What are the alternative therapies?
Rest, modification of activity and then ultimately some type of rehabilitation program with stretching and strengthening.
How long would patients have to try these other things before you think PRP therapy is a good option?
A good general rule would probably be at least two to three months of failing other therapies. And many people that we use PRP for, it's longer than that. It is a big out-of-pocket expense for patients. Insurance doesn't cover it. The price ranges anywhere from $500 to $2,000. I don't think it's in the patients' best interest to do it early on.
I've seen reports of people saying that it started to hurt at the site of injection. Have you had any patients telling you about pain following the treatment?
Definitely. A good example would be that gentleman I was talking to you about with the Achilles problem. After his first injection he was calling me almost daily saying that it was much worse than it was before the injection. So there's no doubt that they can be very sore for upwards of even a couple of weeks. It's already a very sensitive tendon and now all of sudden you're taking a needle and you're sticking it into that tendon and pushing this extra fluid in there. You're increasing pressure and irritating the tissue which can lead to worsening pain early on. But the pain goes away after a couple of weeks.
Tiger Woods had several injections for his patella tendon. Can one injection have a healing effect or are multiple injections usually needed?
There is a study out there where, for patellar tendonitis, they've done one injection a week for three weeks. And the study says that they had good response but we don't even know how that compares to just one injection. Theoretically, if I'm truly enhancing the body's healing response, if I do the injection once and I give the body four to 12 weeks, then maybe it could heal with just the one injection. We know that [the condition] is chronic, it's degenerative. The body certainly can't heal such a condition in one week.
Have you done multiple injections for your patients?
I have [for] a few patients with Achilles tendon and patella tendon problems. I've never done more than two injections. The second injections have helped. Anyone that I've done a second injection for, it's been at least two to three months [after the first injection].
Are you involved in any of the clinical studies going on now?
We are. At the N.Y.U. Hospital for Joint Diseases orthopedic department we are in the middle of some studies, especially on the rotator cuff. For the rotator cuff we're comparing placebo, corticosteroid [anti-inflammatory] and platelet-rich plasma. We're probably at least one year away from having results.
Why is PRP not restricted for athletes in a way that human growth hormone (HGH) is?
Athletes use HGH as a performance enhancer even though there's no good evidence that it does anything to enhance performance or improve strength or endurance, etcetera. And there's nothing that says that HGH enhances healing. Now PRP is certainly not in any way a performance enhancer. It's more about enhancing the body's own healing response. Soneone who's had PRP therapy is not at some kind of competitive advantage over someone who hasn't had it. The platelets secrete completely different growth factors than HGH.
Do you think the results of the clinical trials that are coming out over the next year could change how PRP is used or how much it is used?
One way or the other, I think over the next six to 12 months it'll significantly change the way we use PRP. That could be either in a positive way or in a negative way. Maybe that study is going to come out that says, yes, you do need a second injection or a third injection. Right now it's very subjective how we all use it. Ongoing studies will determine proper usage, including timing and dosage.
The bottom line is that we don't know enough about PRP therapy. It is safe. We're using it. Anecdotally it certainly seems to have some positive effects. How much we'll be using it in the future or what we'll be using it for, those are all questions that really remain to be answered.
Subscription Center
See what we're tweeting about
36 Comments
Add CommentI have accute arthrytis of the knees and I am currently reading about the geneeral plasmic nature of our Universe. My doctorsw haven't helped me and I'm generally in pain especially when I stand. . This plasmic healing could help me and I'd like to know more. In what issue was therer an article on it? Could I buy a copy of the article?
Reply | Report Abuse | Link to thisI had a PRP injection done several months ago on one elbow where I was suffering chronic tendonosis (tennis elbow). I'd had multiple cortisone shots and physical therapy over the course of a year but hadn't gotten relief. The PRP injection itself was so painful that I almost passed out. Three months after the injection, I've definitely noticed an improvement, but my M.D. has recommended another shot in the hope that I can get complete healing (I'll be taking a pain killer beforehand this time around) as the only other alternative at this point is surgery. All in all, I would recommend PRP as a treatment as I'm definitely better off than I was before I got the PRP injection.
Reply | Report Abuse | Link to thisI wonder if this would help with many other kinds of incidents such as whiplash (occurs in most car accidents ).
Reply | Report Abuse | Link to thisI bet the time from injury to application has a major impact on response...
forgot to click email...please ignore this...
Reply | Report Abuse | Link to thisIs it the same as Autologous injections?
Reply | Report Abuse | Link to thisIS THE PRP THE SAME AS AN AUTOLOGOUS INJECTION?
Reply | Report Abuse | Link to thisPrp is similar to autologous injection, but I think the difference is with prp the blood is spun in centrifuge so that the most healing parts, mainly the platelets I think, are concentrated and then only this concentrated part of the blood, super blood basically, is injected back in. This way it is purported to be more potent than just taking blood out of your arm and injecting it as is into your hamstring tendon. Because the prp requires this centrifuge kit, it requires more blood to be drawn and more money to do it to pay for the kit and extra labor. But now at least some doctors are starting to combine it with other things to make it even more potent, like HGH and stem cells. It is basically my last hope of being able to live my life. I have multiple chronically damaged tendons to the point where I really can't manage to stand and walk around any more because of pain. I can physically stand and walk around, just it has become too painful to bear it so I avoid it, in other words, no social life. Is hard to go shopping so is hard to buy stuff I need like new clothes, shoes, end up doing a lot of online shopping, which becomes a pain with shipping boxes back for whatever didn't work out. I think it would work better with more research, but I don't have time to wait for that to happen. I have to try the prp with stem cells now. I just also hate that they can only do one area at a time, I'm not sure yet how many tendons will be hit in one visit, but I hope will be enough to make me feel like I can begin to make some progress.
Reply | Report Abuse | Link to thisI agree with the author's comment that there need to be controlled, randomized, prospective human clinical stiudies but much of the medical community makes important decisions based simply on animal data. Take the bone grafting market, for example. There are over 200 bone grafts on the market that are FDA approved and claim safety and efficacy based on an animal study. There are only a few bone grafts (<5) that have peer-reviewed, published data in humans. If it were my children, my mother, or my wife, I would certainly want the doctor to know that the product being used in surgery had been tested and reviewed by a panel of peers to work in humans, not merely our four legged friends!! Very good point by the auther and one for us to keep in mind when decisions are being made for us.
Reply | Report Abuse | Link to thisI am a college student at the U of M Duluth. I have researched Autologous Platelet Concentrate (AKA:Platelet Rich Plasma), and platelet gel thoroughly. In my sophomore year I conducted research on Platelet Gel and found it to be effective in eleven out of twelve mice in healing wounds made to the neck of each mouse.
Reply | Report Abuse | Link to thisI myself went to St. Louis to a private clinic to have Platelet Concentrate Treatment used in conjunction with a GE Logiq e ultrasound to treat a partially torn UCL ligament and nerve. The treatment worked and my once half torn UCL is now 100 percent. Prior to tearing my UCL i threw 86 MPH as a junior. After tearing the UCL my velocity dropped to mid 70's at best, after the APC injection I am now throwing 90 MPH.
The APC machine used to treat my arm and for my undergrad research was manufactured by Harvest Tech. Medtronic's platelet concentrate system is also suppose to be very effective. In order for APC injections to be effective for subcutaneous injuries Ultrasound Guided Injection is necessary. Something I also learned while dealing with the UCL injury is the Ultrasound imaging picked up my UCL tear where as the MRI had not. The difference between the MRI and the Ultrasound was the Ultrasound cost $150 the MRI cost $2,200. The cost of one set of three PRP injections $450, the cost of and avoiding Tommy John surgery in my opinion priceless, but monetarily in the thousands.
The main lesson I have learned from all of this is MEDICINE and MONEY are prioritized equally. Platelet injection therapies should have been made common place years ago. I hope the AMA and Drug Company owners rot in hell, this treatment could be helping save people from needing surgery, and also help aid healing from life threatening conditions.
My husband just had PRP injections in both of his feet for plantarfaciaitis and tarsal tunnel syndrome (they think) about 4 days ago. He is still in a lot of pain and can't walk very well. We are hoping this cures his pain. He has had this "injury" for 2 years now and he has undergone every kind of treatment there is except cortizone injections (he will not get that done) and doctors say it wouldn't help anyway. If anyone has had the PRP done for plantarfacitis, could you let me know how you are doing or if it helped. We are crossing our fingers this works, because his life for the last 2 years has basically been a nightmare. :( Thanks!
Reply | Report Abuse | Link to thisI'm looking at PRP for a shoulder injury but responding to you about the plantarfaciaitis you're husband is experiencing. I empathize with him and had the same situation about 5 years ago. If PRP doesn't work for him pursue a procedure which is ultrasound to the affected area via a specialized machine where he will need to be knocked out for the procedure. My podiatrist had administered cortizone injections for a period of 6 months before we got to this step ; the shots to the affected area were temporary only. The specialized machine is circulated to, generally, a handful of states as shared as I understand the machine runs about $1M. It actually travels with a trained technician and my doc was actually present during the procedure in an out patient clinic. I'll see if I have the name of that device in any paperwork and I'll try to get that back to you asap. However, your doc should know of this machine. Do note that I had to go thru the cortizone treatments (or so I was informed) before the insurance company with cover this which they did -I only had to pay for a small portion which was related to the out patient facility but not the treatment itself. I only needed to have this treatment done once but realize some patients do need a second treatment. I hope this information helps.
Reply | Report Abuse | Link to thiszoibear...please keep us posted as to how this turns out for your husband - I have had every treatment possible for this diagnosis and my doctor has "given up" (not for lack of trying) and referred me to someone who does the PRP. I too have been dealing with this for almost 2 years. I plan to schedule a consult with that office today...I am soooo hopeful!
Reply | Report Abuse | Link to thisI have suffered with the coccyx for many years The last year has been unbearable , not being able to sleep or sit. My pain became constant. If I finally fell asleep on my side, I would be awakened with such pain that I had to stand or pace for hours for some relief. What a blessing when I got Dr Magaziner's name. I have had 5 sets of shots so far and its made such a difference in my life. I can actually sleep on my back, do not have pain so I am not crying or complaining. I have also started PRP for my shoulder for a rotocup tear. With only one set of shots to date I can only hope for the same fabulous results. I highly recommend PRP. Carole Naso
Reply | Report Abuse | Link to thisi had good results with my treatments cerole in n.j.
Reply | Report Abuse | Link to thisPhil, Pincourt. I had tendonitis on my right shoulder that restricted my full range of motion because of the pain. It has been 3 weeks since my injection (one entry with several injections to the tendon). The pain was an 11 out of 10, that lasted a week (with codein). Now the pain is less, but still hurts when I raise my arm higher than my shoulder, also after a busy day it hurts at night (mild). I`m wondering when I will notice positive results.
Reply | Report Abuse | Link to thisI am a 76 year-old man whose left hip was fused in 1943, resulting in a 4" leg difference, a profound limp, and an almost completely inflexible left knee. Now I have I have a calcified right achilles tendon. Surgery on it would require a long period of having to walk on crutches with my left leg bearing the brunt of the burden, not a pleasant prospect. Is prp my only alternative?
Reply | Report Abuse | Link to thisI am a 52 year old male and have had prp done to my right elbow 5 weeks ago for tendinits from which i was suffering for 4 months before i had the treatment. The prp put me back to day one of the injury, but now i am slowly making progress. Has anyone out there used herbal supplements to speed up the healing process. If so, which ones? I've avoided NSAIDS and steroids per my doctors instructions and will do so for 3 more weeks. He's not at all familiar with homeopathic remedies, as most doctors are not. I'm not sure if anti-oxidants and anti-inflamatory herbs obstuct the healing process as do NSAIDS and steroids. Please help me with this, doctors responses most welcomed also.
Reply | Report Abuse | Link to thisIhave had mild golfers elbow (medial epycondilitis)for about 6 weeks and went to an Orhtopedic specialist to see if there was any therapy available to aid in the healing process. He sugeested PRP and that my insurance would cover it. So I went ahead with it. Fisrt let me tell you the pain was EXCRUCIATING!!! Although the pain was only at 10 on the 10 scale for about 10-15 minutes it was so bad I was moaing loudly throughout the procedure. Was the pain worth it? I don't know yet. It was done yesterday but the pain is pretty much gone after 10-15 minutes or so and remains mildly sore the next morning...Stay tuned
Reply | Report Abuse | Link to thisI have an chronic case of plantar fasciitis. It started two years ago, received a cortisone injection and orthotics and I was fine. Then this past Nov. my foot started hurting again, between now and then I am on my 4th foot doctor. I have received 4 cortisone injections, been on anti-inflammatory meds since Dec, been to physical therapy rest, twice, wearing excellent supportive shoes, heel cups, night splints, stretching exercises, orthotics...after my 4th cortisone shot, I was in excruciating pain so I went to a different doctor to find that I had a heel bone stress fracture. So, on top of all the treatments that haven't worked, I'm now in a soft cast, boot and crutches. Foot is still in pain and can't walk "normal" 4th foot doctor wants to do PRP-Platelet Rich Plasma to heal my damaged fascia at the bottom of my foot. I truly don't know what to do...I'm hoping and praying that someone who has experienced PRP for plantar fasciitis will respond as the doctor thinks I should do it--but of course he does! It's not his foot and the procedure is expensive bringing $ into his pocket---
Reply | Report Abuse | Link to thisWould a person that has to have knee replacement surgery be a candidate for PRP Therapy?
Reply | Report Abuse | Link to thisI too had PRP therapy for arthritis in both thumbs. Had done
Reply | Report Abuse | Link to this4 cortisone injections and was ready for surgery and my
MD referred me to his partner doing this PRP. I did one in
June 2009 then another in Aug 2009 my pain level has been
way down and activities up. The injection was painless,
afterwards had to use meds for several days with ice. It
was all worth it. I would say YES try it to stay out of surgery -
I can now do push ups again. With assistance the body can heal itself.
My doctor had me try NaturaCell, higher Fish Oil supplements,
Reply | Report Abuse | Link to this99% dark chocolate (1 pc per day) for high antioxidants. I eat
healthy and continue to work out - I'm 1 year post PRP and doing 95% to excellent.
two years ago I injured my neck tearing ligaments and tendons and pinching a nerve. i thought i was going to die and at times i really wanted to. for two years the doctors said there was nothing they could do but give me drugs and physical therapy. nothing helped. one day a friend told me to talk with a naturopathic doctor and I did. the doctor said the my tendons were very weak and said a procedure called prolotherapy would help. this is similar to prp but instead of blood a dextrose solution is used. i had the procedure two months ago and i feel 90% better now! the doctor said he wants me to now try prp injections in the hope that i will be 100% better. I just want everyone who is suffering to know there is help. you can be healed, but you must find a doctor who believes in prolotherapy and prp. before i had this procedure i was seriously contemplating suicide. thank god for my naturopathic doctor, he saved my life!
Reply | Report Abuse | Link to thisdavid,
salem, or
Hi! I too had procedure done...five days ago. It was, like for you, one of the most painful things I've ever had done! When does this pain( from injection ) go away?
Reply | Report Abuse | Link to thisI saw your comments relating to PCP therapy for UCL injury. My high school age son is going through a similar situation (MRI shows UCL tear) and we would very much like to learn more details on your experience with PRP therapy as we consider all the options. He also is a baseball player. Please let us know how to connect with you.
Reply | Report Abuse | Link to thisI would like to ask you a few questions about your experience with prp bc i have the same problem with my ucl email me at metsfan157@yahoo.com or text at 516-945-4715
Reply | Report Abuse | Link to thisI had it done twice for plantarfacitis in the same foot. Not much relief it's been six weeks on the second procedure. How did he make out my pain is still horrible. Any suggestions or any ideas My life is falling apart.
Reply | Report Abuse | Link to thisI use to make PRP in the OR. I was a perfusionist from open heart where PRP was initially used. Autologous simply means your own blood. PRP means Platelet rich plasma, but it is not plasma. It lies between the plasma and the red blood cells. PRP is extracted from the blood by spinning blood in a centrafuge, like a blender, at a high speed. plasma rises to the top because it is a light weight and you let it spill over and collect it.....and then when you slow the speed of the centrafuge down a little you can milk off the buffy coat which lies between the plasma and the red blood cells. The blood cells stay at the bottom of the centrafuge because they are heavy weights. This buffy coat is where the PRP resides ...so you extract it and then give the patient back their own Red blood cells and the plasma...no waste.....No use injecting blood when you only need the PRP and you can concentrate it to make it more potent and put it directly on the area you need it on....It works but you have to find someone who really knows how to make the good stuff. It fizzled out because too many clowns didn't know how to make it properly and started making little portable centrafuges that they claimed made lots of PRP from a small amount of blood....there's only so much PRP you can make from a unit of blood, you can't make more appear, it just isn't there unless you dip into the plasma and claim that is PRP also. Remember Autologous PRP means it is made from your own blood which means it is absorbed back into your own body with no chance of catching anything that someone else might have in their blood.The name PRP is misleading because it isn't plasma, they should have called it "Rich Platelets" Hope I explained it simply enough for you to understand. I used it in Cosmetic surgery, Orthopedics and dental implants. I saw it produce bone growth on dental implant exrays which was incredible and I used it on myself for a surgery I had. It works.... but you need the right centrafuge and because it is not covered by insurance it is not promoted....It just fizzled out after 911 when times got tough and patients didn't want to pay cash for it and then the recession hit us and noone could pay for it. It was a shame because it had great potential in different areas of surgical procedures. Hope this helps.
Reply | Report Abuse | Link to thisHi Phil, can you please share what was the results at the end? Was the pain gone? was there an improvement in your original state?
Reply | Report Abuse | Link to thisI am considering both a surgery or PRP injections to repair my shoulder.
Thanks in advance!
My main tendon in my shoulder is badly torn to the point that there are literally only 3-4 fibers left intact. My doctor mentioned that PRP might help and I am wondering if it will...i have been going for physical therapy for 3-4 yrs now with no relief...pls let me know if this therapy will help even if the tendon is almost completely torn...
Reply | Report Abuse | Link to thisHow much is PRP effective in regrowing hair ?
Reply | Report Abuse | Link to thisI'm a 23 yera-old girl who suffers from a minor hormon abnormality.Doctors say that my male hormones are slightly more than the usual amount and it's 8 years that my hair has been falling .I've lost most of my hair I've tried sevelar treatments including taking Ciprotrone compound but none worked.could this treatment help the regrowing of my hair?
Hello Zoibear. Since its been over two years since you posted I dont know if you will receive this but I caught your comments thru a google search. I'm so sorry to hear about your husband. I too suffer from tarsal tunnel syndrome and was curious if the PRP treatments ever proved to be successful on any level. Thanks for your help.
Reply | Report Abuse | Link to this-Ron
I read about PRP and Antonette Carter treatment by platelet rich plasma here. I would like to share it was interesting
Reply | Report Abuse | Link to thishttp://drbillreleford.com/prp-treat-achilles-tendonitis-olympic-hopeful-antonette-carter/
I was recommended for a partial knee replacement in 2001. I had no health insurance so I started doing research on alternatives. In 2007 I found an in-flight article by a doctor in Florida doing PRP treatments. I then found 6 other doctors through out the country doing the same. The least expensive was a doctor in Santa Fe New Mexico. I flew from Sacramento CA three times for treatment. After 1 year the pain in my knee was down from an 8 to a 3, after 2 years it was down to a 1 or 2, after 3 years I have no pain! I became a Fire Chief in Northern Nevada, work out, run, do everything I did at 30, I am now 58. It has been the best $6,000 I ever spent! I am totally pain free! BJ Foster, Fire Chief Walker Lake Nevada.
Reply | Report Abuse | Link to this