What Are Platelet Rich Plasma Injections?
Platelet rich plasma more commonly referred to as PRP injections have been in use for several years and are an alternative treatment for managing chronic tendinopathy and degenerative joint disease such as osteoarthritis. Platelets are they cells in our blood associated with healing and repair, the basic science behind PRP injections are that they aim to harness this “healing potential” of the patients blood to stimulate a regenerative process in tendons or area the platelet rich plasma is injected.
- PRP is defined as, a solution having a concentration of platelets that is above the baseline concentration of whole blood. Basically a solution concentrated in these little powerful healing and repair platelets.
It is well documented elsewhere that tendon conditions heal slowly. Frequently taking upwards of twelve months from onset to resolve. Much of this slow healing is attributed to poor blood supply to the tendon and the same can be said of our joints. This is where these concentrated healing injections step in, aiming to supply a boost of all the little goodies that these tendons and joints don’t get enough of and therefore accelerate what is typically an arduous recovery process.
Bridging The Gap Between Conservative And Surgical Treatment
With regard to tendinopathies, for that small proportion of patients who do not satisfactorily improve with conservative treatment, PRP may be beneficial. Platelet rich plasma injections may bridge the gap between conservative and surgical interventions. Helping patients avoid the need for any surgery when dealing with particularly stubborn complaints that haven’t responded to first line remedies. Conservative treatment in this situation is considered as being prescribed medications like anti-inflammatories (NSAIDs) and physiotherapy. Physiotherapy for tendinopathy may include passive therapy including electrotherapeutic devices such as shockwave therapy, or even dry needling, soft tissue massage, or more active therapy, focusing on appropriate tendon loading and biomechanical, or activity modification. Frequently I find best results in physiotherapy are achieved when any appropriate passive therapy is combined with a more active approach and would like to think that in the majority of situations the need to “resort” surgery is an unnecessary one.
PRP I feel can also play an important role in filling the gap between standard conservative treatment and surgical treatment further negating the need to opt for surgical intervention.
Quality Not Quantity Matters
In the early developmental days of PRP the treatment approach was to inject whole blood into the target area with a view to stimulating a healing response. Ultimately this progressed to harnessing the active healing component of blood by concentrating the platelets and removing from the injection solution the parts of the patients blood that are not considered as useful for healing (this being the red blood cells and excess plasma so ideally platelet concentrations should be greater than 4 times baseline). There is some questionable results in the research regarding PRP injections. But at the same time advocates in the medical world for its use suggest that it is the quality and the way that the PRP solution is prepared and injected that makes the difference and that possibly due to the preparation and injection techniques used in the research studies results varied from the desired outcomes.
It makes sense, at least in my head, that platelet rich plasma therapy effectiveness would be maximized through the use of appropriate concentrations of platelets and targeting this concentrated solution the desired area. Many of the practitioners treating with PRP suggest where possible the solution should be injected under ultrasound, or other imaging guidance to help the accuracy of delivery.
PRP Is A Relatively Safe Procedure
The main side-effect of receiving a PRP injection is feeling pain at and around the injection site. This pain generally lasts for a few days, yet the injection itself can take 2-3 weeks to take effect and can take a good six weeks before pain improves. A second or third injection can be performed if required if results from the first injection are unsatisfactory, however ideally many patients find that a single injection is enough.
Injections Don’t Remove The Need For Ongoing Management
A PRP injection may “work” where conservative treatment has failed yet typically doesn’t negate the need for ongoing changes. All the conservative approaches regarding load management, activity modification, biomechanical adjustments still need to be incorporated. Sadly a PRP injection is not a magic bullet for tendinopathy or osteoarthritis but may help create a positive healing platform where other therapy has failed. It is best practice to use this platform and build on it with returning to the conservative strategies once deemed appropriate by the treating doctor. It is also here that I need to state that physiotherapists are NOT licensed to provide PRP injections to their patients and such a procedure is carried out typically by sports medicine specialists, and sometimes orthopaedic surgeon and general practitioners.
Summing Up Platelet Rich Plasma Therapy
- Injection of platelet rich plasma (PRP) theoretically enhances tissue healing in chronic tendon conditions and may also potentially improve pain in osteoarthritis, and articular cartilage pathology.
- As with most medicine, success is not guaranteed, but on average PRP is suggested to be helpful in around 70% of patients.
- It is advised however that money spent on having “quality” PRP, meaning using a high concentration of platelets (not just whole blood) and having this injected under imaging guidance will most likely give you your best chance of success.
- Physiotherapists can not provide PRP injections, but we can assist in the conservative management before or after injections with both tendinopathies and osteoarthritic conditions to help you achieve the best results and return you to your desired pre-injury levels.
Disclaimer: This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific medical advice or assistance on What Is Platelet Rich Plasma Therapy? should consult his or her general practitioner, physiotherapist, orthopaedic surgeon, sports medicine speclaist or otherwise appropriately skilled practitioner.