PRP Injections: Effect On Recovery Time And Pain Level
Athletes are using platelet-rich plasma (PRP) injections to speed up healing and decrease the recovery time from injuries such as hamstring pulls, rotator cuff injuries, patellar tendinitis, and tennis elbow. Overuse injuries lead to a range of tendon injuries. Tendonitis is inflammation of the tendon, and the more serious tendinosis is the degeneration of the collagen in a tendon due to overuse.
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Platelet-rich plasma or PRP is a derivative of your blood. Blood contains liquid (plasma) and solid components (red blood cells, white blood cells, and platelets). PRP is a concentrated solution of platelets. The platelets in PRP injections are essential in the process of blood clotting but are also rich in growth factors. Injecting PRP mimics the natural healing process and stimulates new cell growth, promotes healing, decreases reported pain levels, and decreases recovery time.
“I hope that when I wake up in the morning, I won’t be in pain, and when I go to sleep, I won’t be in pain.” – Retief Goosen, on undergoing platelet-rich plasma injections for his ailing back that will keep him out at least a couple of weeks.
How Is PRP Made?
Plasma is the liquid part of blood along with proteins and platelets. Platelets contain more than 30 bioactive proteins, many of which are involved in either the blood clotting or tissue healing process.
The process of collecting PRP includes the following steps:
- The patient donates blood.
- The whole blood sample rapidly spins in a centrifuge.
- The blood sample settles out into layers with red blood cells at the bottom, white blood cells, and platelets in a thin buffy coat, and plasma in the uppermost layer.
- Further separation separates plasma into platelet-poor and platelet-rich fractions.
- After isolation, the health care provider can inject PRP with or without an activating agent (Dhurat & Skesh, 2014).
PRP Injections For Tennis Elbow
Tennis elbow or lateral epicondylitis is a common injury of the tendons on the outside of the elbow. Approximately .5%- 3% of people between the ages of 35 and 55 suffer from tennis elbow. It is an overuse injury resulting from repetitive movements such as playing tennis, using hand tools, or painting (Chesterton et al., 2011).
The most common symptom of tennis elbow is aching pain on the outside of the elbow. As symptoms worsen, the pain becomes constant. The initial treatment for tennis elbow may include physical therapy and a course of NSAIDs to decrease inflammation. An injection of corticosteroids to further reduce inflammation and splinting the elbow are additional options. Surgery is a last resort.
PRP injections are a newer treatment option that utilizes growth factors. Growth factors in PRP speed up healing and decrease recovery time. PRP injections are felt to be safe and effective and have reduced the need for surgical intervention (Hastie et al., 2018). Overall, PRP injections seem to decrease pain, especially in the long-term, and have fewer side effects than corticosteroids. Side effects from corticosteroid injections can include skin thinning and atrophy, discoloration, and secondary tendon tears (Kwapisz et al., 2018).
PRP Injection For A Hamstring Pull
Hamstring injuries are common in long-distance runners, sprinters, and jumpers. The hamstrings are a group of three muscles that run from the hip to the knee. The hamstrings extend the leg at the hip and flex the leg at the knee.
Initial treatment for hamstring injuries includes rest, NSAIDs, physical therapy, and corticosteroid injections. PRP injections may be an alternative treatment to surgery in partial hamstring tears. A study conducted by Wetzel et al. (2013) reviewed 12 injuries that were treated with PRP injections after failing conservative treatment and compared them to a separate group of five participants who had physical therapy alone. Both groups initially had improvement in the reported level of pain, but improved pain levels checked at 4.5 months were only statistically significant in the PRP group.
Fader (2014) studied 18 patients whom all received a single injection of PRP via ultrasound for a hamstring injury. Six months after the injection, 10/18 had 80% or greater improvement in their reported pain level. Both studies are small but seem to show that both functional improvement and pain relief are possible with PRP injections.
PRP Injection For Rotator Cuff Injuries
The rotator cuff tendons are a group of four tendons around the shoulder joint. These tendons are commonly injured after trauma or overuse. Over the head movements put the greatest stress on rotator cuff tendons. Injuries start with partial tears, which may or may not cause symptoms. They may progress to full tears of the rotator cuff tendons.
For some people, PRP injections may be an alternative to rotator cuff surgery. Surgical failures are more common after corticosteroid injections than in those who do not get corticosteroid injections. Sari and Eroglu (2020) showed that corticosteroids tend to provide short-term relief from pain. However, PRP injections have demonstrated longer-term relief from pain, improved function, and faster recovery time. PRP injections have fewer side effects than corticosteroids and are sometimes used to speed up healing after surgery.
PRP Injection For Patellar Tendinitis
Patellar tendinitis and tendinosis have been reported in up to 44% of volleyball players, 32% of basketball players, and 28% of track and field athletes. Most of the time, patellar injuries resolve on their own. In 20% of cases, patellar tendinitis is chronic (Li et al., 2020).
Li et al. (2020) reviewed the literature and found that PRP injections demonstrate the potential to treat patellar tendinitis when combined with eccentric exercise rehabilitation. They noted minimal side effects from the injections.
Further Research On PRP Injections And Their Effect On Recovery Time
The Benefits Of PRP
PRP shows promise as a viable treatment option to decrease pain, speed up healing, and decrease recovery time from overuse injuries such as patellar tendinitis and tennis elbow. PRP can be an alternative to surgery for some people, and in others, it can accelerate the healing process after surgery.
The benefits of PRP are well documented in chronic tendon injuries, especially tennis elbow. Further research is needed to compare the effect of PRP injections on recovery time when compared to other treatment options. The benefits of PRP in sprains and muscle injuries need further research as well. The risks of PRP are minimal.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
- Chung-Hsun Chang, Wen-Chung Tsai, Miao-Sui Lin, Ya-Hui Hsu, and Jong-Hwei Su Pang. (2011). The promoting effect of pentadecapeptide BPC 157 on tendon healing involves tendon outgrowth, cell survival, and cell migration. Journal of Applied Physiology. 110:3, 774-780 https://pubmed.ncbi.nlm.nih.gov/21030672/#:~:text=In%20conclusion%2C%20BPC%20157%20promotes,of%20the%20FAK%2Dpaxillin%20pathway.
- Chesterton, L. S., Mallen, C. D., & Hay, E. M. (2011). Management of tennis elbow. Open access journal of sports medicine, 2, 53–59. https://doi.org/10.2147/OAJSM.S10310
- Dhurat, R., & Sukesh, M. (2014). Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author’s Perspective. Journal of cutaneous and aesthetic surgery, 7(4), 189–197. https://doi.org/10.4103/0974-2077.150734
- Fader RR, Mitchell JJ, Traub S, et al. Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J 2015;4(4):461-466. https://pubmed.ncbi.nlm.nih.gov/25767784/
- Hastie, G., Soufi, M., Wilson, J., & Roy, B. (2018). Platelet rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention. Journal of Orthopaedics, 15(1), 239–241. https://doi.org/10.1016/j.jor.2018.01.046
- Kwapisz, A., Prabhakar, S., Compagnoni, R., Sibilska, A., & Randelli, P. (2018). Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature. Current reviews in musculoskeletal medicine, 11(4), 598–606. https://doi.org/10.1007/s12178-018-9520-1
- Li, J., Gragert, D., Wickersham, E., & Chou, A. (2020). In patients with patellar tendinopathy, do platelet-rich plasma (PRP) injections result in lower pain scores, in comparison to common modalities? Journal of the Oklahoma State Medical Association, 113(3), 117–120. https://www.bluetoad.com/publication/?i=664966&article_id=3706011&view=articleBrowser
- Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics 2013;36(1):e64-e70. https://pubmed.ncbi.nlm.nih.gov/23276355/#:~:text=Platelet%2Drich%20plasma%20(PRP),with%2017%20proximal%20hamstring%20injuries.