PRP therapy

PRP has been used to successfully treat a wide range of conditions from sprained knees to chronic tendon injuries. Learn more about what PRP is and how it can help patients with injuries and assisting in their pain management.

What exactly is PRP therapy?

Platelet-rich-plasma therapy, also known as PRP therapy, aims to take advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles or even bone.

A growing number of patients are turning to PRP injections to treat many orthopedic conditions including osteoarthritis, lateral and medial epicondylitis (tennis and golfer’s elbow respectively), rotator cuff and shoulder degeneration, plantar fasciitis, ligament tears, and sprains.

When treating orthopedic indications with PRP, a physician injects the platelet concentrate directly into the affected joint. The goal is to:

Reduce pain level
Potentially slow, stop or repair damage
Improve function

Platelet-rich plasma is derived from a patient’s own blood by placing the whole blood sample into a centrifuge which functions to separate out the platelets into a concentrate.

Plasma refers to the liquid component of blood; it contains red and white blood cells as well as other nutrients that travel through the blood stream including proteins, glucose and antibodies.

Platelets are another component of blood much like red and white cells. They secrete growth factors and many proteins that regulate cell division, stimulate tissue regeneration and promote healing.

How is PRP prepared and what is it composed of?

The most common way to prepare PRP involves drawing a patient’s blood sample into a vial and centrifuging it at high speeds. The spinning causes the blood to separate into layers:

Red cells settle at the bottom of the vial and make up about 45% of the volume.

White cells and platelets form a thin layer in the middle called the “buffy coat” which makes up less than 1% of the centrifuged blood.

Platelet Poor Plasma (a low concentration) of platelets makes up the remaining top layer which comprises about 55% of the centrifuged sample.

Once the centrifuge process is finished, the doctor removes the vial from the centrifuge and prepares the PRP solution for injection.

The exact composition of PRP depends on the individual’s platelet level, the amount of blood drawn in the centrifugation process and whether or not additives were used. Some physicians combine additives with PRP such as thrombin and calcium chloride which can activate the platelets and may also boost the PRP’s regenerative properties.

Advantages of Platelet Rich Plasma Therapy

Platelet-rich plasma is autologous, meaning it comes from the patient’s own body, so it is natural and the injections have few risks.

Other approaches to the treatment of chronic pain such as weight loss or physical therapy are often helpful, but do not always eliminate symptoms.

Repeated cortisone injections can weaken ligaments and tendons over time and may have a detrimental effect on healthy cartilage
Anti-inflammatory medications (NSAIDS) like aspirin or ibuprofen can reduce pain, but long-term use can worsen stomach, blood pressure or heart problems.
Minor surgeries have mixed results
Major surgeries require long-term rehabilitation

Patients should be made aware that the use of PRP in conjunction with lifestyle changes and non-surgical options such as weight loss, physical therapy and use of NSAID’S may lead to a more favorable outcome.

PRP Injection Procedure

Platelet-rich plasma injections are outpatient procedures. Because the patient’s blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.

The American Academy of Orthopaedic Surgeons recommends the following pre-injection guidelines:

Avoid corticosteroid medications for 2-3 weeks prior to the procedure
Stop taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or arthritis medications such as Celebrex, a week prior to the procedure
Do not take anticoagulation medication for 5 days before the procedure
Drink plenty of fluids the day before the procedure
Some patients may require anti-anxiety medication immediately before the procedure

Although the American Academy of Orthopaedic Surgeons published these pre-injection guidelines, the organization does not advocate for or against platelet-rich plasma treatment.

After the PRP Injection: Follow-up

Patients are advised to take it easy for a few days and avoid putting strain on the affected area. The injection site may be swollen and painful for about 3 days, as the platelet-rich plasma typically stimulates a series of biological responses.

Doctors may recommend that the patient:

Does not take anti-inflammatory pain medication; another pain medication may be prescribed by the doctor
Wear a brace or sling to protect and immobilize the affected joint; a patient who receives an injection at the ankle, knee, or hip may be advised to use crutches
Use a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling

Patients who do not have physically demanding jobs can usually go back to work the next day. Patients can resume normal activities when swelling and pain decrease, typically a few days after the injections. Patients should not begin taking anti-inflammatory medications until approved by the doctor.
If the injection(s) is successful in reducing the patient’s pain, the patient will likely be prescribed physical therapy. Doing simple exercises to build and maintain muscle strength around the affected area serves to decrease symptoms and can slow down or stop further degeneration.