Platelet Rich Plasma, or PRP, is a relatively new form of regenerative injections. A sample of the patient’s blood is collected, and then centrifuged to concentrate the platelets and growth factors which directly encourage cell repair and tissue regeneration. The solution is then injected at the site of injury, often using ultrasound guidance. The blood draw and subsequent injections are done in the same visit, typically taking no more than 1 hour.
PRP has similar applications to standard prolotherapy (see below), but may be preferred specifically for tendon or muscle tears, meniscus injuries, and some forms of arthritis or joint degeneration. It is also used in dentistry and surgical procedures to encourage quicker healing.
Conditions for which PRP may be indicated:
- Arthritis, cartilage/joint degeneration of the hip, knee, shoulder, spine, and more.
- Lateral/Medial Epicondylosis/itis (Tennis or golfer’s elbow)
- Meniscal injury or tears
- Shoulder injuries, including labral tears and rotator cuff injuries
- Achilles Tendinosis
- Patellar Tendinosis (Jumpers Knee)
- Partial tendon tears
Prolotherapy is a regenerative injection therapy (RIT) used to strengthen joints weakened or damaged by over-use or chronic injury. Ligament or tendon attachments once stretched, torn, or otherwise injured often have difficulty returning to pre-injury level of functioning due to limited blood supply to these structures. Surgery can often produce more scarring and limited range of motion without addressing the root cause of dysfunction. Prolotherapy can actually stimulate healing of the joint structures without cutting into, or removing, tissue. While there are conditions for which surgery is definitely indicated, it can sometimes be avoided or at least delayed with prolotherapy.
How Does Prolotherapy Work?
Chronic knee pain even following meniscus surgery? Ongoing neck pain after a motor vehicle accident requiring months of physical therapy with minimal improvement? How about cycles of muscles tightness and spasm ever since a shoulder injury, despite lots of massage? Or chronic back pain or disc problems ever since giving birth to your child? All of these scenarios are typical of injuries not healing correctly, leading to instability and weakness around a joint. The result is a pattern of chronic pain, with muscles tightening in attempts to compensate.
When tissues are initially injured, sugars and fats are released at the site to help stimulate the immune system’s repair mechanims. When there is ongoing overuse of an area (such as tennis elbow or achilles tendinosis) the repair process never gets a chance to finish, leading to ongoing breakdown of the tissues. Chronic anti-inflammatory/NSAID use or steroid injections further impair this process. Prolotherapy attempts to reinitiate repair mechanisms at the specific site of injury by injecting dextrose (or other natural stimulants) to the area, creating focalized inflammation and mimicking the original repair process. It stimulates the generation of new fibrous tissue, strengthening tendon and ligament attachments. Once joint structures are strengthened, both joint and muscle pain can be significantly, if not fully eliminated. Degenerative processes, such as those seen in osteoarthritis, can also be stopped, and new cartilage encouraged to regenerate.
Treatment course varies and depends on the joint being treated, but typically results are seen within 3 treatments, although often patients will see significant improvement after one visit. A typical treatment course is 3-6 series of injections, given every 2-4 weeks. Prolotherapy has been used since before the ’50’s, with increasing numbers of controlled studies showing its effectiveness.
Resources and References for Regenerative Injection Therapies
Articles (click on the title to view)
- Prolotherapy – A Simple Solution with Powerful Effects, by Ryan Minarik, ND, LAc
- Prolotherapy and the Athlete, by Mark L. Johnson, M.D., FACS (used with permission)
- Connective Tissue Damage Syndrome, by Mark L. Johnson, M.D., FACS (used with permission)