Monthly Feature: March 2009

Blood Therapy

By Abigail Funk

Platelet-rich plasma (PRP) therapy made headlines following the Super Bowl, when it was revealed that Pittsburgh Steelers Hines Ward and Troy Polamalu had undergone PRP injections in the days leading up to the game. But what is PRP therapy? And how could it improve the treatment of chronic injuries like tennis elbow and knee tendonitis?

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PRP therapy begins by placing a couple of tablespoons of a person's blood into a centrifuge, then rotating the blood at high speed until the red blood cells separate from the platelets. The concentration of platelets left—now three to 10 times that in normal blood—contains proteins and other particles that help the body’s self-healing process.

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When this concentrated substance is injected into an injury site, it jumpstarts the body’s ability to grow new soft tissue or bone cells to repair muscle. Platelets are known for causing clotting because of their rough-edged shape (red and white blood cells are circular with smooth edges). But PRP injections are delivered to ligaments and tendons, where blood rarely goes, so there is no danger of clotting.

PRP therapy has been around since the 1970s, but more recently, advancements in technology have made the option available to the public. For professional athletes like Ward and Polamalu, with a Super Bowl on the line, there wasn’t much to lose in giving it a try.

So far, it seems like the pros outweigh the cons. There is very little chance for rejection or a negative allergic reaction because the injected substance is from the patient’s own body.

“It’s a better solution for problems that don’t have a great solution—it’s non-surgical and uses the body’s own cells to help it heal,” Dr. Allan Mishra, Assistant Professor of Orthopedics at Stanford University Medical Center, told The New York Times.

Another major plus is that the procedure is much less expensive than surgery— an injection runs anywhere from $200 to $500, and three to six injections per injury is average. The sessions take about 20 minutes and there is no scarring. The recovery time compared to surgery and subsequent rehabilitation is a lot shorter, too.

On the negative side, there is one major reason for pause: The PRP therapy described above has been ineffective in 20 to 40 percent of cases. And even in cases where it does work, the therapy can be somewhat painful. A tennis pro who underwent PRP therapy for tennis elbow said the first 10 days after an injection are slightly painful and irritating, but after that, no pain was felt, and he had a successful recovery from injury.

Ward, who sprained the medial collateral ligament in his right knee, and Polamalu, who strained his calf, are the most recent high-profile athletes to try PRP therapy, but Major League Soccer and MLB players, at least one college football player, and hundreds of weekend warriors and recreational athletes have also tried it. Edson Buddle, a player for the Los Angeles Galaxy of MLS, tried PRP therapy for an Achilles tendon injury that had been plaguing him for six years, and is now back on the field healthier than ever.

The New York Times spoke to Los Angeles Dodgers’ team physician Neal ElAttrache, MD, who administered PRP therapy to pitcher Takashi Saito’s partially torn ulnar collateral ligament this past season. ElAttrache said that he couldn’t confirm the PRP therapy was the reason for Saito’s recovery since about a quarter of such cases heal without any intervention, but he is encouraged by its possibilities.

“For the last several decades, we’ve been working on the mechanical effects of healing,” he said. “But we’ve never been able to modulate the biology of healing. [PRP therapy] is addressing that issue … The word I would use is ‘promising.’”

While excited about PRP therapy’s success so far, most doctors are adamant that more research and studies are necessary. Mishra has been credited with developing the procedure. In 2006, he published a study in the American Journal of Sports Medicine that showed PRP therapy had a very positive effect on tennis elbow patients.

“I think it’s fair to say that platelet-rich plasma has the potential to revolutionize not just sports medicine but all of orthopedics,” Mishra told The New York Times. “It needs a lot more study, but we are obligated to pursue this.”

Scott Rodeo, MD, the New York Giants’ Team Physician and Professor of Orthopedic Surgery at Cornell University’s Weill Medical College, does have some questions about PRP therapy. “It's appealing biologically," he told ABC News. “[But] we don't know, for instance, 'should we do more than one injection?' We don't know the best timing for an injection—the healing cascades are different between day one, day three and day five.”

Steve Sampson, DO, a Physiatrist and Osteopathic Physician whose approach to injury treatment is non-surgical, started this blog as a forum for those interested in PRP therapy. You can follow the latest news stories and comment on this new treatment here.

The biggest question surrounding PRP therapy is whether it should be classified as blood doping. The United States and World Anti-Doping Agencies currently do not have language specifically addressing PRP therapy in their guidelines. Blood doping in general is illegal in the agencies’ eyes, but because the PRP substance is not injected into one’s bloodstream, PRP therapy doesn’t technically constitute blood doping.

The New York Times reported that both anti-doping units allow exemptions for athletes with legitimate medical needs, and a torn ligament or muscle strain requiring PRP therapy would fall under that category. So even if the agencies change the language of their guidelines to include PRP injections, athletes who undergo the procedure for medical purposes will be in the clear.

This columnist, however, says that PRP therapy speeding up recovery time is similar to human growth hormone (HGH) in its healing ability. So if HGH is on MLB’s list of banned substances, PRP therapy should be, too. She warns that if the governing anti-doping agencies don’t put rules in place now, athletes will find a way to abuse this new practice.

Medical experts who have spoken out about PRP therapy say it could help immensely with the nagging pains associated with conditions like tendonitis, arthritis, and tennis elbow that are not serious enough to warrant surgery. Researchers are trying out PRP therapy for tennis elbow, Achilles tendon injuries, rotator cuff tears, partial knee ligament tears, and broken bones. Because the PRP therapy is so much cheaper than surgery, some doctors have gone so far to say that insurance companies may begin recommending or even requiring subscribers try the therapy as an option before choosing surgery.


Abigail Funk is an Assistant Editor at Training & Conditioning.

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