Platelet Rich Plasma 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 their pain management.

What exactly is PRP therapy?

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

Although not considered standard practice, a growing number of people are turning to PRP injections to treat an expanding list of orthopedic conditions, including osteoarthritis, lateral epicondylitis, Golfer’s Elbow, rotator cuff or shoulder degeneration, plantar fasciitis or ligament tears & sprains.

When treating orthopedic indications with platelet-rich plasma, a doctor injects PRP directly into the affected joint. The goal is to:

  • Reduce pain level

  • Potentially slow, stop or repair damage

  • Improve function

Platelet-rich plasma is taken from a sample of the patient’s own blood which is then placed in a centrifuge to separate out the platelets. The therapeutic injections contain plasma with a higher concentration of platelets than found in normal blood.

Plasma refers to the liquid component of blood; it is the medium for red and white blood cells and other material traveling through the blood stream. Plasma, although mainly water, also includes proteins, nutrients, glucose, antibodies and other components.

Platelets are a normal component of blood, like red and white blood cells. Alone they do not have any healing properties, but they do secrete growth factors and other 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 intensely high speeds. The spinning causes the blood to separate into layers:

  • Red blood cells settle at the bottom of the vial and make up about 45% of the volume.
  • White blood cells and platelets form a thin layer in the middle called a buffy coat, which makes up less than 1% of the centrifuged blood.
  • “Platelet-poor plasma” (plasma with a low concentration of platelets) makes up the remaining top layer, which comprises approximately 55% of the centrifuged blood 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 platelet-rich plasma depends on the individual’s concentration of platelets, number of white blood cells, how much blood was drawn, the centrifugation process and the use (or not) of additives. Some physicians combine additives with the platelet-rich plasma such as thrombin and calcium chloride, which can artificially activate platelets and may boost the platelet-rich plasma’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.

How to Choose a PRP Therapy Doctor

When selecting a physician for platelet-rich plasma therapy, patients may want to know:

  • How does the doctor assess and diagnose the condition? Any time surgery or injections are being considered, a diagnosis should be verified with imaging technology, such as an x-ray. In addition to a specific diagnosis, the doctor should weigh whether or not the condition is too severe to be treated by PRP therapy.
  • What training does the doctor have using PRP injections? The doctor offering PRP therapy should have either participated in a formal training course or has had extensive one-on-one training with an experienced doctor.
  • What is the doctor’s experience and success rate with PRP injections? PRP injections are used to treat a number of different joint conditions, and patients may want to confirm that the physician is familiar with using PRP specifically for treating their specific orthopedic condition.
  • Does the doctor use imaging technologies to guide injections? Most experienced orthopedic physicians are able to make accurate injections into certain joints without the need for imaging, but in some cases imaging technologies may be used to ensure that the injections are made accurately.

Before administering platelet-rich plasma injections, a doctor should also explain the:

  • Potential risks or side effects
  • Possible benefits
  • Stages of the procedure
  • Follow-up directions
  • Cost of the procedure
  • Informed consent form

What does it typically cost?

Platelet-rich plasma injections are considered “experimental” by most insurance companies. A single treatment of one joint can cost $400 to $2,000 paid out-of-pocket by the patient.

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.
Contact Victory Over Pain for more information.