Platelet-Rich Plasma Therapy

By Dr. Ben Kim

If you have a chronic musculoskeletal injury that isn't responding to appropriate rest, stretching, and other rehab measures, you might consider platelet-rich plasma (PRP) therapy.

PRP therapy involves extracting a small amount of blood from your arm, using a centrifuge to collect the platelets in your blood, and then injecting concentrated platelets into injured tissue(s).

The idea is that natural growth factors that are secreted by your platelets can promote healing that would otherwise be difficult because of inadequate blood flow and healing capacity.

PRP therapy has been utilized by surgeons since the 90's to help aid recovery from various surgical procedures. More recently, it has become popularized by world-class athletes looking to accelerate healing of torn ligaments and tendons that would normally keep them on the sidelines for lengthy periods of rest and rehab. Tiger Woods and Rafael Nadal are two prominent recipients of PRP therapy, and coincidentally, both of them have reportedly utilized this procedure for knee injuries.

I have known three patients who have undergone PRP therapy - one for chronic patellar tendonitis, one for a ligamentous injury in the inner elbow region, and one for hip dysfunction that displayed classic signs of a labral tear.

All three of my clients improved enough with their PRP injections for me to feel that it's a therapy that merits consideration with the following thoughts in mind:

  • Before receiving PRP therapy, I think it makes sense to rest the injured area, and when you're able to do so, stretch all of the muscles and ligaments surrounding the affected tissue(s).

    Chronic inflammation and poor healing of injured tendons, muscles, and ligaments are sometimes due to these tissues having to take on more work than is normal because surrounding tissues are tight and dysfunctional.

  • For the same reason as above, whenever possible, it can be immensely helpful to apply deep massage to the injured tissue(s) and surrounding tissues. Deep pressure can help lengthen shortened muscles, and can also help bring more blood into the area, which is critical for optimal healing.

    This is where use of a foam roller can be immensely helpful - for more on foam rolling, view:

    Stretching and Foam Rolling Archive

  • Some of the beneficial effect of PRP therapy may be from the simple act of inserting a needle into the affected area. Though meant to help accelerate healing via injection of concentrated platelets, a needle can promote healing simply by causing some bleeding in the area, as bleeding attracts platelets and other substances involved in the natural cascade of events that characterize inflammation and healing.

    This is partly why acupuncture can be helpful for promoting healing. And because acupuncture carries less risk than PRP therapy, I think it's worthwhile to try acupuncture first. Acupuncture offers the benefit of being able to stimulate healing deep within a joint - a skilled practitioner can even stimulate ligaments surrounding and within your hip and knee joints.

  • Use of PRP therapy for musculoskeletal injuries is in its infancy. No one knows long term effects, if any, of injecting a concentrated glob of platelets into one area of your body. The desired effect is acceleration of healing. But where there is a predisposition for abnormal growth, could PRP trigger unwanted conditions? There are ongoing clinical trials, but we won't have too many answers on long term effects and safety for a good while, I imagine.

    As with all procedures that involve injections, there is always a small risk of infection, so if your immune system is compromised for any reason, it may be best to avoid PRP therapy.

  • PRP injections are not painless. All three of my clients reported some degree of soreness at their sites of injection, with discomfort lasting for up to about a week. This makes sense, of course, as sticking a needle into a ligament or tendon shouldn't happen without your nervous system being fully aware of it.

  • As of today, health insurance programs don't cover Platelet-Rich Plasma therapy, and with procedures starting at around four to five hundred dollars, it's a significant out-of-pocket expense - more incentive to really work at stretching and foam rolling and getting into the best shape you can, and then reassessing potential need for PRP therapy.

If you decide to pursue Platelet-Rich Plasma therapy, be sure to consult only with licensed medical practitioners who have experience with this procedure. It's becoming more readily available at high performance sports medicine clinics.

As more outcomes of clinical trials are published, I'll update findings and thoughts on Platelet-Rich Plasma therapy here. In the meantime, please remember that you can greatly support self healing of various soft tissue injuries with regular rest, stretching, foam rolling, strengthening, and a nutrient-rich diet that is devoid of large quantities of animal protein that can cause chronic inflammation. Whenever possible, it's always best to do all you can with non-invasive therapies when looking to fully recover from injuries.

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