Prolotherapy using Platelet Rich Plasma

Prolotherapy, also known as regenerative injection therapy, with growth factors in platelet rich plasma is a new application of an already tested and successful method of achieving tissue healing. Regenerative injection therapy is a technique in which injections are made into weakened ligamentous or tendinous structures in an effort to stimulate the structures to heal back to normal ligaments or tendons with the appropriate tissue length and strength.

What are tendons and ligaments?

Tendons connect the muscle to the bone making it possible for you to do many every day physical activities. Overuse or damage to the tendon over a long period of time causes the collagen fibers in the tendons to form small tears, a condition called tendinosis. Damage to tendons, most often occurs in the knee, ankle, shoulder, wrist, biceps, calf, and Achilles tendons.

Ligaments are composed of collagen fibers that hold one bone to another, stabilizing the joint and controlling the range of motion. When they ligament is damaged, it is no longer able to provide support, weakening the joints.

Tendons and ligaments have poor blood supply. Combined with the stress of day-to-day activities, they do not easily heal from damage. As a result, the tendons and ligaments become insufficient causing chronic pain and weakness. Intervention may be necessary. Prolotherapy is an ideal treatment. The use of PRP, platelet rich plasma is an enhancement to Prolotherapy.

How do tissues heal?

It is well known that the healing cascade in the human body involves the series of events which includes inflammation at an injured area, to clean out the damaged tissue and to bring in the appropriate growth factors to stimulate and enhance the healing of the tissues. We depend upon the body to provide those growth factors and to create the stimulus for healing. Once the initial inflammatory phase of healing is completed, the body lays down new collagen, which eventually forms into new ligament or tendon or bone tissue or whatever tissue collagen is required to form into, and the tissue progresses to its full healing potential.

Under normal circumstances, we would expect the body to provide an adequate amount of these healing growth factors. Sometimes the body doesn't provide the proper quantity or the proper stimulus for a host of reasons, and the results therefore, are weaker ligaments, or tendons, than the body needs to perform its functions without pain.

Prolotherapy provides an opportunity for us to stimulate the body into this healing cascade and awaken a dormant area, forcing it to heal.

We depend upon the body to provide the growth factors to the area.

The plasma of our blood contains these growth factors and it is the plasma portion of the blood that reaches an area of injury that delivers these growth factors to the injured area.

What is platelet rich plasma and how is it obtained?

There is a technique of concentrating the platelets in the serum and vastly increasing the amount of growth factors, and platelets in the area of the damaged tissue. We use the patient's own blood. A given amount of the patient's blood is drawn and centrifuged in a specific type of centrifuge to concentrate and separate the platelets from the rest of the blood. Once we have this highly concentrated amount of platelets in a far reduced amount of plasma, we remix the platelets into the plasma and use this newly collected and concentrated platelet rich plasma for injection into the areas of damaged ligaments or tendons.

The technique has been used in open surgery for a number of years and has proven itself to expedite the healing process, shortening the recovery time, enabled the rebuilding of tissue in badly damaged tissue areas and generally accomplishing results that were not possible without this technique.

The recent application of this technique to Prolotherapy has enabled the prolotherapist to employ this advanced tissue healing technique to further expedite the results of Prolotherapy and probably reduce the number of treatments necessary to achieve the goal of total pain reduction.
What are the benefits of this technique?

How safe it is the use of this technique?

It is the patient's own blood that is being spun down to concentrate the patient's own platelets and growth factors so that the patient's own tissue is reinjected into the patient in the appropriate places to force these tissues to heal.

There is no possibility of transferring disease from one patient to another as this is the patient's own concentrated platelets in the patient's own concentrated plasma.

It is a targeted injection specifically to the ligament areas that are weak or injured, to force those tissues to heal and provide those tissues with the greatest stimulus possible for them to heal in the shortest possible time.

I have heard of cortisone injections; is this the same?

This is not a cortisone injection. It is Prolotherapy done with a different solution, the patient's own platelet rich plasma.

Cortisone shots weaken tissue. Platelet rich plasma PRP forces strengthening of these tissues in some cases, as much as 40% more than normal.

The patient's can see significant improvement in symptoms. This may eliminate the need for more aggressive treatment such as long-term medication or surgery. That may provide a remarkable return of normal function.

PRP can be performed on tendons and ligaments all over the body. Sports injuries, arthritic joints, lower back problems, degenerative disk disease, more specific injuries such as tennis elbow, carpal tunnel syndrome, anterior cruciate ligament tears, shin splints, rotator cuff tears, plantar fasciitis, and any other ligament tissue in the body, can be treated with PRP.

While responses vary, most people require 3 to 6 sets of injections spaced 4 to 6 weeks apart, there is no limit to the number of treatments, and many patients require less than the 3 injections to get results.

Is PRP right for me?

If you have a tendon or ligament injury, and traditional methods have not provided relief, PRP, may be the solution. It is less aggressive and less expensive than surgery. It will heal tissue with minimal to no scarring. It alleviates further degeneration of tissue. An initial evaluation with the physician can tell you whether this is the right treatment for you.

Are there any special instructions?

Patients cannot take any nonsteroidal anti-inflammatories (NSAIDs) one week prior to treatment and throughout the course of treatments.

Initially, the procedure may cause some localized soreness and discomfort. Most patients only require some extra strength Tylenol to help with the pain. Ice and heat may be applied to the area. We prefer heat.

The first week after the procedure patients will typically start a rehab program with physical therapy if needed. Aggressive physical activity is discouraged until healing occurs.

How soon can I get back to regular physical activities?

PRP helps regenerate tendons and ligaments, but it is not a quick fix. This therapy is stimulating the growth and repair of tendons and ligaments requiring time and rehabilitation. Her regular visits your doctor, will determine when you are able to resume a regular physical activities.