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Plasma Rich Platelet Injections


Welcome back to the dancer blog! We’re gonna put our discussion on dance related injuries on pause for a moment and discuss a treatment I mentioned during our discussion on ACL tears. This week we’re going to be talking about Plasma Rich Platelet Injections or PRP. PRP is a bit of a controversial topic due largely to the contradictory evidence out there surrounding the effectiveness of this treatment. Because of this and given that as dancers we are always looking for conservative forms or care as a means of avoiding things like surgery, I thought that this would be an important topic to cover. So this week we will be discussing what PRP is, when it’s utilized and how effective or ineffective the research suggests that it may be.

Let’s start with what PRP is and how it works. The following is a SUPER basic breakdown of what Platelet Rich Plasma is, if you want a more medical breakdown you can find a lot of sources online through various medical organizations, but for our purposes I’m gonna streamline a lot of it. A couple things we need to understand, our body is filled with blood, on average about 5 liters worth. Most of our blood is composed of what’s called plasma. Within our plasma are red blood cells, white blood cells and platelets. Now, most people know that platelets are key players when it comes to blood clotting. But platelets are also a rich source of what’s called Growth Factor. As it relates to PRP, growth factor is good because it helps promote wound healing, such as tears and ruptures. So basically, PRP is about creating a solution of plasma that has a much larger concentration of platelets than normal that can then be injectected into an area of injury to help the injured tissue heal faster.

How is PRP created? To put it simply, blood is drawn from the patient, yes your own blood and your own platelets are used to create your PRP injection. Once the blood is drawn, it is placed in a centrifuge which spins the blood down seporting the various materials into layers; a layer of red blood cells, white blood cells and platelets. From here the desired layers are taken out and placed into a new solution where the concentration of platelets is now between two and eight times higher than what is usually found in the body. This new solution is then injected into the area of injury where it can promote wound healing at an accelerated rate. Again this is very streamlined, depending on the type of injury PRP is being applied to there may be many more steps and variations of solutions created but this is more or less the idea.

Ok so now that we have our PRP solution, what can we use it to treat? Well, PRP injections have actually been used for a large variety of injuries and purposes. As injuries go, tendon and muscle tears/ruptures are most common. This can include rotator cuff injuries of the shoulder, ACL tears, Achilles tendon ruptures or hip and shoulder labral tears. There is even evidence that PRP injections can help with arthritis. And because platelets are so rich in growth factors, PRP injections have also been used to promote hair growth.

The core idea here is that PRP injections take materials from your own body, concentrate them and inject them back into your body. The healing process taking place is your own healing process but amplified. The benefit here is that with PRP there is never a risk for rejection because the procedure uses your own blood.

So it sounds pretty perfect right? Well let’s look at the research. In one of the largest studies conducted on the effectiveness of PRP therapy, 230 patients with “tennis elbow” were treated with either PRP or traditional care. The study reports that after 24 weeks, about 84% of the patients treated with PRP reported that they felt 25% or greater relief of their pain. This is compared to the patients who were treated with traditional care where only 68% reported the same levels of pain relief.

On the other hand, one systematic review composed of 6 studies, three of which were considered high quality studies and three of which were considered low, found that PRP therapy for “tennis elbow” found no measurable difference in pain relief between patients treated with PRP and those treated traditionally. To make things even more confusing, other studies have found that while some patients respond very well to PRP, other patients with the same conditions do not.

So what does this all mean? Well I want to start by pointing out a couple of things. The first study I mentioned is one of the largest out there right now and it only evaluated 230 participants. Additionally, that systematic review only reviewed 6 studies. Understand that there are systematic reviews out there that review thousands of studies containing millions of participants. Additionally in the studies I discussed here, we were looking at PRP injections to treat “tennis elbow” specifically. This is not to say that the results would be the same for PRP therapy to treat ACL tears, Achilles tendon ruptures or any other condition PRP purports to treat. And of course I only used two examples in this blog, there are other studies out there obviously. Overall, what I’m trying to demonstrate here is that there just isn’t enough evidence right now to validate or discredit PRP as a viable form of care.

As much as we like to think that research just gives us the answers to the questions we're asking, the reality is that no one study can tell you anything. Instead, as researchers, we look for trends across thousands, millions of studies to see what we can expect. Right now, the research surrounding PRP therapy just is not that comprehensive. It will be someday, and on that day we will be able to better understand whether or not this form of care works and under what circumstances it does work.

Kind of a nothing answer I know, but right now it's the best we got. What I will say definitively however is this: PRP therapy is not covered by most medical insurances. This means that for most patients, to receive PRP injections means you will be paying out of pocket. On average, PRP costs between $500 and $2,000. Keep in mind that even under the best circumstances, PRP is not meant to serve as your soul form of care. Rather this is meant to complement your other forms of care such as rehab and conditioning.

So what’s the take away? Well like I said during our ACL tear discussion, treatment for serious and potentially career altering injuries is never black and white. There is no one answer that applies to every dancer. As such, you need to look at your injury and your situation and have a discussion with your healthcare provider on what the best road to recovery is. For some this may be surgery, for some this may be conservative care and yes for some this may include PRP. As dancers we are always looking to avoid invasive forms of care like surgery. It is equally important that we give ourselves the best shot at a long and healthy career. With this in mind, I felt that giving you all an understanding of PRP and the reality of what you can expect was important.

Personally, a dancer friend of mine who received PRP therapy reported a lot of pain relief for their torn hip labrum. Her experience may not be yours but it was her experience. And as always, this topic serves a great reminder of why it’s so important to have a healthcare provider whom you trust and who understands your needs as a dancer. Your career is invaluable, your health is invaluable and you should always be taken care of by a provider who understands this!

Ok a different kind of blog this week. I actually had a lot of fun diving into PRP and the research so if there are other treatment types you’d like me to cover and if you enjoyed this topic give it a like and leave me a comment. This week’s dancer shout out goes to Sally Mementowski. I’ve known Sally since undergrad back at the University at Buffalo. She’s a good friend of mine and an amazing dancer who’s performed professionally all over the world. Some of her favorite jobs include; Norwegian Cruise Line, Holland America Cruise Line and One Man's DreamII in Tokyo Disneyland. Side note, I’m super jealous of the Tokyo Disneyland job, I’ve always wanted to live in Japan! Besides dance, Sally also teaches dance at Performers Edge Dance Studio and Dancer's Pointe, make sure to check her out! Bonus fact, Sally plans on going back to school to become a Physical Therapist Assistant. Add her to the growing list of professional dancers joining the healthcare industry!

And remember, if you have any questions or topics you would like me to address here on the Dancer Blog comment below and let me know! Also if you want to help this community grow faster, please like and share this blog on Facebook, Instagram, and Twitter. Until next time!

References:

  1. Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Platelet-Rich Plasma Significantly Improves Clinical Outcomes in Patients With Chronic Tennis Elbow: A Double-Blind, Prospective, Multicenter, Controlled Trial of 230 Patients. Am J Sports Med. 2013 Jul 3. [Epub ahead of print] PubMed PMID: 23825183.

  2. de Vos RJ, Windt J, Weir A. Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med. 2014 Jun;48(12):952-6. doi: 10.1136/bjsports-2013-093281. Epub 2014 Feb 21. Review. PubMed PMID: 24563387.


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