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I am a physical therapist interested in platelet-rich plasma (PRP) treatment for sports injuries. Some of the more recent research suggests that the inflammatory process at the beginning of an injury should not be slowed down by using ice or taking antiinflammatory medications like ibuprofen. But what about the PRP treatment? Doesn't that introduce an elevated number of white blood cells and growth factors? Doesn't that heighten the inflammatory process?You are right about the recent re-thinking on the use of antiinflammatory medications following acute injuries. Ice and ibuprofen have been the first line of treatment for swelling for a long time. And come to find out (as you suggest), this may not be helpful.
It has been determined that treatment should be geared toward reducing but not eliminating the swelling. The goal is to prevent an overreaction by the immune system but without stopping the inflammatory process.
(PRP) (also known as blood injection therapy) is a medical treatment being used for a wide range of musculoskeletal problems. Platelet-rich plasma refers to a sample of serum
(blood) plasma that has as much as four times more than the normal amount of platelets. This treatment enhances the body’s natural ability to heal itself and is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries.
Platelets are part of the blood that circulate around the body ready to help with blood clotting should you have a cut, broken bone, injury that bleeds internally, or any other type of injury. Besides containing clotting factors, the platelets release growth factors
that help start the healing sequence.
With a concentrated amount of platelets, larger quantities of these growth factors are released to stimulate a natural healing response. Plasma is the clear portion of the blood in which all the other blood particles such as platelets, red blood cells, and white blood cells travel.
Blood injection therapy of this type has been used for knee osteoarthritis, degenerative cartilage, spinal fusion, bone fractures that don’t heal, and poor wound healing. This treatment technique is fairly new in the sports medicine treatment of musculoskeletal problems, but gaining popularity quickly.
In theory, blood injection therapy could be used in any area where a rapid healing response is desired such as the tendon-muscle junction, muscle injuries, torn ligaments, damaged joints, or inflamed tissue (e.g., plantar fasciitis).
Torn tendons and ligaments don’t always heal well because they have a poor blood supply. Connective tissues such as ligaments and tendons heal by filling in with scar tissue that doesn’t bear the brunt of large loads well. This increases the risk of re-injury.
Other available treatments for chronic tendon problems do not necessarily improve the tendon’s ability to heal in the same way that PRP does. And injections of PRP don’t have the side effects that can occur with steroid injections or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs).
More recent studies have started to show that there is considerable variability in the number of platelets (with their growth factors) and white blood cells in samples of platelet-rich plasma. Some methods of preparation actually yield high levels of these substances while others produce much lower levels.
This information is helpful when considering what you have pointed out: too many white blood cells can cause an overreaction in the tissues. And too much inflammation at certain points in the healing process may not be a good idea.
Perhaps the double spin method (which yields lower levels of platelets and white blood cells) would work best when a mild healing response is needed. Likewise, there may be times and situations where increased antibacterial and an increased immune response would be helpful. In those cases, the single-spin method might be the most useful. Physicians may want to take this fact into consideration when selecting the preparation method used to develop the platelet-rich plasma used in injection therapy.Augustus D. Mazzocca, MS, MD, et al. Platelet-Rich Plasma Differs According to Preparation Method and Human Variability. In The Journal of Bone and Joint Surgery
. February 15, 2012. Vol. 94A. No. 4. Pp. 308-316.
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