Platelet-rich plasma therapy big with athletes
MINNEAPOLIS – On December 10, 2011, Portland guard Brandon Roy announced his retirement. He was 27 years old at the time, at the end of just his fifth year in the league. He’d been the NBA Rookie of the Year in 2007 and was a three-time All-Star.
Yet in the face of chronic knee problems, none of that mattered.
Roy retired due to persistent issues in both of his knees. He’d undergone six knee operations, and there was no longer any cartilage remaining in the joints. Trail Blazers team doctors warned him that he should not continue playing and that to do so would have devastating long-term effects.
Not even a year later, and he’s announced his comeback. Many teams have expressed interest in signing him, including the Timberwolves.
That’s quite the turnaround for a player who was warned that to play basketball any longer might spell difficulties walking later in his life. It’s the kind of story where one wonders what detail is missing; the turnaround is too drastic. And in that brief narrative, something was missing: platelet-rich plasma (PRP) therapy.
PRP therapy is a process by which a small quantity of blood is extracted from a patient. The blood is then placed in a centrifuge and spun until it separates into its component parts. Doctors then remove the platelets and inject them back into the patient at the point of injury, peppering the surrounding area with injections for maximum efficacy. The growth factors in platelets are said to promote healing and tissue regeneration, speeding the healing process.
The therapy has been used for nearly a decade, but it’s received increased attention in recent years. There’s no medical consensus on it yet, and it’s still a procedure that’s largely relegated to athletes and patients with disposable income. It can cost between $500-$2,000, though prices do vary, and it’s rarely covered by insurance.
Dr. Bradley Nelson, a physician at the University of Minnesota School of Medicine, said that the most common use of PRP therapy is for chronic tendinopathy. That’s different from the case in Roy’s knees, where he’s lacking cartilage. Using PRP therapy cases like Roy’s, though, is becoming more widespread, but it doesn’t have the same healing effects as it does in treating tendinopathy, such as tennis elbow. Recent studies have begun to indicate that PRP can be effective in reducing the pain of arthritis, and using the therapy in such treatments is the newest trend in PRP.
“Some people are injecting (PRP) into the knee joint in patients that have early osteoarthritis, and they can feel better,” Nelson said. “It does not grow new cartilage. It does not reverse the course of cartilage damage. It just helps with the pain associated with arthritis.”
For a case like Roy’s, more experimental stem cell treatments might hold a better chance in actual healing. It’s unclear whether Roy has undergone any such stem cell treatments, but he has received PRP therapy in both his hamstring and his knees. In recent years, some of the biggest names in sports have been associated with the therapy, most notably Kobe Bryant. Bryant, who received the treatment in Germany during the summer of 2011, had been suffering from lingering problems with an arthritic joint in his right knee.
“It wasn’t long before the sports community figured out this stuff is really powerful,” said Dr. Mayo Friedlis of the Capitol Spine and Pain Centers, a Washington, D.C.-area practice. “It’s much better than cortisone and much better than surgery in a lot of cases. So athletes wanted to maintain their careers of course jumped on it.”
Other well-known players have also acknowledged trying PRP therapy, and today, many professional sports teams’ training rooms contain a centrifuge. Hines Ward received a variation of it just weeks before Super Bowl XLIII, and Tiger Woods, Fred Couples, Alex Rodriguez, Tracy McGrady, Chris Canty and Cliff Lee are among other athletes who have tried it.
Right now, PRP therapy is still breaking into the mainstream, but it’s widely accepted in the medical community. In fact, the therapy is nothing new; Friedlis has been using it for about seven years, and it actually was first pioneered longer ago than that. Originally, Friedlis said, a form of PRP was used after open-heart surgery to help the sternum mend, and since then it’s been used intraoperatively, especially in plastic and orthopedic surgery.
“This is the tipping point,” Friedlis said. “You’re seeing it right in front of your eyes. Biologics like PRP and stem cells are going to the wave of the future for treating any musculoskeletal injury, because first of all, they tap right into the body and heal it. They’re not just treating pain; they actually heal it, and they’re doing it in a natural fashion, so the healing that you get is true healing.”
So far, there’s not a sufficiently large body of research on PRP therapy for it to be covered by insurance companies, but that’s not to say that doctors aren’t taking advantage of it. Friedlis said that it’s such a natural process – using the body to heal the body – that it doesn’t have many potential negative side effects, making it something with which doctors are more willing to experiment. Even Nelson, who’s more cautious about the therapy’s efficacy, said that research has not found negative side effects, which makes it a procedure with which it’s easier to experiment.
Although the research on the therapy is limited, it’s inconclusive, and Friedlis cautioned that many researchers have not yet standardized the proper ways to administer the therapy in their studies. For instance, some studies involve just one injection at the site of the tear, rather than several surrounding it, Friedlis said. Others use any of about 20 different types of equipment, making it difficult for the results to be universally applicable. Even physicians, Nelson said, administer the therapy in different ways, and the consensus is still out as to the precise best way to deliver the therapy over different instances and injuries.
One recent study published in the British Journal of Sports Medicine by Dr. Leon Creaney, a London-based doctor, found that PRP injections were no more effective than whole blood injections in treating tennis elbow after three months and that whole blood was more effective after six months. However, another study by Dr. Allan Mishra at Stanford University found PRP more effective than cortisone in treating tennis elbow.
Much of the research support for PRP therapy has been derived from studies in which the procedure worked on mice. In such studies, muscle contusions and lacerations were inflicted upon the mice, and the therapy accelerated healing. Looking at the differences in study results, the changes efficacy might lie in the injuries themselves. The lacerations and contusions were acute injuries, the type that cause the body to initiate a much for effective, quick healing response. Injuries that most athletes suffer, everything from professionals’ knee problems to a mild case of tennis elbow, are the result of overuse. Those kinds of injuries cause the body to react differently, perhaps reducing PRP’s ability to enhance healing, and Nelson said that PRP’s efficacy in acute injuries is more agreed-upon than its effects in other circumstances.
That research, however, pales in comparison to the success stories and athletes who swear by PRP, and it’s too early in the process of learning about the therapy to allow such studies to take away from its possible impacts. In spite of its only recent popularity, or perhaps because of it, PRP is becoming more and more prevalent among athletes, and the procedure is fully acceptable in American professional sports.
There are few roadblocks to the procedure for athletes – it’s perfectly legal, and they have the financial resources to try it – and the only questions that remain are about its long-term efficacy. Many players who’ve undergone the treatment have improved; only a minority has not. Whether that improvement is a result of true healing or just pain reduction can depend on the injuries themselves and even on doctors’ opinions.
So far, there have been few downsides to trying the procedure. It hasn’t harmed an athlete’s performance, nor has it worked as an illegal performance enhancer. It’s simply a means of healing and pain relief, so teams whose players want to experiment with it shouldn’t take issue. The bigger questions come with athletes like Roy, whose problems were once so crippling that they were forced to retire. Can PRP therapy, especially in Roy’s case, where it might only provide pain relief, really cause such a turnaround? Or is a more experimental stem cell procedure necessary? There’s no way to prove Roy’s recovery empirically, and as a works out and meets with teams in the coming days, it’ll be up to them to judge.
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