PLATELET RICH PLASMA (prp)
Unlock your body's healing power
What is PRP?
PRP (platelet rich plasma) is a concentrated sample of platelets that are taken from your own blood. Your blood has 3 main components: red blood cells (carry oxygen), white blood cells (fight infection) and platelets. Platelets help our tissues heal. When we have a cut and develop a scab, it is our platelets at work. These small cells release both anti-inflammatory molecules that fight inflammation and also growth factors, which promote tissue healing. These growth factors include vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-B), Insulin-like growth factor 1 (IGF-1) and platelet derived growth factor (PDGF) (1,2). These factors are important in tissue healing. By isolating and then concentrating your platelets, we can produce a very potent healing serum from your own blood.
How long has PRP been used?
For years, PRP has been used by ENT and plastic surgeons to promote graft healing after surgery and heal heavily damaged tissues from burn victims. In the world of sports medicine, its use has grown exponentially in the past 15 years as more people realize its potential healing power.
Is it safe?
Yes. Since PRP is produced from your own blood, the product itself is very safe. This has been shown consistently across the literature. The act of the needle injection itself carries a small risk of pain and infection, as does any injection in a doctor’s office.
What conditions can it treat?
PRP has been shown to be an effective treatment for many kinds of osteoarthritis, including knee and hip arthritis. It can substantially improve pain, reduce swelling and improve mobility. PRP is also very effective in treating most tendon problems, from inflamed tendons to partial tears.
Can a PRP injection speed up my recovery?
Yes! Multiple studies have demonstrated that a PRP injection can improve healing times and get you back in the game more quickly. A recent systematic review and meta-analysis compared PRP treatment to standard conservative therapy (physiotherapy, stretching, etc). The study concluded that PRP leads to both faster healing times and quicker return to play (3).
Are there different kinds of PRP?
Yes. PRP comes in different formulations – with platelet concentrations as low as 1.5x the normal amount, to greater than 10x baseline levels. Some PRP formulations have white blood cells, others do not. Some have higher levels of anti-inflammatory molecules like IL-1Ra (Interleukin-1 receptor antagonist). Others have higher levels of anabolic growth factors important for tissue healing.
Different conditions require different concentrations of each of the above. For example, most tendon problems benefit from the use of a white blood cell-rich PRP formulation (4). Your treating physician should be well acquainted with the research around PRP formulations and the indications for treating different conditions.
How long does it take to work?
The effects of a PRP injection can be felt within the first couple weeks. However, the full healing response continues for 3-6 months after an injection.
prp + arthritis
PRP has been shown to be a very effective treatment for knee arthritis. It can improve swelling, pain and overall mobility. This is thought to occur through the anti-inflammatory effects of the injection. A typical treatment protocol includes 3 injections a week apart.
A systematic review including more than 6 randomized control trials with over 1000 patients, looked at the effect of PRP in knee OA (osteoarthritis) compared with hyaluronic acid (HA) and placebo injections. The results were extremely positive. The study concluded that PRP injections “result in improved functional outcome scores compared with HA and placebo when used for treatment of knee osteoarthritis” (5). Another study looking at PRP vs placebo injection for knee OA followed patients for 1 year after treatment. At the 1 year follow up, individuals treated with PRP had a 78% decrease in pain vs the placebo group of 7% (6).
More recent studies have also demonstrated the effectiveness of PRP for hip arthritis. A 2016 randomized control trial involving more than 100 patients compared hip injections of hyaluronic acid (HA) versus PRP. Studies had already shown intra-articular hip injections of hyaluronic acid to be effective in treating hip OA symptoms. This 2016 study however, showed PRP might be even better. At 2, 6 and 12 months post injection, PRP pain scores were lower at all time points compared to HA. The authors concluded “Results indicated that intra-articular PRP injections offer a significant clinical improvement in patients with hip OA without relevant side effects. The benefit was significantly more stable up to 12 months…” (7)
prp + Tendinopathy
Many different tendon and muscle problems can be treated effectively with PRP. See below for examples.
Chronic buttock pain? Trouble lying on your side at night because of pain? Difficulty climbing stairs? Most often, this is a gluteal tendon problem – affecting the gluteus medius and/or gluteus minimus tendons. The tendon can become inflamed, degenerative and start to tear. It commonly affects individuals over 40 years old and affects women more than men (8).
Most people think their “hip joint” or a “bursitis” is the problem. However, a recent ultrasound study showed that most cases of buttock/lateral hip pain are in fact due to a gluteal tendon problem (9). Bursitis occurs in only a minority of cases. This can be diagnosed with an in-office ultrasound.
If the gluteal tendons are damaged, treatment usually starts with physical therapy, activity modification and anti-inflammatory medications. However, these results can be inconsistent (10). In these instances, a platelet rich plasma (PRP) injection can be very helpful. Compared with a cortisone injection, an ultrasound guided injection of PRP into the tendon can provided superior relief at 12 weeks (11). Moreover, these results can be long lasting. A more recent 2019 study showed the positive results of a PRP treatment can last up to 2 years or more (12).
Sprinting and had to pull up because of pain? Feel a pop or bruising? Hamstring tears, both acute and chronic, are very common in sports with sudden acceleration and deceleration. Runners, soccer and football players are often affected. A big fall during waterskiing is also a classic injury pattern. The hamstring is composed of 3 muscle groups: biceps femoris, semimembranosis and semitendinosis. These 3 muscles originate from a common tendon that comes off the bone you sit on, the ischial tuberosity. Your hamstring helps you flex your knee and extend your hip.
Hamstring injuries can range from a mild strain, to an avulsion fracture where the tendon pulls away the bone. An ultrasound, xray and/or MRI is helpful to determine the severity.
After a hamstring injury, a good exercise program is important in your recovery. It should include a stretching and gradually progressive eccentric strengthening component. If your progress has plateaued or need a quicker recovery, a platelet rich plasma (PRP) injection might make all the difference. A randomized control trial comparing physical therapy alone vs physical therapy plus a PRP injection, showed athletes can recover on average 2 weeks sooner (14).
The patellar tendon is a frequent cause of pain below the knee cap. Commonly called “jumper’s knee”, this affects jumping athletes, such as volleyball and basketball players. These stubborn injuries are often missed and go undiagnosed leading to compounded problems. A simple in-office ultrasound can make the diagnosis.
Treatment strategies include load management, addressing biomechanical factors such as gluteal tendon weakness, patellar straps, extracorporeal shockwave therapy and eccentric loading programs. However, some athletes have persistent pain despite these interventions.
Recent studies have shown that platelet rich plasma (PRP) injections can be extremely helpful. A systematic review and metanalysis including over 2000 patients concluded that when treating patellar tendinopathy “exercise is an effective strategy to obtain the best short-term results, but multiple PRP injections offer better results after 6-months follow-up, which remain stable at long-term follow-up” (13)
Nagging pain on the outside of your elbow? Difficulty lifting a bag of groceries or typing for a long time? Tennis elbow (lateral epicondylitis) is often a repetitive strain injury that can be settled with stretching, activity modification, a good physiotherapy program and shockwave therapy. But sometimes these stubborn injuries persist. A platelet rich plasma (PRP) injection often cures this issue and has been shown to be the best treatment in some cases (15).
PRP, in fact, has been shown to be one of the more effective strategies for treating this kind of tendon injury. Double-blinded, randomized control trials have shown that compared to a cortisone injection, a platelet rich plasma injection (PRP) is far superior for encouraging healing and a permanent solution. Studies have shown continued improvement for 1-2 years after a single injection (16,17).
Eppley BL, et al. (2004). Platelet Quantification and Growth Factor Analysis from Platelet-Rich Plasma: Implications for Wound Healing. Plast Reconstr Surg. 114(6): 1502–1508.
Halpern et al. (2012). The Role of Platelet Rich Plasma in Inducing Musculoskeletal Tissue Healing. Hospital for Special Surgery. 8 (2) 137-145.
Sheth et al. (2017). Does Platelet-Rich Plasma Lead to Earlier Return to Sport When Compared With Conservative Treatment in Acute Muscle Injuries? A Systematic Review and Meta-analysis. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 1-8.
Fitzpatrick, J., Bulsara, M., & Zheng, M. H. (2017). The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. The American Journal of Sports Medicine, 45(1), 226–233.
Riboh, J. C., Saltzman, B. M., Yanke, A. B., Fortier, L., & Cole, B. J. (2016). Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. The American Journal of Sports Medicine, 44(3), 792–800.
Smith, P. A. (2016). Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis: An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial. The American Journal of Sports Medicine, 44(4), 884–891.
Dallari, D., Stagni, C., Rani, N., Sabbioni, G., Pelotti, P., Torricelli, P., … Giavaresi, G. (2016). Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. The American Journal of Sports Medicine, 44(3), 664–671.
Del Buono, A, Papalia, R, Khanduja, V, Denaro, V, Maffulli, N. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull. 2012;102:115-131.
Long et al. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013, Nov; 201 (5); 1083-6.
Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. British Journal of Sports Medicine 2017;51:97-104.
Fitzpatrick, J., Bulsara, M. K., O’Donnell, J., McCrory, P. R., & Zheng, M. H. (2018). The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. The American Journal of Sports Medicine, 46(4), 933–939.
Fitzpatrick, J., Bulsara, M. K., O’Donnell, J., & Zheng, M. H. (2019). Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up. The American Journal of Sports Medicine, 47(5), 1130–1137.
Andriolo, L., Altamura, S. A., Reale, D., Candrian, C., Zaffagnini, S., & Filardo, G. (2019). Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine, 47(4), 1001–1018.
A Hamid, M. S., Mohamed Ali, M. R., Yusof, A., George, J., & Lee, L. P. C. (2014). Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries: A Randomized Controlled Trial. The American Journal of Sports Medicine, 42(10), 2410–2418.
Lhee S, Kim J, Jeon J, et al. (2016). Prospective randomized clinical study for the treatment of lateral epicondylitis; comparison among PRP (Platelet-Rich Plasma), prolotherapy, physiotherapy and ECSWT. British Journal of Sports Medicine, 50 (4).
Peerbooms, J. C., Sluimer, J., Bruijn, D. J., & Gosens, T. (2010). Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial: Platelet-Rich Plasma Versus Corticosteroid Injection with a 1-Year Follow-up. The American Journal of Sports Medicine, 38(2), 255–262.
Gosens, T., Peerbooms, J. C., van Laar, W., & den Oudsten, B. L. (2011). Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis: A Double-Blind Randomized Controlled Trial With 2-year Follow-up. The American Journal of Sports Medicine, 39(6), 1200–1208.