Chiropractor Chandler AZ

PRP INJECTION RECOVERY TIME

CONVENTIONAL METHODS TO TREAT MUSCULOSKELETAL INJURIES

Musculoskeletal injuries are a global concern as a public health issue and a huge financial burden. According to World Health Organization (WHO) statistics, musculoskeletal injuries are the biggest cause of disability and long-term pain and it affects millions of people across the globe.

Musculoskeletal injuries affect bones, muscles, tendons, ligaments, nerves, blood vessels and other soft tissues. The traditional treatment for these injuries is very expensive and, in 2004, $894 billion was spent in the United States. Individual loss of mobility, function, and work capacity is an ongoing struggle for people suffering from musculoskeletal injuries.

Traditional methods to treat musculoskeletal injuries are:

1. Anti-Inflammatory Drugs
2. Corticosteroid Injections
3. Surgery
4. Ice
5. Heat
6. Rests
7. Wraps And Braces
8. Physical Therapy
9. Surgery
10. Chiropractic Adjustments

These methods have different recovery times. Anti-inflammatory drugs cause immediate pain relief but they do not heal the injury and can increase the injury in the long-term. Same goes for corticosteroid injections that are frequently used for musculoskeletal injuries.

Corticosteroid injections effectively relieves pain caused by musculoskeletal injuries in short-term, but they are less effective in the long term and they do not repair the damage, only mask it by eliminating pain. Ice/heat and rest are short-term methods and they are effective for minor injuries.

Wraps and braces take a very long time to repair the damage by immobilizing the damaged part. Physical therapy takes a very long time to reduce pain through exercises.

Surgery is most widely used to repair the musculoskeletal damages when all the other conventional methods fail to eliminate the pain, but recovery time is very long. Recovery time for elbow ligament reconstruction surgery is one year. Anterior cruciate ligament (ACL) surgery takes approximately 6-12 months to recover fully.

Thus, any treatment method that is efficient, effective and has short recovery time is required. Platelet-rich plasma (PRP) Prolotherapy is an alternative treatment method that fulfills these criteria.

Platelet-rich plasma (PRP) Prolotherapy has been used since 1987 in different medical fields such as orthopedics, neurosurgery, ENT, wound healing and cardiothoracic surgeries. It is part of the medical field known as Orthobiologics which includes the use of biological components and the body's own ability to heal itself. Recently, PRP Prolotherapy started being used to treat musculoskeletal injuries and has shown great results.

WHAT IS PLATELET-RICH PLASMA PROLOTHERAPY

Platelet-rich plasma Prolotherapy is an alternative treatment method that uses the patient's own blood component to heal the actual cause of injury. The blood consists of 94% red blood cells, 1% white blood cells, and 5% platelets. Platelets have a role in blood clotting, cell regeneration, and repair. Platelets are manipulated in PRP in which the composition of blood is reversed to 94% platelets and 6% red blood cells. This platelet-rich plasma is then injected at the site of injury where it gets activated and starts the healing process.

HOW DOES PLATELET-RICH PLASMA PROLOTHERAPY WORK

Platelets contain alpha granules that are filled with growth factors. When the platelet-rich plasma is injected into the body, it gets activated and releases all the alpha granules. Alpha granules then release the growth factors which stimulate the epithelial growth factors (EGF) at the site of injury. The role of EGF is cell migration and replication at the site of injury. Activated EGFs then repair the injured part. The whole recovery time of PRP Prolotherapy depends on the time taken in this process.

STAGES OF PLATELET-RICH PLASMA PROLOTHERAPY

Research has shown that the PRP Prolotherapy takes three stages to healing the injury completely.

Stage 1 is the inflammation phase in which 100% of alpha particles and then growth factors are released at the site of injury. On average, this phase takes 2-3 days but it depends on the site of injury, extent of the injury, and the PRP protocol followed.

Stage 2 is the proliferation phase which is the most important stage in musculoskeletal regeneration. At this stage, the growth factors attract the repair cells of the body at the site of injury and start the repair process. It takes around 2-4 weeks on average to fully complete.

Stage 3 is a remodeling phase which is the final stage. At this stage, the newly made structures are matured and strengthened and the injury is fully recovered. It takes over a year and sometimes more in the case of larger joints such as the hip and knee joints after the proliferation stage.

The whole process of PRP injection takes 30-40 minutes maximum. The platelet-rich plasma Prolotherapy specialist makes sure that these three phases are completed to ensure the complete recovery from the injury.

RECOVERY TIME FOR PLATELET-RICH PLASMA PROLOTHERAPY

Patients may experience soreness and pain at the site of injection 2-3 days after the injection. Painkillers are prescribed to relieve this pain. It is important for the patient to rest for a few days or weeks after the injection so as not to push the injected area too quickly. It takes 3-4 weeks to relieve pain and continues to improve over a period of 3-6 months following an injection. The recovery time is dependent on the following factors:

1. The location of injection
2. The extent of injury
3. PRP Prolotherapy procedure used

Some parts respond quicker than the others. Tendons and ligaments grow very slowly and PRP Prolotherapy takes much longer to relieve pain in case of tendonitis. Research has shown that arthritic joints respond much faster to PRP injection. Most injuries can be completely recovered after 5-6 months, but in some cases it can take up to 2 years.

A research study was conducted on 18 human athletes who had Achilles tendons. 12 of them were treated with platelet-rich plasma, while the other 6 were placed in the control group and not given PRP injections. The athletes treated with PRP injection showed earlier recovery and improved functional recovery after 7 weeks as compared to the control group that recovered after 11 weeks. The PRP treated were able to do gentle exercise after 11 weeks while the control group took 18 weeks to reach that level. The PRP treated athletes were fully recovered after 14 weeks and were able to train fully while the control group took 21 weeks to recover fully.

WHAT TO EXPECT AFTER PLATELET-RICH PLASMA PROLOTHERAPY

1. Pain: The platelet-rich plasma is injected under local anesthesia so after the procedure, the injected part will be numb. This can last for few hours. After that, soreness and pain will cause discomfort to the patient at the site of injection. Pain can last for 2-3 days. Painkillers are prescribed to relieve the pain.
2. Activities and exercises: It is strongly recommended to avoid hard physical activity and exercise for the first 3 days after PRP injection. The patient can resume physical activity after 1 week.
3. Work: It depends on the type of work. For patients whose jobs require physical and manual work are advised to stay away from work for a week. Patients who have desk jobs can resume their work as soon as they feel better which usually takes 2-3 days.
4. Driving: Patients treated with PRP can resume driving a week after the procedure when they feel comfortable.
5. Follow-up appointments: Patients are evaluated by a physical therapist or physician for pain improvements and any side effect for 3 weeks. If there is pain relief and no side effect then there is no need for further appointments.

FACTORS THAT DELAY THE RECOVERY AFTER PRP PROLOTHERAPY

1. Infection: PRP Prolotherapy is an invasive method that uses a needle to inject PRP at the injury site and, just like any other invasive method, there is always a risk of infection and needle breakage. Infection at the site of injury can reduce the effectiveness of the procedure and delay the recovery.
2. Site of Injection: Those parts of the body that have high blood supply are more likely to recover faster as compared to the parts with poor blood supply.
3. Anti-inflammatory drugs: It is advised for patients not to take any anti-inflammatory drugs 1 week prior and 3 weeks after the PRP injection as it can interfere with Stage 1 of the recovery stages and can delay recovery or even make PRP injection ineffective.

FACTORS THAT ENHANCE THE RECOVERY AFTER PRP INJECTION

1. Rest: It is important to take proper rest so that the body can use its healing machinery to repair the damage. Any hard exercise can affect the recovery time.
2. Combination of therapies: The effectiveness of PRP can be enhanced by using it with alternative therapies such as acupuncture, yoga, physical therapy and weight and lifestyle management.

PRP Prolotherapy is a costly method and it is important for the patients to discuss recovery time and possible factors that can affect the recovery time when considering it as a treatment option.

BIBLIOGRAPHY

Z, J. X. (2012). Synergy of tendon stem cells and platelet-rich plasma in tendon healing. J Orthop Res, 991-7.

A, H., et al. (2012). Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats. Wound Repair Regen, 748-56.

Forootan, K. S., Karimi, H., & Dayani, A. R. (2014). PRP and Metaplasia in repaired tendon. Journal of Acute Disease, 284-289.