How Does PRP Therapy Relieve Joint Pain?
It is unclear how platelet-rich plasma therapy may alleviate tendon pain in some people. Experts theorize that the PRP might:
- Stimulate healing, including stimulating the production of collagen, which is an important component of tendon and ligament tissue.
- Contain proteins that alter a patient's pain receptors and reduce pain sensation.
What Are Platelets and Plasma?
Platelet-rich plasma is derived from blood. A blood sample from the patient is processed using specialized medical equipment to produce a therapeutic injection(s) that contains plasma with a higher concentration of platelets than is found in normal blood.
- Platelets are a normal component of blood, just like red and white blood cells. Platelets release substances called growth factors and other proteins that regulate cell division, stimulate tissue regeneration, and promote healing. Platelets also help the blood to clot.
- Plasma refers to the liquid component of blood. It is mostly water but also includes proteins, growth factors, nutrients, glucose, and antibodies, among other components.
How Is PRP Made?
Methods vary, but the most common way to prepare PRP involves centrifuging a patient's blood sample. A vial of blood is placed in a centrifuge, where it is spun at intensely high speeds. The spinning causes the blood to separate into layers. Once the centrifugation process is complete the doctor or medical technician will remove the vial from the centrifuge, extract the necessary blood components for PRP, and prepare the PRP solution for injection.
Advantages of Platelet-Rich Plasma (PRP) Therapy
People diagnosed with tendinosis or tendinopathy might consider PRP therapy for several reasons:
- Other traditional treatments may fail to provide adequate relief.
- PRP is derived from the patient's own blood, and the injections carry few risks.
- Other treatments have side effects or drawbacks:
- Physical therapy is often effective but does not always satisfactorily relieve symptoms or improve function.
- Cortisone injections can temporarily reduce pain; however, symptoms can recur. In addition, tendons exposed to cortisone may weaken, making the injury worse.
- Non-steroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen may effectively reduce pain, but habitual use can cause or aggravate stomach problems, blood pressure, and heart problems.
- Minor surgeries to treat tendon damage and degradation, such as arthroscopic debridement, do not always work, tend to carry more risks, and have longer recovery times.
- Because there is no surefire way to treat damaged tendons, and because PRP injections carry few risks, some doctors believe PRP therapy is worth trying.
The American Society of Anesthesiology recommends patients avoid or discontinue certain medications prior to injection:
- Avoid corticosteroid medications for 2 to 3 weeks prior to the procedure.
- Stop taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin (low dose, 81mg, aspirin may be permissible), or arthritis medications such as Celebrex, a week prior to the procedure.
- Do not take anticoagulation medication for 5 days before the procedure (done only under doctor supervision)
Platelet-Rich Plasma Injections, Step-by-Step
This is an in-office procedure that involves a blood draw, preparation of the PRP, and the injection:
- Blood is taken from a vein in the patient's arm into a syringe.
- The blood is processed using a centrifuge machine.
- The centrifuged platelet-rich plasma is prepared for injection.
- The affected joint area is cleansed with disinfectant.
- A lidocaine injection
- Ultrasound is used, with a special gel applied to an area of skin near the injection site. An ultrasound probe will be pressed against the gel-covered skin. A live image of the tendon will be projected onscreen for the doctor to see.
- Using a syringe and needle, the doctor injects a small amount (often just 3 to 6 mL3) of platelet-rich plasma into the affected tendon.
- The injection area is cleansed and band aid applied.
The platelet-rich plasma typically stimulates a series of biological responses, including inflammation, so the injection site may be swollen and painful for about 3 to 5 days.
After the PRP Injection: Immediate Follow-up Care
Platelet rich plasma injections may cause temporary inflammation, pain, and swelling. Patients are often advised to take it easy for a few days and avoid putting strain on the affected joint.
- Avoid anti-inflammatory pain medication; for 72 hours after the PRP injection.
- Apply a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling.
- If the patient does not have a physically demanding job, he or she can usually go back to work the next day. Patients can usually resume normal activities a few days after the injections, when swelling and pain decrease. Patients should not begin taking anti-inflammatory medications until approved by the doctor.
Contraindications for PRP Therapy
Platelet-rich plasma injections may not be appropriate for a patient who:
- Has a medical condition that could worsen or spread with injections, such as an active infection, a metastatic disease, or certain skin diseases.
- Has certain blood and bleeding disorders.
- Is undergoing anticoagulation therapy (and cannot temporarily suspend treatment).
- Is anemic.
- Is pregnant.
- Iliotibial Band Tendinitis (ITB)
- Psoas Tendinitis and Bursitis
- Greater Trochanteric Bursitis
- Hip Labrum tears
- Sacroiliac joint dysfunction
- Patella Tendinitis
- Patellar Femoral Syndrome
- Chondromalacia patella
- Partially torn or strained ACL/LCL/MCL
- Meniscus Tears
- Whiplash injuries
- Headaches related to the neck
- Tension Neck Syndrome
- Chronic low back pain
- Facet joint arthritis
- Osteoarthritis of the spine
- Rib problems
- Pain associated with scoliosis.
- Rotator cuff tendinitis or tear
- Rotator cuff impingement syndrome
- Bicipital Tendinitis
- Labrum tear Arthritis
Elbow and Hand
- Medical and lateral epicondylitis
- De Quervain's Tenosynovitis
- Wrist and finger tendinitis
- Ligament tears
- Carpal Tunnel Syndrome
Foot and Ankle
- Achilles Tendinitis
- Peroneal Tendinitis
- Plantar Fascitis
- Recurrent Ankle Sprains
Hair and Scalp
- Increase follicular density.
- Induce anagen in resting follicles.
- PRP micro-needling for scalp rejuvenation
- Promote vitality and stop thinning hair