Chronic tendon pain is debilitating. Rest and physiotherapy are the normal recommended routes to recovery. But, what happens if these don’t work? A procedure that involves an injection of platelet-rich plasma (PRP) has been shown to relieve symptoms.
Tendons are the soft tissues that connect muscle to bone. They can start to degenerate as a result of aging, overuse, injury and stress. Tendon damage can be:
(a) Tendinitis – an inflammatory condition
(b) Tendinosis, or Tendinopathy – tendon degeneration
Injections of platelet-rich plasma have been shown to be effective for each type of tendon pain.
How PRP injections work
Doctors don’t yet fully understand how the procedure works but many believe that platelets and plasma have natural healing properties that stimulate the damaged tendons to repair and heal. They may do this by stimulating the production of collagen, which is an important component of tendon and ligament tissue.
Some experts also think that they contain proteins that alter a patient’s pain receptors and reduce pain sensations.
Although how the process works remains unclear, the fact is that PRP injections do provide relief from symptoms for patients with chronic tendon pain and promote healing and repair in the damaged tendon.
What is platelet-rich plasma?
- Platelets release substances called growth factors and other proteins that regulate cell division. They also stimulate tissue regeneration, promote healing and help the blood to clot.
- Plasma is the liquid component of blood. It is mostly water but also includes proteins, growth factors, nutrients, glucose, and antibodies.
What does treatment entail?
Platelet-rich plasma is obtained from the patient’s own blood. A sample is taken and placed in a centrifuge and spun at high speed. This spinning causes the blood to separate into layers. Red blood cells, which make up around 45%, are forced to the bottom of the vial.
White blood cells and plasma – less than 1% of the sample – comprise the middle layer and platelet-poor plasma collects at the top (around 55%).
Your orthopaedic surgeon then extracts the necessary components to create a form of plasma with a higher concentration of platelets than is found in normal blood.
This is then injected into the damaged tendon to promote healing and relief from pain.
Is it effective?
There is a growing body of research that demonstrate the effectiveness of PRP therapy but more research is needed.
A recent study has show that PRP together with physiotherapy is effective in treating knee tendinopathies, relieving pain for upto 1 year.
Kaux JF, Bruyere O, Croisier JL, Forthomme B, Le Goff C, Crielaard JM. One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellartendinopathies. Acta Orthop Belg. 2015 Jun;81(2):251-6.
It can also more effective at treating chronic conditions such as plantar fasciitis, when compared to steroid injections.
Mahindra P, Yamin M, Selhi HS, Singla S, Soni A. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo. Orthopedics. 2016 Mar-Apr;39(2):e285-9
It appears to have a regenerative effect in the tendons for difficult conditions such as chronic Achilles tendonosis
Monto RR1. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014 Apr;35(4):313-8
The treatment can sometimes provide relief where other treatments fail. It carries few risks as the PRP is derived from the patient’s own blood, and reported side-effects are few particularly in comparison with other treatments such as cortisone injections, anti-inflammatories and minor surgery.
The advice from many orthopaedic surgeons is to use PRP in conjunction with other non-surgical treatments and lifestyle changes, such as physical therapy and weight loss.
