POST-PRP TREATMENT REHABILITATION
When it comes to platelet-rich plasma (PRP) injections and other regenerative medicine techniques, it’s still a relatively new and exciting frontier with varied opinions. You can learn more about the details of PRP and see our Q&A with below
PRP is a portion of your own blood plasma that is highly concentrated with platelets using a centrifuge. It is then injected into injured musculoskeletal tissue (tendons, muscles, joints, ligaments) in order to speed healing by kicking the body’s natural processes into overdrive. It is also at this point when we want to optimise on healing and performance.
There are only a few studies exploring the use of PRP in conjunction with corrective rehabilitation.
PRR and Corrective Rehabilitation
2013 case-series concluding PT after PRP injection for patellar tendinopathy is promising and feasible.1
2014 study showing that a single PRP injection combined with a rehab program was more successful than the rehab program alone.2
2015 case study showing PRP injection, manual therapy, and exercise was successful in treating a professional hockey player with inguinal disruption (sports hernia), returning him to action in 3.5 weeks. 4-8 weeks is a more typical return to sport timeline.3
Rehabilitation following on from our PRP injection treatment is extremely important for the full effective recovery following your injury.
Weeks 1: Relative rest of the injured tissue. Minimal overload stress, but active mobility activities should be formed.
Week 2-3: Rehabilitation treatment begins 4 x per week. Starting with light exercise, including light exercises for tendon injuries and stretching. High repetitions and low resistance. It is important to stress the injured tissue in a controlled manner in order to stimulate further healing. Begin cycling (bike, arm cycle, cross-trainer) or other minimal impact cardio exercises.
Weeks 3-6: Progress exercise program gradually in order to avoid re-injuring the tissue. Pain is used as a guide for exercise progression and pushing through pain is not advised. By 5 weeks, the patient will hopefully have attained full strength, no pain with typical activities, full ROM, and appropriate proprioception (balance, control of the limb).
Weeks 6+: Your clinician will monitor your healing and indicate if further injections are needed. Once the tissue is healed, your therapist will help facilitate a program that helps you return to sport or your typical functions. This program will consist of strengthening, sport/job-specific movements, training for neuromuscular control, stability, and addressing any other factors that may be risks for re-injury. Work in multiple planes with increased resistance and repetition. Work toward dynamic neuromuscular control and functional/sport-specific activities. Increase velocity and impact gradually.
PRP Injection Treatment
As rehabilitation therapists, we try our best to rehabilitate our patients by working on our patients’ strength, range of motion and posture. However, there are times when the patients’ tissue damage is extensive that physical therapy and rehabilitation progress can plateau. At this point, we may have to consider surgical reviews. However, it is at best efforts that is this prevented.
If surgery is not deemed an option, or if our patient is very dismissive to the idea surgery, there are still conservative options available to consider.
Platelet-Rich Plasma (PRP) injections are a form of regenerative medicine, the goal is to restore the function of tissues through tissue regeneration and repair. Physicians versed in PRP take the patients’ blood and centrifuge it to separate various blood components. A portion of this centrifuged blood will be rich in platelets, which store a number of growth factors that play a critical role in the tissue healing process. The platelet-rich portion is then injected into the damaged region (be it a tendon, cartilage…).
Over time, PRP has anti-inflammatory effects that can reduce chronic inflammation in a joint. PRP may also stimulate the synovium in a joint to produce more hyaluronic acid, which enhances cartilage cushioning and lubrication.
Recent results are very promising when PRP injections are combined with the correct rehabilitation in helping the patient return back to function, and more recent randomised control trials are showing improved return to sports for patients who have chronic and moderate tissue damage. (see articles below).
Q. When should a patient consider PRP injections for their injury?
A. Platelet-rich plasma (PRP) uses a patient’s own concentrated platelets to augment the healing cascade. A small amount of a patient’s blood is drawn and then spun at high speed. This liquid is then injected around or near the area of injury being treated. The PRP at this stage contains five times the concentration of growth factors compared to normal human blood. These growth factors stimulate healing. The goal is not only to relieve symptoms but to create actual healing. So when a patient has tried conservative therapies, such as rest, stretching or physical therapy, and has made little progress, they might consider PRP injections. In some cases, PRP may reduce the need for medication and/or surgery.
Q. Which areas of the body does PRP therapy work the best on?
A. It is used to treat tendon, ligament, cartilage and bone injuries, as well as arthritis. PRP is used in shoulder injury and tendinitis, degenerative joint disease (arthritis) of the shoulder, knees, hips, tennis elbow, plantar fasciitis, Achilles tendinitis, and ankle ligament injuries. Recent evidence even shows significant success when injected into painful lumbar ligaments and disks (lower back). PRP has been used in sports medicine for over a decade and has a very good safety profile.
Q. Does the patient have to be healthy in order for the therapy to be effective?
A. We want to avoid injecting blood if there is a fever or general signs of infection. We also avoid PRP in patients on blood thinners, certain cancers, and patients who have religious beliefs against using blood products.
Q. Could PRP injections cause any harm to a patient?
A. As PRP is obtained from a patient’s own blood, the risk of reaction is low. As with any injection, there is a small risk of injury to any structures in the area as well as a very small risk of infection.
Q. How many doses would a patient need?
A. I may recommend a single injection or a series of injections based on the injury being treated and a patient’s initial response to the rehabilitation therapy. Typically, patients respond well after two injections. Some patients experience mild pain and irritation of the area for several days following the injection. We ask patients to limit motion or weight-bearing activity immediately following the injection. The use of a brace or boot may be recommended during the early post-injection course. Three to seven days after the injection, patients return to normal physical activities and are encouraged to continue with physical therapy.
Q. What are the costs for PRP therapy and can insurance cover for it?
A. Some major insurance companies do cover your PRP treatment. In certain circumstances, such as Workers Compensation and motor vehicle accidents, PRP may be covered if prior approval is obtained. Generally speaking, the average hospital treatment cost per joint is between £300-500, which includes follow-up and any necessary bracing, however, we will do them out of office at £180.00 Out of pocket costs depend on the size of the joint and how many are being injected, which reflects the amount of blood being processed.
Q. How can a patient reach you and get started with PRP therapy?
A. Dynamic Regenerative Medicine offer PRP injections: Henley In Arden, Solihull & Birmingham
Rossi et al. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2016 Apr 16.
Raeissadat et al. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial).Clin Med Insights Arthritis Musculoskelet Disord. 2015 Jan 7;8:1-8. doi: 10.4137/CMAMD.S17894. eCollection 2015.
Kavadar G et al. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci. 2015 Dec;27(12):3863-7. doi: 10.1589/jpts.27.3863. Epub 2015 Dec 28.
Thompson et al. Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy April 2016, Vol 96, No.4 pp 560-569.
Mayo Clinic Center for Regenerative Medicine:http://mayo.edu/research/centers-programs/center-regenerative-medicine