What is Platelet Rich Plasma (PRP)?
Platelet Rich Plasma (PRP) is produced when red blood cells are separated from the plasma and white blood cells in a specialized centrifuge. The layer of plasma white blood cells and platelets are known as PRP. Normal platelet concentration is 200,000 platelets/ul, PRP has a baseline of 1,000,000 platelets/ul.

Why Platelets?
Platelets are a component of blood and considered the most important in stimulating the healing response of injured tissue. We are all familiar with a cut on our skin and the clot that forms within minutes to stop the bleeding. Platelets are responsible for creating the blood clot, which stops the bleeding but they also activate the repair of the damaged tissue. The process for the repair of the skin is no different than it is for the repair of other tissue types, such as tendons, ligaments, joints, and cartilage of our musculoskeletal system. Based on this principle, platelets are now able to be extracted from your blood and put back into areas of the body which suffer from chronic injuries. By placing concentrated platelets and white blood cells into areas which have a limited blood supply the injured area gets “jump started” to heal. The platelets and white blood cells begin creating a network of fibers and proteins to begin rebuilding and bring growth factors for all cells involved in rebuilding and regenerating.

Platelets contain many proteins and growth factors (IGF-1, TGF-Beta, VEGF, PDGF, and BFGF) which are secreted when they become activated and signal the migration of cells to produce enzymes necessary to digest the old injured tissue and proteins and growth factors to create new tissue. One important cell which is recruited is the mesenchymal stem cell. As we have heard in the news – stem cells rejuvenate any tissue they come in contact.

As described above the platelets are powerful messenger cells for healing, but credit is also due to the white blood cells as they also contain important cytokines and enzymes. Cytokines (interleukins and lymphokines) are considered regulatory proteins which help to generate an immune response. It is the white blood cells which are considered responsible for long term tissue regeneration via macrophages and increased monocyte adherence. As for infection, it should be noted that the white blood cells also significantly inhibit the growth of Staphylococcus aureus and Escherichia coli, two common bacteria responsible for wound infections.

 

PRP versus Prolotherapy: who should consider PRP?
A few factors should be taken into consideration before pursuing PRP. First and foremost, do you have adequate veins to be drawn? If so, are you willing to pay double the price of prolotherapy with the understanding PRP is approximately 4 times more powerful in tissue regeneration than P2G and dextrose, the standard proliferants. The cost is offset by the need for fewer standard prolotherapy treatments; this point is important for endurance athletes where recovery time is of highest importance. In general, patients opting for PRP treatments, on average are able to resume reasonable activities within one to two weeks with full activity after three weeks. Whereas standard prolotherapy will take up to six weeks for range of motion, strength and joint stability to return, most PRP patients report they are able to exercise within seven to ten days after treatment. If your injury is severe enough for you to be contemplating surgery it is probably a good idea to consider PRP. Lastly, PRP is described as having less ache and stiffness post procedure than traditional prolotherapy. All of these factors should be taken into account, but as with prolotherapy -rest, proper nutrition and focus on healing are still paramount for optimal results.
 

What general conditions can be treated with PRP?
Many different types of musculoskeletal injuries and pain respond well to PRP treatment. Some common conditions include, but are not limited to:

  • Tendonitis/tendonosis
  • Musculoskeletal pain related to osteoarthritis
  • Degenerative joint disease
  • Degenerative disc disease
  • Rotator cuff partial tears
  • Chronic strains and/or sprains
  • Low back pain
  • Neck pain
  • Plantar fasciitis
  • Bursitis
  • Carpel tunnel syndrome
  • Whiplash injuries
  • Migraine headaches
  • Temporomandibular joint dysfunction (TMD)
  • Sciatica

Since the early 1990s, and especially within the last couple of years, the use of platelet rich plasma (PRP) as a prolotherapy formula has gained an increasing notoriety as a result of its use by some of the nation's top medical institutions and proven success in the treatment of sports injuries in professional athletes.

  
 


When should PRP be used first?
As mentioned above if your injury is severe enough to warrant surgery and/or your joint degeneration has progressed to moderate/severe, PRP should be considered prior to the more invasive surgical option. If you have a tear in the meniscus (knee cartilage) or the labrum (shoulder cartilage) PRP will deliver and recruit the necessary blood growth factors and stem cells to repair these types of tissues.
 


How does it work?
Following an initial consultation and evaluation, treatment options will be discussed and information will be provided for you to make an informed decision regarding your treatment. A full explanation of the procedure including risks and benefits will be reviewed. On the day of your PRP treatment, blood is drawn from your arm and placed in a special centrifuge unit which separates platelets, white blood cells and serum from red blood cells. The platelets and white blood cells are then concentrated and collected into a sterile syringe. Your skin and soft tissue is first anesthetized with local anesthetic followed by the injection of the PRP. Depending on the area(s) being treated, one or more injections may be made.