Do You Suffer From Pain?
You May Benefit From Regenerative Medicine
Introduction to Platelet Rich Plasma
What is platelet rich plasma?
Platelet rich plasma (PRP) is derived directly from your own blood. PRP is a blood plasma with concentrated platelets. Contained within platelets are high concentrations of bioactive active proteins that aid in healing, including growth factors which are necessary to initiate connective tissue healing. With concentrated amounts of these proteins in an injured area, healing and tissue repair is accelerated. Healing can occur in various tissues including tendons, ligaments, muscle and bone. Along with tissue repair the regeneration process also stimulates new blood vessel growth which also promotes the wound healing process.
Where Does PRP Come From?
A small amount of your blood (30-60 cc) is taken from your arm. The blood is then placed in a special kit and centrifuged. The centrifuge processes the blood, extracting the PRP, leaving the excessive plasma and red blood cells in the container. The PRP is a concentration of platelets and growth factors, concentrated up to 500%
The painful or tender areas are identified and marked. The skin is prepped in a sterile fashion and the area in anaesthetized with local anesthetic. PRP can then be injected into the anaesthetized area of tissue damage whether that be bone, ligament, tendon or muscle. This stimulates a mild degree of inflammation that triggers the healing process to begin. Initially there may be some localized soreness and discomfort. Most patients need only some Tylenol and an ice pack for the first 1-2 days, as needed. Chemical proteins in the PRP send out signals to recruit other cells such as fibrinocytes. Fibrinocytes lay down the protein matrix that allows new collagen to formed in the injected area. As it builds up and matures, collagen naturally contracts down, causing a tightening of the tendons or ligaments, thereby repairing the damaged tissue. This entire process takes 6 weeks. Patients may be started on a gentle rehabilitation program one week after the treatment.
Damage to or overuse of muscles can injure the tendons which in turn causes pain. What occurs is the collagen fibers in the tendons develop small tears which causes inflammation known as tendonitis. Tendon damage is common in the shoulders, knees, ankles, elbows (tennis elbow), biceps and hamstrings. The calf muscle and Achilles tendon are also frequently injured.
Ligaments connect bone to bone. These are the connect tissue that holds joints and the spine together. Ligaments are in all joints and provide strength and stabilization to the joint. They also serve to limit the range of motion in a joint, which prevents further injury. Over stressing a joint will lead to ligament injury and tears. When this happens, the ligament can no longer support or stabilize the joint. Pain occurs and other muscles try to compensate for the damaged ligament. This results in further muscle/tendon strain, injury and pain. It is a vicious cycle that can be difficult to control.
Tendons and ligaments typically have a poor blood supply, by their very nature. When injured, healing can take a long time due to this decrease blood supply. Not only is healing delayed, continued injury occurs as the tendons and ligaments are continually stressed even from activities of normal daily living. As a result, these structures become inefficient and the muscles become the main support structure. This entire cycle cause chronic pain and weakness. Medical treatment is usually necessary to reverse the process.
How Many PRP Treatments Are Necessary?
The response to PRP therapy varies from patient to patient and depends on the degree of injury. Most patients respond well to anywhere from 1-3 treatments, given at 4-6 week intervals. As opposed to cortisone injections, there is no actual limit on the number of PRP treatments that can be given, as tissue regeneration will occur with each treatment. The risks and side effects of PRP treatment are quite minimal and do not change with repeated treatment. The PRP actually has a bactericidal effect, so the risk of infection is minimized. As PRP is derived from your own blood, there is no risk of transmissible diseases.
How Soon Can I Go Back To My Regular Activities?
PRP therapy promotes tissue repair and regeneration in tendons and ligaments through stimulation of growth factors and other healing components of the blood. This requires time, usually 4-6 weeks. Some rehabilitation may be necessary. Regular, follow-up visits with your treating doctor will help in determining when you can resume normal physical activities.
Is PRP Therapy Appropriate For Me?
Only after a detail examination can this be determined for certain but if you have a tendon or ligament injury, that does not seem to be responding to traditional therapies, PRP may be one option for treatment and relief. If you have continued shoulder pain or knee pain after surgery or arthroscopy, you may be an ideal patient for PRP therapy.
What Happens After PRP Treatment?
The platelets are active for up to 6 weeks after injection, forming new collagen deposits. Remodeling of the collagen can take up to 6 months. During the first 6 weeks, you should not take anti-inflammatory medications such as aspirin, ibuprofen, naproxen or Celebrex. Use only Tylenol products. The goal is to get a 60% improvement in pain at 4-6 weeks, so it is at this time that the need for another PRP treatment will be determined. Depending on the patient and degree of injury, more than one treatment may be needed. Generally after the first week, you can resume light physical activity and gradually build back up to normal routine over 6-8 weeks.
Remember, what you consider to be a normal level of activity may in fact be too much. Patients may experience a “roller coaster” syndrome of symptoms, meaning they have good days and bad days. This is a normal part of the healing process. Tylenol products and an insulated ice pack will usually provide relief. Try not to use ice after the third week post injection.
Initial activity for gentle range of motion and flexibility can be started 1 week after treatment. Rehabilitation can assist in core body strengthening and correct any skeletal imbalances that occurred as a result of the original injury.
Daniel Kassicieh, D.O., FAAN, FACN
Board Certified Neurologist
Sarasota Neurology, P.A.
3501 Cattlemen Road, Suite B
Sarasota, FL 34232