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WHAT
IS PLATELET RICH PLASMA?
Platelet Rich Plasma, or PRP is blood plasma with concentrated platelets.
The concentrated platelets found in PRP contain huge reservoirs of bioactive
proteins, including growth factors that are vital to initiate and accelerate
tissue repair and regeneration. These bioactive proteins initiate connective
tissue healing: bone, tendon and ligament regeneration and repair, promote
developmentof new blood vessels, and stimulate the wound healing process.
WHAT ARE TENDONS & LIGAMENTS?
Tendons, composed of collagen fibers, connect muscle to bone making it
possible for you to perform every day physical activities. Overuse or damage
to tendons over a long period of time causes the collagen fibers in tendons
to form small tears, a condition called tendinosis. Damage most often occurs
in the knee, ankle, shoulder, elbow, wrist, biceps, calf, hamstrings
and Achilles tendons.
Ligaments are also composed of
collagen fibers, connecting bone to bone i.e. joints: ankles, knees,
shoulders, spine, etc., stabilizing the joint and controlling the range of
motion. A damaged ligament is no longer able to provide support, weakening
the joints and shifting the burden of
support to muscles (and thence to the tendons) which should primarily act as
movement engines. Tendons and ligaments have poor blood supply particularly
where they connect to bone, (entheses). Once injured (sprains or
strains) they do not heal easily and the damage progresses with the stress
of day-to-day activities. As a result the tendons and ligaments become
inefficient, the muscles are over-taxed causing chronic pain and weakness
and further damage. Medical intervention may be necessary.
PRP INJECTION APPLICATION SITES:
SPINE
MIDDLE AND LOWER BACK, NECK
SHOULDERS
ELBOWS
WRIST AND HAND
HIP/PELVIS
KNEE
ANKLE AND FOOT
ARTHRITIC JOINTS
HOW DOES PRP THERAPY WORK?
To prepare PRP, a small amount of blood is taken from the patient. The blood
is then placed in a centrifuge. The centrifuge spins and automatically
produces the PRP. The entire process takes less than 15 minutes and
increases the concentration of platelets and growth factors up to 500%.
When PRP is injected into the damaged area it stimulates the tendon or
ligament causing mild inflammation that triggers the healing cascade. As
a result new collagen begins to develop. As this collagen matures it begins
to shrink causing the tightening and strengthening of the tendons or
ligaments of the damaged area.
I’VE HEARD OF CORTISONE SHOTS; IS THIS
THE SAME?
Studies have shown that cortisone injections may actually weaken tissue.
Cortisone shots may provide temporary pain relief and stop inflammation, but
do not provide long term healing. PRP therapy heals and strengthens these
tendons and ligaments. Strengthening and thickening the tissue up to 40% in
some cases.
WHAT ARE THE POTENTIAL BENEFITS?
Patients can see a significant improvement insymptoms. This may eliminate
the need for more aggressive treatments such as long term medication or
surgery as well as a remarkable return of function.
WHAT CAN BE TREATED?
PRP injections can be performed in tendons and ligaments al over the body.
Sports injuries, arthritic joints, lower back, degenerative disc disease and
more specific injuries including tennis elbow, carpal tunnel syndrome, ACL
tears, shin splints, rotator cuff tears, plantar fasciitis and iliolibial
band
syndrome may all be effectively treated with PRP.
HOW MANY TREATMENTS ARE NECESSARY &
HOW OFTEN IS THIS
THERAPY ADMINISTERED?
While responses to treatment vary, most people will require 1-3, some as
many as 6 sets of injections. Each set of treatments is spaced approximately
4 to 6 weeks apart. There is no limit to the number of
treatments you can have, the risks and side effects do not change with the
number of injections
IS PRP RIGHT FOR ME?
If you have a tendon or ligament injury and traditional methods have not
provided relief, then PRP therapy may be the solution. The procedure is
less aggressive and less expensive than surgery. It will heal tissue with
minimal or no scarring and alleviates further degeneration of the tissues.
there will be an initial evaluation with your doctor to see if PRP therapy
is right for you.
ARE THERE ANY SPECIAL INSTRUCTIONS?
You are restricted from he use of non-steriod antiinflammatory medications (NSAIDs)
one week prior to the procedure and throughout the course
of treatments.
Initially the procedure may cause some
localized soreness and discomfort. Most patients only require some
extra-strength Tylenol to help with the pain. Ice and heat may be applied to
the area as needed. The first week after the procedure, patients will
typically start a rehabilitation program with
physical therapy. However, aggressive physical activity is discouraged.
HOW SOON CAN I GO BACK TO REGULAR
PHYSICAL ACTIVITIES?
PRP therapy helps regenerate tendons and ligaments but it is not a quick
fix. This therapy is stimulating the growth and repair of tendons and
ligaments requiring time and rehabilitation. Through regular visits your
doctor will determine when you are able to resume regular physical
activities.
DOES INSURANCE PAY FOR PRP?
With the exception of Medicare, some insurance companies, including workers
compensation may cover partial reimbursement after pre-authorization.
Before and after treatment with Platelet Rich Plasma (PRP)
Before
treatment:
-
Your initial visit to the Center for Sports and
Osteopathic Medicine in relation to platelet Rich plasma injection will
consist of a full physical assessment based on injury or physical
complaint which MAY
include x-rays, diagnostic ultrasound, blood work, range of motion
and/or strength measurements, MRI if needed. If you are a runner we ask
that you bring your running shoes and, if you have them, orthotics with
you so that your foot strike pattern can be properly evaluated.
-
If taking NSAIDS( anti-inflammatories
i.e.: Motrin, Naprosyn, Advil, Aleve, aspirin [other than low-dose
aspirin] etc.) please discontinue 2-4 days prior to treatment
-
Follow your normal daily routine on
procedure day, make sure to drink plenty of water. The test procedure
will take approximately 1 hr.
-
Upon arriving at the Center your blood
will be drawn and you will be prep'd for your procedure. Your blood will
be spun down in a special centrifuge which takes about 15 minutes.
-
The painful/tender areas will be marked
and numbed with local anesthesia.
After 10 minutes you may be asked to test
the areas of pain by walking, running, going up and down stairs, moving your
limb in range of motion, if you are pain free, then your Platelet
Rich-Plasma (PRP) will be injected into the same areas that have been
numbed.
Post-treatment:
-
You may be numb in the areas treated for
4-6 hrs after the procedure.
-
Due to the numbness we ask that you
refrain from any strenuous activities but
STAY
as mobile as possible. If some of
the local anesthetic should wash out into the tissues surrounding some of
the larger nerves, you may notice weakness and numbness of part of a limb.
Be assured this is transient and should not be a cause for undue concern.
-
After the anesthesia wears off you may
resume activities to tolerance of pain.
-
You will experience some pain and
soreness for 2-5 days after your treatment.
-
No anti-inflammatory medication (see
above or ask Dr. Bachrach) for 4-6 wks after treatment.
-
You may take Tylenol (acetaminophen) up
to 4 g daily.
-
If excessive pain is anticipated, you
will be given a prescription, on request, for a stronger painkiller such
as an opioid. Such medication is only rarely necessary, but excessive
pain is not useful.
-
You may use ice, adequately insulated, as
needed for pain and/or swelling (10 minutes to cool the skin, repeat
every 2-3 hours as needed). Be sparing of your use of ice beyond 3
weeks postinjection.
-
Follow a program for flexibility and core
strengthening to rehabilitate and correct any imbalances in the kinetic
chain.
-
Follow the 10% rule and the FIT
principles for returning to activities to decrease the incidence of
re-injury and increase the healing potential.
What you consider to be a
normal level of activity may, in fact, be outside the envelope. Please
make sure you review the extremes of your activity levels with Dr.
Bachrach and/or your physical therapist before you resume "normal"
activities
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You may experience the “roller coaster”
syndrome where you feel great one day and for no apparent reason the
area treated starts to hurt again, this is normal in the healing
process.
-
The platelets are active for 6 weeks and
it can take up to 6 months for normal collagen to form and heal
completely.
-
Our goal is 80 % improvement in pain, so
you may or may not need more than 1 treatment to reach that goal. Some
times a series of 2-3 treatments are needed to achieve complete healing.
If subsequent treatments are needed they are usually performed 4 weeks
apart.
Autologous Platelet Concentrate and
Prolotherapy
Individuals undergo Prolotherapy (ligament reconstruction/ injection
therapy) for a variety of reasons. For some the decision is prompted by the
need to repair damage caused by trauma, birth defects and/ or the aging
process. In the past ligament and tendon repair (ligament reconstruction
therapy, regenerative injection therapy, prolotherapy) has been initiated,
stimulated and/or accelerated by injection of naturally occurring
substances, principally dextrose (sugar), frequently augmented by sodium
morrhuate (cod liver oil), glycerin, phenol, etc. into the injured areas (
i.e. tears at the attachment of ligaments or tendons to bones (entheses) and
at the apposing surfaces of bones involved in delayed or nonunion of some
fractures. These and other substances are used to stimulate a normal
controlled inflammatory cascade and thus the production of the body's
natural growth factors which promote healing. With the advent of techniques
for office production of Autologous Platelet Concentrate (APC+),
regenerative injection therapy, ligament reconstruction therapy,
Prolotherapy, is being revolutionized.
APC + is made from a small sample of your
own blood (approximately 1 1/2 ounces). The process concentrates the
platelets found in the blood sample. These concentrated platelets contain
huge reservoirs of growth and wound healing factors. Growth and wound
healing factors are natural components of your body. Clinical data has
shown that growth and wound healing factors may enhance and accelerate your
body's normal healing process. The use of APC+ may increase the healing
rate, reduce injection and postinjection pain, decrease overall healing
times, reduce the frequency and number of Prolotherapy injections necessary,
the total volume of injections, and consequent bleeding and bruising.
HOW LONG HAS APC + BEEN USED?
APC + has been used clinically for over a decade by leading clinicians
and specialists such as dental, ear nose and throat, facial plastic and
reconstructive, orthopedic, cardiovascular, plastic surgeons and in wound
healing, to deliver a cocktail of natural bioactive growth factors.
IS APC + SAFE?
APC + is derived from a small quantity of your own blood drawn at the
time of the injection procedure. APC + is made point -of-care at the time
of injection and under your physician's control. Also since he APC + is
made from your own blood, it is insulated against the risk of disease
transmission.
WHO MAKES APC +?
Historically, the production of APC + at the time of surgery was
complex, time-consuming, expensive, and required large blood volumes. The
process often involve outside personnel and a transfusion of blood
products. The recent introduction of small automated office-based APC +
systems make the benefits of APC + practical in the office and outpatient
setting. Now your physician or his assistant can prepare a PC + in parallel
with the injection procedure.
HOW IS APC + MADE?
Approximately 20-50 cc of your blood is drawn just prior to the
procedure. The blood is placed in a specialized centrifuge that spins it
and automatically separates the red blood cells from the plasma. The plasma
is then further centrifuged to concentrate the autologous platelets and
enhance your natural growth factors. The APC + is then available for use as
needed. The entire process takes less than 15 minutes and adds no extra
time to the procedure.
WHAT IS AUTOLOGOUS PLATELET
CONCENTRATE (APC)?
Autologous platelet concentrate (APC +) is composed of platelets in
plasma. Platelets per tiny cells that are partially responsible for causing
blood to clot. Platelets also contain large reservoirs of natural growth
factors. While a normal concentration of platelets circulating in your
blood is 200,000 per microliter, the platelet count in PRP can exceed 2
million platelets per microliter.
WHAT ARE GROWTH FACTORS?
Platelets contain potent growth factors necessary to begin tissue repair
and regeneration at the wound site. Growth factors derived from platelets
initiate connective tissue healing, bone regeneration and repair, promote
development of new blood vessels and stimulate the wound healing process.
IS AUTOLOGOUS PLATELET CONCENTRATE
ENRICHED WITH GROWTH FACTORS (APC +) FOR YOU?
The use of APC + is considered by many to be a new frontier of clinical
therapy. Since APC + can be used in so many types and procedures and for so
many types of patients you should discuss your specific problem with your
doctor.
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