As we become more active we often push/strain our tendons, joints and ligaments beyond what they were used to. Stress injuries such as tendonitis and osteoarthritis can be the end result. By now many of you have heard of PRP, or Platelet Rich Plasma. While PRP is not a magical cure, it does seem to be affective at minimizing pain from many conditions.
PRP – Platelet Rich Plasma
PRP injections are being used to try and treat many different orthopedic injuries and degenerative conditions such as arthritis. Many people believe that PRP might cure them of osteoarthritis. There are many other misconceptions about what PRP is and what it can do. Once you choose to proceed with a PRP injection there will be many questions relating to how fast the recovery is following a PRP or platelet rich plasma injection.
PRP Most Common Questions:
- will PRP help my condition?
- how is the PRP procedure performed?
- how long is recovery from a PRP injection?
What is a PRP injection and how is it performed?
PRP injection (Platelet-Rich Plasma) is an increasingly common treatment option being offered to patients for many orthopedic injuries and conditions. PRP is not a magical cure, but it does have a role in minimizing pain and improving function. We will discuss the potential uses below.
These injections are an in-office procedure. The entire PRP procedure from start to finish takes 30 minutes or so. During a PRP injection we take a sample of blood from your arm. That blood is placed into a special canister and then it is placed into a centrifuge. The centrifuge will separate blood into various components. There is a layer that forms when the tube is spun in the centrifuge. That layer has the platelets in it. We are then able to remove the layer that has the platelets and other larger cells (stem cells) in it. That layer, containing the platelets will then be injected into the joint, tendon or ligament that is injured. Depending on the area being injected an ultrasound machine might be used to guide the needle to its proper position.
The risks of PRP injections are very low because you are receiving your own blood. We do not typically add any medications to the PRP injection so you are only being injected with a portion of your own blood. Most people experience soreness after the procedure. Some will describe it as pain. It will vary significantly. Knee, shoulder or elbow joint PRP injections typically produce mild swelling and very little pain. Injections of PRP into muscles or tendons typically causes much more pain than a joint injection. That discomfort or pain can last 2-3 days or longer.
How do I prepare for a PRP injection?
During the PRP injection procedure we will be collecting your platelets and injecting them into the damaged or injured area. Platelet function is affected by certain medications. You may need to consult your cardiologist or primary care doctor. Aspirin, motrin, advil, alleve, naprosyn, naproxen and diclofenac will all interfere with platelet function and would be expected to lessen the response to the injection. We ask people to be off of aspirin or other anti-inflammatories for 1 week before the injection and two weeks after the injection. Tylenol will not affect platelet function and may be taken during the treatment period.
Will PRP work for my injury?
PRP therapy is used to treat osteoarthritis of the knee, elbow, shoulder, and hip. PRP might also be very useful for many overuse sports injuries including:
PRP when used alone will not heal a meniscus tear. However, at the time of surgery, when we repair the meniscus using sutures we will often inject the PRP around the repair site. The current thinking is that PRP might have a role at improving the chance that the repaired meniscus will heal after suturing.
Rotator cuff injuries:
Many people with bursitis or inflammation of their rotator cuff might respond to a PRP injection. PRP can reliably decrease inflammation. That is the main goal of PRP. These injections will not reliably heal a rotator cuff tear without surgery. Similar to a meniscus tear, we might injection PRP in the area after we repair the rotator cuff. Again, the thought is that this might improve the chance that the rotator cuff tear will heal. In cases of bursitis without a tear, the PRP is often effective at alleviating the pain due to inflammation of the bursa.
One of the most common uses for PRP is to treat osteoarthritis of the knee, and less commonly of the shoulder and hip. This post goes into more detail about PRP injections for knee arthritis. PRP will not reverse or cure the arthritis. The main goal of the PRP is to decrease the inflammation within the joint. We have used this successfully in combination with other procedures such as an embolization for people looking to delay a knee replacement.
knee ligament injuries
PRP seems to be most useful for injuries to the medial collateral ligament (MCL). Most MCL injuries heal on their own within 2-3 months. Some MCL injuries become chronic. That means that the inflammation and swelling last well beyond the normal expected recovery time. PRP injections in this setting have been demonstrated to improve the healing and minimizing the chronic inflammation. These happen to be fairly painful injections. Many of you will feel worse, and more stiff for a few weeks after the injection.
- tennis elbow,
- elbow ulnar collateral ligament injuries (to avoid Tommy John Surgery)
- ankle sprains, tendonitis and ligament sprains.
In PRP therapy, a patient’s blood is drawn, separated and re-injected into injured joints and muscles to ease pain. After the injection, your platelets release special growth factors that often lead to tissue healing and repair. This is why it can take a while to see results after an injection. This is also why PRP injections into the tendons, muscles and ligaments will hurt. PRP will initially cause acute inflammation to heal the problem. That acute inflammation could hurt for a few days to a few weeks. It takes time for the recruited repair cells to come to the injured area and start the repair process.
PRP recovery time: What can I expect after an injection?
Patients may experience approximately two to three days of being sore after joint injections. People receiving PRP for soft tissue injuries can expect pain for a few days. They may also experience stiffness. Tylenol is often effective at managing the pain. Prescription pain medication is rarely needed. Patients often rest for a few days after the treatment but this is not absolutely necessary. Pain relief typically starts to occur within three to four weeks after the injection. Your symptoms continue to improve over a period of three to six months following a PRP injection. The recovery time frame varies depending on what we are treating. The pain or discomfort of osteoarthritis usually responds faster than tendon related pain such as tennis elbow, golfers elbow or patella tendonitis. PRP has NOT been very useful for achilles tendon pain. Sometimes arthritic joints respond much faster to these injections than a patient being treated for tendonitis.
Why PRP and not Cortisone?
If successful, PRP generally results in long-lasting relief because the degenerative tissue has potentially started to regenerate or regrow itself. The bioactive proteins stimulate healing and repair. New research shows PRP to be more effective than cortisone injections –which simply mask inflammation and have no healing capabilities.
Cortisone has no healing properties, does not work long term and on occasion can lead to tissue damage. More recently (2017), cortisone injections are now thought to potentially lead to cartilage damage as well, thus potentially worsening osteoarthritis.
If you have a sports injury or osteoarthritis and have questions about PRP injections, please ask me in the comments below or contact my orthopaedic office in Fishkill, NY – Hawthorne, NY or in Westchester County, New York.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.