PRP injections: Does platelet-rich plasma therapy work?

Creator: SingleCare
Published: 2020-06-16T18:02:40-04:00

By SingleCare Team | Jun. 16, 2020 Medically reviewed by Anis Rehman, MD

Regenerative medicine is a promising new frontier. Therapies like platelet-rich plasma (PRP) treatment harness the power of the body’s considerable ability to heal itself. Using a patient’s own platelets, PRP injections work by expediting the healing process, particularly for injuries that are slow to heal and even chronic. Many astounding claims are being made for this bold new therapy, but through research and consultation with healthcare providers, it is possible to figure out if PRP is the right treatment option for you.

What is a PRP injection?

Platelet-rich plasma is a preparation of the patient’s own blood so that it has an above-average concentration of platelets. When injected back into the patient at an injury site, it jump-starts the healing process there.

Platelets are tiny, disc-shaped cells in the bloodstream. They serve as the body’s fixers, forming blood clots when there is an injury. When an injury activates them, platelets go to work, form blood clots, and rapidly release growth factor proteins to start the healing process. These proteins signal cells in the injured area to grow, differentiate, produce new blood vessels, and lay down fibrous tissue to repair the damage.

Platelet-rich plasma therapy involves drawing blood from the patient and spinning it in a centrifuge. This process separates the red blood cells and most of the white blood cells from the blood plasma, which consists of water, electrolytes, proteins, and platelets. The platelet-rich plasma separates from other blood components and returns to an injured part of the body through an injection. The platelets are often activated before injection, meaning the clotting process is artificially started before the platelets are introduced to the injured area. Some physicians, however, believe it is better to let the platelets activate within the body. When activated, the platelets immediately start to clot and produce growth factor hormones that start healing the affected area.

Except for surgery, these procedures are usually outpatient. The healthcare provider will draw blood, prepare the blood in a centrifuge, and reinject the platelet-rich plasma directly at the site of the injury with or without activating the platelets first. The healthcare provider may use a local anesthetic at the injection site first. Some procedures may require the use of ultrasound or an endoscope to help the doctor guide the injection to the injury.

Uses

For most injuries, the body heals itself fairly quickly and doesn’t require special interventions. PRP treatment is most commonly used to treat conditions where the healing process is frustratingly slow, such as injuries to the muscles, tendons, or bones. These slow-healing injuries can take months or even years to resolve, but platelet-rich plasma therapy can speed up the process. Most patients will encounter platelet-rich plasma therapy as an elective procedure for sports injuries, chronic tendon injuries, and hip or knee osteoarthritis.

Safety

However, the FDA has not approved PRP treatment. The FDA has “cleared” the centrifuges, but not the treatments, so every PRP treatment is technically “off-label” and not covered by insurance.

What’s more, not all doctors and scientists agree about which conditions should be treated by PRP.

Additionally, there’s little consensus on PRP treatment protocols. There are fundamental disagreements about platelet-rich plasma preparation. How many platelets are needed? Should white blood cells be included? What about fibrin, a protein critical to blood clotting? Should it be included? Is activating the platelets before the injection a good idea? The answers to all these questions are still being discussed and debated in the medical and scientific community.

Navigating through the thicket of claims can be difficult when deciding on whether PRP is the right medical treatment. Fortunately, the science and experience with PRP treatment are solid for some injuries and conditions. For others, however, the science is less conclusive. The place to start is with the conditions PRP treats and the research that backs up the claims.

PRP treatments

Platelet-rich plasma treatment was first used in open-heart surgery to speed up wound healing due to the operation. Maxillofacial surgeons started using it to accelerate the healing of bone procedures, such as jaw reconstruction. Soon, sports medicine professionals adopted platelet-rich plasma injections to speed up sports injury recovery, and that’s when the rest of the world began to pay attention.

Today, PRP treatment is useful for a full spectrum of conditions:

Orthopedists and sports medicine physicians use it for bone, tendon, joint, ligament, and muscle injuries.
Dentists use PRP injections for tooth extractions, implants, or periodontal surgery to speed up recovery as well as heal soft tissue damage and bones.
Surgeons of all stripes use PRP to speed wound healing and reduce infection rates.
Plastic surgeons have long used PRP to speed the healing process of cosmetic surgery, but some use PRP injections to promote connective tissue growth in the face to smooth out wrinkles and restore skin color.
Dermatologists use PRP along with the medications minoxidil or finasteride to reverse hair loss in men and women. Platelet growth factors stimulate the hair follicles to grow, and the medications manage the effects of testosterone on the hair follicle.
Some ophthalmologists have started using PRP eye drops directly on the eye surface for corneal ulcers or dry eye injuries. PRP eye drops placed directly on the tear glands can increase tear production.
Otolaryngologists have used PRP injections to treat hearing or smell loss.
Finally, some urologists give PRP injections to treat erectile dysfunction.

Not everyone is a candidate for PRP injections. You should not get a PRP injection if you:

have low platelet counts
take blood thinners
have cancer
are pregnant
have an active infection

Does PRP really work?

For some conditions, platelet-rich plasma treatment is controversial and not solidly supported by science. Individual practitioners report dramatic results, but the supporting studies often include only a small sample of patients. Some studies show dramatic improvements, and some show the opposite.

There is no universally accepted “right way” to prepare a PRP injection. Several factors that could influence the success of a PRP injection are still debatable, including when to activate the platelets, whether white blood cells in the injection help or hinder the healing process, and how much fibrin (a blood-clotting protein found in plasma) should be included with the injection. In other words, there is no established protocol for PRP injections relative to any of the conditions that they treat.

As a result, there is no consensus on a “success rate” for PRP injections. Depending on the condition and the PRP injection preparation, a PRP injection may or may not work.

Tendon, muscle, and ligament injuries

For other conditions, however, PRP treatment has strong support and has achieved excellent results. The science is persuasive that PRP injections are a highly successful treatment for tendon injuries (tendinopathy). These include tennis elbow (epicondylitis), rotator cuff injuries, “jumper’s knee” (patellar tendonitis), Achilles tendonitis, plantar fasciitis, and tendinosis, among others.

All these tendon injuries are notoriously difficult to treat and manage. They take a long time to heal and can significantly decrease the quality of life for active people. Many develop into chronic and even lifetime conditions. The success rate of PRP injections for resolving these conditions is very high.

The use of PRP in treating muscle soft tissue injuries and ligament injuries is a little less certain. The evidence so far indicates that PRP does speed up healing time. Recovery from a muscle injury (such as a pulled hamstring) or a ligament injury (such as an ankle sprain) can be a long and complicated process. Many of the PRP effects contribute to faster recovery from muscle and ligament injuries.

Arthritis and cartilage regeneration

The science supporting the use of PRP in treating cartilage injuries is more uncertain. Osteoarthritis, the most common and debilitating of cartilage conditions, has long been a candidate for PRP injections. However, cartilage has only a minimal ability to grow and regenerate. In one study with 200 osteoarthritis patients, PRP injections reduced pain and increased function after 12 months compared to other patients.

So PRP injections may help cartilage regenerate better than other treatment options, making it a reasonable alternative to steroid or hyaluronic acid injections. However, all therapies intended to regenerate cartilage (including PRP) have mixed results. More studies are needed in this area.

PRP for other health problems

The use of PRP in dentistry and surgery is equally well-supported. Platelet-rich plasma both speeds up healing and significantly reduces the incidence of infection.

However, PRP treatments in urology, ophthalmology, dermatology, cosmetic surgery, and other areas need more study. Patients considering PRP treatment for conditions other than tendon, muscle, or joint problems should do their due diligence and research, exercise caution, and consult with one or more healthcare providers.

How long does it take for PRP injections to work?

PRP injections do not relieve symptoms or fix the problem in the same way as drugs or surgery. Instead, they start a natural regenerative process that will take weeks to months to complete depending on the nature of the injury.

For joint, bone, or muscle PRP injections, the effects of a PRP injection should be noticeable in about three months and complete in six to nine months. If there hasn’t been sufficient improvement in pain or mobility at that time, another injection may be required. When the healing process has completed, the effect will be permanent.

What to expect after PRP injections

Platelet-rich plasma injections into a joint, muscle, or tendon will require some recovery time. As mentioned, PRP does not fix the problem or relieve symptoms but instead begins and accelerates a natural regenerative process. That healing process will take several weeks or months to complete, but the treatment area will be painful and probably swollen for the first few days. In fact, swelling is part of the initial healing process.

Recovery time and limitations

In general, PRP injection recovery time is one to two days of rest and up to two weeks with walking support (i.e., crutches), after which physical therapy will begin.

Some PRP treatments will allow patients to return to work the next day. Others will require one or two days of rest. Avoid exercise and keep activities that use the affected area down to a minimum. If you have had an injection into your hip, knee, or ankle, avoid walking during this time. Depending on the injection, a patient may need to use a sling, walking boot, or crutches for anywhere from a few days to two weeks.

Although the area treated may swell, anti-inflammatory medications, such as steroids or NSAIDs, should be avoided for at least a week. Your physician may prescribe pain relievers that also are not anti-inflammatory.

Any physical therapy will begin about two weeks after the treatment. For joint, muscle, or tendon treatment, the healthcare provider will want a follow-up visit in six to eight weeks to assess progress. The pain will gradually subside over the following weeks and months.

Side effects

Platelet-rich plasma therapy uses blood from the patient, so it’s remarkably safe and free from side effects. The only side effects people may experience are temporary injection site reactions. Local site reactions such as nerve injury, tissue damage, or local pain are from the injection itself. There is a small risk of infection as there is with all injections.

How much does a PRP injection cost?

Insurance does not cover platelet-rich plasma treatment unless it is part of a surgical procedure, and even then, it may not be covered. The patient will foot the entire PRP injection cost.

There is no consensus on how much PRP treatment should cost. The average cost of PRP treatment is $750, but the procedure could cost anywhere from $300 to $2,500. An initial consult may be an additional cost, and it, too, may not be covered by insurance. So, in general, the out-of-pocket cost of most PRP procedures can range from $300 to $2,700.