Platelet-Rich Plasma Therapy Part 1: Does PRP Work for Chronic Tendinitis?

This blog follows on the heels of last month’s blog which encouraged shifting away from the knee jerk reaction of applying R.I.C.E (rest, ice, compression, elevation) to acute musculoskeletal injuries and instead instituting P.O.L.I.C.E (protection, optimal loading, ice, compression, and elevation).¹ Why? Because we reviewed in one of our monthly multi-disciplinary journal clubs new evidence that shows ice (the major thrust of R.I.C.E.) actually delays healing of exercise-induced muscle damage by interrupting inflammation, the body’s innate healing response after soft tissue injury.² So…in thinking about this further, perhaps we want to encourage this natural inflammatory response to optimize the healing process. This concept underlies what happens with regenerative therapies including Platelet-Rich Plasma.

What is Platelet-Rich Plasma therapy? While PRP has been used over the last decade by many professional athletes (think golfer Tiger Woods, basketball star Stephen Curry and football player Jameis Winston, it is a relatively new advancement for treating musculoskeletal injuries in the general population. PRP is made in a simple in-office procedure by taking a small sample of a patient’s blood and then spinning it in a centrifuge machine which separates out the red blood cells. The remaining plasma portion has a high concentration of platelets (up to 8 times that of whole blood) which contains cells such as growth factors and stem cell signaling markers. These cells are vital for tissue healing and regeneration. The PRP is then precisely injected using ultrasound guidance into an area of soft tissue injury to promote the body’s natural healing process and help repair and rebuild the damaged tissue. This accelerated healing process leads to a faster and more efficient restoration of the injured tissue to a healthy state, thereby improving pain and overall function.

So, does PRP work? One focus of research has been on determining the efficacy of PRP for chronic tendonitis. This is one of the most common musculoskeletal complaints and frequently involves the tendons of the rotator cuff, gluteal, elbow (i.e. tennis or golfer’s elbow), Achilles, and patella. In our monthly journal club we reviewed an article on the efficacy of Platelet-Rich Plasma injections for chronic tendonitis.³ A total of 16 randomized injection-controlled trials of PRP versus control (saline, local anesthetic, corticosteroid) were included in this systematic review. PRP was found to be more efficacious than control in reducing tendonopathy pain with a moderate treatment effect. The results also suggest that PRP may even have a greater efficacy with longer follow-up duration at 12 months.

Another recent study performed a systematic review and meta-analysis on 37 trials comparing the efficacy of PRP vs control (saline injection, dry needling, autologous whole blood injection, corticosteroid injection) for tendon and ligament injuries. ⁴ The results show that patients with rotator cuff tendonitis and lateral epicondylitis who underwent PRP treatment had significantly less pain both in the short and long-term compared to the control groups. The study also found that of the 1937 patients treated with PRP, no significant adverse events were reported. These results further support the safety and long-term efficacy of using PRP for tendon and ligament injuries.

Platelet-Rich Plasma is no longer just for professional athletes. It is now readily available to any patient, from a college athlete who wants to speed up recovery to get back into the game or an older adult struggling with pain secondary to arthritis or chronic tendinitis in Mesa or Phoenix. We offer this in-office procedure in the Phoenix, Scottsdale, and Mesa locations of Desert Spine and Sports Physicians. If you have an injury that doesn’t seem to be healing with other standard non-surgical treatments such as activity modification, anti-inflammatories, physical therapy, and steroid injections, PRP may be a good option for you. PRP is safe for most patients with some of the rare contraindications including history of metastatic disease, active infection, or very low blood count. ⁵ To learn more about PRP injections, you can check out our PRP handout and Pure PRP brochure.  For more information, check out Part 2 of this blog on PRP where we look at the studies that show that PRP is also efficacious for patients with joint arthritis. Exciting new research is on the way!

¹ https://www.verywell.com/the-police-principle-for-acute-sprains-and-strains-2696549
² Tseng, CY, Lee, JP, et al. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res.2013;27(5):1243-61.
³ Miller, LE, Parrish, WR et al. Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomized injection-controlled trials. BMJ Open Sports Exerc Med. 2017;3:1-11.
⁴ Chen X, Jones IA, Park C, Vangsness CT Jr. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med. 2018;46(8):2020-2032. doi:10.1177/0363546517743746
⁵ https://emedicine.medscape.com/article/1997643-overview#a3