Platelet Rich Plasma (PRP)


Platelet Rich Plasma or PRP is simply a specific portion of blood that is acquired by taking a sample of blood, and spinning that blood until the red blood cells separate from the plasma or the watery portion that makes up blood. Within that plasma are all the platelets. If you remember from high school biology, platelets are cells that act to form scabs and help heal damaged tissue. Those same platelets can be taken and reintroduced into an area to help regenerate and heal damaged tissue. In the plasma the platelets settle so there is a higher concentration at the bottom. Compared to whole blood PRP has up to an eight times more platelet count. So now here is how it is done in order. Blood is drawn, blood is spun in a centrifuge to separate the whole blood into red blood cells and plasma, the plasma is drawn into syringes, one syringe for most of the plasma that doesn’t’ hold many platelets and then the platelet-rich plasma, the PRP is then injected into any area that has damaged tissue. 


How does this work? How and why is it effective? In short, injecting PRP creates a “fresh injury”. Now, this does not mean that injury or damage is taking place. The essence behind PRP is to jump-start healing again for chronic problems or give the body a good dose of its “own medicine” to speed the healing process for acute injuries or post-surgery. The nitty-gritty of PRP lies within the physiologic response of the platelets themselves. Platelets carry growth factors in great varieties to repair and regenerate tissue. Platelets also carry proteins and peptides as well as cytokines. A whole bunch of big medical words describes how platelets help repair and regenerate damaged tissues. Growth factors are signaling proteins that stimulate cell growth, tissue repair, and inflammation. Acute inflammation is therapeutic and protects against chronic pain. As platelets are activated they divide, multiply and differentiate to become healing cells for injured tissue, as they change they release growth factors. Another great benefit of PRP is that there is stem cell attraction and binding. Stem cells are like blank canvases, they can become anything that the body needs to help repair the damage. Stem cells have also been seen to potentially lay dormant within tendons and ligaments, the same tissues that have little blood supply as well as the potential to have chronic issues and pain. PRP can activate those stem cells within those troublesome areas to achieve long-lasting pain relief and recovery. PRP also helps create and release exosomes. Exosomes are molecules within cells that act as communication for the rest of the cells of the body. These exosomes relay information to recruit other cells for the repair and recovery of damaged tissues. Exosomes also help to decrease pain. There is a portion of the separated blood called a buffy coat. This thin layer between the plasma and the red blood cells is highly valuable for PRP because it holds a lot of these exosomes as well as some white blood cells that help to remove the debris from the damaged cells. 


Now let’s talk about the difference between steroid injections and PRP. Steroid injections have been the industry standard for a very long time because they help to reduce inflammation and pain. This is a great option when needing a quick fix because pain and inflammation are a real drag. Here is the downside. Steroid injections are a quick fix and a band-aid, they do not fix the problem. So you could go in to get a cortisone injection and walk out feeling really good. A few weeks go by and all of a sudden the same pain returns, or worse, it is even more intense than before the injection. This comes back to relieving the pain rather than fixing the problem or damage. Another detriment of cortisone or steroid injections is that the compound itself is very damaging to tissue. So even though it is helping to relieve pain it is destroying the very tissue that has inflammation and damage. It’s just a powder keg waiting to go off as soon as the cortisone’s effects wear off. So where does PRP fit into all of this? 


First, let’s start with the fact that PRP is natural. It comes from the same person that the PRP is being injected into. There are no chemicals, no compounds, or other products in PRP besides what is already naturally occurring within the blood. Second, PRP encourages the healing and recovery of damaged tissues instead of masking the problem. We have already established that PRP boosts the body’s ability to heal, therefore, we don’t need to worry about the destructive tendencies that cortisone or other steroid injections have. Lastly, PRP is long-lasting. PRP continues to work and be productive weeks and even months after the injection or series of injections. 


PRP has other benefits besides direct recovery and healing of tissue. Neurotransmitters are specialized molecules within the body to turn up or down certain functions within our body systems, mainly the nervous system. PRP specifically increases serotonin. Serotonin is vital as it affects our mood, emotions, appetite, digestion, and restful sleep. Serotonin is considered the happy neurotransmitter. A boost of serotonin helps us to feel happy, content, and level-headed instead of having drastic mood swings. And let’s be honest, having a more restful sleep is just great for anyone. All of these changes also occur with PRP. More than likely it isn’t a huge drastic change but a little bit can go a long way. 


Combine PRP with a healthy lifestyle and there is a potent combination for increased overall health. Dr. Micheal Baum is a renowned regenerative medicine specialist and had this to say about PRP: “If you eat well and try to take care of your body, you may make it to 80-85 years old, but if you want to reach 100 you will likely need PRP and other regenerative medicine procedures”. This may seem a little drastic but overall health care and longevity are in decline. Prescription medication and poor food options have led to this dilemma. Modern medicine has come a long way since bloodletting and exploratory surgical procedures, however, the advancement of certain medications to treat this and counteract side-effects of the other drug is just another way to mask problems instead of treating them at their core. These things also have detrimental effects on the possible longevity of cells and how well they are able to recover. The body is easily dependent and continuing to place products and medicine into the body changes its natural function. This is easily displayed with opioids and illegal drugs. This same pattern can also be visualized with prescription medication. But we digress, this is not an article about how the prescription medication is bad and should be avoided at all costs because there are situations where people need medical intervention with prescription medication in order to live and function. This being said, we can try and move away from using steroids and prescription meds and use our body’s natural healing processes to gain more efficient cellular function which leads to less degenerative processes from those cells that are less efficient. 


Let’s get back to the differences between steroids and PRP. Because of their nature corticosteroids or steroids, in general, are anti-inflammatory. So, in a small area corticosteroids will block the natural healing process within the body or what the body perceives as trying to heal chronic conditions such as tendonitis or ligament sprains. Over time with chronic conditions that have this cyclical pattern of being between inflammatory and noninflammatory, there is never a full recovery. PRP can then be used to break this cycle, create a miniature inflammatory response without the repercussions of damaged tissue, and boost healing and recovery. So what ends up happening is the area that is damaged, due to overuse or a traumatic injury or degenerative processes like arthritis, can get this massive boost of growth factors, stem cell migration, and differentiation to become healing cells for injured tissue and we see true healing and eventual pain relief. This is miles above the head and shoulders of what cortisone or steroid injections provide.


Now, here is where corticosteroids and PRP can become symbiotic. The steroid injection will reduce the inflammation and pain leading to fast relief. Then about 6 weeks later as the steroids start to exit the body and all its systems is when PRP can be incorporated. This is a potent combination when other methods of treating conditions and injuries just aren’t cutting it. In our office we make this a standard if someone has had a steroid injection then we encourage a PRP procedure to maximize the overall probability of permanently healing an injury or chronic condition.


PRP is very effective in treating multiple conditions and problems. The biggest caveat to this therapy is its efficiency and efficacy in obtaining the PRP product. First and foremost, is the quality of the PRP. Poor PRP can be beneficial but it will not be as effective if the collection of the PRP is not done well and if the plasma does not have a high concentration of platelets. Next is the physiologic state of the person that is needing PRP. If someone has a poor diet, does not exercise, and is unhealthy overall then the effectiveness of PRP goes down. In order to get good results from a therapy like PRP is it important to have a healthy lifestyle or at least start a more healthy lifestyle? Someone who does not eat well does not exercise or has a sedentary lifestyle will not get as good results as someone who is active, has a well-rounded diet, and takes care of their body. PRP is only as good as the physiologic state of the person that PRP is taken. In essence, the better the overall health of a person the more effective PRP will be.


We have touched on what kinds of conditions PRP can help treat but let’s go into a more extensive list. Chronic conditions that PRP can help treat are tendonitis in all its varieties, plantar fasciitis, osteoarthritis, disc bulges or herniations, rheumatoid and psoriatic arthritis, and ankylosing spondylitis. More acute conditions or injuries that can be treated with PRP are common sprains/strains, rotator cuff tears, post-surgery of joint or muscle repairs, and muscle tears. If there is something that is not mentioned on these two lists that you may be suffering from please call and we can determine through a thorough exam and history of the problem.


PRP is one modality that we use to help treat patients after a motor vehicle accident. Because of the musculoskeletal injuries sustained in a car crash, PRP is one of the best therapies that we offer. All of the reasons and conditions mentioned previously apply just the same for someone who has been in an auto accident. Many times PRP is the ultimate therapy for the treatment and recovery after a car crash. PRP is not limited to only those who can afford high-end medical procedures. It can be costly but the benefits outweigh the costs when someone can have lasting pain relief and full recovery from injury. In the world of car accidents or personal injury cases, it is very easy to justify the use of PRP for recovery and healing because car crashes are very damaging to soft tissue like muscles, tendons, ligaments and spinal discs. These injuries have long-lasting complications if not treated to full recovery or there is a buildup of scar tissue that results from inappropriate healing of the damaged soft tissues. PRP can be used to step in and treat these conditions to achieve complete and proper recovery with the regeneration of the damage done after a car crash.


PRP is a great option to be able to help heal and recover from new and old injuries or conditions. However, it may not be an option for everyone. It is all about how well the PRP can be obtained and the overall health of the patient which will impact the quality of the PRP. Low PRP quality will result in a low probability of results. 99 times out of 100 PRP can be acquired with minimal problems or imperfections. Results can vary however and PRP is not going to be 100 percent effective for everyone. Everyone will respond differently to PRP just like with almost any other procedure. Be mindful that PRP has good success when done properly by well-trained professionals but the success varies from person to person. In our office, we use many modalities that overlap in the treatment of different conditions and we base our decisions on what would be most effective in that specific moment with a history of the problem. 


In conclusion, PRP is valuable for the best recovery and regeneration of damaged tissue from degenerative processes or injury. The best quality of PRP is that it is derived from the person who is receiving the treatment so the risk of infection or side effects or other complications is infinitesimal. We combine PRP with ozone to make that risk almost non-existent (you can read about ozone in our other articles). A therapy that can be applied using constituents from the host is by far one of the best treatments that can be done to aid recovery and healing. Creating an environment where the body and its cells can be more efficient to slow down degeneration from aging or overuse is a wonderful option for therapeutic intervention and pain relief.