Platelet Rich Plasma (PRP)

What is PRP?

Platelet Rich Plasma (PRP) also known as autologous conditioned plasma is a portion of the plasma where the platelet and all the protein/growth factors they contain are concentrated after centrifuging the patient’s own whole blood.

How does PRP works?

Platelets play a major role in healing. Yes, they not only help in clotting when you cut yourself, but also they are rich with hundreds of different proteins called growth factors (GF), which play a critical role in the healing of injuries. Growth factors, stored within platelet α-granules, include platelet derived growth factor (PDGF), insulin like growth factor (IGF), vascular endothelial growth factor (VEGF), platelet derived angiogenic factor (PDAF), and transforming growth factor beta (TGF-β). In addition to growth factors (GFs), platelets release numerous other substances (e.g., fibronectin, vitronectin, sphingosine 1-phosphate, etc.) that are important in wound healing. Due to all these growth factors, when PRPis injected into the damaged area such as for example a joint, it stimulates the Stem Cells we all have in our body and promotes healing! 

What can PRP be used for?

The use of platelet-rich plasma (PRP) has been rapidly increasing in popularity, however, its true effectiveness has yet to be fully established. It shows promise but more research is needed.  Several studies find that injecting PRP to the site of injury does not provide any significant benefit with respect to clinical outcomes; however, many others report the contrary.There is variety of ailments for which PRP seems to works very well. Even surgery can be avoided at times or posponed at least. Some examples include knee arthritis, tennis elbow and golfers’ elbow, For other conditions such as  rotator cuff tears, gluteus medius and minumus tendon tear there is less evidence. Ligament tears such as ACL tear as long as there is no separation of the broken ends may be helped with it.  Labrum tears of the shoulder and hip, knee meniscus tears, and also joint pain may improve . These are just a few of the conditions frequently treated with PRP. Many more conditions can be treated with PRP. We want to be clear, PRP shows promise although more research is needed and it doe not always work. 

What to look for when considering PRP therapy. 

There are two things to consider. First, who is the person doing the procedure and second, does he/she has the right equipment. 

Who is performing the procedure is extremely important. There are many good docs out there but not all have the skills to preform presicion guided injections under fluoroscopy or ultrasound guidance. There has been a flood of Physicians and even midlevel providers offering these Cell Therapy procedures, without having not even the most basic training on these types of interventional procedures, making them both dangerous and ineffective. Among those lacking the proper skills are primary care physicians, and chiropractors. This last ones use mid-level providers such as nurse practitioners and physician assistants to do the actual injection, because Chiropractors are not licensed to do injection procedures. 

Having the right equipment and knowing how to use it is important. Some very specialized equipment is mandatory to do PRP therapy procedures properly and safely. A properly equipped procedure room includes a fluoroscopy table, C-Arm fluoroscopy equipment, an Ultrasound machine, centrifuge, adequate monitoring and emergency resuscitation equipment, oxygen, intubation equipment etc. in a “clean” room specially dedicated to carry out these procedures safely. 

How long do PRP injections last?

Pain usually gradually subsides as the injured tissue improve and pain relieving factors activate. This can take weeks, but when successful, the effect is long lasting.  Up to three PRP injections may be given within a six-month time frame, usually performed three to four weeks apart. You may, however, gain considerable to complete relief after the first or second injection. Maximum effects are usually seen at 6-9 months.

Is PRP therapy a painful procedure?

In general, PRP injections are not painful. This may vary by the patient or by the area of the body in which the injection is being made. You may feel more pain at first, since we are causing swelling in the area that was already sore. The swelling is needed for the blood cells to start helping you heal for the long term. Most patients begin to experience relief within three to four weeks following an injection. The pain tends to improve over the next three to six months. However, it is important to note that all patients heal differently, and some areas may respond faster to PRP injections than others. The results of PRP treatment are most noticeable after at least six months, and are not permanent; patients may require touch-up injections once every one or two years.