By John Dooley MD, Pain Centers of Iowa, P.C.
the understanding of how the human body repairs itself are now making
their way into the clinical practice of medicine and can be offered as
an option to those with injuries to tendons, cartilage, and connective
tissue. Instead of injection of medicines that have downsides or surgery
that many not turn out right, the body’s own reparative mechanisms can
be marshaled to heal pain and provide function to damaged parts. An
attractive feature of this approach is that it involves only the body’s
existing substances to achieve the desired goals.
that have led to these techniques are the discovery of growth factors,
where the growth factors are stored, and the mechanisms that deliver
these growth factors to areas of damage. When a piece of the body is
damaged through a sudden large force or repetitive smaller force there
is enough damage that bleeding occurs into the area of damage. A normal
process is for the body to stop this bleeding by plugging the holes in
the tiny blood vessels that are leaking from the damage. A formed
element of the blood known as platelets function like plugs that get
caught on rough edges of the torn blood vessel or in the meshwork of
chemical bonds that occur in the leaking area; after enough accumulate
the bleeding stops. The platelets contain many active substances that
initiate and maintain tissue repair. Many of these substances are
proteins and enzymes that have developed over ages of evolution as
defense mechanisms for the living organisms.
substances have many different functions and produce many actions. One
of the first is to signal other cells that help to clean up the
abnormal, damaged or nonfunctional tissue involved in the injury. These
cells are like chemical digesters of the unwanted tissue in the area of
injury. After that work is finished, growth factors signal normal tissue
to divide and give rise to new tissue adjacent to the injury and infill
the defective areas. Another way of regeneration is to activate cells
that are in various areas of the body or storage areas waiting to help
out. These cells are an un-matured form and can mature into many
different types of adult cells that have different functions. These
immature cell forms are similar to stem cells that one reads about in
the research world. They are pluripotent which means that they can
develop into different functioning cell lines from the same immature
cell. The proteins and enzymes that are in a platelet and the other
reparative cells that accumulate in an area of injury help signal the
pluripotent cells to come to the area of injury and to mature into the
cell form needed to replace the damaged cell that has been removed.
Frequently, this complex process of repair and regeneration results in a
strong and fully functional tendon, ligament, or cartilage.
Although the body has the ability to regenerate damaged tissue, it does
not always achieve enough to alleviate symptoms of injured tendons,
ligaments and cartilage. Medical intervention is sought and treatment
prescribed; the treatment could be injections of corticosteroids to
reduce the inflammation of injury. The downsides to that choice is that
it may relieve pain but do nothing to repair the tissue, and
corticosteroids may weaken the tissue instead of making it stronger
because it diminishes the body’s reparative mechanisms. Physical therapy
and ultrasound to the area may stimulate the body’s reparative
mechanisms but may not always be enough to diminish symptoms to an
acceptable level. Surgery may be able to remove the damaged tissue and
rearrange the remaining tissue to better function but also has risks of
infection, complications, and anesthesia.
A better option for
those who do not like the idea of the use of foreign substances to heal
injuries would be to introduce the regenerative factors in the platelets
and the pluripotent cells into the area of injury. How is that done?
The technology exists to harvest and concentrate the platelets out of
one’s own blood for re-injection. The blood is drawn as in a laboratory
blood draw and then placed in a centrifuge to concentrate the platelets
to a small volume to re-inject back into the area of injury. The
platelets will activate and then regenerate the injured tissue in many
The injuries that respond to this type of treatment
include either trauma such as a strained or disrupted tendon along its
length or at its insertion into bone or muscle, ligaments that hold
boney structures, tendons, or muscles together, or cartilage destruction
from direct trauma or from degeneration of aging. Common injuries that
may respond to Platelet Rich Plasma (PRP) include tennis elbow, golfers
elbow, Achilles tendonitis, plantar fasciitis, rotator cuff tears, knee
ligament and cartilage tears, hand and forearm tendon tears, and ankle
ligament tears. There is no age limit for using this technique and it
can be useful for athletes, weekend warriors, workers involved in
repetitive movements, and elderly. If conservative measures of treatment
like physical therapy, ice, rest, and anti-inflammatory medications do
not work, PRP injection should be considered.
procedure involves drawing blood and processing it in a sterile, closed
system that maintains sterility; the processing takes about 15 minutes.
The area of injury is identified using non-invasive and non-radiation
ultrasound. Overlying skin is anesthetized with local anesthetic to
provide comfort for the injection of the PRP. The PRP is then injected
after the injection needle is precisely placed under ultrasound
The area of injection will often ache the next day or
two. Ice, mild oral analgesics, and reduced use will decrease the
discomfort. In 72 hours gentle stretching is encouraged. Return to full
activity in 4-6 weeks in most situations is expected. Most situations
respond to 1-3 injections over several weeks depending on the area of
injury. There is no drug effect or incision so repeating the injection
presents no increased risks.
The downsides to PRP injections do
not include any major clinical problems. One consideration, though, is
that many insurance companies will not pay for it. The barrier for
payment is high these days and large enough scientific studies have not
been completed to satisfy some insurance companies. The specific
policies need to be checked for each company in order to know whether or
not it is considered a covered procedure for each specific injury. If
one has to pay for it, it can be a cost effective solution to chronic
injury, pain and dysfunction.
are offered at Pain Centers of Iowa, P.C., offices in the Quad Cities.
To schedule an appointment for examination to determine if your
chronic injury may respond to PRP injection under ultrasound call
563-344-1050 during regular business hours. Pain Centers of Iowa, P.C.,
treats a wide variety of painful conditions including sports injuries
and degenerative conditions with advanced techniques.