Chiropractor Chandler AZ
PLATELET-RICH PLASMA PROLOTHERAPY FOR HIP PAIN
During the past couple of years, advancements have been made in the treatment of musculoskeletal injuries. These advancements are mainly due to the improved diagnostic tools and surgical procedures. Although surgery can repair the broken soft tissue, a positive long-term outcome is not given if the structure cannot heal itself and regain its strength.
Recently, the techniques that use the body's natural healing system to repair the damage are gaining importance. Platelet-rich plasma Prolotherapy is one of the techniques that use the body's healing mechanism to repair the damage. In this technique, platelets are used to start and accelerate the healing process at the site of injury. Platelets are small in size but are multipurpose cells.
Their functions are:
- Clotting
- Haemostasis
- Connective tissue repair
The healing ability of platelets is manipulated in PRP Prolotherapy. In this technique, the patient's own blood is drawn under sterile conditions and centrifuged. This step separates the platelets from red blood cells. The platelet-rich plasma is then injected back into the patient at the site of injury where it starts the healing process and goes through the following three steps:
- Inflammation phase that lasts for 2-3 days. In this phase, growth factors are released.
- Proliferation phase that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
- Remodeling which lasts over a year. In this phase, collagen is matured and strengthened.
The concerns associated with the use of any invasive method are:
- Immunogenic reaction
- Bloodborne disease transfer
- Tumor formation
Since PRP PRolotherapy injections use the patient's own blood, the risk of immunogenic reaction or the transfer of blood borne diseases is excluded.
The growth factors attach to the cell surface and not the nucleus of the cell, thus the chances of tumor growth are also eliminated.
RISKS ASSOCIATED WITH PLATELET-RICH PLASMA PROLOTHERAPYAs the platelet-rich plasma Prolotherapy is an injection-based procedure, the risks involved in the procedure are:
- Anaesthesia allergy
- Infection
- Neural trauma
- Organ trauma
- Needle breakage
After the knee joint, the hip joint is the largest weight-bearing joint in the body. It is a very strong joint because of its structure and the strong muscles and ligaments attached to it. During walking, the stress on the hip is 5 times a person's body weight. Various parts of the joint help in mobility and weight bearing ability of the hip joint. Any damage to even one component can lead to discomfort and partial or complete lack of mobility.
ANATOMY OF THE HIPThe structure of hip is made of the thigh bone (Femur), and three bones of the pelvis (Ilium, pubis, and ischium). Two iliac bones are attached to the most posterior bone of the lower back (sacrum) with ligaments and muscles. The hip joint is a ball and socket joint which is much more stable than the shoulder joint due to its unique structure.
The muscle groups that are found in the hip are:
- Gluteals: Three gluteal muscles are the muscles in the buttocks.
- Quadriceps: The four heads of the quadriceps muscles are located at the front of the femur.
- Iliopsoas: This is the primary hip flexor muscle.
- Hamstrings: These are three muscles at the back of the thigh.
Adductor group of muscles: These muscles are attached to the pubis and run down on the medial side of the thigh.
The ligaments provide stability to the structure of hip. Three main ligaments of the hip joint are:
- Iliofemoral ligament
- Pubofemoral ligament
- Ischiofemoral ligament
The nerves that supply different muscles in the hip include:
- Femoral nerve
- Lateral femoral cutaneous nerve
- Obturator nerve
- Sciatic nerve.
The blood vessels that supply blood to the hip include:
- Internal and external iliac
- Femoral
- Obturator
- Superior and inferior gluteal arteries
Hip pain not only causes severe discomfort, but also limits the ability to move and sit comfortably. There are several causes of hip pain, such as:
OSTEOARTHRITIS : Osteoarthritis is one of the leading causes of hip pain in people over 65. Cartilage is present on bones in the joint which help them to slide smoothly without causing friction. In osteoarthritis, this cartilage is worn out and the head of the thigh bone rubs directly against the inner hip socket and it restricts the normal hip movement. The symptoms of osteoarthritis are a pain in the groin and the front thigh, swelling, and stiffness
HIP FRACTURES : The incidences of hip fractures increase with age. Worldwide, 1.66 million fractures were estimated to occur in 1990. The causes of hip fractures are osteoporosis and stress on the hip bones. It causes severe pain and is treated as a medical emergency that requires surgery immediately.
TROCHANTERIC BURSITIS : Bursitis is the inflammation of the fluid-filled sacs that protect the joint after any injury. In Trochanteric bursitis, the outer surface of the hip joint is affected. Symptoms include pain in the hip while walking and climbing up.
OSTEONECROSIS : The bone cells are destroyed when the blood supply isn't sufficient and it is called Osteonecrosis. Osteonecrosis affects the hip joint the most and is one of the causes of severe hip pain.
TENDONITIS : Tendonitis is a common sports injury and it is caused by repetitive stressful movements. In this condition, the tendons that bind the muscles to the hip bones are inflamed and cause pain.
STRAINS : Overuse of the hip causes small tears at the hip muscles. When abdominal muscles are weak, they do not provide support which leads to back and hip muscle strains.
HERNIATED DISCS : The discs in the spinal column act as shock absorber. These discs can be damaged by falling, aging, and heavy lifting. The pain from the herniated discs is transferred down to the hip along with the sciatica nerve.
TREATMENT FOR HIP PAIN
CONVENTIONAL TREATMENTMost causes of hip pain can be treated by using conventional methods such as:
REST: In arthritis, bursitis, and tendonitis, resting and less use of the hip joint helps to lessen the pain.
ICE: Pain and swelling can be reduced by applying ice to the hip.
PHYSICAL THERAPY: When the cause of the hip pain is diagnosed, physical therapy can help to reduce pain with exercises and stretches.
PAIN RELIEVERS: Anti-inflammatory drugs such as acetaminophen, ibuprofen or naproxen are prescribed to relieve the hip pain.
SURGERY: In some cases, such as osteoarthritis, surgery is performed to relieve the pain.
HIP REPLACEMENT: Hip replacement is performed in the case of severe osteoarthritis when the hip pain becomes chronic and swelling and stiffness hinder the movement of the hip.
Platelet-rich plasma Prolotherapy is an alternative technique that relieves the pain by using the body's own healing mechanism.
Several in vitro and animal studies have proven the role of PRP Prolotherapy in promoting the growth of new bone. A research conducted on 40 patients with monolateral severe hip osteoarthritis showed a decrease in the pain score after 7 weeks and 3 PRP injections while the side effects were negligible and were limited to the sensation of heaviness at the injection site.
Scientific evidence is available which shows that the growth factors such as TGF- β, HGF and IGF are required for muscle repair and regeneration. PRP injections do exactly the same function: they release the growth factors that stimulate the muscle repair and regeneration. This makes PRP very useful to treat the pain caused by hip strains.
Studies have shown the efficacy of PRP Prolotherapy in wound healing. Rabbit models of cartilage injury were given PRP injections and after 4 and 22 weeks, samples were evaluated by microscopic examination, histological evaluation, and microcomputed tomography. The results showed cartilage improvement and bone formation in the rabbits treated with PRP injections. PRP Prolotherapy has shown positive results in healing the broken tendons in rat models.
When a study was conducted on the patients with chronic elbow tendinosis, the group that received PRP injections showed a 60% decrease in pain as compared to the control group which showed only a 16% decrease. A combination of PRP Prolotherapy and Physical therapy is more effective to treat hip pain as compared to Physical therapy alone.
Although PRP Prolotherapy is showing promises in treating the causes of hip pain, there is very little clinical research available that evaluate the procedure through clinical trials. Also, this technique is not FDA approved yet. Due to the insufficient human data, caution must be taken in the use of PRP Prolotherapy in areas where currently not so reliable evidence is available.
CONSERVATIVE TREATMENTS TO COMBINE WITH PRPWhile PRP and stem cell treatments are enhancing the tissue repair and regeneration, conservative treatments can enhance healing, strengthen the muscles, and stabilize joint movements to maximize your recovery.
COLD LASER THERAPY TREATMENTS
- Accelerated tissue repair and cell growth
- Faster wound healing
- Reduced fibrous tissue formation
- Anti-inflammation
- Pain relief
- Increased blood flow
- Increased repair and regeneration
- Nerve function and repair
- Increased energy production- ATP
Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of hip tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.
Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.
Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.
Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.
Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.
Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reduces your perceived pain.
Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.
Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.
Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.
ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have the ability to heal and repair.
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercises and flexibility programs.
Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries are common because of weakness and poor stabilization of the leg and hip muscles. The combination of muscle weakness, poor coordination, and altered gait mechanics produce excessive strain on the soft tissues.
The lower extremities work as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles. Learn more about the importance of hip stabilization for running and walking.
Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments foot pain and exercises.
BIBLIOGRAPHY
Mehta, V. (2010). Platelet-Rich Plasma: A Review of the Science and Possible Clinical Applications. Orthopedics.
Sánchez, M., Anitua, E., Delgado, D., Sánchez, P., Orive, G., & Padilla, S. (2014). Muscle repair: platelet-rich plasma derivates as a bridge from spontaneity to intervention. Injury, S7–S14.
Sánchez, M., Guadilla, J., Fiz, N., & Andia, I. (2011). Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology , 10.1093.