Platelet Rich Plasma (PRP) therapy is an emerging treatment in a new health sector known as Orthobiologics. It is hailed as the ultimate solution when it comes to the acceleration of healing in terms of tendon and muscle injuries as well as osteoarthritis. It was initially used over 20 years ago in the Dental 
Community to enhance wound healing in cancer patients with jaw reconstruction. Soon afterwards its application was extended across many fields of medicine from cardiovascular surgery to orthopedics. It is now being used to accelerate the healing of muscle and tendon injuries in the athletic community, but just what exactly is this treatment and, more importantly does it really work?
I decided to look into this procedure in depth and what follows is my assessment of this process. Those wishing to explore its potential for themselves are advised to use the contacts listed at the end of this article. So, that being said, let's begin this scientific journey by taking a closer look at your blood and what this treatment does to manipulate it and heighten its natural healing potential....
YOUR BLOOD 101
Blood contains plasma, Red Blood Cells (RBC), White Blood Cells (WBC) and platelets. Plasma is the liquid component of blood made mostly of water and acts as a transporter for cells. Plasma also contains fibrinogen, a protein which acts like a net and catches platelets at a wound site to form a clot.
Red Blood Cells help pick up oxygen from the lungs and deliver it to other body cells while removing carbon dioxide. White Blood Cells fight infection, kill germs and carry off dead blood cells. Platelets are responsible for hemostasis, construction of new connective tissue and revascularization.
A typical blood sample contains 93% RBC, 6% Platelets and 1% WBC. Now when it comes to PRP, the rationale for its benefit lies in reversing the blood ratio by decreasing RBC to 5% - since they are less useful in the healing process- and increasing platelets to 94% to stimulate recovery.
To date PRP has been used in the athletic community for treating chronic non-healing tendon injuries including the elbow, patella and Achilles - although use is not limited to these areas.
PLATELETS AND THE HEALING PROCESS
Platelets were initially known to be responsible for blood clotting however, in the last 20 years it has been revealed that when activated in the body, platelets release healing proteins called GROWTH FACTORS which are known to accelerate tissue and wound healing. Using the PRP procedure, the baseline concentration of these platelets is increased and therefore a powerful cocktail of these growth factors is created which are thought to dramatically enhance tissue recovery.
PRP...THE PROCEDURE
So the obvious question now is what exactly happens to the blood during this process in order to re-arrange its structure in such a way that promotes a healing response?
Well, first of all, about 30-60ml of venous blood is drawn from the patient. The blood is then placed in an FDA approved device and centrifuged for 15 minutes at 3200rpm. This step removes the unwanted components of blood that are not primarily responsible for healing including plasma, WBC's and RBC's. Following this, the blood is separated into Platelet Poor Plasma (PPP) and Platelet Rich Plasma (PRP). Next, the PPP is extracted through a special port and removed from the device. What remains is an increased concentration up to 10x above baseline of platelets, which are rich in healing properties called growth factors.
During this time the patient receives either local anesthetic (inj.) or conscious sedation (via IV) as determined beforehand by the physician and patient. Then, using musculoskeletal ultra-sound, the area of the injury is properly identified and marked. The injection is performed with ultra-sound guidance to ensure that the proper target is reached within a millimeter. The patient then rests for 5-10 minutes and is discharged with post procedure instructions.
After 4 weeks the patient usually receives a follow-up ultrasound to assess the healing process and a decision is made as to whether a second shot is required. In most cases 1- 3 injections given at four week intervals is usually sufficient to obtain results.
PRP...THE SIDE EFFECTS
As far as side effects are concerned, patients typically experience an increase in pain for approximately 7 days following the injection. In this case, it's recommended to treat the sore area with ice along with a modification of activity. Acetaminophen is usually recommended for pain relief or Vicodin for breakthrough pain. The use of NSAID's is not recommended during this period.
This temporary worsening of symptoms is considered to be caused by a stimulation of the body's natural response to inflammatory mediators.
In addition, one must also consider the possibility of infection which may occur after and injection. No relief of symptoms, neurovascular injury, scar tissue formation and calcification at injection site are also remote risks.
Finally, an allergic reaction or local toxicity to Bupivacaine HCL or Lidocaine (although uncommon) could also trigger and adverse reaction.
FINAL THOUGHTS
As I said at the beginning of this article, I am presenting the facts on this procedure and allowing you to make up your own mind when it comes to investigating it further. However, I can't help but having some concerns. One of these concerns was regarding the white blood cell count during this process and how it was affected. I asked Dr Steve Sampson a practitioner of PRP about this and here is what he told me...
"Concentration of platelets and other factors of blood may vary based on the manufacturer (of the equipment used). Currently there are approximately 7 systems on the market. However, this will increase as soon as the patent expires and many more kits will likely emerge. One of the systems I use has a 3.2 x baseline increase in WBC. This occurs because the white cells separate from the RBC and stay with the platelets in general. The increased white cell count is one of the reasons PRP is used in cardiac bypass surgery to decrease infection rates."
Now, I know I am not a medical professional but this increase in white blood cell count in an otherwise healthy patient still concerns me.
Another concern is the fact that the initial response is an increase in pain and inflammation. I understand that this is a healing trigger, but it is still a sign that the body is responding with a defense action to a foreign substance.
On the plus side, there have been many reported successes with this treatment although, since the process is still relatively new in terms of sports injury treatment, long term results (and I am talking 5-10 yrs down the road) may still be open to question.
For a generally healthy patient with a muscle tear or tendon injury with no added complications this may be a viable treatment to explore though and that is where I leave the decision in your hands. If this treatment is of interest to you I urge you to research it further and, should you want to discuss it with a qualified practitioner you can contact Dr Steve Sampson directly at [email protected]
So there you have it... you know the facts and I have given you my opinion but ultimately the decision is yours!
You can also find out more about PRP by going to
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