PRP, or platelet-rich plasma, therapy is an emerging technique for sports medicine and those who are suffering from chronic athletic-related pain.
This therapy has gained a lot of interest after a number of high profile athletes received injections, such as Tiger Woods, Takashi Saito and Troy Polamalu.
Dr. Robby Bershow, a sports medicine physician with Sports and Orthopaedic Specialists, gives us the lowdown on PRP therapy.
Is PRP Therapy Right For My Injury?
Featured Speaker:
Robby Bershow, MD – Sports Medicine & Family Medicine
Robby Bershow, MD, is a sports medicine and family medicine physician with professional interests in non-operative orthopedics, joint injections, fracture management and preventive care for cyclists and runners. He provides care through Sports and Orthopaedic Specialists. Transcription:
Is PRP Therapy Right For My Injury?
Melanie Cole (Host): PRP or platelet-rich plasma therapy is an emerging technique for sports medicine and those who are suffering from chronic athletic related pain. This therapy has gained a lot interest after a number of high-profile athletes have received injections and gotten great relief from it. My guest today is Dr. Robby Bershow. He’s a Sports Medicine Physician with Sports and Orthopedic Specialists at Allina. Welcome to the show, Dr. Bershow. So what is PRP or platelet-rich plasma therapy?
Dr. Robby Bershow (Guest): Sure. Well, thanks Melanie, for having me on. PRP is one of the newer regenerative therapies that as you’ve noted have become increasingly prevalent in the fields of orthopedics, sports medicine over the past several years. The basic idea is that PRP can augment or enhance the body’s own healing ability in certain settings. And the reason that that’s important is that while traditionally we think of musculoskeletal injuries like sprains or broken bones as acute injuries that the body heals, there are a number of conditions where the body either doesn’t or can’t fully recover a problem. For example, like chronic tendon degeneration that we would see, tennis elbow or jumper’s knee. So in those instances or those conditions, using the PRP can help stimulate the body to restart an active healing process, especially when other therapies haven’t been effective.
Melanie: So how does it work, and what can the patient expect? Is this a big shot? Is this something that takes a while to work? Explain the process a little.
Dr. Bershow: Sure. Well, the most important is that when we do the shot is we use a tiny needle. So that’s the most important thing.
Melanie: That’s very important.
Dr. Bershow: Generally speaking, the procedure, though it sounds fairly complex and though the science behind it is somewhat complex, the procedure itself is not that big of a deal. Basically, the way that it works is that PRP allows us to deliver a person’s own specific growth factors and healing factors directly to injured tissue. The way that we do this is that if a patient comes into the office, we draw their blood right in the office, and then right away we spin that down in a centrifuge, which separates the blood into three layers. First, the red blood cells, which primarily carry oxygen; second, the plasma, which is the fluid or the water portion of blood; and then third, a thin layer of both platelets and white blood cells. And what we typically think of platelets as being responsible for are forming clots, like when you nick yourself shaving. Platelets also act little capsules that contain a large number of those growth factors our bodies use to heal injured tissue. So, after the blood is spun down in the centrifuge, a concentrated amount of those platelets are collected with the plasma fluid. And that’s where it gets the name “platelet-rich plasma.” So once it’s been collected, which generally is a small blood draw, 10 to 15 ccs, one or two tubes, if you’re used to getting your blood drawn, once that’s been collected, we spin it down. And then usually it’s about 4 or 5 ccs that we inject into the desired area. And oftentimes we’ll use our ultrasound machine in the office just to help ensure accurate placement. So the whole process takes somewhere along the lines of 30 to 45 minutes just because of all the steps. But again, the actual active injecting it is pretty minimal. It’s like getting any other injection you would have in your body.
Melanie: Are there some people, Dr. Bershow, that are not candidates? Who would be a good candidate, and how long does it take to see results from PRP?
Dr. Bershow: Yeah, great, great question. So most patients are able candidates because it’s not that invasive of a procedure. There aren’t a lot of contraindications to doing it, the main one being sometimes if patients are on blood thinners or anticoagulants, because when we do the procedure we do some associated needling with it, that can cause some increased bleeding. Otherwise, for the most part, there aren’t a number of contraindications. People that would be good candidates are anyone who has sort of more chronically injured tissue, especially tendons, which again can become degenerated often through overuse. So people who have tennis elbow, golfer’s elbow, Achilles tendinosis of the ankle, patellar tendinosis of the knee. But we also have some good support to medical literature for other applications such as knee arthritis or partial ligament sprains, or sometimes even after surgery to try and promote healing. And it’s not an instantaneous benefit that we see. People that have had cortisone injections in the past sometimes had that injection, and after a couple days or after a week, things felt 100 percent better. And this is sort of little bit slower than the action, but the idea is that it is sort of stimulating that healing process as we’re moving forward. And so, sometimes it can be up to six weeks or even longer before we see the full benefit, but usually then we’re getting good solid healing and helping the body really recover more fully.
Melanie: So because it helps in this healing process and these growth factors and the proteins and the platelets can help speed the process, could it be used—because I see so many torn rotators, and people have to undergo surgery—could it be used to help speed healing for some of these injuries that we’re seeing so prevalent today, from golf or from all of these different weekend warrior sports?
Dr. Bershow: Yeah, absolutely. Again, the evidence has been mixed. There are some studies that have shown definite benefit with the rotator cuff specifically; others not as much. One of the problems with the shoulder specifically is that it is a complex joint and there’s a lot that goes into healing of that particular area. But the same general theory applies that where it’s going to be helpful with those other chronic tendon injuries in the elbow, in the ankle, in the knee can also be helpful in the shoulder, although we use it a little bit less there just because, again, of all the other factors that play into that.
Melanie: Dr. Bershow, with so many people getting cortisone shots so many times is, there any contraindication between the two? Is there any interaction between the cortisone shot in the same area that you’re going to have PRP?
Dr. Bershow: Sure. Well, a lot of the time, just because it’s a good example, getting back to tennis elbow, it’s something that for a long time we use to do cortisone injections very routinely. And what we found is that when we do those over and over again, the cortisone, even though it provides a good-short term relief of pain, oftentimes it’s not really healing the underlying condition. So what can happen is that we’re sort of masking that tissue degeneration or degradation. And so, over time, that tissue can get more and more injured to the point where we’re no longer able to really feel it or fix it at all. And so, with the PRP, the idea is that it works differently. Whereas we don’t get that same initial boost in pain relief and oftentimes, to be honest, patients feel little bit worse initially because I put that medication in there and we do sort of needle around the tendon a little bit, pain can be worse initially. But the idea is that it really stimulates that healing response over the longer term. Sometimes for conditions like arthritis, we will continue to do both. But a lot of these conditions that we formerly used cortisone for, we’re moving away from doing that now. With these cases, when it’s more of a chronic injury, sometimes the body has simply stopped paying attention to that area. It knows that it’s injured, but it also knows that it’s not dangerous, so it just decides to wall it off and move on. And the PRP injection sort of sends up a signal flare to the body to let it know that that tissue is still injured, needs to be repaired, and the growth factors in there can really help kickstart that healing process.
Melanie: What a fascinating form of medicine, Dr. Bershow. In just the last few minutes, give us your best advice, please, about people suffering from chronic injuries, whether from overused or acute injuries and how PRP therapy might be able to help them.
Dr. Bershow: Sure. Well, my best advice with these is that prevention is always very, very important. And so, if we find that patients are starting to move towards the direction of having this discomfort with activity, having pain, getting in and seeing someone early on can really help with guidance on activity modification or specific therapy exercises. And while PRP is really a terrific and exciting treatment that we have, it’s not a standalone treatment and it’s not a substitute for physical therapy. So I’m always very clear with patients that this really, again, helps augment or enhance your body’s healing, but it’s really very important that we look at the whole picture and couple the PRP with ongoing efforts of physical therapy, with looking at how the body moves, with looking at how we can decrease the stress across these areas so the injuries aren’t happening over and over again. And when we put all of that together, we do really get some excellent results for these conditions that otherwise can be really problematic for patients and can become these frustrating, nagging things without a good solution. We’ve really made good advances in helping those patients heal and get better.
Melanie: Thank you so much. You’re listening to the WELLCast with Allina Health. For more information, you can go to allinahealth.org. That’s allina.org. This is Melanie Cole. Thanks so much for listening.
Is PRP Therapy Right For My Injury?
Melanie Cole (Host): PRP or platelet-rich plasma therapy is an emerging technique for sports medicine and those who are suffering from chronic athletic related pain. This therapy has gained a lot interest after a number of high-profile athletes have received injections and gotten great relief from it. My guest today is Dr. Robby Bershow. He’s a Sports Medicine Physician with Sports and Orthopedic Specialists at Allina. Welcome to the show, Dr. Bershow. So what is PRP or platelet-rich plasma therapy?
Dr. Robby Bershow (Guest): Sure. Well, thanks Melanie, for having me on. PRP is one of the newer regenerative therapies that as you’ve noted have become increasingly prevalent in the fields of orthopedics, sports medicine over the past several years. The basic idea is that PRP can augment or enhance the body’s own healing ability in certain settings. And the reason that that’s important is that while traditionally we think of musculoskeletal injuries like sprains or broken bones as acute injuries that the body heals, there are a number of conditions where the body either doesn’t or can’t fully recover a problem. For example, like chronic tendon degeneration that we would see, tennis elbow or jumper’s knee. So in those instances or those conditions, using the PRP can help stimulate the body to restart an active healing process, especially when other therapies haven’t been effective.
Melanie: So how does it work, and what can the patient expect? Is this a big shot? Is this something that takes a while to work? Explain the process a little.
Dr. Bershow: Sure. Well, the most important is that when we do the shot is we use a tiny needle. So that’s the most important thing.
Melanie: That’s very important.
Dr. Bershow: Generally speaking, the procedure, though it sounds fairly complex and though the science behind it is somewhat complex, the procedure itself is not that big of a deal. Basically, the way that it works is that PRP allows us to deliver a person’s own specific growth factors and healing factors directly to injured tissue. The way that we do this is that if a patient comes into the office, we draw their blood right in the office, and then right away we spin that down in a centrifuge, which separates the blood into three layers. First, the red blood cells, which primarily carry oxygen; second, the plasma, which is the fluid or the water portion of blood; and then third, a thin layer of both platelets and white blood cells. And what we typically think of platelets as being responsible for are forming clots, like when you nick yourself shaving. Platelets also act little capsules that contain a large number of those growth factors our bodies use to heal injured tissue. So, after the blood is spun down in the centrifuge, a concentrated amount of those platelets are collected with the plasma fluid. And that’s where it gets the name “platelet-rich plasma.” So once it’s been collected, which generally is a small blood draw, 10 to 15 ccs, one or two tubes, if you’re used to getting your blood drawn, once that’s been collected, we spin it down. And then usually it’s about 4 or 5 ccs that we inject into the desired area. And oftentimes we’ll use our ultrasound machine in the office just to help ensure accurate placement. So the whole process takes somewhere along the lines of 30 to 45 minutes just because of all the steps. But again, the actual active injecting it is pretty minimal. It’s like getting any other injection you would have in your body.
Melanie: Are there some people, Dr. Bershow, that are not candidates? Who would be a good candidate, and how long does it take to see results from PRP?
Dr. Bershow: Yeah, great, great question. So most patients are able candidates because it’s not that invasive of a procedure. There aren’t a lot of contraindications to doing it, the main one being sometimes if patients are on blood thinners or anticoagulants, because when we do the procedure we do some associated needling with it, that can cause some increased bleeding. Otherwise, for the most part, there aren’t a number of contraindications. People that would be good candidates are anyone who has sort of more chronically injured tissue, especially tendons, which again can become degenerated often through overuse. So people who have tennis elbow, golfer’s elbow, Achilles tendinosis of the ankle, patellar tendinosis of the knee. But we also have some good support to medical literature for other applications such as knee arthritis or partial ligament sprains, or sometimes even after surgery to try and promote healing. And it’s not an instantaneous benefit that we see. People that have had cortisone injections in the past sometimes had that injection, and after a couple days or after a week, things felt 100 percent better. And this is sort of little bit slower than the action, but the idea is that it is sort of stimulating that healing process as we’re moving forward. And so, sometimes it can be up to six weeks or even longer before we see the full benefit, but usually then we’re getting good solid healing and helping the body really recover more fully.
Melanie: So because it helps in this healing process and these growth factors and the proteins and the platelets can help speed the process, could it be used—because I see so many torn rotators, and people have to undergo surgery—could it be used to help speed healing for some of these injuries that we’re seeing so prevalent today, from golf or from all of these different weekend warrior sports?
Dr. Bershow: Yeah, absolutely. Again, the evidence has been mixed. There are some studies that have shown definite benefit with the rotator cuff specifically; others not as much. One of the problems with the shoulder specifically is that it is a complex joint and there’s a lot that goes into healing of that particular area. But the same general theory applies that where it’s going to be helpful with those other chronic tendon injuries in the elbow, in the ankle, in the knee can also be helpful in the shoulder, although we use it a little bit less there just because, again, of all the other factors that play into that.
Melanie: Dr. Bershow, with so many people getting cortisone shots so many times is, there any contraindication between the two? Is there any interaction between the cortisone shot in the same area that you’re going to have PRP?
Dr. Bershow: Sure. Well, a lot of the time, just because it’s a good example, getting back to tennis elbow, it’s something that for a long time we use to do cortisone injections very routinely. And what we found is that when we do those over and over again, the cortisone, even though it provides a good-short term relief of pain, oftentimes it’s not really healing the underlying condition. So what can happen is that we’re sort of masking that tissue degeneration or degradation. And so, over time, that tissue can get more and more injured to the point where we’re no longer able to really feel it or fix it at all. And so, with the PRP, the idea is that it works differently. Whereas we don’t get that same initial boost in pain relief and oftentimes, to be honest, patients feel little bit worse initially because I put that medication in there and we do sort of needle around the tendon a little bit, pain can be worse initially. But the idea is that it really stimulates that healing response over the longer term. Sometimes for conditions like arthritis, we will continue to do both. But a lot of these conditions that we formerly used cortisone for, we’re moving away from doing that now. With these cases, when it’s more of a chronic injury, sometimes the body has simply stopped paying attention to that area. It knows that it’s injured, but it also knows that it’s not dangerous, so it just decides to wall it off and move on. And the PRP injection sort of sends up a signal flare to the body to let it know that that tissue is still injured, needs to be repaired, and the growth factors in there can really help kickstart that healing process.
Melanie: What a fascinating form of medicine, Dr. Bershow. In just the last few minutes, give us your best advice, please, about people suffering from chronic injuries, whether from overused or acute injuries and how PRP therapy might be able to help them.
Dr. Bershow: Sure. Well, my best advice with these is that prevention is always very, very important. And so, if we find that patients are starting to move towards the direction of having this discomfort with activity, having pain, getting in and seeing someone early on can really help with guidance on activity modification or specific therapy exercises. And while PRP is really a terrific and exciting treatment that we have, it’s not a standalone treatment and it’s not a substitute for physical therapy. So I’m always very clear with patients that this really, again, helps augment or enhance your body’s healing, but it’s really very important that we look at the whole picture and couple the PRP with ongoing efforts of physical therapy, with looking at how the body moves, with looking at how we can decrease the stress across these areas so the injuries aren’t happening over and over again. And when we put all of that together, we do really get some excellent results for these conditions that otherwise can be really problematic for patients and can become these frustrating, nagging things without a good solution. We’ve really made good advances in helping those patients heal and get better.
Melanie: Thank you so much. You’re listening to the WELLCast with Allina Health. For more information, you can go to allinahealth.org. That’s allina.org. This is Melanie Cole. Thanks so much for listening.