PRP, Platelet Rich Plasma, Vancouver
PRP, Platelet Rich Plasma Regenerative Injection Therapy, under ultrasound guidance, for the treatment of back pain, neck pain, tendonitis, shoulders, elbows, wrists, fingers, hips, knees, ankles, feet, all joints of the body.
PRP Regenerative Injection Therapy, Platelet Rich Plasma
A new treatment for pain is becoming popular among orthopedic and pain specialists: the injection of platelet rich plasma PRP. Most everyone thinks of blood platelets as being responsible for blood clotting after injury which is true. What many people do not know is that blood platelets serve many other important functions. Blood platelets are responsible for bringing white blood cells to the injured area to clean up the remains of dead and injured cells, which is what most people believe is "chronic inflammation or tendonitis. This non productive stagnant "swelling" is called tendonosis and is not helpful for healing and must be resolved for recovery to proceed. Most importantly, blood platelets release growth factors that are directly responsible for tissue regeneration. PRP has also been shown to increase chondrocytes, the cells which grow into cartilage tissue. PRP has been used for years in surgical centers around the US and abroad to improve the success of bone grafting (especially in dental surgery) and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. More recently PRP is being used for the treatment of chronic pain. All joints, ligaments and tendon injuries can be treated, whether chronic or acute, including: tennis elbow, plantar fasciitis, Achilles tendonitis, rotator cuff tears, shoulder dislocations, meniscal tears, osteoarthritis and chronic low back, neck pain and many more areas are are all being treated with the injection of PRP; the goal being to promote the regeneration of degenerated and/or torn or strained connective tissue, ligaments, tendons and joints. The reports are of great success at a magnitude greater than regular dextrose prolotherapy, and of benefit where prolotherapy effects have plateaued or not been sufficient.
What is PRP - Platelet Rich Plasma ?
Platelet Rich Plasma or PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process.
While a normal concentration of platelets circulating in your blood is 200,000 per micro liter, the platelet count in Platelet Rich Plasma can exceed 2 million platelets per micro liter. To be considered PRP the platelet count must be 4x or greater above baseline.
Normal Platelet Count
Concentrated Platelet Count
How is Platelet Rich Plasma made?
The process of creating Platelet Rich Plasma begins by drawing 20 - 60 cc of blood (500 cc is taken in blood bank donations).
The blood is then put into the Harvest SmartPReP®2 Platelet Concentrate System and spun down separating the red blood cells, plasma and concentrating the platelets.
Here’s how it works:
All injuries result in tissue damage. The body’s natural response to injury is an organized process of regeneration and remodeling of damaged cells, ultimately returning the injured tissues to their normal state. Collectively this process is known as the healing cascade. This healing cascade is primarily controlled by bioactive tissue growth factors found in platelets. With PRP prolotherapy, these growth factors are concentrated and injected directly into the site of injury.
Growth Factor Biology
The response of living tissue to injury forms the foundation of all surgical practice:
- All surgery results in tissue and cellular damage
- The body's natural response to this injury is a series of regeneration and remodeling steps collectively referred to as the "Healing Cascade"
- The steps are initiated and controlled by bioactive proteins found in platelets, plasma, and white blood cells
- Cellular regeneration, remodeling, and proliferation required a combination of:
- Scaffold (structure or matrix)
- Undifferentiated Cells (Mesenchymal stem cells)
- Signal Proteins (platelets, plasma and white blood cells)
- Increasing the concentration of the bioactive proteins acts as a catalyst for accelerating the wound healing process and forms the foundation of tissue engineering
Bioactive proteins replace, repair, and regenerate tissue. These proteins are natural components found in the body and are considered by many to be a “new frontier” of clinical treatment. Increasing the bioactivity at the wound site takes medicine one step closer toward its ultimate goal of naturally accelerating the body's normal healing process.
The bioactive proteins carried by platelets are already being used succesfully for hemostasis, wound sealing, and wound healing in surgical disciplines such as: oral and maxillofacial, orthopaedic, neurology, otolaryngology, cardiovascular, vascular, general, plastic and reconstructive, non-healing wounds, and pediatrics.
Why use your own platelets?
Platelets are tiny cells that are critical to healing. They are the body’s primary source of bioactive tissue growth factors, including CTGF (Connective Tissue Growth Factor) PGDF (Platelet Derived Growth Factor), TGF-β (Transforming Growth Factor-beta), EGF (Epidermal Growth Factor), IGF (Insulin Growth Factor), bFGF (basic Fibroblast Growth Factor), and VEGF (Vascular Endothelial Growth Factor. By concentrating these growth factors and injecting them at the site of injury or degeneration,, the body's own stem cells are drawn to the injured area and differentiate to cause regeneration of new healthy and robust ligaments, tendons and cartilage..
PRP provides a fibrin matrix graft. : Fibrin matrix provides the scaffolding for new collagen to form along damaged ligaments and tendons. With a fibrin matrix graft, even severely damaged tissues can re-organize and heal.
PRP concentrates Mesenchymal stem cells (MSCs).
MSCs are multi-potent stem cells that can differentiate into a variety of cell types during tissue repair processes. Cell types that MSCs have been shown to differentiate into include collagen secreting cells, bone forming osteoblasts and cartilage forming chondrocytes. Together these cells have the potential of rejuvenating tissues damaged by injury, degenerative changes, and osteoarthritis.
What does it do?
The PRP process concentrates fibrin, mesenchymal stem cells, and platelets so that each cubic millimeter of solution contains 1.5 to 2 million platelets, resulting in up to a five-fold increase in platelets and bioactive growth factors. Because it is so concentrated, PRP acts as a potent tissue growth stimulant, amplifying the natural process of tissue repair and healing. Studies show that PRP induces the production of new collagen by the fibroblasts, bone and cartilage cells at the site of the injection, rebuilding the joint cartilage and strengthening injured ligaments and tendons. This new collagen is naturally incorporated directly into your existing cartilage and ligaments, making them thicker, stronger and more elastic.
How Does PRP Regenerative Injection Therapy Compare With Cortisone Shots?
Occasionally a single cortisone shot may give someone significant relief. Usually however, cortisone shots provide temporary relief and stop inflammation, but may not provide long term healing requiring ongoing injections. The problem is that cortisone is catabolic to tissues, meaning that its use will promote degeneration and wasting over time and with continued use.. PRP therapy is healing, regenerative and strengthening these tendons and ligaments and in some cases thickening the tissue up to 40%.
How Does PRP Regenerative Injection Therapy Compare With Hyaluronic Acid Injections?
Hyaluronic Acid injections ( Synvisc™, Hyalgan™, and Orthovisc™ and more) are very effective at increasing comfort and range of motion in injured joints. It does not, however, provide a mechanism of regeneration and it is necessary to continue injections about every 3 months to maintain benefit. PRP is regenerative, which means it stimulates the body to actually grow new ligaments, tendons and joint tissues which will last and function like normal healthy tissues.
How Does PRP Regenerative Injection Therapy compare with regular Dextrose Prolotherapy?
Clinical and anecdotal experience is demonstrating that using PRP as the regenerative injection method creates a much more profound healing effect and results in improved results in less treatments. Prolotherapy is a very effective and useful therapy, but PRP is especially useful when regular prolotherapy has provided positive results, but recovery has not been ideal. In these cases PRP is often the treatment that will resolve these less responsive or more injured areas.
Frequency Of Treatments
While responses to treatment vary, most people will require 2 to 6 sets of injections of PRP. Each set of treatments is spaced 4 to 6 weeks apart. Usually positive development is evident after 2 treatments. Often satisfactory results may occur even sooner, but cannot be predicted with certainty.
The American Journal of Sports Medicine; May 2013
This study gives positive evidence for the use of PRP in sports injuries.
Drs. Luga Podesta and Lew Yocum, demonstrated that 30 of 34 athletes (88%) had returned to the same level of play without any complaints. The average time to return to play was 12 weeks. As well, real physical changes inside the elbow were observed.
The study included 34 patients with a wide range of tendon and soft tissue injuries, from rotator cuff tendinitis to plantar fasciitis, an inflammation on the bottom of the foot....patients received an injection of concentrated platelets from their own blood. The platelets release growth factors into the area to start the healing process. Researchers found maximum benefits tended to occur within four months after the procedure. More than 70 percent of patients had better use of their tendons, and 76 percent reported improvement in pain. In addition, researchers found some indication of tendon healing, which was detected with sophisticated ultrasound imaging.
"I feel 100 percent ,and it's the first time I can say that in a long time," Kinsler said
Tiger Woods discusses PRP Platelet Rich Plasma
Tiger woods held a press conference a the Augusta Masters today to address concerns of his medical treatment among other issues that have been circling in the media. Tiger clarified that he has never used performance enhancing drugs (PED’s). However Tiger did confirm that he received 4 injections of PRP Platelet Rich Plasma to his knee ligament (LCL) following a slow post operative recovery from ACL repair. Woods also received treatment for his Achilles tendon which he tore & adversely affected his driving distance . He claims that the treatments were successful & he feels strong.
While Tiger Woods has been surrounded by disappointments of his family & fans of infidelity, it appears that he has not violated any medical laws or restrictions in sport. PRP has been used to treat many athletes & even more weekend warriors. We are conducting several studies including a 10 multi center clinical trial on tennis elbow as well as a pilot knee arthritis study that was submitted for publication.
So hopefully the bright side of all this media frenzy will be the attention placed on an emerging therapy PRP. In no way is this a panacea but it appears a safe alternative to cortisone. More studies will emerge soon, some pro and some con to best determine which patients and injuries will be proper candidates for PRP.
Efficacy of Dextrose Prolotherapy in Elite Male Kicking-Sport Athletes With Chronic Groin Pain Archives of Physical Medicine and Rehabilitation 2005; 86: 697-702
Conclusions: " marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes."