Why does my injury not heal?
When we are injured, we typically stress or strain our joints. These joints use tendons and ligaments to hold them together. When we over exert or stretch these joints, we develop an inflammation and/or tear in our tendons and ligaments. Since ligaments only heal up to 60% of their original strength, the joint becomes loose and unstable. The injury then becomes a chronic condition and is prone to re-injury. Chronic pain results from premature wear and breakdown of the cartilage in the joints and muscle tendons.
Tendons and ligaments naturally have a very limited blood supply, so once they are injured it is difficult for the body to get its own healing factors to the damaged area. Scar formation can make this even more difficult. The body relies on blood flow to bring platelets and white blood cells for healing, but since the blood supply is so poor, healing is incomplete and of limited quality. This results in the cycle of weakness, injury, inflammation and further damage.
Why does my injury not show up on X-Ray?
Tendons and ligaments are soft tissues and X-Ray only shows bone. Unless there is an injury to bone, it will not show on X-Ray. Only when bones are not aligned will it show on X-Ray.
Chronic and long term inflammation along with degeneration of joints will result in the body naturally depositing bone around a joint to stiffen it. This will show up on X-Ray and is what we call “arthritis”.
Soft tissue imaging such as MRI or Ultrasound will show abnormalities in tendons and ligaments and can be a guide to treatment.
What is PRP?
PRP is platelet-rich-plasma therapy. The therapy is a process placing your own concentrated platelet-rich plasma directly to your injury site.
By drawing a 60ml. syringe of blood from your arm and concentrating this down to 6 ml., the platelet-rich portion of plasma can be used for injection into your injured area.
How does PRP work?
In recent years, scientific research and technology has provided a new perspective on platelets, usually known for the clotting process. Studies suggest that platelets contain an abundance of growth factors that can affect inflammation, bone formation along with wound, muscle tear and soft tissue healing. Research shows that platelets also release many bioactive proteins responsible for attracting white blood cells, stem cells and bone- building cells that not only promote removal of degenerated and dead tissue, but also enhance tissue regeneration and healing.
In studies on tennis elbow chronic pain conditions, when PRP was compared with steroid injections the steroid treated patient felt pain relief quicker but the effect was short lived, needed to be repeated, and did nothing to make the tendons stronger. The PRP patients, on the other hand, saw slower pain relief but their pain relief was longer lasting and the tendons showed continual signs of strengthening for the long term.
Although, it is not exactly clear how PRP works, the increased concentration of growth factors and proteins in PRP are thought to intensify and speed up the body’s efforts to heal.
What conditions does PRP help?
- Labral/labrum tear
- Rotator cuff tears
- Arthritis of the shoulder joint
- Labral tears or degeneration
- Rotator cuff tendonitis
- AC joint separation
- Recurrent shoulder dislocations
- Golfer’s elbow
- Tennis elbow
Back and Neck
- Lumbar facet injury
- SI Joint Syndrome
- Cervical Instability
- Cervical facet injury
- Neck, back or rib instability
Ankle and Foot
- Ankle instability
- Peroneal tendon tear or split
- Ligament sprain or tear
- Sub-talar arthritis or instability
- Patellofemoral syndrome/chondomalacia
- Pes anersine bursitis
- Patellar tendonitis
- Meniscus tear
- MCL sprain or tear
- ACL sprain or tear
- PCL sprain or tear
- LCL sprain or tear
- Biceps Femoris insertional tendinopathy
Will Health Insurance pay for PRP therapy?
Your initial visit is covered by your insurance because it is a regular physician evaluation.
Why are there limited research studies on PRP?
Studies are very expensive to conduct and usually done by pharmaceutical companies, who can afford the testing. Since we are using the patient’s own blood and there is no drug product involved, pharmaceutical companies have no reason to back any research or pump money into scientific studies.
If there isn’t hard evidence yet, why do you give PRP to your patients?
Platelet Rich Plasma therapy was initially developed in the 1970s and first used in 1987 in an open heart surgery procedure. Doctors have used PRP since the mid-1990s to aid bone healing after spinal injury and soft tissue recovery following plastic surgery. In 2004, studies at Stanford University found that PRP therapy got 90% healing at 6 months in injuries as long out as 20 months. PRP and stem cell treatments have been used extensively outside the United States for over 20 years with reported good health results. For years, elite athletes have had to travel to Europe to get these treatments before they were available in the U.S.
There is some evidence from cohort studies, and anecdotally we have had some good experiences where we think it’s worthwhile to offer it to some patients. The ones that we offer it to have failed other types of conservative therapy, such as physical therapy, manipulation, acupuncture and steroid injection.
Who is using PRP therapy?
PRP is being used by Pain Management doctors, Orthopedic doctors, Physical Medicine and Rehabilitation doctors, Plastic Surgeons, Oral Surgeons, Radiologists and Veterinarians. A search on youtube.com will show many different medical specialties using PRP and Stem cells with good reported outcomes.
PRP has gained publicity when used by high profile athletes such as golf’s Tiger Woods, football’s Troy Polamalu, baseball’s Takashi Saito and basketball’s Brandon Roy.
Dr. Bruning and Dr. Eubanks have also had PRP Therapy with good results.
How is the PRP treatment performed?
- 60ml of blood is taken from the patient’s arm and placed in a centrifuge to separate the plasma from the red blood cells.
- The plasma is again centrifuged to separate the platelet rich plasma.
- PRP is collected into a sterile syringe
- The skin is cleaned with antiseptic and the area is anesthetized with a local numbing agent.
- With the aid of ultrasound or fluoroscopy, The PRP filled syringe is then guided into the injured body site and the area filled with the PRP.
How long does the procedure take?
The procedure takes about 30-45 minutes from start to finish.
Will the PRP injection hurt?
There will be discomfort. A greater degree of discomfort will result if the underlying tissue is severely inflamed or painful and depending on the severity and duration of the injury. Local anesthetic helps numb the skin, surrounding tissue and joint.
What should I expect during recovery?
You may return to work immediately and resume regular activities or light exercises. Avoid strenuous physical activity for the next 7 days.
The anesthetic utilized to numb the skin generally wears off in 1-2 hours. Mild pain, swelling, and bleeding may occur at the injection site for several hours. You may have local bruising.
You will feel a notable increase in pain and swelling of your injury site up to 3 days following the injection. Some of the swelling is due to the volume of PRP being injected which must be absorbed by the body. Pain intensity will become less each day.
When will I feel results from PRP therapy?
You should notice gradual improvement in symptoms and return of function 2-8 weeks after PRP therapy.
Pain relief is not expected to be immediate as with other treatments. Remember that this is to stimulate healing in the body and create the long-term effect of a stronger joint and/or ligament structure.
How long will results last from PRP therapy?
Results can last from 6-9 months or years.
What are alternative therapies?
- Do nothing
- Physical Therapy
- Manipulation (Chiropractic care)
- Steroid injection
What are the risks of PRP?
- Pain or itching at the injection site (usually resolves in 24 hours)
- Post treatment discomfort, swelling, redness, and bruising (usually resolves in 3 days
- Post treatment infection requiring further treatment (Rare, but can be serious)
- Injury to a nerve and/or muscle
- Tendon or ligament rupture
- Dizziness or fainting (during or after blood draw)
- Pneumothorax, if injection site is near the lungs
- Loss of limb or death
Are there contraindications to PRP?
Patients with the following conditions are not candidates for PRP:
- Acute or Chronic infections
- Abnormal platelet disorders
- Blood or bone cancer
- Anemia (Hemoglobin <10)
- Use of a blood thinner within 5 days prior to the procedure
- Use of anti-inflammatory medicine within 1 week prior to the procedure
- Use of a corticosteroid within 2 weeks prior to the procedure
Is PRP Therapy FDA approved?
Since the cells used for PRP therapy come from the individual patient’s body and are not altered, there is no need for FDA approval. We are just concentrating your own body’s cells and putting them where they are needed to promote healing.
PainCARE’s position on PRP
Up until now, we have been limited in treatments for injuries that are bad enough to possibly need surgery. Treatments are either just monitoring the body healing itself or lessening the pain while the body heals. We believe that utilizing PRP therapy provides a treatment option for injuries previously deemed untreatable, helps heal chronic injuries, slows the progression of more serious injuries, decreases the overall time of healing and may be an alternative to surgical intervention.
Is PRP therapy a substitute for surgery?
Possibly. While many chronic conditions may respond to PRP therapy, obviating the need for a surgical procedure, it is impossible to predict which will respond and which will fail to improve.
On average, how many platelets for injection will be yielded in the PRP process?
Our office uses a two-spin centrifuge process. We believe this yields a purer platelet yield, eliminating as many red blood cells as possible. There are between 7.5 – 9.5 trillion platelets in a 7ml. treatment sample.
How often do I need PRP and when should I start treatment?
There is no clear consensus in any published articles on when to start PRP Therapy or how often to repeat the therapy. Most physicians using PRP therapy find relief comes within the first or second injection. Our doctors recommend waiting at least 1 month after the first injection before you consider a second injection. You will need to discuss this with your physician 1 month after the first injection.
What is the expected cost of PRP therapy?
PRP therapy will cost between $800 and $1200 per injection depending on the injection site
Is PRP the same as Stem Cell Therapy?
The differences are:
- PRP is obtained by drawing blood from the patient’s arm. Stem cells are obtained from the patient’s hipbone or collected adipose tissue (fat).
- PRP therapy may be administered in less than one hour while stem cell therapy may take up to 2-3 hours
- There is more immediate discomfort to obtain a patient’s stem cells than platelet-rich plasma. It may also take several days longer to recover from retrieval of the patient’s stem cells.
- PRP provides proteins to signal the patient’s stem cells to activate, while stem cell therapy directly places stem cells into the injured area.
- Stem cell therapy is more costly than PRP.
Are stem cells better than PRP?
There are no clinical trials showing better results with Stem Cell therapy vs. PRP therapy.
The doctors at PainCARE believe that PRP is a reasonable first therapy for treatment.
If there is no response to PRP, you and your doctor can discuss whether Stem Cell therapy is the next appropriate step.