PRP: Buzzworthy?

Platelet Rich Plasma (or PRP) injections have been more and more popular in the last several years. Many people ask what is “PRP” and does it really work?

Platelet Rich Plasma is exactly that - blood is drawn, processed through a device that spins the blood at a high velocity in order to separate out the plasma component. The resulting solution is 3-5 times more concentrated than normal blood following separation and “spinning”. The plasma is platelet dense and contains specific growth factors which stimulate healing.

This is what is so appealing about PRP injections - the fact that a “healing” solution can be injected directly into painful, irritated tissue. PRP injections can be useful for tendon, ligament, cartilage, and bone injuries. The solution is injected into the tendon or ligament sheath, and in the case of cartilage and bone, into the joint space. PRP Injections are not to be used in the presence of infection or cancer.

A normal course of treatment involves 3-5 injections, however, additional injections are not usually recommended if no improvement is seen after the first one or two.

The current research on the effectiveness of PRP injections is mixed. All sources agree that the primary advantage of PRP over many of the other tissue engineering products in that it is autologous - it comes from YOUR own blood and body, nothing engineered or shared!

Several studies specifically compared corticosteroid therapy with PRP therapy in the treatment of plantar fasciitis. All of the studies agreed that PRP is an “attractive alternative” to traditional treatments as patients had significant clinical improvement 3 months after injection with PRP being more effective than cortisone.

Another study published in the British Journal of Sports Medicine compared Achilles tendonitis treated with eccentrics (a well-established exercise protocol used in the treatment of chronic tendonitis) and PRP, or PRP alone. Both groups did equally well. Eccentric exercises have the same growth factor stimulating effect. This is why eccentrics are so effective and therefore this comparison essentially makes sense.

When interviewed by the New York Times, Dr. Cardone (a clinical associate professor at New York University’s Langone Medical Center) was asked, “So what is someone with a sore ankle, knee, elbow, shoulder, abdominal muscle or other sports injury to do?” His response,

 “First, exhaust the standard treatments. Begin with physical therapy which has a proven track record against overuse injuries and is much less expensive and invasive than PRP.”

Finally, the American Academy of Orthopedic Surgeons made this statement:  “Treatment with platelet-rich plasma holds great promise. Currently, however, the research studies to back up the claims in the media are lacking.”

PRP sounds good in theory however the research and clinical evidence to support its use is somewhat lacking. Ultimately, there is no quick fix. While injections such as PRP can help promote a better environment for tissue healing, the underlying cause of the initial injury likely still exists (i.e. a faulty movement pattern, a muscular imbalance, fascial restrictions). Treatment therefore, must be all inclusive in order to break the cycle of injury. PRP can be complementary to skilled manual therapy and specific corrective exercises.

 

References:

Clin Podiatr Med Surg. 2011 Jan;28(1):155-70. Current concepts for the use of platelet-rich plasma in the foot and ankle.Soomekh DJ.

Foot Ankle Surg. 2014 Mar;20(1):10-3. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report.

Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S.

Foot Ankle Int. 2014 Apr;35(4):313-8. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Monto RR.

Arch Orthop Trauma Surg. 2012 Jun;132(6):781-5. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis.

Akşahin E, Doğruyol D, Yüksel HY, Hapa O, Doğan O, Celebi L, Biçimoğlu A.

Akşahin E, Doğruyol D, Yüksel HY, Hapa O, Doğan O, Celebi L, Biçimoğlu A.

Br J Sports Med. 2011;45. Platelet-rich plasma for chronic achilles tendinopathy: a double-blind randomised controlled trial with one year follow-up. S de Jonge, R J de Vos, A Weir, H T M van Schie, S M A Bierma-Zeinstra, J A N Verhaar, H Weinans, J L To.

New York Times “Well” Section. Phys Ed: Does Platelet-Rich Plasma Therapy Really Work?

By GRETCHEN REYNOLDS JANUARY 26, 2011 12:01 AM