Platelet rich plasma therapy (PRP therapy) is a type a complementary and alternative (CAM) treatment.
What are Platelet Rich Plasma Injections?
Platelets, which are part of the blood, are important for soft tissue and wound healing. Platelet rich plasma therapy is performed via injections. By using a patient’s own platelet rich plasma, or PRP, a healthcare practitioner aims “to promote healing of injured tendons, ligaments, muscles, and joints” in “various musculoskeletal problems”. The process involved centrifuging the patient’s blood, and then “the activated platelets are injected into the abnormal tissue”, with the idea that “releasing growth factors that recruit and increase the proliferation of reparative cells”. Technicians may opt to use ultrasound imaging to guide the PRP injections. PRP treatment is said to decrease pain and improve functioning for patients with osteoarthritis, and tendinosis of the hip, shoulder, knee, ankle, elbow, and wrist. This type of treatment should have limited side effects since the patient’s own blood is used. Typically, rest is necessary after the procedure, and then strengthening and stretching may be performed.1
It is believed that PRP treatment can improve bone and soft tissue healing, based on animal models and “basic science studies”, where it was found that the PRP therapy increased the tendon strength and number of cells in Achilles tendon injuries. In addition, calf muscle injuries were demonstrated to have “improved muscle regeneration”. In a small osteoarthritis study, platelet rich plasma injections were “shown to be more effective than hyaluronic acid treatment”. Platelet rich plasma therapy has also shown positive results in MCL and rotator cuff tears. In general, the treatment is considered to be low risk, but more studies and research are needed. There are some concerns about PRP treatment. Anti-inflammatory medications should be discontinued during the PRP therapy, since PRP is hoped to optimize the inflammatory healing response. Additionally, since PRP contains “endogenous growth factors”, it could be considered “a performance-enhancing substance”. The US and World Anti-Doping Agencies “forbid the injection of PRP within muscles”; however, there are “no data to suggest that PRP is actually a performance-enhancing substance”.2
Prolotherapy, Cortisone, and PRP
Prolotherapy, also known as regenerative injection therapy or proliferation therapy “uses injection of an irritant solution into ligament or tendon insertion in an effort to relieve pain”. It is used to treat osteoarthritis, low back pain, and tendinitis.3 Hyperosmolar dextrose is the irritant used in prolotherapy. There is also a version called saline prolotherapy. In a 2010 JAMA study comparing saline injection and PRP for Achilles tendinopathy, “there was no statistical difference between the improvement of both groups”, and both therapies could be considered for stimulating “natural healing” and for “connective tissue repair”. For some patients, though, PRP may be more useful because it is believed that “PRP increases the initial healing factors and thereby the rate of healing”. There was also a Netherlands study, in 2010, that compared PRP to cortisone injections. This study was a well-designed “two year randomized controlled blinded trial…of 100 patients”. Researchers believed that the inflammation phase was important in the treatment, since macrophages that migrated to the injury released more growth factors, increasing the synthesis of collagen. The study concluded that “PRP reduces pain and significantly increases function, exceeding the effect of the corticosteroid injection”.4
PRP vs. Stem Cell Therapy
In platelet rich plasma therapy, the practitioner puts the patient’s blood in a centrifuge and concentrates the platelets to “3-5 times their normal concentration”. Platelets are thought to increase the repair response in the body; therefore, PRP is useful for injuries that may heal or on their own or that are “stuck in the healing process and need a little ‘kick’ to get things going”. There is another therapy, stem cell injection therapy, that is said to be “more advanced”. The Mesenchymal stem cells (MSCs) are believed to be able to differentiate into the lost tissue and coordinate a repair response. Thus, MSC therapy may be best for degenerative diseases. Another difference between the two therapies is that PRP is made more simply, by just a centrifuge, but MSC requires “a sophisticated cell culture lab by cell biologists usually over a…two week period”.5 Platelet rich plasma therapy only takes a few hours, which includes the preparation time as well as recovery time. It does not carry the risks of anesthesia, surgery, or prolonged recovery. In general, PRP therapy is given as 3 injections within 6 months. The healing process can be seen via MRI and ultrasound images, and PRP can reduce the need for surgery by treating damaged tissues before the condition and damage progresses.6 There is still a lot unknown about the effectiveness and safety of some stem cell treatments, so before trying stem cells in unproven treatments, patients would need to weigh the health and financial costs of the procedures.7
Learn more about prolotherapy.