PRP Therapy: An Approach to Healing Pain and Injuries

Platelets are mainly known for their coagulation properties. For example, if you ever have a small cut and you start to bleed and within seconds, you stop and see a scab forming, platelets are hard at work to stop the blood from flowing freely down your arm. They coagulate the blood. Obviously, in regards to bigger lacerations/cuts, you may need a band-aid, gauze, compression, and up-to-stitches or other medical interventions. Originally, platelets were well-researched for this coagulation effect, or, hemostatic activity.

It’s now also been found that platelets contain a vast amount of growth factors and cytokines and can positively impact inflammation, angiogenesis (formation of new blood vessels), cell proliferation, and stem cell migration.

The platelets in PRP are vital and PRP itself serves as a natural source to signal molecules once the platelets in PRP is activated. The key to remember is that PRP contains platelet levels that are above the baseline of platelets contained in peripheral blood of the human body (before they are placed in a centrifuge).

Another key to PRP is that once the blood drawn is placed into a centrifuge, the blood will separate into its parts based on their densities (as in the image below).

My Injury and Experience with PRP Therapy

A little more about my story:  I had developed tendonosis in my left shoulder and inflammation around the soft tissue in my rotator cuff from playing competitive sports throughout my life. It’s been a persistent issue for over 20 years.

I wish I knew then what I know now, but am amazed that treatments such as these exist. In addition to the recommended approaches like RICE and eventually PT, I had tried other forms of therapy such as:

• prolotherapy
• acupuncture
• cupping
• gua sha
• dry needling
• electric stim
• reiki
• KT Taping
• kinesiology guidance

While all were giving me some relief, none were lasting. I was interested in trying PRP after learning more about it and how it is touted for cell regeneration.

Before the injections were administered, my medical team performed an ultrasound exam so they could determine exactly the best areas in the joint to inject. This is an example of what can take place with a shoulder issue; obviously, PRP can be used for other joints and connective tissue. The shoulder cavity is larger than joints such as the wrist or ankle, so the imaging helped locate the most effective injection sites.

Here’s a video showing the ultrasound exam that was done. Once the ultrasound was done, it was also explained to me where the injections were to be made and why:

I went through three rounds of injections, the first in January 2019. Each subsequent round of injections was done two weeks following the last one, respectively. Research indicates that PRP tends to be more effective over a period of time,

 

 

Due to the large region of the shoulder and its three degrees of freedom, my outcome was unfortunately not very favorable. The doctors who performed the procedure informed me that the shoulder is a challenging joint for PRP because the injected treatment (my own platelets) didn’t have a chance to stay within the joint long enough to “work their magic”. Despite resting afterward and limiting movement, the qualities of the shoulder joint make success difficult.

While I don’t feel worse, I don’t feel better either. I don’t fault the doctors since this was a trial and we adhered to current research stating the benefits of PRP therapy.

While PRP is not a new treatment, the use of it in this capacity is relatively new. There is some supporting research that PRP treatment can be beneficial to augment rotator cuff treatment but its use as a stand-alone treatment in rotator cuff tears is inconclusive.

There is very little research on its use in the glenohumeral joint and my specific condition and we must also take into consideration that my injury was long-standing. There is research done on a case study of using PRP to successfully treat tendinitis in a patient, yet the case study used didn’t have the history with her injury that I did.

Despite the lackluster results of the PRP treatment in my shoulder, it was beneficial to try it. The procedure was minimally invasive and the research does support its safety when using it in the adult human population. There is also research supporting PRP’s results in terms of improving pain, disability, and shoulder range of movement in patients with adhesive capsulitis of the shoulder.

An Unexpected Outcome

While I only highlighted my PRP therapy done on my shoulder, I also had an ankle injury that was treated with PRP before I ventured to have the series done on my shoulder. Having suffered a grade 1 inversion ankle sprain of my left lateral collateral ligament complex in 2017 that was successfully treated with physical therapy, corrective exercise, and PRP injections.

I used the same docs for my ankle injury as I did for the shoulder treatment. I talked to them about why the treatment went well for the ankle. They said chiefly that the ankle is a smaller, less mobile joint, so the medication (my PRP) could sit in the joint and do its work longer than in a larger joint such as the shoulder.

Also, the ankle joint (or talocrural joint) is a synovial joint formed by the bones of the leg (fibula and tibula) and the foot (talus). It’s classified as a hinge joint (allowing for dorsiflexion and plantarflexion), thus has fewer degrees of freedom than the shoulder (the ankle joint has two degrees of freedom). Since it has less movement and is a smaller/tighter area, the PRP was able to saturate it more.

The doctors additionally discussed the probability that since the injury was more recent and not a chronic, recurring injury, it may have had better results. Research supports these statements; PRP is an effective treatment for the treatment of acute lateral ankle sprains.

PRP Takeaway

The purpose of this article wasn’t to put PRP on the ‘chopping block’ or put the onus onto my docs or even the therapy for the failed shoulder outcome. The fact is, the PRP worked beautifully on my ankle. Since it had worked so well on the ankle, we tried it on the shoulder, and with fingers crossed, given available research.

Overall, I felt it was worth the investment in money and time despite no improvement in my shoulder. Given my experiences, both noteworthy and disappointing, any fit pro would benefit from being informed on the topic. There are some amazing treatment modalities out there and our clients look to us, inquiring about the latest and greatest all the time.

We can’t draw general conclusions based on my experience alone and make a blanket statement that PRP is not effective in larger regions of the body or ball and socket joints. Obviously, we didn’t try it on my hip joint!

Other factors to consider:

• My ankle injury had been acute and fairly recent, whereas I had struggled with the shoulder injury for years.
• We have discussed doing more injections in the shoulder region or even the stem cell procedure. For now, though, I have yet to make that decision. Perhaps additional treatments will be more effective?
• I’m continuing to do corrective exercise techniques for my shoulder and making sure it stays in optimal positioning during my training so as not to make it worse.

PRP is not for everyone. Sometimes surgery or other treatments are needed. This is a conversation to have with your medical provider and loved ones. I sometimes have clients who are either currently getting PRP treatments or asking me about it. I have personal experience with it that’s been positive and I’m always looking to educate my clients and colleagues using solid sources about what’s available in the industry.

There’s much more to be said about PRP treatment such as its history, current research on the treatment, its long-term effects, and my own experience with the treatment.  While the use of PRP for soft-tissue injuries is relatively new, the concept is not.  Because of this, much of the presenting research includes case studies and larger clinical trials are pending.

There’s plenty of reading and approaches to take for shoulder issues such as assessing and preparing the shoulder for pull-ups and strengthening it. Don’t forget proper warm-up techniques for the shoulder before starting a training session is the best way to improve mobility and prevent injury.

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References

www.leeds.ac.uk/chb/lectures/anatomy4.html

Seijas, R.,  Ares, O., Alvarez, P.,  Cusco, X.,  Garcia-Balletbo, M. & Cugat, R. (2012). Platelet-rich plasma for calcific tendinitis of the shoulder: A case report.  Journal of Orthopaedic Surgery, 20(1), 126-30.