Dr. Aryn Bartoshyk, ND

PRP

PLATELET RICH PLASMA (PRP)

 
 

WHAT IS PLATELET RICH PLASMA (PRP)?

PRP is derived from whole blood and contains:
1. A small amount of plasma 
2. A high concentration of platelets 
(up to a 8-10 fold increase relative to whole blood)

Whole blood is composed of:
1. 55% plasma
2. 41% red blood cells 
3. 4% white blood cells and platelets

PRP is derived when an individual’s whole blood (25 - 180 mL) is drawn and put into a centrifuge to separate the red blood cells and excess plasma, with an end product of plasma rich in platelets (2 to 5 mL). Once separated, the PRP is injected into the injured area to accelerate tissue repair and regeneration.

HOW DOES PRP ACCELERATE HEALING?

When an injury occurs, the human body naturally recruits platelets and other blood cells to heal the damage. Platelets are a primary cell type present during the acute phase of an injury and act to initiate wound healing. Although platelets are most commonly known for their ability to form a clot and stop bleeding, they are responsible for:

1. Bringing white blood cells to the injured area to help resolve chronic, stagnant swelling.
2. Secreting growth factors that are directly responsible for tissue regeneration and wound healing.
3. Increasing chondrocytes, the cells which grow into cartilage tissue.
4. Signalling and recruiting mesenchymal stem cells and fibroblasts, the cells that produce collagen.

Because PRP is so concentrated, it acts as a potent tissue growth stimulant and amplifies the natural process of tissue repair and regeneration to heal and strengthen the previously damaged area.

THERAPEUTIC HISTORY OF PRP

Doctors began performing PRP injections in the 1970’s to help very ill patients. It wasn’t until the 1990’s when PRP was used for musculoskeletal pain.


FREQUENCY OF TREATMENTS

While responses to treatment vary, most people will require 2 to 6 sets of PRP injections spaced 6 to 12 weeks apart. 

RISKS AND SIDE EFFECTS

PRP therapy is a relatively low-risk procedure. Soreness and/or bruising at the injection site are the most common side effects. More serious side effects are rare but may include:

  • Light-headedness, fainting, myoclonus 

  • Infection

  • Allergic reaction 

  • Muscle or nerve injuries

  • Spinal headache

  • Pneumothorax (collapsed lung) if injections are within proximity of the lungs


WHOE IS NOT A GOOD CANDIDATE FOR PRP THERAPY?

PRP is absolutely not recommended if:

  • Same day airline travel

  • Total replacement of the injured site (e.g., knee replacement as a synthetic joint cannot be regenerated)

PRP may not be recommended if:

  • Surgical hardware (e.g., screws, anchors)

  • Compromised circulation (e.g., in the presence of diabetes, cardiovascular disease)

  • Cancer at or near the site

  • Pregnant

  • Smoker

  • On immune suppressant drugs (e.g., prednisone, Imuran, methotrexate)

  • Hormone deficiencies 


TREATMENT COURSE

  1. Prehab (before treatment): Optimize the overall state of the body via adequate sleep, hydration, nutrition, and exercise prior to your visit. In PRP you’re literally using your own blood as the initial healing agent and the outcome can be influenced by your current health status.

  2. Blood draw: On the day of your appointment, the practitioner will draw 25 to 180 mL of your blood (note that 500 mL is taken in blood bank donations). Ensure you’re hydrated and have eaten beforehand to prevent feeling lightheaded.

  3. Blood processing: Once the blood is drawn, it will be placed into a centrifuge to extract the PRP. This will take 5 to 30 minutes. 

  4. Injection: The PRP will then be injected into the site of injury.

  5. Rehab (after treatment): Proper management and care is essential to promote the best results:

    • Limit or avoid any aggravating factors, if possible, and always remember that “pain is a request for change.”

    • Continue other therapies that are supportive to healing (e.g., acupuncture, physiotherapy).

  6. Repeat: PRP is typically repeated 2 to 6 times about 1.5 to 3 months apart.

Note: Refer to my blog ‘PRE- & POST-INJECTION CARE’ to see how you can optimize your healing response.

How does PRP therapy compare to other treatment options?

WHEN TO CONSIDER PRP AS YOUR BEST OPTION FOR REGENERATIVE INJECTION THERAPY

  • Dextrose prolotherapy has resulted in some benefit with confidence the treatment has been performed properly but the results are not optimal.

  • Severe, advanced, or complex injury.

  • Labral or meniscal tears.

  • Muscular tears.

  • High performance athletes who place increased demand on joints.

  • Persons who wish to maximize their results with a minimum number of injection visits (e.g., live out of town and cannot return frequently, needle phobia with a preference for less visits and fewer injections overall).

PROFESSIONAL SUCCESS STORIES

 

RESEARCH SUMMARIES

PLANTAR FASCITIS

Tiwari, M., & Bhargava, R. (2013). Platelet rich plasma therapy: A comparative effective therapy with promising results in plantar fasciitis. Journal of Clinical Orthopaedics and Trauma, 4(1), 31-35. doi:10.1016/j.jcot.2013.01.008

  • Treatment: Platelet Rich Plasma (5 mL) vs Steroid (40 mg methyl prednisolone acetate)

  • Frequency: Single injection

  • Participants: 60 participants; ages 30-85

This prospective two-arm non-blinded RCT compared platelet rich plasma (PRP) with steroid injection to compare the effects on plantar fasciitis. It was hypothesized that PRP injection would be superior to local steroid injection. Sixty participants, age 30 to 85 years, with medial tubercle calcaneum pain and tenderness upon weight bearing after rest were equally randomized to a single injection of platelet rich plasma or methyl prednisolone acetate. Outcome measurements were assessed the using the Visual Analog Scale (VAS) scale where a score of 0 is no pain and 10 is maximum pain. At one, three, and six months the VAS score was significantly improved in the PRP group, demonstrating superiority with this method in comparison to the steroid group. There were no complications in either group.

 

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