Platelet-Rich Plasma Rehabilitation Guidelines (PRP)
PRP is the newest and hottest non-surgical treatment in the sports world for muscle, tendon, and joint pain and injuries. PRP is the concentration of platelets derived from the plasma portion of one’s own blood (3) . While platelets are widely known to play a large role in clotting processes, their use in treatment of tendon disease is due to their abundance of enzymes and growth factors related to the healing process (4,5). Tendons have a poor blood supply, meaning it is difficult for these tissues to receive the nutrients needed to stimulate repair (1,4,6). An injection of PRP to the injured site provides the tendon tissue with healing growth factors that are otherwise difficult for the body to deliver because of the poor blood supply. Similar mechanisms have been theorized for treatment of ligament injuries such as medial collateral ligament sprains of the knee or cartilage deterioration, such as osteoarthritis of the knee (7). The injection can also restart a healing inflammatory process, which is why patients are often given initial activity restrictions. Subsequent referrals to physical therapy are often made so that patients may be taught to load the tissue in an appropriate fashion to rebuild strength and flexibility.
What is Tendinopathy?
Tendons are strong bands of connective tissue comprised primarily of a substance called collagen. Mechanically, tendons connect muscle to bone and transmit the force to generate movement. Muscle and tendon injuries account for a significant percentage of the over 100 million physician visits in the U.S. per year and this number will continue to raise as our population ages and remains active. Tendonitis is an inflammatory process although the recent research shows that rarely are any inflammatory cells present in tendinitis. The actual problem seems to be a breakdown of of the structural properties of the collagen and thus the correct terminology is tendinopathy. Tendinopathy results from over-stressing the muscle and tendon, more often due to repetitive injuries.
What is Platelet Rich Plasma (PRP)?
Dr. Adam Weglein, DO (http://www.houstonsportsdoctor.com/) explains PRP as follows:
PRP is the injection of the patients own platelets, in high concentration into an injured tendon, ligament or muscle tear. The Platelets contain growth factors which help stimulate natural healing.
When we injure ourselves, one of the first repair cells that travels to the injury are platelets. Platelets are rich in many different growth factors. These growth factors help attract other repair cells, (neurtophils, monocytes, fibroblasts) these “worker” cells then allow normal healing to take place.
Unfortunately, our tendons and ligaments have a very poor blood supply, which leads to an incomplete or much delayed healing response. With PRP we are helping to bring these natural healing cells to an area that has been deficient, thereby allowing the body to repair the tissue faster.
This leads to much quicker reduction in pain and faster return to sports and daily living activities
Physical therapy after PRP injection is paramount to returning to competitive sports or the rigorous daily activity without re-injury.
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