Platelet Rich Plasma

Platelet-rich plasma (PRP) therapy is a perfect example of a much needed advancement in the way that we go about treating chronic pain and dysfunction – although the procedure may sound like something created by a mad scientist. Luckily, PRP is, in fact, a real form of regenerative medicine with real science, and real world anecdotal evidence to support its use.

When you begin to analyze the mechanisms by which PRP can facilitate the healing of various tissues, it is easy to see why drawing blood, spinning it in a centrifuge, and reinjecting some of the constituents back into injured tissue may just be able to create monumental changes in the healing process for individuals suffering from osteoarthritis, tendonitis, sexual dysfunction, and more.

Understanding the details of how exactly PRP can provide a multitude of healing benefits is the key to appreciating just how much potential it has for helping individuals actually heal – unlike the current standard of care for similar degenerative diseases and dysfunction. Entirely unique from the traditional allopathic approach, PRP therapy can enable the body to heal at the level of the injury, rather than just suppressing symptoms.

How Does PRP Work?

In order to understand just how PRP works, we must describe what exactly the platelets and plasma that it harnesses the power of are.

As we’ve already mentioned, PRP is a form of regenerative medicine that uses injections of concentrated platelets from the patient’s own body to accelerate the healing of various tissues – primarily tendons, ligaments, muscles, and joints, although it is commonly used for the healing of many other kinds of tissue.

In order to enlist the patient’s own healing systems, blood is first drawn from the patient and placed in a centrifuge. Here it is spun in order to separate the blood it into its constituent parts and isolate the plasma, or the clear, extracellular fluid that comes from blood. Plasma serves as a medium for transporting all manner of proteins, growth factors, and much more.  Once separated from the rest of the blood, the plasma, now containing a supraphysiological (way more than normal) concentration of platelets, is re-injected back into the target tissue. This procedure is often performed with the assistance of an ultrasound in order to guide injections to the appropriate area. Re-injecting plasma containing high concentrations of platelets has been found to significantly enhance the healing process – for one obvious reason: platelets are like little healing superheroes.

What Do Platelets Do?

Under normal conditions, platelets are activated upon injury to the wall of a blood vessels – this injury signals to platelets in the surrounding area to get to work at creating a clot in order to stop the bleeding.

But besides simply clotting blood and healing tissue, platelets are involved in vasoconstriction, the immune response, the inflammatory response, angiogenesis (blood vessel formation), and tissue regeneration. You may be wondering why boosting platelet concentrations to supraphysiological (higher than would occur naturally) can also boost the healing process. This is because of the wide array growth factors that platelets contain. Right now, within us we have platelets circulating are system which function to store growth factors like PGDF, EGF, TGF- 𝛃1, VEGF, FGF, HGF, IGF-1, and the list goes on. Each of these unique growth factors are released when platelets begin to break down and they are collectively responsible for stimulating cellular regeneration, the activation of stem cells, and they ultimately drive the healing process. Overall, platelets contain over 800 proteins and molecules including cytokines, chemokines, membrane proteins, metabolites, messenger molecules, and soluble proteins,  All of which play some role in the body.

As we age blood platelet levels remain relatively stable until we pass the age of around 60, at which point levels begin declining and their ability to heal declines as well – suggesting that PRP may be an effective anti-aging treatment. By now there should be little doubt as to whether or not injecting plasma with high concentrations of platelets has the potential to aid in the healing process. At least mechanistically, it makes sense – we are simply concentrating growth factors to enhance our own body’s ability to heal. But does scientific research back up this notion? Well, the answer is: it depends. 

What Does the Research Say?

Although a quick PubMed search for “platelet rich plasma” yields over 10,000 research articles, finding well-controlled, quality studies is another task entirely.

Unsurprisingly, the effectiveness of PRP can be highly varied depending upon the targeted tissue(s). Although PRP has been around in some form since the 1970s, it still appears to be considered a somewhat fringe procedure in the public eye – admittedly, more randomized controlled trials are required before PRP becomes a more mainstream intervention.

However, this is quite likely to happen due to the fact that musculoskeletal injuries are so common. In fact, the WHO states that musculoskeletal injuries are the most common cause of long-term pain and disability around the world, affecting hundreds of millions of people. Currently, the standard of care for chronic musculoskeletal pain and dysfunction involves the use of corticosteroids.  Although effective at relieving pain, at least in the short-term, corticosteroids offer no actual healing properties – they simply suppress the symptoms.

Recently, a meta-analysis concluded that PRP was favorable to other interventions like hyaluronic acid (HA) injections and corticosteroids for osteoarthritis treatment. Fortunately, PRP reduces the need for pain management or anti-inflammatory medications, and it is largely considered to be side-effect free because the plasma usually comes from your own body.

Currently there is abundant empirical evidence supporting the use of PRP for issues such as lateral epicondylitis (tennis elbow) and osteoarthritis of the knee, as well as moderate evidence for patellar tendinopathy and plantar fasciitis – from there the research evidence dwindles a bit.

This lack of conclusive evidence is likely due to the lack of standardization within research. There are many protocols that are utilized for administering PRP therapy, ranging from a single shot once daily, all the way to three shots weekly – taking place over the course of weeks to months. In order for more rigorous trials to be able to elucidate some of the mystery around PRP, more standardization of protocols is absolutely required.

While there are many other common uses of PRP such as arthritis in the hip, rotator cuff tendon problems, ACL repair, Achilles tendon issues, and sprains, these currently lack sufficient evidence to fully support their use. However, this does not entirely negate PRP therapy for these purposes. In fact, some of the more widespread applications of PRP have little or no actual scientific research behind them, yet.

Two majorly overlapping fields in the health and wellness space are sexual health and anti-aging. Many of the interventions that PRP enables are exactly what someone looking to improve their sex life or slow down the hands of time might be interested in.  PRP is often utilized for the regrowth of hair, rejuvenation of skin, and quite popularly the improvement of sexual function.  When platelet-rich plasma is injected into the genitals, the healing of blood vessels and other structures is enhanced – thus enhancing sexual function overall (do a quick google P shot/O shot). With an overwhelming percentage of the population suffering from some sort of sexual dysfunction (an estimated 43% of women/30% of men), and musculoskeletal pain (see WHO figure above), it is likely that more and more people will turn to PRP as an alternative treatment for these issues.

Where to Get PRP Injections

It is important that you receive your PRP injections under the supervision of an experienced practitioner. This alternative treatment is not for everyone though, and some people will definitely respond much better than others to the protocol – although it is important to note that there have been virtually no adverse events ever reported from PRP injections.

Speaking with a professional will allow you to further determine whether or not PRP is a viable option for you and your particular issue(s). Although the current research does not fully verify PRP as an effective treatment for all conditions, the mechanisms by which it may improve the healing process are quite straightforward and effective. Additionally, the conditions for which PRP has abundant research evidence are quite possibly only the tip of the iceberg in terms of it’s potential benefits. Overall, it is up to you to determine whether or not you will give PRP a try. Because PRP is a more affordable option than utilizing stem cell injections, and due to the fact it has little or no possibility of side effects, it should likely be considered as a first step in the management of degenerative joint diseases, sexual dysfunction, chronic pain, and more. 

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