You are receiving this information because you are interested in having treatment injection treatment of Platelet Rich Plasma (PRP) for your musculoskeletal problem. Moreover, your condition has been identified as one that may benefit with this form of treatment. Here, we provide some basic information instructions regarding this injection procedure.
Background on platelet rich plasma (PRP) injection treatment
PRP is derived from your own blood by taking a sample of blood, placing it in a special PRP tube and processing blood in a centrifuge for about 10-15 minutes. This separates the blood into important components including red blood cells, platelets and plasma (the non-cellular fluid in the blood). Here, we extract PRP, which contains highly concentrated platelets and some white blood cells, the cells that are responsible for promoting blood clotting and healing. The cells also contain a number of specialised chemicals called great factors. These factors interact with local cells and send signals that initiate a variety of events such as cell division and migration. The basic idea behind PRP injection treatment is to deliver high concentrations of growth factors to a site of injury or damage to promote and stimulating a healing response, at the same to as reducing pain/inflammation in tissue, and to prevent degradation.
PRP has been used for decades to help promote healing dental, orthopaedic, and plastic surgery procedures. Over about the past 10 years, PRP has been recognised for its huge potential in healing and treating both chronic and acute musculoskeletal injuries involving tendons, ligaments and muscles, including cartilage. This procedure is gaining wider media attention as it has been used in professional athletes for speeding up recovery during injury. Furthermore, more and more clinical trials are being published almost daily, reported by safety and great clinical success.
Potential risks and benefits
Today, injection of PRP into damaged or degenerated tissue has been shown to be highly safe and affective in the majority of patients, and clinical research is continually ongoing and amplifying to boost and promote the natural treatment. Most PRP injections are being done in areas of cartilage damage like early onset, osteoarthritis and tendon degeneration or chronic injury which are causing pain for the patient. Examples include the plantar Fasciitis, Achilles tendon, tennis elbow, shoulder tendinitis and many other injuries or complaints of the musculoskeletal system.
Overall, your clinician will be looking at what tissues are potentially damaged and causing you pain, this, along with contributing factors to what is maintaining the problem. From here, condition will determine whether PRP is a good option for your condition, along with other conservative forms of treatment like - physiotherapy, osteopathy and rehabilitation.
Because PRP is derived from your own blood (meaning autologous), there is very minimal risk of allergic reaction. Indeed, in the literature, side-effects or complications of PRP injections are very rare. The main risk of PRP injection treatment may include local infection, however, this is extremely rare. We generally tend to see a little bit of mild post-treatment soreness (85% of cases) which is generally short-lived and well tolerated. Of course this to be expected with any injection procedure and generally settles after a couple of hours to a day or so. In 15% of cases, if you get a small reaction, it can be a little bit stiff and sore for a few days. It is possible, but extremely uncommon that you get a severe reaction. But if so, it can be associated with pain, discomfort and stiffness for a couple of weeks. However, this is seldom seen (less than 5%). Continued post treatment pain can always happen, but is extremely rare. But if this happens, it may warrant further investigation and maybe surgical opinion.
Worst case side-effects are obviously, infection, nerve/vessel damage, tendon damage/rupture, severe reaction. However, very strict protocols are adopted to minimalise this risk with the best sterile care. Fortunately, we can say that in all of our years of practice we have zero reported cases. We expect to see progress of symptoms in a week, but sometimes it can take longer.
It is also important to understand the NICE guidelines around PRP therapy for musculoskeletal conditions. Particularly safety and efficacy. Also, that NICE guidelines are based mainly of all on NHS practice, and private practice use more autonomy with treatment variety and variation based on clinical success and safety.
What to expect during the procedure
You should limit taking any non-steroidal anti-inflammatory medication (Ibuprofen) seven days before the procedure, and should not take these medications again for five days following the procedure. Common examples are inclusive of naproxen and aspirin (unless on strict prescription). Non-steroidal medication to work for blocking the action of some of the growth factors present in PRP, this may, but not in all cases, reduce the effectiveness of the treatment.
Post procedure guidelines
Generally speaking, the majority of people will carry about their normal business, but taking things easy for a couple of days. Mild post-treatment discomfort should be short, lived and well tolerated in 85% of cases. Guidelines post treatment individually based following clinical recommendation. Very uncommon, but if post-treatment soreness does continue or if the condition worsens, then an appointment should be made by the patient with the attempt to settle the discomfort or to plan for further investigations.
Activity level and follow-up
For the day of the procedure and after, limit the activity related to be injection site to activities to daily living. Depending on the injection site and the instructions from your clinician. Return to higher level activities such as running, cycling, golf, weight-bearing, et cetera… will be directed by your procedure clinician and rehabilitation therapist.
Complications and risks of this treatment are very uncommon and rare, but as in any treatment, side-effects are always possible.
If the area is exposed to a lot of scar tissue, then occasionally in less than 10% of cases a slight treatment reaction can occur, whilst the area can be sore and stiff for a couple days, with increased swelling.
Infections: fortunately are extremely rare, but if do happen in any case, need to be dealt with very promptly. Signs of infection are hot, very swollen, very stiff and general feeling of unwell. If this is to be expected, it is advised to head to A&E to get treated immediately with antibiotics.
Contraindications to PRP:
– Acute and chronic infections
– Skin diseases (i.e. SLA, porphyria, allergies)
– Chemotherapy treatments
– Severe metabolic and systemic disorders
– Abnormal platelet function
– Chronic liver pathology
– Anticoagulation treatments
– Underlying sepsis
– Systemic use of corticosteroids within two weeks of the procedure
Results and benefits of PRP treatment
Results are expected to be noticeable following 7 days, but more importantly continue to improve gradually over a period of 2–4 months. It is, however, of fundamental importance that corrective rehabilitation is adopted for maximum effect and for the promotion of long term benefits. Advanced chronic conditions are more difficult to treat, like severe arthritis. Current data shows results may last up to 2 years. Of course all individuals are different so there will be variations from person-to-person.
Please do get in touch to find out further information on PRP process, what conditions it may benefit and anything else. We would be more than happy to advise.
Dynamic Regenerative Medicine