PRP–PROLOTHERAPY

Individuals undergo Prolotherapy for a variety of reasons. For some the decision is prompted by the need to repair damage caused by trauma, birth defects and/ or the aging process. In the past ligament and tendon repair has been initiated, stimulated and/or accelerated by injection of naturally occurring substances, principally dextrose, frequently augmented by sodium morrhuate, glycerin, phenol, etc. into the injured areas and at the apposing surfaces of bones involved in delayed or nonunion of some fractures. These and other substances are used to stimulate a normal controlled inflammatory cascade and thus the production of the body's natural growth factors which promote healing. With the advent of techniques for office production of Platelet Rich Plasma, regenerative injection therapy, ligament reconstruction therapy, Prolotherapy, is being revolutionized. PRP- Prolotherapy is now easily available from the Prolotherapy clinic.

WHAT IS PLATELET RICH PLASMA?

Platelet Rich Plasma, or PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins, including growth factors that are vital to initiate and accelerate tissue repair and regeneration. While a normal concentration of platelets circulating in your blood is 200,000 per microliter, the platelet count in PRP can exceed 2 million platelets per microliter. These bioactive proteins initiate connective tissue healing: bone, tendon and ligament regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process.

WHAT ARE GROWTH FACTORS?

Platelets contain potent growth factors necessary to begin tissue repair and regeneration at the wound site. Growth factors derived from platelets initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process.

HOW IS PRP MADE?

Approximately 20-50 cc of your blood is drawn just prior to the procedure. The blood is placed in a specialized centrifuge that spins it and automatically separates the red blood cells from the plasma reach platelets with high concentration of growth factors. The PRP is then available for use as needed. The entire process takes less than 15 minutes and adds no extra time to the procedure.

HOW DOES PRP THERAPY WORK?

When PRP is injected into the damaged area it stimulates the tendon or ligament causing mild inflammation that triggers the healing cascade. As a result new collagen begins to develop. As this collagen matures it begins to shrink causing the tightening and strengthening of the tendons or ligaments of the damaged area. The use of PRP may increase the healing rate, reduce injection and post-injection pain, decrease overall healing times, reduce the frequency and number of Prolotherapy injections necessary, the total volume of injections, and consequent bleeding and bruising.

WHAT ARE THE POTENTIAL BENEFITS?

Patients can see a significant improvement in symptoms. This may eliminate the need for more aggressive treatments such as long term medication or surgery as well as a remarkable return of function.

WHAT CAN BE TREATED?

PRP injections can be performed in tendons and ligaments all over the body. Sports injuries, arthritic joints, lower back, degenerative disc disease and more specific injuries including tennis elbow, carpal tunnel syndrome, ACL tears, shin splints, rotator cuff tears, plantar fasciitis and iliolibial band syndrome may all be effectively treated with PRP.

HOW MANY TREATMENTS ARE NECESSARY & HOW OFTEN IS THIS THERAPY ADMINISTERED?

While responses to treatment vary, most people will require 1-3, some as many as 6 sets of injections. Each set of treatments is spaced approximately 4 to 6 weeks apart. There is no limit to the number of treatments you can have, the risks and side effects do not change with the number of injections

IS PRP RIGHT FOR ME?

If you have a tendon or ligament injury and traditional methods have not provided relief, then PRP therapy may be the solution. The procedure is less aggressive and less expensive than surgery. It will heal tissue with minimal or no scarring and alleviates further degeneration of the tissues. there will be an initial evaluation with your doctor to see if PRP therapy is right for you.

ARE THERE ANY SPECIAL INSTRUCTIONS?

You are restricted from the use of non-steroid anti-inflammatory medications (NSAIDs) one week prior to the procedure and throughout the course of treatments.

Initially the procedure may cause some localized soreness and discomfort. Most patients only require some extra-strength Paracetamol to help with the pain. Heat may be applied to the area as needed. The first week after the procedure, patients will typically start a rehabilitation program with physical therapy. However, aggressive physical activity is discouraged.

HOW SOON CAN I GO BACK TO REGULAR PHYSICAL ACTIVITIES?

PRP therapy helps regenerate tendons and ligaments but it is not a quick fix. This therapy is stimulating the growth and repair of tendons and ligaments requiring time and rehabilitation. Through regular visits your doctor will determine when you are able to resume regular physical activities.

Before treatment:

• Your initial visit to the Prolotherapy Clinic in relation to platelet Rich plasma injection will consist of a full physical assessment based on injury or physical complaint which MAY include x-rays, blood work, range of motion and/or strength measurements, MRI if needed.
• If taking NSAIDS( anti-inflammatories i.e.: Voltaren, Naprosyn, Celebrex, Acoxia, aspirin [other than low-dose aspirin] etc.) please discontinue 2-4 days prior to treatment
• Follow your normal daily routine on procedure day, make sure to drink plenty of water. The test procedure will take approximately 1 hr.
• Upon arriving at the Center your blood will be drawn and you will be prep'd for your procedure. Your blood will be spun down in a special centrifuge which takes about 15 minutes.
• The painful/tender areas will be marked.
• Platelet Rich-Plasma (PRP) will be injected into the marked areas.

Post-treatment:

• You may be numb in the areas treated for 4-6 hrs after the procedure.
• Due to the numbness we ask that you refrain from any strenuous activities but STAY as mobile as possible. If some of the local anesthetic should wash out into the tissues surrounding some of the larger nerves, you may notice weakness and numbness of part of a limb. Be assured this is transient and should not be a cause for undue concern.
• After the anesthesia wears off you may resume activities to tolerance of pain.
• You will experience some pain and soreness for 2-5 days after your treatment.
• No anti-inflammatory medication (see above or ask Dr. Zul) for 4-6 wks after treatment.
• You may take Paracetamol up to 2tab 3x /day
• If excessive pain is anticipated, you will be given a prescription, on request, for a stronger painkiller such as "Tramal". Such medication is only rarely necessary, but excessive pain is not useful.
• You may use warm, adequately insulated, as needed for pain and/or swelling (10 minutes to cool the skin, repeat every 2-3 hours as needed).
• Follow a program for flexibility and core strengthening to rehabilitate and correct any imbalances in the kinetic chain.
• Follow the 10% rule and the FIT principles for returning to activities to decrease the incidence of re-injury and increase the healing potential. What you consider to be a normal level of activity may, in fact, be outside the envelope. Please make sure you review the extremes of your activity levels with Dr. Zul and/or your physical therapist before you resume "normal" activities
• You may experience the "roller coaster" syndrome where you feel great one day and for no apparent reason the area treated starts to hurt again, this is normal in the healing process.
• The platelets are active for 6 weeks and it can take up to 6 months for normal collagen to form and heal completely.
• Our goal is 80 % improvement in pain, so you may or may not need more than 1 treatment to reach that goal. Sometimes a series of 2-3 treatments are needed to achieve complete healing. If subsequent treatments are needed they are usually performed 4 weeks apart.

WHAT ARE TENDONS & LIGAMENTS?

Tendons, composed of collagen fibers, connect muscle to bone making it possible for you to perform every day physical activities. Overuse or damage to tendons over a long period of time causes the collagen fibers in tendons to form small tears, a condition called tendinosis. Damage most often occurs in the knee, ankle, shoulder, elbow, wrist, biceps, calf, hamstrings and Achilles tendons.

Ligaments are also composed of collagen fibers, connecting bone to bone i.e. joints: ankles, knees, shoulders, spine, etc., stabilizing the joint and controlling the range of motion. A damaged ligament is no longer able to provide support, weakening the joints and shifting the burden of support to muscles (and thence to the tendons) which should primarily act as movement engines. Tendons and ligaments have poor blood supply particularly where they connect to bone, (entheses). Once injured (sprains or strains) they do not heal easily and the damage progresses with the stress of day-to-day activities. As a result the tendons and ligaments become inefficient, the muscles are over-taxed causing chronic pain and weakness and further damage. Medical intervention may be necessary.

I'VE HEARD OF CORTISONE SHOTS : IS THIS THE SAME?

Studies have shown that cortisone injections may actually weaken tissue. Cortisone shots may provide temporary pain relief and stop inflammation, but do not provide long term healing. PRP therapy heals and strengthens these tendons and ligaments. Strengthening and thickening the tissue up to 40% in some cases.