Platelet Rich Plasma (PRP)
Your blood is made up of mostly liquid (plasma) but it also contains some solid components (red blood cells, white blood cells, and platelets). Platelets are best known to be responsible for blood clotting, however they are also a rich source of growth factors and other proteins that enhance your natural healing and growth processes which are very important in the recovery of injuries. PRP is a concentration of platelets (therefore growth factors) in a small volume of plasma which is prepared by drawing your own blood, extracting the platelet rich portion by centrifugation, and then injecting back into the affected area.
PRP is an emerging treatment in a new health sector known as “orthobiologics”: the philosophy of which is to merge cutting edge technology with the body’s ability to heal itself. When injected, the concentrated platelets release huge reservoirs of bioactive proteins, including growth factors that help to initiate and accelerate tissue repair and regeneration. PRP initiates the body’s natural processes necessary for the repair of damaged or worn tissue, such as tendons, ligaments, cartilage and muscle.
A systematic review of all the recent research has confirmed the benefit of PRP in alleviating pain in osteoarthritis of the knee. It can also be used to treat all other osteoarthritic joints such as the ankle, thumb, big toe and hip.
PRP is increasingly being used as an alternative to a steroid injection to treat tennis or golfer’s elbow as well as many other tendinopathies. It can also be used to treat partial tendon, ligament or muscle tears as well as both acute and chronic injuries and may be recommended where conservative treatments have failed.
The main benefit of PRP is that it uses the body’s own natural healing properties to alleviate a pain or problem in the musculoskeletal system. Unlike steroid injections, there are no limits on the number of injections you can have.
PRP FAQ’s
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PRP treatment may involve a single injection or additional injections over time, depending on the condition being treated, its severity and how you respond to treatment.
For some tendon conditions, one injection may be sufficient. For osteoarthritis, the benefits of PRP may last approximately 6–12 months, and treatment may be repeated if symptoms return and your provider feels another injection would be appropriate.
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PRP does not usually prevent you from having surgery, but the timing of the injection may be important. If surgery is planned on the same joint, many surgeons prefer to wait approximately 12 weeks after a PRP injection before operating.
If surgery is planned on a different joint, the injection will not usually affect the timing of surgery. Always let your surgeon know about any recent injections, including the type of injection, where it was given and when it was performed.
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The effectiveness of PRP varies depending on the condition being treated, such as knee osteoarthritis, tennis elbow or rotator cuff tendinopathy, as well as individual factors including age, severity of the condition and overall health.
At ASMC, we have seen positive results with PRP and are currently reviewing outcomes from patients treated at our clinic. This will help us better understand how PRP has affected our own patient population.
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These injections tend to have a more gradual effect. Some people begin to notice improvement within 2–4 weeks, but it may take 6–12 weeks or longer to experience the full benefit.
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nSTRIDE (autologous protein solution) is a version of PRP that is spun in the centrifuge twice and is specifically indicated for osteoarthritis. The second spin isolates more of the anti-inflammatory proteins.
Studies show that nSTRIDE has a longer duration of effectiveness and can last for multiple years.
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PRP has relatively minimal risks because it is prepared from your own blood. Your blood is processed in a centrifuge to concentrate the platelets, which are then injected back into the treatment area. This means there are fewer medication-related risks than with treatments involving a drug or other foreign substance.
As with any injection, there are still potential risks and side effects. These may include temporary pain, soreness or swelling at the injection site. Some patients may also experience a temporary increase in pain after the injection as part of the body’s response to treatment. This post-injection flare usually improves within 24–48 hours, although symptoms may occasionally last longer. There is also a small risk of infection with any injection procedure.
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This is considered an elective procedure and not funded by OHIP.
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Some private insurance plans may offer partial coverage under extended health benefits, but that varies and often requires patients to submit claims themselves.
The areas we have seen patients have PRP/nStride covered by their Extended Health Benefits are through “Health Spending Accounts” or as a “Medical Device” category.
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Yes. Cortisone can decrease the effectiveness of PRP. It is recommended to wait 6-8 weeks post cortisone injection before doing PRP to get maximum effectiveness.
It is also recommended not to have cortisone 6-8 weeks after a PRP injection. This is more applicable to the area that was injected with PRP as opposed to injecting cortisone in a different area. However, the administration of cortisone in any area has the potential to decrease the effectiveness of the PRP.
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No there is not an interaction between hyaluronic acid and PRP. In fact there have been recent studies looking at using the two together, as they work differently, to further improve outcomes.
Combining the two may not be possible depending on the size of the joint/severity of the condition due to the lack of physical space for the amount of fluid that will be injected. This would be assessed on an individual basis.
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Avoid the use of NSAID’s 48 hours prior to injection. These may include but are not limited to Advil (ibuprofen), Aleve (naproxen), Aspirin (ASA). This includes both oral and topical formulations.
Drink plenty of water (1-2 L) starting the day before as well as the day of the injection as this helps make the blood draw easier.
If pain relief is needed, Tylenol (acetaminophen) may be used. Heat or ice may also be used for symptom relief before the procedure, if needed.
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We recommend allowing approximately 60–90 minutes from arrival to departure for your PRP appointment. Most appointments are completed toward the shorter end of this timeframe, although the total time can vary depending on the treatment area and the time required to prepare the PRP.
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Yes, we use ultrasound guidance with our PRP injections. It is not necessary for all injections but is available and most often used.
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Rest the injected area for the first 24-48 hours. You can do day to day activities but avoid strenuous activities or heavy lifting.
Gradually return to low-impact activity after 2-3 days, as tolerated.
Avoid high impact activities (running, jumping, heavy weight training) for at least 1-2 weeks.
Avoid the use of NSAIDs for 10–14 days after your injection, unless otherwise directed by your healthcare provider. These include medications such as Advil (ibuprofen), Aleve (naproxen) and Aspirin (ASA), including both oral and topical formulations.
If pain relief is needed, Tylenol (acetaminophen) may be used. Heat or ice may also be used for symptom relief before the procedure, if needed.
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It is recommended to have a driver for hip joint injections. Most injections are ok to drive afterwards, but you may experience pain due to the injection, so it may be beneficial to have someone drive you.
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There is no set time between injections. We often suggest waiting 6-8 weeks between injections in the same body part so that the full effect may be evaluated before deciding if you need another one.
If you get an injection in one body part, you can get a PRP injection into a different body part at any time.
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PRP is being studied for a variety of spinal and back-related conditions, but its role in treating spinal cord injuries is not yet well established.
At ASMC, we do not perform injections into the spine itself, including the spinal canal or spinal structures in the neck or back. In select cases, PRP may be used to treat the paraspinal muscles and other soft tissues surrounding the spine. We have seen positive results in appropriately selected patients, and your provider can determine whether this type of treatment may be suitable for your condition.
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Whether you can return to work after an injection depends on the area being treated, your baseline symptoms and the physical demands of your job. Some patients are able to return to work the same day, particularly if their work is sedentary or involves light duties.
If your job is physically demanding, involves heavy lifting or places significant stress on the treated area, you may need to modify your duties or take some time away from work. Temporary soreness or discomfort after the injection may also affect what you are comfortable doing.
Your provider can offer guidance based on the type of injection, the area treated and the demands of your occupation.