Platelet Rich Plasma (PRP) Therapy on Knees & Elbows

[SkiJay]

A couple of months ago, I had PRP injections under both kneecaps to see if it would help with the patella femoral arthritis-related knee pain I was suffering. I promised to report back, so here you go. I'll start with a quick background.

 

Platelet rich plasma is refined out of your own blood. Your platelets contain storage pools of growth factors and active metabolites which influence rapid healing and tissue regeneration. Injecting your platelets into an injury site is touted as being an alternative to surgery for labral and meniscal tears, and even osteoarthritis and tendinopathy. Professional golf, hockey, baseball, and football players, etc. swear by this therapy (largely, I think, because they can afford it at $500 to $700 per round).

 

I have a high degree of confidence that what I'm suffering is patella femoral syndrome as it was diagnosed by a top sports knee specialist with the aide of an MRI. He assured me that it's nothing unusual, referring to it as "age appropriate wear" and that a LOT, maybe even most, of 50+ athletes are in the same boat. If you have a dull ache in your knees, that occasionally flairs into a stabbing sharp pain under your kneecap, welcome to the club. If lunges, squats, kneeling, or jumping off of anything higher than a curb hurts your knees, you too have probably thoroughly enjoyed wearing down the cartilage on the back of your kneecaps as a life long athlete.

 

I had the shots done September 17, and they hurt more than the injury. I also had my arthritic L5 disk injected, and that didn't hurt at all. Apparently, the knees hurt more than any other site on the body. Yay! Simply walking hurt like hell, so skiing was out. 10 days later, I decided to ski anyway. So long as I stayed tall on my ski and took it easy, there wasn't too much pain. But if I compressed coming off the ball, yeowzer! Nothing like stabbing pain to point out that you just broke form!

 

For three weeks it was like that. I could ski two sets per day, but if I got sloppy, I'd be out for a day letting my rear knee recuperate. Oh, and I forgot to mention, no ibuprofen (Advil, Aleve, etc.) because inflammation is part of the healing process, so Advil can stop the platelets from doing their magic.

 

For the last couple of weeks in Florida, my knees were feeling pretty good actually, with daily runs at 38 off not causing any pain at all. I've since come back to Calgary for a month, and a second round of PRP. The doctor was a little horrified that I'd been skiing so much during the treatment period because every little setback uses up resources of the injected platelets that would otherwise have been better spent making gains on regeneration and a more complete healing. Oops....

 

So this time, I'm taking a month off of skiing to let the second round do its thing without the constant setbacks. I have to say, however, that I'm pretty impressed with the progress my knees made despite having given in to my obsessive compulsive skiing addiction. And having stopped skiing completely last week, my knees were feeling great.

 

During my second round of injections three days ago, I learned that the more injured the injection site, the more inflammation and pain the injections cause. I could barely walk for two weeks after the first injections. This time, the pain has been so minimal, I forget that I've just had these shots. According to the doctor, this is a clear sign that my knees have healed significantly despite my stupid decision to get back to skiing again too soon.

 

Finally, I've not experienced a single recurrence of the stabbing/stinging pain behind my kneecaps since starting PRP therapy, despite hitting the gym hard and skiing as hard as I ever have for my last three weeks in Florida. I'm really looking forward to seeing how my knees feel after a month of platelet enhanced healing with no gym and no skiing related setbacks. I will report back in December.

 

For more info on PRP, here is a good description of the therapy:

paradigmhealth.ca/therapies/platelet-rich-plasma

[ToddF]

so how long is the treatment suppose to last once done?

[gregy]

There was an article in the paper recently about using laser therapy for injury. Anybody try this yet? They claimed it stimulates the cell to heal faster. They specifically mentioned knees on the article.

[SkiJay]

@ToddF The accelerated healing of each treatment is most active for four to six weeks. As far as long lasting healing goes, healing is healing. This isn't a temporary lubrication of the knee that your body eliminates within three or four months. It's injecting your body's natural healing compounds in concentrated form into injuries that are poorly serviced by normal blood circulation.

 

I was told the healing is permanent, within the constraints of normal aging, wear, and tear of course. In some cases, the healed tissue can be stronger than it was before the injury. My ankle reacted like this, and it's been super durable for ten years now.

 

Platelets can help a tear heal. But if the cartilage is gone, that's a job for stem cell therapy or surgery. Stem cells are the regeneration champions because they actually become the missing cells. There are stem cells in platelets, but only at very low concentrations.

 

I'm no doctor or scientist, so I'm just regurgitating what I've learned through research. There is no shortage of experts who don't buy into any of this. But there is also credible research supporting it.

 

I've read that the placebo effect is effective at healing 1/3 of the time. I choose to believe the research supporting PRP and Stem Cell healing. If believing it is 1/3 of the battle and it's supported by credible research, I'm in before I'll go under anyone's knife. And my personal experience with this PRP treatment is pretty impressive so far. Time will tell.

[SkiJay]

@gregy Any chance you can post a link to the article?

[A_B]

I used cold laser therapy years ago on my shoulder. I am mixed on the results. Actually looked into buying one for home, but didn't pull the trigger.

 

Www.Erchonia.com

 

 

[Steven_Haines]

@Skijay, how'd the injection work on your back?

[SkiJay]

@Steven_Haines I herniated my L5 back in 1987, so it's been messed up for a long long time and I'm not expecting a miracle here. However, every morning for the last 26 years, I've had to stretch before I can get off the bed in the morning and stand up straight. I also have to do a couple of stretches before I can bend over the sink to shave in the morning (I doubt skiing is helping any of this). In the last few days, however, I've been able to get straight out of bed, and bend over the sink with noticeably less pain and no stretching. No complete cure here ... yet, but there has been a noticeable improvement. I'll be watching this over the next month of sedentary healing too.

[A_B]

Here is one study on low level laser impact on healing. Not specific to muscle or tendon, but this sort of lends credence to tissue repair.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC522143/#__abstractid1065597title

 

 

[Steven_Haines]

@Skijay, that's some pretty exciting stuff! Are you going to do another round on your back?

Right after I hurt my back in 2010 I was seeing a chiropractor that was using the Laser therapy as @AB mentioned along with traction. It worked really well! I only had a few sessions with him before he went out of business. Most if not all of his patients got substantial relief. It turns out that he couldn't find enough cash paying patients to keep him afloat as he couldn't get insurance to cover any of thecosts since it was a new practice.

[SkiJay]

@Steven_Haines I was originally only going to do two treatments, but depending on how this goes over the next month, I may adopt the program a bunch of the players for the Calgary Flames are on. They come in for treatments whenever they won't be playing for awhile. I'm thinking that any time I plan to take a month off from skiing, I may do another round until it's all good.

 

I've been skiing 12 months of the year for the past three years, with only short unavoidable breaks. My program for this winter is to take off November, January, and three weeks in March to let my body catch up. Starting each of these breaks with PRP therapy might be the plan.

[SkiJay]

I forgot to mention, I also got my elbow done during my last visit. I've had golf and tennis elbow in my left arm for the past three months, and on and off over the last 10 years. Both sides of the joint have been really inflamed lately, so I'll share how this PRP enhanced healing goes in this thread too.

[jayski]

Your a wreck... ; )

[A_B]

Steven, a Chiro also had the laser that I went to. She was pretty well established. Just an additional treatment for her. I think I worked out a deal where I just paid her like $20 for a treatment. The device was fixed on a mount, so pretty much turn it on and walk back in when done. I had it on my shoulder and I did get better, but can't for sure say it was the reason. It's still a sloppy joint and will need to get fixed.

[Steven_Haines]

@Skijay, is this therapy covered at all by your insurance? Probably not a relevant question since you're in Canada.

 

@AB, The unit my guy was using was a hand held similar to the one in the link you posted. The guy I used was established at one time but for some reason he closed up shop and started all over with this new technique. Fast forward 1 year and he's no where to be found. Pretty sad deal!

[SkiJay]

@Steven_Haines It's not covered by the government's insurance program, but I can claim it through my self-administered employee insurance plan. Essentially, my company can pay for it and get a write off.

[Steven_Haines]

Very nice!

[A_B]

Steven, if you have a flex spending account, throw it against there. I am pretty sure I did with mine and it was deductible, at least it was back then. The government is eliminating coverage for a lot of stuff every year.

[Steven_Haines]

@AB, that's a great idea! If it's still $500-$700 that'd make it pretty painless

[A_B]

At least you get it pre-tax, so better than nothing.

[Steven_Haines]

Ya... that's a real savings when you look at it! And would be really easy way to save for it. My wife has a plan thru her work that they just made available. Our company is shopping new coverage so maybe that will be available to me. I might be wrong, but I thought I saw that Aflac has an FSP.????

[skiinxs]

I'll am totally sold on the benefits of PRP, as I have had nine injections over the past three years. Shoulders, elbows, and tendons in both feet. All except two have made huge improvements. The two that didn't work were in a shoulder that I later had surgery on. It was way too far gone for the PRP to have had a chance as it involved anchors for the rotator cuff, grinding to make room to remove impingement, and lots of repairs to the Labrum. I will never again have a surgery without trying PRP at least twice to see if it can be easily resolved. I believe that several of the other surgeries I have had in the past on knees, both shoulders (one twice 6 years apart), and elbows would have been unnecessary if PRP had been available at the time (or if it was I didn't know about it). Elbows are a piece of cake as far as pain during the injections, shoulders are a little more painful, but still not to bad, but heels are probably the worst place in the body to stick a needle through. Still glad I had them though. Would have been in a boot and on crutches for at least four weeks without the PRP, ended up ditching the crutches and boot a couple days after the injections.

[lpskier]

I had my elbow done three weeks ago. So far, so good. Has anyone tried it on an ankle? @skijay Please keep us posted on the progress of your back. Mine suffered some trauma early in life and it pretty much sucks, too. I am thinking about getting it done. I have a doctor's appointment Tuesday as a follow up on the elbow, and I intend to ask what he thinks. How debilitating was it in the several days post procedure? Could you go to work if you were home and doing such a thing? By the way, both sides of my elbow was $250 total.

[SkiJay]

@lpskier The knees hurt enough the first round that I'm glad I didn't have to stand all day for the first couple of weeks. My back didn't hurt at all, either time. $250 is pretty good. I get charged by the kit, and each kit costs $600 here!

[gator1]

Going in this week for PRP on patellar tendon. Had it done on elbow 3 years ago. Worked great on elbow.

[A_B]

Gator, please let us know how it goes. I had mine scoped in 1989 and has again become a problem, along with 5 other things!

[Patmaster]

Well, there is hope then. I'm 52 and just getting comfortable with 32 and 35 off….need to get to 38 at least!

[SkiJay]

Wow @AB! I thought I was a bucket of bolts!

Water Skiing rocks. In what other highly physical sport can 50+ year old worn out athletes still play at such extreme levels?

[SkiJay]

Update

 

After the last PRP treatment (second), I took a full month off from skiing and the gym to maximize the PRP healing potential for my knees and elbows. By the end of the month, my knees felt the best they had in a couple of years and my elbow had improved markedly, though not completely.

 

A month ago, I resumed skiing. The first day was great, then on day two, I got a single shot of sharp pain under the kneecap of my back leg (the worst knee) when I let myself get too compressed exiting an off-side turn. It was a major disappointment. I thought it had all been a waste. But since then, nothing, no pain. Both knees have actually felt excellent ever since. Before the treatment, I was getting stabbing pains in my knees, especially the back one, just about every time I skied. Now, no pain at all.

 

In fact, I skied 52 sets over the last 30 days, often in wind and significant chop, a lot of which was at -35 and -38 so with plenty of knee-testing fails. It even included a stretch at the end where I ran a nonstop 18 pass set (which I counted as three sets) every day for 11 days straight! I pushed myself to the extreme limit, and my knees were simply not an issue.

 

My elbow got a bit sore with the heavy schedule, but in different locations. The actual injection sites are feeling pretty good. I'm only a few days away from 57 years old, so it's certainly no surprise that I have a few very minor recovery issues after this marathon month.

 

I'd sum up this experience with Platelet Rich Therapy as follows. PRP helped my knees heal even while skiing during the first round of the treatment, and the healing was even more thorough with rest during the second treatment. It didn't return my knees or elbow to their 25 year old glory. If I super-load a knee in a flexed position, it will remind me that it's still getting worn out. If I over-train/ski, my elbow won't get the recovery time it needs. On the other hand, I was preparing myself for the possibility of having to quit water skiing with all the knee pain I was suffering prior to the PRP. Now, I'm not even aware of my knees.

[gator1]

Just got the back of my rear kneecap injected with prp. Hope it works as well as @skijay

[SkiJay]

@gator1 Is it pretty uncomfortable right now? Mine hurt like hell the first round.

[gator1]

Not too bad. Nowhere near as bad as the patellar prp

[cragginshred]

Ski Jay I am hoping someone has reviewed basic mechanic of the ***Cause*** Arthritis common to age changes are rarely explained with MRI's. The most common Cause of patellar femoral syndrome can be simplified this way -The kneecap is the train the femur is the track. The train follows the track. You have 17 muscles that cross over the knee, many whose origins begin on the pelvis or top of femur. Therefore you should be doing a whole lot of hip rotator, abduction and extensor exercises (see my hip rotator video for some examples).

A simple test we do in the PT clinic is a single leg squat. Watch yourself do one in the mirror. Not too deep. If your knee dives inward your hip musculature is not decelerating the femur's internal rotation and thus causing the train to derail and causes pain -the likely Cause.

Hope this helps!

Don

[cragginshred]

I should also say, there is growing interest in PRP treatments in the orthopedic setting and research journals, however, one still needs to consider am I addressing the cause, or chasing symptoms.

[gator1]

@cragginshred:Can't find the link to your vid. Could you post that again? I think I was doing some of those if one of them is the "lay on your side, big rubber band around your knees, knees bent, then spread your knees keeping ankles together", but I'd like to see if you have others/more/different. I cured my back by trying every non-surgical exercise, stretch or routine, and finally hit on a regime that works, so I'll try anything that makes sense on this stupid knee.

 

And I got the PRP last Thursday. Didn't feel very good till this morning. Today, I walked up the stairs at work on both legs. Still hurt like a bitch, but haven't done that since end of Sept. Mental? Placebo? Too soon to have any affect? I don't give a damn if I can ski.

 

Maybe the killer app is both exercise and PRP to fix the damage done.

[cragginshred]

gator1 your right outcome is everything! Just go to YT and type in 'cragginshred' I have several exercise videos on there.

[jimbrake]

We need a "Ask Cragginshred" thread. Cragginshred - you may recall that I've been battling really bad elbow tendinitis that started mid-summer last year from water skiing. Stopped water skiing in mid-October and have been rehabbing it ever since. Also, had to quit swimming back in September or so, to give the elbow a break. Was having some success with some of the common forearm stretches and strengthening. Bought a theraband flexbar and have been using that, too. Was all going pretty well. Started swimming again and could even do a few pullups with only light pain, which was a definite improvement. THEN, a week ago I surfed two evenings in a row and holy crap, the tendinitis is back almost as bad as before. You'd think freestyle swimming and paddling would be similar, but for some reason paddling was way worse on the elbow. Anyway, since it's January now I'm preemptively worried about water skiing in the spring. Should I be more aggressive on therapy, less, do something else, just ski in pain and take it? What? Wish you were closer - I'd come see you.

[SkiJay]

@craiginshred You are absolutely right about the importance of understanding the cause as well as the symptoms. My doctor, trainer, physiotherapist, and the MRI clinic have all given me one version or another of the "train going off the tracks" analogy. I have a few VMO squats and leg lifts specifically prescribed to strengthen the muscles necessary to improve my patellar tracking (which isn't actually all that bad). I purposely didn't do any of these exercises during my month of maximum healing. Then I skied so much I had nothing left for the gym! Unfortunately, not exercising became a habit over the month, so thanks for the kick in the butt to remind me that I have to get back on that program--now. An ounce of prevention . . .

[A_B]

@jimbrake, PM sent.

[cragginshred]

Jim, keep icing. The swimming should not have flared you up, that really sucks. Sorry to hear that. @Skijay, your welcome and glad to hear you have gotten good info from specialists.

[SkiJay]

Update Three

 

I suffered a knee pain setback a month ago from an unlikely cause. Two months ago, I returned to cycling with a vengeance. Every second day, I was out for a 15 to 30 mile ride on a TT bike and I was going at it pretty hard—until my patella femoral pain flared up for the first time since PRP.

 

I would expect as much from running too far too often, but not from cycling; so I did some research. It turns out that in any given year, 40% of professional cyclists suffer from patella femoral pain syndrome. CRAAAAAAP! I thought the low-impact nature of cycling was the ticket. Apparently, just bending your knees under load is just as much a culprit as high impact.

 

I didn't go straight back for another round of expensive PRP to see if it would settle itself down by quitting cycling and taking last month off from skiing. This has not worked and my knees still feel like they are burning behind the kneecaps. PRP supported WAY better healing than simple rest. So here is my new take on PRP.

 

PRP is a fabulous, if expensive, way to stop painful inflammation for the long term if your patella femoral pain is more due to arthritis than to chewed up meniscus. However, if you insist on putting a lot of load on the back of your kneecaps, either too much all at once or less but with too much frequency, you can expect the inflammation to come back.

 

I've ruled out lunges, deep squats, distance running, hiking where a lot of downhill can be expected, and now cycling =( The good news is that water skiing doesn't seem to bother it at all—so long as I ski tall. If you have arthritis-related patella femoral pain, PRP is a great way to get rid of the pain and inflammation for a long time, but it's not the fountain of youth so care and attention is still required. Sigh . . .

[gator1]

@skiJay: bummer. Sorry to hear you're back in pain. My PRP benefits faded out in a couple of months. Then I got my knee scoped and found a flap of cartilage was getting pinched, so I'm doing a lot better after the doc cleaned that flap out and beveled a nice lead-in where the flap was..He also drilled a bunch of holes in my kneecap down into the marrow so it keeps doing "self funded" PRP.

 

My PRP guy is telling me its not a one time fix for back of the kneecap. Need to do it every 6 months to a year.

 

Its a couple hundred bucks a round down here. Come on down for a little medical tourism!

[SkiJay]

Thanks @gator1. I had an MRI and it didn't reveal any mangled cartilage, but I like the sound getting the kneecap to contribute some benefit.

[SkiJay]

Does anyone know of a good PRP Doctor they'd recommend in Orlando?

[gator1]

@skijay: The MRI didn't show my problem either. That technology doesn't do well on this type of issue. Basically my buddy (doc) and I decided we'd tried everything else, there was such a obvious clunk, and the pain was so much worse on the way down, that something had to be mechanically screwed up. Went to sleep not knowing, came out of the ether looking at his big grin, hearing "you'll be ready before the water is warm". And "I drilled a bunch of holes, its gonna hurt because I can't put any painkiller in there or it will screw up the blood coming out of the holes". The "its gonna hurt part" was not an understatement.

[A_B]

Well, the alternative is not so great either. My wife just had bilateral knee replacement and it has been pretty rough. We hope she will be golfing by summer end but her pain right now is very high. Glad we are getting a late start anyway.

[SkiJay]

Bumped for the weekend:

Does anyone know of a good PRP Doctor they'd recommend in Orlando?

[Adman]

old thread needs a bumping.

 

Not a skier anymore, 75 years now, outta shape about 350 lbs and have about 40% cartilage and osteo doc recommended PRP injections. Also on blood thinners and have a low platelet condition called ITP. Any thoughts on if its worth considering for me. Doc is afraid my age and weight might hinder knee replacements.

[Gloersen]

Regenexx

 

Expensive, out of pocket cost, vendor based "research", not FDA approved.

 

Maybe worth investigating.

 

First line of Rx, truthfully, is to work your BMI<<40.

[Stevie Boy]

Have to say I considered regenexx, then heard they were doing some real good stuff with stem cells at a research center 50 miles away, I made some enquiries to see if I could get on the trial program and was then invited to attend, for assessment, they told me that any stem cell treatment or plasma platelet program would not benefit me in any way as my knee was too far gone, it seems it works great if you have small areas of damage but no good for arthritic knee, or severe damage, I had the microfracture a while ago and that did not last long, my last Op was December, they cleaned it all up, shaved some bone and trimmed the fat pad, after telling me my knee was now 85% bone on bone, zero meniscus as well, they advised that, I build up muscle, try exercise everyday on a bike to keep the surfaces smooth, this seems to work at the moment all I have to manage is the Bruising of the Bone, I continue to slalom with some discomfort, eventually I will have to have a replacement, but will choose to pay for a custom knee that is produced on a 3D printer and then made, I am led to believe that these knees feel more like your original knee, there is less cutting of bone the alignment is spot on and the fit is perfect, hopefully this leads to quicker recovery and less pain, as well as a better outcome for the patient.