A Letter Released to Chiropractors on
December 27, 2010

Platelet Rich Plasma
Resetting the Healing Process for Chiropractic Patients

This past November, Dynamic Chiropractic published an article wherein Warren Hammer, DC, DACBO listed platelet-rich plasma as an alternative for patients with recalcitrant muscle strains or tendinopathies.¹  Across the nation, more and more DC / MD practices are adding platelet-rich plasma to their list of services.  Why would this therapy be more than an intellectual curiosity for chiropractic physicians?

As Scott Cuthbert, DC, BCAO points out, spinal health (and proper joint function in general) relies in part on dynamic stability (i.e. proper functioning of muscles and tendons).²  As illustrated by the work of Thomas Myers,³ any disruption in the kinematic chain creates disruptions elsewhere in the body.  Tendinopathies, chronic fasciitis, and non-healing muscle strains rank significantly among the lesions that can disrupt the kinematic chain.  Ideally, first line treatments for soft-tissue healing will help patients achieve full healing of muscles, tendons, and fascia.  The first line treatments would typically include protection, restricted activity, strengthening, conditioning, activity modification, etc.  Chiropractic mechanical load techniques such as Graston, ART, and fascial manipulation may also progress patients toward needed soft-tissue healing.  However, some patients prove recalcitrant to all first-line techniques.  Degenerative processes can become chronic for a tendon, fascia, or muscle. 

While platelet-rich plasma treatments have been around for decades, the use of platelet-rich plasma (PRP) for tendon and muscle complaints is a relatively new application.  The past two years have seen an explosion of published studies on the various uses of PRP.  Recent literature has connected PRP with improved healing in osteoarthritis,⁴  lateral epicondylitis / chronic elbow tendinosis,^5,6 rotator cuff tears,⁷ achilles tendinopathy,⁸ achilles tendon tears,⁹ jumper’s knee,^10,11 plantar fasciitis,¹² and muscle strains.¹³  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.¹⁴  The effects of PRP are enough to reverse some degenerative processes in tendons and fascia.¹⁵

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 injured area.  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.

When you have cases of tendon, muscle, or fascia complaints that do not resolve fully with first-line approaches, please feel free to call me to discuss complimentary medical treatments.

References

1. Hammer W. The latest on tendinopathy. Dynamic Chiropractic. November 18, 2010; 28 (24).
2. Cuthbert S. What are you doing about muscle weakness? Pt. 2: Cervical Spine. July 1, 2009: 27 (14).
3. Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone, Edinburgh, 2001.
4. Filardo G, Kon E, Buda R. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2010 Aug 26. [Epub ahead of print]
5. Peerbooms J, Sluimer J, Bruijn D, et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up.  Am J Sports Med. 2010 Feb;38(2):255-62.
6. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. The American Journal of Sports Medicine. 2006 November; 34 (11): 1774-1778.
7. Gamradt SC, Rodeo SA et al. Techniques in Orthopaedics 2007;22:26-33.
8. Gaweda K, Tarczynska M, Krzyzanowski W.  Treatment of achilles tendinopathy with platelet-rich plasma. Int J Sports Med. 2010 Aug;31(8):577-83.
9. Filardo G, Presti ML, Kon E, Marcacci M. Nonoperative biological treatment approach for partial Achilles tendon lesion. Orthopedics. 2010 Feb 1;33(2):120-3.
10. Filardo G, Kon E, Della Villa S, Vincentelli F, et al. Use of platelet-rich plasma for the treatment of refractory jumper's knee. Int Orthop. 2010 Aug;34(6):909-15.
11. Kon E, Filardo G, Delcogliano M. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper's knee. Injury. 2009 Jun;40(6):598-603.
12. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005;72:2237–2242.
13. Hammond J, Hinton R, Curl L. Use of autologous platelet-rich plasma to treat muscle strain injuries. Am J Sports Med. 2009 Jun;37(6):1135-42.
14. Lyras DN, Kazakos K, Verettas D. The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int. 2009 Nov;30(11):1101-6.
15. Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing.Sports Med. 2003;33:381–394.