The Power of Platelets
Platelet-rich plasma therapy can remedy tough-to-treat injuries
Illustration by Elizabeth Ellis
Golfer Tiger Woods caused a stir when he admitted that he used it for his knee. Football player Hines Ward used it just before helping his team win the Super Bowl. Pro basketball player Kobe Bryant and tennis star Rafael Nadal have also tried it. But platelet-rich plasma therapy isn’t just for elite athletes anymore.
Now, if we’re sidelined by a stubborn orthopaedic injury or condition such as tennis elbow, Achilles tendonitis or a sore heel brought on by plantar fasciitis, even those of us among the masses can turn to platelet-rich plasma therapy (PRP), a controversial treatment that has led to dramatic improvement in some, but not all patients.
Part of PRP’s appeal lies in its low-risk approach. Medical experts have long recognized the value of minimally invasive treatments that work with the body’s natural healing process, and PRP seems to fit the bill by, in effect, using injections of patients’ own blood as medicine. For treatment of an orthopaedic injury, a typical PRP procedure requires about a syringeful of the patient’s blood, which is spun in a centrifuge to separate the platelets from other components of the blood. A doctor then injects the platelet-rich layer of blood directly into the patient’s injured area. Most patients require only a one-time injection session, and because the patient’s own blood is used, risk of adverse side effects is minimal, says Joshua A. Siegel, MD, director of sports medicine and orthopaedics and an orthopaedic surgeon at Access Sports Medicine and Orthopaedics in Exeter and other NH locations.
PRP was first developed in the 1970s, according to the American Academy of Orthopaedic Surgeons, and appears to be gaining acceptance among orthopaedic specialists. Today, it has practically become de rigueur among professional athletes, who “almost routinely” use it, says Siegel. “It’s really everywhere now in professional athletics, in every sport you can think of,” he says. Pitchers turn to it for elbow or shoulder problems, for example, and football players commonly use it for knee injuries. Using traditional methods, such injuries might have been treated with medication, physical therapy or even surgery, followed by a long recovery. PRP, in contrast, can bring faster healing and carries less risk than some conventional treatments.
By delivering a highly concentrated punch of platelets directly to an injury, PRP takes advantage of the body’s own regenerative powers to repair damaged bone and soft tissue. Indeed, exploiting the growth factors that occur naturally in platelets and stimulate the healing process fuels the healing potential of PRP. “The growth factors send signals to the body, [in effect saying,] ‘Hey, come over here,’” and prompting the body to jump-start the healing process, says Siegel.
Studies of PRP offer a mixed bag, however, with some research confirming PRP’s effectiveness while other research shows lackluster PRP results. And because PRP is still considered experimental, it is not usually covered by insurance. Patients footing the bill for PRP can expect to pay anywhere from $300 to $800, depending on the practitioner they choose to see.
But some of the patients who have been willing to take a gamble on PRP have achieved impressive results, says Christopher E. Gentchos, MD, an orthopaedic surgeon specializing in foot and ankle surgery at Concord Orthopaedics in Concord and Derry, and at Concord Hospital.
Gentchos remembers the case of a female patient who suffered from plantar fasciitis for two-plus years. After trying multiple non-surgical measures, the patient had foot surgery with a reputable podiatrist. “This [podiatrist] knew what he was doing. The surgery just didn’t work,” says Gentchos. The only thing the patient hadn’t tried was PRP. “I explained that [PRP is] considered experimental, so there were no guarantees and it would be out of pocket. She did it and I would say achieved close to 90-95 percent resolution of her symptoms.” Such dramatic results do not always occur with PRP, Gentchos cautions. “I’ve known folks who had a lower extremity injury, tried PRP, and ended up having surgery anyway. But for some, with PRP they get significant improvement.”
Because our bodies regularly produce new platelets, PRP is suitable for patients of just about any age. “This is one of the few treatments where age doesn’t seem to be terribly important,” Siegel says. “Platelets [in the body] are continually turning over, so it’s not like a 20-year-old’s platelets are better than a 60-year-old’s platelets,” Siegel says.
And PRP can be used to treat a range of orthopaedic woes, although it tends to work best when applied to conditions that are located in parts of the body that often don’t readily heal. Lingering pain from an injury and sluggish healing are very common in certain areas, such as the shoulder and elbow, Gentchos says.
In addition to the out-of-pocket cost and apparently uneven track record, another downside to PRP is the discomfort that comes with it. The sting at the injection site is like that of getting a tetanus shot, Siegel says. Some doctors numb the area, but others do not, fearing that the numbing medicine might somehow interfere with the platelets’ healing effect. Researchers have yet to determine whether those fears are grounded or not. Regardless, the soreness can last for weeks, and in many instances following PRP treatment, patients are instructed to wear a sling, brace, or walking boot for a few weeks depending on the location of the treatment area, Gentchos says.