This week's question
My doctor is recommending PRP injections for my shoulder, is this a "real" treatment or some type of "voodoo" My answer - PRP, or platelet rich plasma injections are a treatment that is gaining popularity and interest. It involves taking "stem cells" either from yourself or from a lab - based source and injecting them into an injury site to stimulate tissue repair.
As a PT, providing these treatments is obviously outside of my purview but sharing my thoughts is important, as treatments like these often are used by my patients.
The research on PRP is not definitive, but is leading towards a positive trend for many soft tissue injuries like tendon and muscle issues. With ANY treatment, there is some balance of risk and reward, of pro and con. Even something as simple as placing an ice pack or a hot pack could lead to skin or sensory nerve irritation, and taking and Advil or alive (with many many pills over time) could lead to liver or kidney issues. I think most of us would agree that in the time when we need these type of treatments, the pros outweigh the cons. However, when you begin introducing a "foreign" substance into the body through an injection, at several hundred dollars per injection these pro/con lists become a bit more important.
In my anecdotal experience, which closely mirrors the research, PRP injections general do not have a negative effect. The dangers include the same dangers of getting a flu shot, or even getting blood drawn. Anytime you puncture the skin there is risk of infection, and anytime you introduce an outside substance to the inside, there is risk of an immune response.
However, once we look past the negative, it is important to note that not all results are positive. Some people will have a PRP injection with a very neutral effect, feeling no worse, and no better, than before the injection.
The largest group of people will likely have a "moderately positive" response, meaning some help with the original problem, but some symptoms do remain. In many cases, this important reduction of symptoms will better allow someone to participate in the activities that will help with remaining symptoms, like physical therapy and strength training.
Finally, some subset of people will have a complete resolution of symptoms with the PRP injection.
Now you may say, Sara why are you promoting a treatment where a significant amount of people will pay money and have no results? To answer this it is important to take a step back and think why people are considering these injections. It's usually not just because they. have a free Tuesday afternoon and a few hundred dollars burning a hole in their pocket. It is typically because they have pain interfering with their daily life, or in the case of the gentleman who asked this question, are considering surgery as an alternative.
When we place PRP against surgery, which in some cases CAN lead people to feel worse than before they got it, a treatment with a small risk of a negative outcome sounds good. When we compare PRP to "never lifting overhead again" or even worse "never picking up your kid again," any chance of a positive outcome seems like a good idea.
With all of these being said, PRP may help repair tissue, but following it up with PT and strength training is the way to strengthen that tissue and avoid further injury. We don't want you to just "get back to where you used to be" because that is where you got injured. If you want help making your muscles and tendons more resilient than ever, shoot us an email at firstname.lastname@example.org