What is PRP?
“Platelet-Rich Plasma Therapy speeds healing of musculoskeletal Injuries”
Platelet- Rich Plasma (PRP) therapy, a treatment for aiding the regeneration of ligament and tendon injuries, helps to shorten rehabilitation time and often eliminates the need for surgery. Platelet-rich plasma therapy is part of a relatively new field of medicine known as orthobiologics that includes the use of stem cells and emphasizes employing the latest technologies along with the body’s natural ability to heal itself.
“One of our major goals is to make healing time fast for patients with soft tissue injuries,” says Christopher S. Ahmad, MD, Director, Center for Pediatric and Adolescent Sports Medicine at New York-Presbyterian Morgan Stanley Children’s Hospital. “For example, a patient undergoing elbow ligament reconstructive surgery, commonly referred to as Tommy John surgery, may take a year to recover. That’s a long time. Recovery time for anterior cruciate ligament (ACL) surgery is approximately six months.
So while we are very good at performing surgery to correct the injuries, we’re now accelerating the healing by biologic manipulation. That’s where platelet-rich plasma comes in.
What is Platelet- Rich Plasma?
Blood is made of red blood cells, white blood cells, plasma, and platelets. Platelet-rich plasma (PRP) is the name given to blood plasma with a high concentration of platelets that contains huge doses of bioactive proteins, such as growth factors, that are critical in the repair and regeneration of tissues.
In order to extract these platelets, a small amount of blood is drawn from the patient and it immediately undergoes centrifugation, a process in which mixtures are separated using centripetal force. This process separates our red blood cells, which carry oxygen, and the platelet and the plasma. The platelets with the plasma have all of the healing agents. Once the separation is done, the platelet-rich plasma is extracted and can then be injected into the patient’s injured area. It is their own platelet- rich plasma—it isn’t taken from another person or derived in a laboratory.
Growth factors can dramatically enhance tissue recovery and the special proteins also initiate new blood vessel formation, bone regeneration and healing, connective tissue repair, and wound healing. There is little chance for rejection because the components used for treatment are extracted from a person’s own body. This makes the procedure entirely safe. The PRP injection also carries less chance for infection than an incision, with a considerably shorter recovery time that after surgery.
PRP Injection Overview
Platelet rich plasma therapy can help injured joints and other problems. It uses parts of your own blood to reduce pain and speed up healing.
Can it Help Me?
PRP may help if you have: meniscus tears in your knee. Rotator cuff tears in your shoulder. Planter fasciitis in your foot. And injuries in your spine, hip or elbow.
Benefits of PRP
Parts of your body have a hard time healing. For example, ligaments and tendons (they connect bones and muscles) don’t get much blood from the body. Sprains and strains of these tissues heal slowly. PRP uses your own blood to speed up the healing in these areas.
Creating the Mix
The process begins with a sample of your blood. It is spun around in a centrifuge. This separates it into platelets, plasma, and red and while blood cells. The platelets are then concentrated and mixed with some of the plasma. This mixture is called “platelet rich plasma.” The doctor injects this into the site of your injury.
After the injection, your immune system (the system that keeps your body healthy) reacts quickly. Special white blood cells called “macrophages” rush in. They take away damaged cells. They help prep the site for healing. Then, stem cells and other cells begin to multiply. Over time, they repair and rebuild the injured tissues.
The PRP process is quick. You can go home the same day. It may help your injury heal faster. PRP can help treat and eliminate the cause of your pain. Some people need more than one treatment before they heal completely.
From: Diversified Integrated Sports Clinic
Post PRP Rehabilitation
The following rehabilitation protocol is applicable to acute injuries, chronic injuries and trigger point areas (myofascial syndrome). This guideline may vary according to the degree of pathology, patient response and advice from the physician or therapist.
|Day After Treatment||Acute Injuries||Chronic Injuries|
|Same Day after procedure (1st PRP)||RICE regime- Rest, Ice, Compression and elevation is important- ICS on treated area 20 minute of each hour every 2 hours for first 12 hours- No active movement or exercise. Normally painful at end of day.|
|Day 2 (48 hours post procedure)||Start with passive stretching, light massage and range of movement exercises. Bruised feeling will be subsided to a lower grade. Ice at end of the day.|
|Passive stretches, light exercises, start with using the joint/muscle at 20-30% of normal use. You may start normal exercise within pain limits. Bruised feeling at injected are will be between 1-3/10|
See physio/chiropractor or sports therapist on Day 3 or Day 4
|Day 5-6||Active stretches or moderate exercise at 50% of normal use or within pain free range. During exercise, the treated area will have 0-1/10 pain but will still feel weak due to the lack of training in that area.|
|Day 7||2nd PRP + RICE Regime||Follow up with Physician|
|Day 8||RICE regime, no local or deep tissue treatment||Slowly increase activity according to advice from Physician|
|Day 9-10||Start exercises where ended on Day 6, bruise feeling will decrease to 0-1/10, Weakness will improve||Focus on strengthening the structure that was treated.|
Increase training volume.
|Day 11-13||Slowly increase activity according to advice from Physician.|
See Physio/ Chiropractor and sports therapist on Day 3 or Day 4
|It is important to monitor the response of you injury the day after the last training- Do not train the treated area into pain or to stiffness.|
See Physi/Chiropractor or Sports therapist on day 11 or Day 13
|Day 14||3Rd PRP if needed and repeat RICE regime||2nd PRP for Chronic|
|2nd PRP only if needed|
Day 15 and after
|RICE regime if PRP was done||RICE Regime||RICE Regime if PRP was done|
|See Physio/ Chiropractor and Sports Therapist on Day 18 onwards for final stage rehabilitation and full return to training.|
|Notes||Activities that were the main cause of the original problem will have to be reduced or avoided.|
|Day 28||3Rd PRP maybe required according to Physician advice|
- The physician will follow the below guidelines and advice if PRP will be of benefit to your healing and reduction of symptoms
- Once the 1st PRP infiltration is completed (2-3 min), the area will be covered with a small plaster
- Pain in the first 24-48 hours will cause discomfort and a feeling like “bruising” and heat in the treated area.
- You are not supposed to feel any other symptoms like numbness, heat, redness or skin reaction. Should you, you must contact your doctor.
- You must follow the regime below, and will start feeling better 48 hours after the 1st treatment
- As with any other treatment, there is always a small group of patients that do not respond according to what we expect. Should your pain not improve within the first 5 days, please contact the doctor.
RICE- Rest, Ice, Compression and Elevation
Rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness
Cold will reduce pain and swelling. Apply an ice or cold pack right away to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply heat to the area that hurts. Do not apply ice or heat directly to the skin. Place a towel over the cold or heat pack before plying it to the skin.
Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling. Don’t wrap it too tightly, because this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. Talk to your doctor if you think you need to use a wrap for longer that 48 to 72 hours; a more serious problem may be present.
Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
From: Diversified Integrated Sports Clinic
PRP in OA knee- update, current confusions and future options
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
|Positive results have been uniformly observed by various researchers for platelet-rich plasma (PRP) in early osteoarthritis (OA) knee in the past few years. PRP has clearly demonstrated its supremacy in comparison to hyaluronic acid (HA) and placebo in various clinical trials and is undoubtedly the best option available for symptomatic treatment in early OA.|
Protective Nature of Platelet-Rich Plasma Against Chondrocyte Death When Combined with
|1Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.|
2 Center for Sports Medicine, University of Pittsburgh, Pennsylvania, USA.
3 Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
|The addition of PRP can significantly reduce the cytotoxic effects of corticosteroids and/or local anesthetics applied to chondrocytes. PRP can improve the proliferation of chondrocytes compared with corticosteroids or local anesthetics alone|
|Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the context of the Spanish National Health Care System|| |
Department of Orthopedic Surgery and Traumatology, Virgen de la Victoria University Hospital, Malaga E- 29010, Spain
|Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades.|
Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review
Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.
|In patients with symptomatic knee OA, PRP injection results in significant clinical improvements up to 12 months postinjection. Clinical outcomes and WOMAC scores are significantly better after PRP versus HA at 3 to 12 months postinjection. There is limited evidence for comparing leukocyte-rich versus leukocyte-poor PRP or PRP versus steroids in this study.|
From: Diversified Integrated Sports Clinic