I posted a quick bit on a PRP (Platelet Rich Plasma) therapy last month. You’ll recall I tore tendons at my left medial epicondial (the bony bump on the inside of your elbow) last summer, rock climbing. I received my first PRP injection last fall at Steadman-Hawkins in Vail, then another at Boulder Community Hospital with Dr. Roger Nichols, a month ago.
For a PRP injection, docs remove some of your blood (approx 50cc) and centrifuge it for a short time. As the blood spins, heavier stuff (hemoglobin, or red blood cells) settles to the bottom, while lighter fluid (plasma, or the liquid in which your white and blood cells travel) comes to the top. A thin, middle layer remains, made up of white blood cells, growth factors, or other gunk I’m not smart enough to identify. This layer becomes the “PRP” and is injected to an injured tendon or ligament. The area to be treated must be vascularized to some degree; meaning, it must have a blood supply. Therefore, the interior of a joint (a meniscus, for example?) doesn’t seem to benefit from PRP nearly as much as more “external” tissues, like IT bands, etc., with a regular blood supply.
I’m intentionally vague with some of the details because the medical community has yet to agree upon the particulars for PRP injection. At Steadman, docs removed 60cc of blood and isolated 8cc of PRP, at roughly an 8x concentration of growth factors (versus one’s “natural” concentration). Dr. Nichols at BCH, on the other hand, took a bit less blood and only reinjected 2cc of PRP, at a (if I remember correctly) 2-4x concentration. Steadman-Hawkins did NOT use lidocaine during the injection, while Nichols did. Guess which one hurt more.
The PRP is packed with proteins and growth factors which encourage the body’s healing response. That said, they also provoke a vigorous inflammatory response–which the patient does NOT counteract with ice or non-steroidal anti-inflammatories (ibuprofen, etc.). Docs inject the PRP and within minutes the injury site is pretty pissed–post-injection hurt far worse than the injury itself, but after 24 hours the pain is significantly diminished and the body begins trying to heal the area.
Naysayers counter that there have not been randomized, double-blind studies conducted to validate PRP’s efficacy. They also say pinpricking around an injury (meaning an empty needle just poking at an injury) encourages the body’s own healing response without injecting PRP, so results are tough to differentiate between simply monkeying around and the PRP itself. Nevertheless, PRP is a hot area of research and everybody from yours truly to Tiger Woods is getting them. For the record, I am NOT getting horizontal with the hostess from our neighborhood Perkins.
After my first injection I had no improvement in my condition. This, according to Dr. Karli at Steadman and Dr. Nichols at BCH, does happen–patients require an additional bomb of PRP to keep the healing going. I took my second injection six months later, not ideal from what I’ve read and what most docs say. You’re supposed to follow an unsuccessful PRP with another within eight weeks…BUT, Karli and Nichols both said the PRP works for several months after injection. How long? Another gray area–yet to be determined.
This latest round seems to have helped a bit more. Cumulative effect, or something different with this particular PRP? No idea and it’s too early to tell if I’m “saved”.
I’m still rehabbing at the gym–light (1-3 lb) dumbbell curls and some rotating, range-of-motion exercises. Less pain, some soreness after a “workout”, though that diminishes after a day. Am I fixed? Remains to be seen: I’ve yet to pull hard on a climb or return to push-ups and pull-ups. And believe me–I miss it. Folks, you don’t maintain a physique like mine without a LOT of working out.
My girlfriend just puked in her mouth. Sorry, honey.
Anyway, that’s where I’m at. Some advice: call your insurance company BEFORE you get a PRP. These dimwitted bastards still consider PRP experimental, so they’ll deny you quick as they can say “health insurance companies suck the fluids from a dead camel’s nuts”. You or your doc should call before and try to get pre-approval, playing the “I’m trying to avoid surgery and trying to save you $12K” card.
I’d also request “guided” PRP injections. These involve the doc using ultrasound to guide the needle into the injured area. Steadman-Hawkins did not use a guiding technique on their injection, while BCH did–I had much less pain with the BCH procedure in the days following the procedure and the folks at Boulder Center for Sports Medicine say it’s more effective.
Drop me a line with any questions–like I said, I’m no expert on the matter, but I can try to turn you on to someone who is, or at least something helpful to read. Best of luck!
