Have you heard about platelet-rich plasma yet? If you deal with pain, arthritis or injuries, then you’re going to want to read up about this revolutionary procedure. Commonly referred to as PRP, it’s used in prolotherapy treatments for wound and soft tissue healing. PRP treatments work by supplying injured areas with natural proteins, cytokines, stem cells and other bioactive growth factors.
Starting in the early 1990s, physicians began using various prolotherapy injections in dental treatments, periodontal surgeries, cosmetic surgeries and skin grafting treatments. Then starting around the early 2000s, the use of PRP in prolotherapy, which utilizes a patient’s own blood platelets and growth factors, expanded into orthopedic treatments— including those aimed at reducing joint deterioration, damaged tissue fibers and chronic pain. This revolutionary treatment is now even being used to naturally treat hair loss!
While conventional therapy for sports injuries often follows the RICE protocol (rest, ice, compression and elevation), there’s been growing interest in PRP therapy in order to improve soft-tissue healing as well as lower recovery time.
From my experience, PRP treatment is one of the most cutting-edge and beneficial types of prolotherapy available today. The Prolotherapy website states that “Prolotherapy is like planting seeds in a garden; while PRP Prolotherapy is like planting seeds with fertilizer.” (1)
Who can benefit from PRP therapy the most? PRP is most useful for anyone with:
- Arthritis or osteoarthritis, especially those with degenerative knee cartilage
- A torn ligament or ligament sprains
- Tendonitis or tendon injuries
- A bulging or herniated disc
- Injuries due to sports or exercising (such “tennis elbow,” plantar fasciitis in runners, or common injuries affecting the rotator cuff)
- Sacroiliac problems
- Sciatica/sciatic nerve pain
- Common hand injuries experienced by younger and middle-aged adults, such as carpal tunnel syndrome, Skier’s or “Gamekeepers” thumb and “Texting thumb”
- Chronic pain in any susceptible area such as the neck, lower back, knees or shoulders
- Instability, loss of balance, stiffness and loss of flexibility/range of motion
- Sinus lift augmentation (2a)
The type of PRP therapy that I recommend most is through the Regenexx clinic. I have personally used Regenexx, after suffering from a herniated disc lifting weights as well an injured shoulder, as has my wife for overcoming her past injuries. (In particular, I went to see Dr. Chris Centeno, Dr. John Schultz and Dr. John Pitts, who run the Regenexx clinic located in the Cayman Islands. I consider these three doctors to have the most researched stem-cell and PRP clinic in the world.)
What Is Platelet Rich Plasma (PRP)?
Platelet-rich plasma (PRP) is defined as “autologous blood with concentrations of platelets above baseline levels, which contains at least seven growth factors.” PRP is taken directly from a patient’s own body (usually removed from bone marrow or adipose/fat tissue) and then injected into another site, wherever the affected area might be. Because PRP contains growth factors that heal damaged tissues, it works by naturally triggering localized inflammation, collagen production and other regenerative processes.
As a form of prolotherapy, PRP treatment is performed through a series of injection procedures that help resolve tiny tears or injuries to connective tissue located throughout the musculoskeletal system. These can include injured/damaged ligaments, tendons, muscle fibers, fascia and joint capsules.
Most patients need to receive injections over the course of anywhere from four weeks to six months. The goal of PRP treatment is for new blood vessels and fibers to form, helping to tighten, repair and strengthen damaged joints or tissue.
How PRP & Stem Cell Treatments Work
According to Dr. Brian Browning, of the Neuromusculoskeletal Medicine Residency Program at Florida Hospital East Orlando, “The basic mechanism of Prolotherapy and PRP is simple”: (2b)
- PRP substance is injected into the affected tissue (joints, ligaments or tendons, for example), which leads to local inflammation and a “wound healing cascade” resulting in: deposition of new collagen, plus healing initiated and controlled by bioactive proteins found in platelets, plasma and white blood cells.
- Some platelet-rich plasma treatments also inject high concentrations of stem cells into the affected area (more on this below).
- New collagen shrinks as it matures, and this tightens the damaged ligament or tendon, making it stronger (similarly to how collagen helps tighten aging, sagging skin).
- PRP substance is very different than an ordinary blood sample because it contains much higher concentrations of platelets and cell ratios (for example “normal blood” has about 6 percent platelets while PRP has about 94 percent). Platelets contain a number of proteins, cytokines and other bioactive factors that initiate and regulate basic aspects of natural wound healing, including those of the skin, connective tissue, etc.
- Research shows that growth factors in platelet-rich plasma therapy help stimulate cell replication, proliferation of myoblasts, vascular endothelial growth, and insulin-like growth factor-1 that carry out repair of skeletal and muscular structures. The main growth factors found in PRP include: platelet-derived, angiongensis, fibroblast, hepatocyte, insulin-like, epidermal and transforming factors. Three plasma proteins (fibrin, fibronectin and vitronectin) also contribute to the body’s repair matrix.
7 Benefits of PRP Treatment
1. Helps Treat Unresponsive Chronic Pain & Injuries
Have you relied on taking pain-reducing medications (including Advil, aspirin, ibuprofen and oral steroids) frequently or for long periods in order to dull muscular or joint pain, yet experienced little improvement? Maybe you’ve had the same disappointing experience after having corrective surgery for an injury or tried physical therapy without much success?
Then you’re the perfect candidate for PRP treatment. PRP can often help patients who haven’t responded well to other treatments overcome ongoing pain, stiffness, limited range of motion, trouble exercising, sleep trouble and other limitations.
Wondering why the body won’t resolve certain injuries on its own and relies on treatments like prolotherapy to heal properly? One theory is that over time the body can stop recognizing an area as “something to repair,” especially in the case of chronic injuries, degeneration or conditions such as severe tendonosis that cause lots of pain. Because of this, some speculate that PRP might be one of the best suited types of prolotherapy for these kinds of injuries, due to it increasing natural “irritation” and growth factor expressions.
The way that PRP and stem cell treatments help to resolve chronic pain is causing a purposeful, mild inflammation response near damaged tissue. This type of inflammatory response is usually what happens following an injury, but in some cases the healing process doesn’t always correctly rebuild the damaged area and the body then “forgets” to keep attending it. PRP ultimately helps to restart the process and for new fibers to then grow back.
2. Reduces Tendonitis Symptoms
Research published in the Journal of the American Medical Association shows that an estimated 30–50 percent of all sports-related injuries are tendon disorders, many of which become unresponsive to treatment after some time. (3)
PRP prolotherapy has been found to help with common sports injuries, including those of the Achilles tendon or elbow, such as: medial or lateral epicondylitis (better known as golfers’ or tennis elbow), extensor or flexor tendonitis/tendonosis or tears, tendinopathy, and ulnar collateral and radial collateral ligament tears. In 2010, even Tiger Woods reported using PRP to overcome injuries in his knee and Achilles tendon!
Stanford University published the first human study supporting the use of PRP for chronic tendon problems in 2006. They found that patients experienced on average a 93 percent reduction in pain at the two-year follow up point. Stanford has been recommending prolotherapy for pain and other conditions (such as stroke recovery) ever since. (4)
3. Helps Decrease Osteoarthritis Symptoms
Studies have found that osteoarthritis and degenerative joint disease patients receiving platelet-rich growth factor injections experience restored hyaluronic acid concentrations and improved angiogenesis, which help to reverse joint damage and stop disease progression.
PRP and stem cell treatments have been found to specifically restore hyaluronic acid due to the presence of synovial fibroblasts and hepatocyte growth factors. These effects have been found to be especially beneficial for those with knee pains due to osteoarthritis (one of the most common symptoms).
A 2010 pilot study that was published in the American Journal of Physical Medicine Rehabilitation found that OA patients with knee pain who received treatments for four weeks on average reported no adverse events and saw significant (and almost linear) improvements in all measured knee injury and osteoarthritis outcome scores. The majority of patients experienced the most results after about 12 months following treatment. (5)
4. Helps Heal Conditions like Plantar Fasciitis & Jumper/Runner’s Knee
In addition to treating knee pain due to osteoarthritis, other studies have found that PRP therapy is beneficial for those with trauma or sports-related knee or leg pains such as “refractory jumper’s knee” and plantar fasciitis (a common injury caused by running).
One study involving 15 patients who had failed previous nonsurgical or surgical treatments found that PRP injections given on three occasions, two weeks apart, combined with standard physical therapy resulted in 70–80 percent symptom improvements! (6) Seven out of nine patients with plantar fasciitis in one study reported “complete pain relief” at the one year follow-up and some patients had full recovery in half the expected time. (7)
5. Reduces Lower Back Pain
PRP is commonly used to treat chronic low back pain, and 2015 report published in Epoch Times even found that treatments could cure cases that were previously very difficult to treat. Following treatment up to 90–100 percent symptom improvement was achieved in some patients! Around 60 percent of patients experienced significant improvements in measures of pain, posture and stability. (8)
Research shows that a high percentage of chronic low back pain is actually due to torn or bulging discs, musculoskeletal compensations, ligamentous instability and poor postural alignment. These damage tissue over time and often cause injuries or pain to spread to other body parts (such as down the legs from the lower back). Some of the ways PRP can reduce low back pain include treating structural ligaments (such as iliolumbar, sacroiliac, lumbosacral and supraspinous ligaments) and, therefore, improving stability and dispersion of weight.
6. Natural Hair Loss Treatment
Certain clinics now recognize and use PRP as “an all-natural autologous medical procedure performed in office for scalp, skin and hair stimulation.” Recently, a study published in Dermatologic Surgery supported the use of clinical application of PRP in hair restoration. (9a)
The way that PRP works for reversing hair loss and helping with wound healing following cosmetic surgery is by: increasing the proliferation of dermal papilla cells, stimulating extracellular signal-regulated kinase (ERK), stimulating Akt signaling and supplying Fibroblast growth factor 7 and beta-catenin for accelerated hair growth plus less inflammation.
7. Dental and Oral Surgery Adjunct
PRP is a new approach to tissue regeneration within the field of oral maxillofacial surgery. Immunity & Ageing study authors remarked, “It is becoming a valuable adjunct to promote healing in many procedures in dental and oral surgery, especially in aging patients.” (9b) Similarly, promising results were also seen with oral implant surgery, when PRP was used as a coating material.
Prolotherapy, PRP & Stem Cell Treatments: They How Fit Together & Differ
Although various prolotherapy treatments have been used in medicinal practices at least as far back as the early 1930s, it wasn’t until much later that PRP emerged.
There are several things that distinguish PRP and stem cell treatments from other forms of prolotherapy:
- Compared to other types of prolotherapy treatments, which utilize substances such as glucose or saline to increase healing (such as in the case of dextrose prolotherapy), PRP prolotherapy uses your body’s own natural stem cells and growth factors.
- PRR has been called the “modern” version of dextrose prolotherapy, which relies on the use of glucose. In PRP treatment, patients are given injections of autologous centrifuged blood with high platelet concentration as opposed to substances foreign to their body.
- Although they use different substances to initiate localized inflammation, PRP stimulates musculoskeletal healing in basically the same manner as dextrose prolotherapy or other common types. Some studies have found similar results from dextrose prolotherapy and PRP depending on the condition being treated, but others have found that PRP is better suited in some cases (such as for tendonitis or osteoarthritis).
- One important factor that sets PRP apart from other prolotherapy treatments is that it provides natural growth factors, which dextrose treatments do not. These have been found to have significant healing effects.
- In any prolotherapy treatment, the injection, irritation and needle microtrauma are what help start the repair process, but PRP speeds this up by providing more growth factor. When the body has stopped recognizing that an area is damaged and needs healing, PRP may be more appropriate.
- Recent advances in PRP show that treatment can now help chronic conditions that have been unresponsive to other care. Some research has shown that PRP is likely a better option over dextrose prolotherapy specifically in the case of tendon sheath or muscular injuries, due to how it helps treat fibro-osseous junctions (enthesis).
Stem Cell PRP vs. Other “Standard” PRP Treatments:
While most PRP treatments rely on using your body’s own growth factors along with a portion of stem cells, more advanced stem cell treatments take this one step further. The clinic I recommend most, Regenexx, for example, uses advanced injections that have a much higher concentration of stem cells than typical “bedside PRP” treatments, including mesenchymal stem cells (or MSC’s). (10) It’s the stem cells that are especially beneficial and appropriate for treating degenerative diseases — where there is lost tissue, torn fibers and sometimes a bulging disc involved.
If you aren’t familiar with how stem cells work, they are unique and extremely valuable because they can be moved from one location of the body to another through injections, and then automatically transform into the type of cells the body needs to heal itself.
For example, if you were to tear a ligament in your knee, it would be possible to inject stem cells from another body part into the knee in order to repair the damage. The type of stem cells used by organizations like Regenexx are carefully isolated and grown inside a culture lab by a biologist over about a two-week period, at which point they mature enough to be used in PRP injections.
History of Platelet-Rich Plasma
Using natural “growth factors” and stem cells found in PRP to boost healing has been a medical practice since at least the early 1900s. Clinical PRP treatment was not made available, however, until about the late 1990s. Stanford University was one of the first major institutions to publish findings from studies indicating the effectiveness of PRP for common unresponsive injuries.
Since then, celebrity athletes have touted the benefits of PRP treatment: former Pittsburgh Steelers’ wide receiver, Hines Ward, received PRP for a knee medial collateral ligament sprain; Takashi Saito, closing pitcher for the L.A. Dodgers, also recovered using PRP; golfer Tiger Woods reported that PRP helped him return to his sport after being injured.
Today PRP therapy and prolotherapy are thankfully more affordable and effective than ever. Devices have become more portable, and there are now several available models that allow physicians to create PRP injections from small samples of a patient’s own blood in many different office settings.
The more advanced forms of stem cell therapy (including those using MSC’s) emerged starting around 2005 and have continued to show promising results in thousands of patients, many of which are being tracked for symptom improvement as you’re reading this.
Where to Go for PRP Treatments
Prolotherapy treatments, including PRP, are different than traditional pain-management approaches and even surgery because there is less risk involved, plus they usually help to permanently solve an injury, rather than only acting temporarily to fight pain. That being said, PRP and prolotherapy in general is still only practiced by a small percentage of trained practitioners.
Prolotherapy College reports that most doctors still consider these treatments to be alternative therapies, many recommend using them in conjunction with other treatment methods, and the majority of medical school students are still not taught how to perform prolotherapy as part of their standard training.
I recommend looking for a physician with accreditation through The American Association of Orthopaedic Medicine (AAOM), specifically who has completed training in a Prolotherapy (RIT) Certification Program, or through The American Osteopathic Association of Prolotherapy Regenerative Medicine.
Personally, I most suggest checking out one of the world leaders in cell-based orthopedic medicine, Regenexx. Regenexx has been leading the way providing the highest quality and most studied PRP and stem cell treatments since 2005.
Regenexx is the only organization to run large-scale analysis of patient stem cell procedure outcome data, and has published numerous findings from tracking their own patients on their website here. Much more detailed information on improvements that can be expected following PRP procedures — including those for knee meniscus, arthritis, hip dysfunction, knee pain, wrist/hand injuries, ankle/foot pain and shoulder/rotator injuries — can be accessed through Regenexx directly.
Precautions Regarding PRP
PRP and other forms of prolotherapy are considered to be very safe overall. The biggest risk is believed to be associated with visiting a practitioner who is not well-trained in administering the procedure, so always do your research.
Most mild side effects following an injection go away within several days, but icing the area or temporarily taking an over-the-counter pain medication can help to manage pain while healing begins to take place. It’s best to avoid intense exercise for several days following injections, but mild exercise and movement usually isn’t a problem.
Like other forms of prolotherapy, PRP treatment side effects can sometimes include:
- Swelling at the injection site
- Increased pain and stiffness
- Signs of an allergic reaction
- Although very rare, cases of spinal fluid leaks and permanent nerve damage have also been reported
- Platelet-rich plasma (PRP) is blood plasma that has been enriched with natural platelets, stem cells and growth factors. PRP is injected into damaged tissue to help boost healing and reduce pain.
- Conditions that can be treated with PRP include: osteoarthritis, tendonitis, running injuries, trauma or impact injuries, chronic pain and even hair loss.
- PRP is a type of a prolotherapy treatment, but different from other PRP treatments because it contains additional growth factors and stem cells that are taken from the patient’s own body (as opposed to substances like saline and dextrose). Advanced PRP treatments use high concentrations of stem cells (MSCs) to further improve healing.