Platelet Rich Plasma Therapy (PRP)
Similar in theory to prolotherapy in terms of creating a healing inflammatory response, PRP therapy involves injecting a patient’s own concentrated platelets to initiate healing in damages tissues and joints.
Although a relatively new therapy, studies are showing excellent results in using platelet rich plasma to heal damaged ligaments, tendons and muscles. Platelets are often thought of as clotting cells, causing blood to thicken and form scabs after injury; however, platelets serve many other important functions. These small cells are responsible for attracting white blood cells into injured areas to “clean up” damaged and dead cells, which often produce non-productive stagnant swelling and lead to chronic inflammation or “tendonitis.” This chronic damage, once thought to be an active inflammatory problem, hence “tendonitis,” has recently been renamed “tendonosis” because of the lack of inflammation found. Thus, the area is prevented from healing because the swelling is non-productive and must be resolved for recovery to proceed. Platelets injected into the area not only draw white blood cells in to “clean up,” they also release growth factors that are directly responsible for tissue regeneration.
PRP is not a new therapy as it has been used for years in surgical centers to improve the success of bone grafting, dental surgery and cosmetic surgery. More recently, doctors began to use PRP in athletic injuries to speed healing. The results were so promising that the technique caught on not just for acute injuries but also for chronic pain as well. All joints, ligaments and tendons are treatable areas whether the problem is acute or chronic. Conditions such as tennis elbow, chronic low back pain, unstable ACL/PCL, pubic symphysis strains, Achilles tendonitis, rotator cuff tears, meniscal tears, osteoarthritis, and neck pain are responding where other therapies have plateaued or failed.
What is Platelet Rich Plasma?
Platelet rich plasma, or PRP, is concentrated blood plasma containing a very high number of platelets. These platelets release growth factors that are vital to initiate and accelerate tissue repair and regeneration. The growth factors increase stem cell production that are vital to repair connective tissues such as tendons and ligaments, help bone regeneration, promote the formation of new blood vessels and stimulate the healing process. The normal concentration of platelets in blood is between 150,000 and 400,000 per micro liter. In PRP, where platelets have been concentrated, the count can exceed 2 million platelets per micro liter. To be considered PRP, the count of platelets must be at least 4x greater than baseline measurements.
How is Platelet Rich Plasma obtained?
Depending on which area is to be injected, 15-60cc of blood will be drawn from the patients arm. This blood is then spun down to separate the red and white blood cells from the platelets and plasma. The concentrated platelets are then injected into the area that requires healing.
What does PRP do?
The PRP process concentrates fibrin, mesenchymal stem cells, and platelets so that each cubic millimeter of solution contains 1.5 to 2 million platelets, resulting in up to a five-fold increase in platelets and bioactive growth factors. Because it is so concentrated, PRP acts as a potent tissue growth stimulant, amplifying the natural process of tissue repair and healing. Studies show that PRP induces the production of new collagen by the fibroblasts, bone and cartilage cells at the site of the injection, rebuilding the joint cartilage and strengthening injured ligaments and tendons. This new collagen is naturally incorporated directly into your existing cartilage and ligaments, making them thicker, stronger and more elastic.
How does PRP compare to other injection therapies,like cortisone, hyaluronic acid and regular dextrose prolotherapy?
Although cortisone shots may temporarily provide pain relief and reduce inflammation, studies have shown that cortisone can actually weaken tissue. This occurs because cortisone blocks all inflammation, and some inflammation is required for healing. PRP therapy introduces healing factors that promote healthy inflammation that leads to healing. PRP can strengthen tendons and ligaments, in some instances up to 40%.
Hyaluronic injections are very effective at increasing comfort and range of motion in injured joints. It does not, however, provide a mechanism of regeneration and it is necessary to continue injections on a regular basis to maintain benefit. PRP is regenerative, which means it causes the body to grow new ligaments, tendons and joint tissues. Ultimately, this healing will last and the tissues will function like normal healthy tissues.
Compared to dextrose prolotherapy, clinical and anecdotal experience is demonstrating that using PRP as the regenerative injection method creates a much more profound healing effect and results in increased healing in less treatments. Prolotherapy is a very effective and useful therapy, but PRP is especially useful when regular prolotherapy has provided positive results, but recovery has not been ideal. In these cases PRP is often the treatment that will resolve these less responsive or more injured areas.