News Letter, Vol. 7 (3)
August, 2016 © Copyright
Jun Xu, M.D. , Peter Zheng, M.D.
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
Tel: (203) 637-7720
Why did Tiger Woods receive PRP treatment for his knee and ankle pain?
A few years ago Tiger Woods was in the center of media, all his wrong doing such as extra-marital affairs, car crashes, voicemails to girlfriends, etc. attracted many eyeballs. He was also accused of using human growth hormone. In an interview, Woods explained that he was actually receiving PRP therapy with excellent result for his knee pain. (http://abcnews.go.com/Health/Technology/tiger-woods-admits-platelet-rich-plasma-therapy/story?id=10303312)
“I had PRP, platelet-rich plasma treatments, and basically, what that is, is they draw blood from your arm, spin it in a centrifuge, and take the plasma out and insert it into the injuries. Well, as you all know, in 2008, I blew out my ACL. And part of my reconstruction of my LCL wasn’t reacting properly. It was a little bit stuck, and so I had the PRP injection into my LCL.
And then, in December, I started to train, started running again, and I tore my Achilles on my right leg. And I then had PRP injections throughout the year…And did everything I possibly could to heal faster so I could get back on the golf course, you know, through the PRP injections.”
Did the PRP help Woods?
So, how did Woods do after the PRP injections in December of 2008? Actually, Year 2009 was one of the best years of his career. In the 17 events he played in, he made the cut in 16 of them. He won six of the events, finished second in three others, and finished in the top 10 in all but three. He earned over $10 million on the tour alone, and was given the following awards that year:
PGA Tour Player of the Year
PGA Tour Leading Money Winner
Byron Nelson Trophy
FedEx Cup Champion
Many famous athletes — including Tiger Woods, tennis star Rafael Nadal, and several others, such as Fred Couples, Alex Rodriguez, Tracy McGrady, Chris Canty, Kobe Bryant, and Cliff Lee, have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, acupuncture, physical therapy, or even surgery. Many athletes have credited PRP with their being able to return more quickly to competition.
The American Journal of Sports Medicine, Jun 6, 2016 , published an article “The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials.” A total of 18 studies (1066 participants) were included. Eight studies were deemed to be at low risk of bias. The most significant outcomes in the PRP groups were seen in those treated with highly cellular leukocyte-rich PRP (LR-PRP) preparations. The authors concluded ”There is good evidence to support the use of the injection of LR-PRP under ultrasound guidance in tendinopathy. Both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance. “ (http://www.ncbi.nlm.nih.gov/pubmed/27268111)
Even though PRP has received extensive public attention, there are still myths about it, such as:
What exactly is platelet-Rich plasma?
How does it work?
What conditions are being treated with PRP?
Is PRP treatment effective?
What Is Platelet-Rich Plasma (PRP)?
As you know, blood contains mainly liquid (plasma) and small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries, such as synthesis of collagen, growth of cartilage, production of tendon and fibers, and induction of blood vessels, etc.
PRP is plasma enriched with high concentration of platelets and growth factors — can be 5 to 10 times greater (or richer) than usual by PRP centrifuge procedure. Then the increased concentration of platelets is injected to the injury sites of human body. The following figures explained how the PRP is made from.
Fig. 2. https://french.alibaba.com/
How Does PRP Work?
Although it is not exactly clear how PRP works, many researches have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
Fig. 3. http://www.nfinders.com/img/product/product_img1_1_1.jpg
To speed healing, PRP is carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, a mixture of PRP and local anesthetic can be injected directly into the heel cord. Afterwards, the pain might be reduced and the injured tissue might quickly heal within one or two months.
What Conditions are treated with PRP? Is It Effective?
Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. Many conditions are treated with PRP, and showed good results. The following figure indicate the areas of PRP treatment
Fig. 4. http://www.absolutehealtheugene.com/files/2014/6808/4960/prp_treatment_of_whole_body.jpg
1. Chronic Tendon Injuries
PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, rotator cuff , bicipital tendonitis, wrist tenosynovitis , and iliopsoas tendonitis. The use of PRP for other chronic tendon injuries — such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper’s knee) showed strong evidence that is clinically very effective.
Fig. 5. http://www.podiatrytoday.com/files/pt1114ortho3.png
Research has being done to evaluate the effectiveness of PRP in the treatment of the arthritis. The preliminary data supports PRP is an excellent option to treat different osteoarthritis, such as knee, shoulder, hip and hand.
Fig. 6. http://ihplus.com/wp-content/uploads/2015/11/knee-injection-1024×570.jpg
3. Acute Ligament and Muscle Injuries
Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. Recently Kobe Bryant went to Germany for PRP treatment. http://grantland.com/features/kobe-bryant-dr-chris-renna-regenokine-knee-treatment/. All the clinical data indicated it might work on the acute sport s injury.
Fig. 7. https://www.3bscientific.com/thumblibrary/VR1188UU/VR1188UU_01_3200_3200_Sports-Injuries-Chart.jpg
More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.
Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be some benefit from using PRP in this instance.
PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.
Treatment with PRP opened a new way to cure your pain. There is much evidence to support this new technology. For all the acute and chronic tendonitis, osteoarthritis, and other pain diseases, we are comfortable to treat with PRP. We have already equipped with state of the art instruments to embrace this new wave. We also received intensive training to perform this new therapy. You are welcome to give us a call to discuss about the benefits and side effects regarding PRP treatment.
Acupuncture and physical therapy are good therapeutic methods before you try PRP treatment. If you tried all the non-invasive treatments, PRP might be your next option.
The risks associated with PRP are minimal: There may be some pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.
By the way, please be advised that few insurance plans provide even partial reimbursement.