Platelet Rich Plasma (PRP) FAQ
What is Platelet Rich Plasma (PRP)?
PRP is a regenerative injection therapy that is used to stimulate the repair of injured and damaged tissues ultimately resulting in reduced pain and inflammation, and improved function. Although, PRP is similar to prolotherapy regarding mechanism of action and medical application for pain management and tissue repair, it is a more advanced and effective technique. PRP involves removing a volume of blood from a patient in order to collect and concentrate platelets. This high concentration of platelets contains a number of growth factors crucial to reduce inflammation and stimulate tissue repair. PRP has gained popularity in the media through its use by famous athletes including Kobe Bryant, Rafael Nadal and many others. Furthermore, numerous clinical trials have demonstrated the safety and efficacy of PRP in orthopedic medicine.
What is Regenerative Injection Therapy?
Regenerative injection therapies such as Prolotherapy, Prolozone Therapy, Platelet Rich Plasma and others are a safe, cost effective injection technique used for treating musculoskeletal injuries and chronic pain in various parts of the body. It is noninvasive, has limited side effects and does not require sedation. Regenerative injection therapy is a treatment that provides a long term solution and in many cases should be considered before prolonged narcotic therapy or surgery.
Unlike steroid injections which act to reduce inflammation, regenerative injection therapy stimulates the growth of cells and therefore repairs and strengthens tendons, ligaments, articular cartilage and joints. Since chronic pain is often caused by injury and/or weakness of these structures, regenerative injection therapy can significantly alleviate and often times cure chronic pain by addressing the root cause.
Is there research on PRP?
Yes. Numerous clinical trials have demonstrated the safety and efficacy of PRP in orthopedic medicine. PRP has been found to reduce inflammation, support cartilage repair, provide long-term pain relief, and improve joint function. Although, the most widely researched condition is osteoarthritis, PRP is used in various orthopedic conditions. Below is a select list and brief summary of recently published studies demonstrating safety and efficacy of PRP in orthopedic medicine.
A 2019 meta-analysis of 15 randomized controlled trials comparing PRP with hyaluronic acid in the treatment of knee osteoarthritis of 1314 patients found that PRP was more effective in long term pain relief and functional improvement of the knee joint.
A 2018 systematic review of 27 studies assessing the efficacy of intra-articular injections in the treatment of ankle arthritis in 1085 patients found evidence that favors PRP injections for reducing symptoms and pain.
A 2017 double blind randomized controlled trial comparing clinical outcomes between hyaluronic acid and PRP in the treatment of knee osteoarthritis found similar effects on pain but other patient reported outcome measures favored PRP. PRP also was associated with a decrease of inflammatory cytokines suggesting the anti-inflammatory properties contribute to improvement of symptoms.
A 2017 meta-analysis of 10 randomized controlled trials assessing the efficacy of intra-articular injection of PRP in the treatment of knee osteoarthritis in 1069 patients found that PRP was associated with significantly better pain relief and functional improvement after 12 months compared to hyaluronic acid and normal saline.
A 2016 randomized control trial comparing the efficacy of ultrasound guided PRP, hyaluronic acid or combination of both in the treatment of osteoarthritis of the hip found that intra-articular injections of PRP alone offered significant clinical improvement without relevant side effects. The benefits were stable up to 12 months and hyaluronic acid did not lead to significant improvements.
A 2016 pilot study assessing the efficacy of the combination of intra-articular and intra-osseous injections of PRP for the treatment of severe knee osteoarthritis found that PRP significantly improved knee joint function and reduced pain.
A 2015 meta-analysis of 59 articles concluded that current literature shows an overall support towards PRP therapy for joint degeneration and that PRP may influence the entire joint environment not just cartilage repair.
What do you inject during PRP?
PRP involves removing a volume of blood from a patient via standard phlebotomy, concentrating and extracting platelets from the blood and injecting them back into damaged joints and/or connective tissue. This high concentration of platelets contains a number of growth factors crucial to stimulate the repair of injured or damaged tissues.
Do the injections hurt?
The most common side effects of PRP are pain, soreness and a sense of fullness at the injection site. Bruising and mild bleeding from needle trauma may also occur. Pain and soreness post injection are self-limited and typically last 24-72 hours but may last longer. Since the solution contains anesthetics, patients often report an immediate relief of pain. In the rare instance that you experience persistent post injection pain please contact Dr. Hibbitts as you may require pain medication and/or further evaluation.
Can I take ibuprofen, aspirin or naproxen?
These over the counter non-steriodal anti-inflammatory drugs (NSAIDs) may provide pain relief, however they are counter-productive to the repair process that most regenerative injection including PRP stimulates and therefore should be avoided. If you feel you need further pain management with medication please discuss this with Dr. Hibbitts and he will recommend the best course of action.
Please note that all NSAIDs should be discontinued 3-4 days prior to injections and abstained from use for another 3-4 days after the treatment.
How do I know if PRP is working?
Most patients receive PRP until they are pain free or achieve an acceptable level of improvement in pain and/or mobility. It is normal to experience waxing and waning of pain and mobility during the course of treatment. Below is a list of signs that PRP is working:
Pain level and tenderness is decreasing
Clicking or grinding of the joint is decreasing
The amount of pain medication required is decreasing
Function and mobility is increasing
Level of exercise and tolerability are increasing
What if I don’t feel any immediate improvement?
Many patients report improvement in pain and mobility after the first treatment while others require multiple treatments before improvement is seen. Do not be discouraged if you don’t experience improvement after your first injection! It is normal to experience waxing and waning of pain and mobility during the course of treatment. Dr. Hibbitts generally tells his patients to plan on receiving at least three treatments. If you haven’t experienced improvement after multiple treatments you may be reevaluated and other therapies will be considered.
How Many treatments will I need?
The number of treatments varies with each patient and depends on a multitude of factors including severity of injury and the patients overall health. Typically, patients receive between three and eight sessions of PRP, given at two to six week intervals. Some patients need more treatments and others need less. It is normal to experience waxing and waning of pain and mobility during the course of treatment. Repeated treatments should provide continued repair to damaged or weakened tissues and longer periods of pain relief until maximum improvement is achieved. To help accelerate the repair process other treatments may be used including nutrition, supplements, and exercise.
Can I go back to work after PRP?
Since PRP is a relatively quick and noninvasive procedure most patients are able to return to work the next day if not the same day, however this is completely dependent on the individual, the individual’s line of work and how many areas were injected.
What else can help accelerate my healing?
Prolozone therapy as well as stem cell therapy can be used in combination with PRP to maximize effects. Aside from regenerative injection therapy, Dr. Hibbitts will perform a thorough intake and evaluation to identify any risk factors that may be preventing you from healing. This may include standard lab testing for hormones, thyroid function and other conditions that effect healing. Prolotherapy is just one tool used by Dr. Hibbitts to address pain and connective tissue injury. He also uses diet and nutrition, lifestyle modifications, supplements, IV therapy and other treatments.
What are the risks of PRP?
PRP and other regenerative injection therapies are extremely safe and have been safely administered to hundreds of thousands of patients The most common side effects of PRP therapy are pain, soreness and a sense of fullness at the injection site. Bruising and mild bleeding from needle trauma may also occur. While all injection procedures are performed with universal precautions and safety measures there is a potential risk for lightheadedness and fainting, allergic reaction, infection, bruising and hematoma. Of these, the most common reaction to injection therapy is lightheadedness and fainting, also known as a vaso-vagal response. Serious adverse events are extremely rare when PRP is used for treating joints such as the shoulder, elbow, wrist, knee and hip. Dr. Hibbitts has extensive knowledge of musculoskeletal anatomy and has attended numerous injection therapy training courses, assuring the highest level of efficacy and safety of his treatments.
Contraindications: Reasons NOT to get PRP
The contraindications for PRP include acute infection such a cellulitis, abscess and infectious arthritis. Prolotherapy is not typically used to treat acute injuries such as recent sprains/strains or bone fractures. In addition, allergies to the specific anesthetics used in PRP are absolute contraindications. Dr. Hibbitts will perform a thorough intake and physical exam to ensure you are an appropriate candidate. Please note that if a tendon or ligament is completely torn or if a nerve is pinched surgery is typically warranted.