity however for at least several days after injection.
Depending on your response to treatment, one to three PRP
injections may be required. Following the initial treatment a follow
up visit will usually be scheduled within 2-3 weeks. At that time a
decision may be made regarding the need for additional treatment. In
general, chronic or severe injuries require more treatment then mild
injuries. Restorative therapy including exercise or physical therapy
may be prescribed as well.