A Letter Released to Physicians on
October 04, 2010

Platelet Rich Plasma
for Tendon and Muscle Complaints

The past two years have seen an explosion of published studies on the various uses of platelet-rich plasma (PRP).  One of the more recent applications for PRP has been for the improvement of muscle and tendon complaints – especially chronic, recalcitrant problems.  Recent literature has connected platelet rich plasma with improved healing of lateral epicondylitis / chronic elbow tendinosis,^1,2 rotator cuff tears,³ achilles tendinopathy,⁴ achilles tendon tears,⁵ jumper’s knee,^6,7 plantar fasciitis,⁸ muscle strains,⁹ and osteoarthritis.¹⁰  At my private, referral-based practice, we provide platelet-rich plasma treatments for tendon and muscle complaints, and we have seen some very positive results.

PRP treatments involve the injection of autologous blood concentrated with platelets into the injuredarea.  First we draw 20-60cc of venous blood from the patient and spin it down in a specially designed centrifuge.  The centrifuge process takes approximately 15 minutes.  We administer a local anesthetic to the skin and subcutaneous tissue to maximize comfort during the PRP injections.  Treatments usually involve multiple PRP injections over the injured area. The treatments may only be needed once or they may be repeated as needed once every four to eight weeks.  There are no known side effects other than those typically associated with injections.  The use of autologous blood negates any risk of immunogenic reactions or disease transfer from the plasma. 

It is now known that platelets contain multiple growth factors important in three different stages of the tissue repair process (e.g. transforming growth factor beta, vascular endothelial growth factor, platelet derived growth factor, and epithelial growth factor).  Injection of PRP in areas of injury has been shown to speed the healing process, enhance neovascularization, improve the organization of collagen fibers, and promote scar tissue of better histological quality. ¹¹  The effects of PRP are enough to reverse some degenerative processes in tendons and fascia.¹²     

Many cases of tendinopathies, muscle strains, and muscle sprains will resolve with more standard treatments – ideally with strengthening, conditioning, and activity modification.  Corticosteroid injections may have certain drawbacks such as increasing the risk of future injury by masking pain, subcutaneous atrophy caused by superficial injections, and permanent adverse changes within the ultrastructure of tendons caused by intratendinous injection.¹³  Repeated, local corticosteroid injections have been linked to plantar fascia rupture by multiple studies.^14-17  Peerbooms and colleagues found PRP treatments to be superior to corticosteroid injections for lateral epicondylitis (73% success vs. 49% success).¹   When you have cases of tendon or muscle complaints that do not respond fully to first-line approaches, please tell your patients about the pain medicine practice of Neal Taub, MD, physiatrist.

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