Informational video on PRP
The use of platelets in the treatment of injuries has been available for over 30 years. In more recent years, high profile athletes have brought its benefits to recovery and quick return to sport to the forefront. Now Platelet Rich Plasma (PRP) is considered a first-line treatment to muscle, fascial, ligament or joint injuries that cause pain and/or dysfunction.
Platelet Rich Plasma is derived from blood. A centrifuge is used to remove red blood cells, white blood cells and most of the plasma, the yellow liquid form of blood. Platelets are then concentrated by a second centrifuge, and are re-suspended in the plasma. Hence the name, Platelet Rich Plasma.
Platelets are produced in the bone marrow. Within the platelets are clotting factors, growth factors, honing molecules and other proteins that regulate healing. Platelets, which live for 7-10 days, stop bleeding, initiate healing, and encourage a new blood supply.
Healing occurs in 3 distinct phases.
The first is an inflammatory phase, which begins when platelets are drawn to a site and become activated, releasing the growth factors necessary for healing. This phase lasts 3-5 days, and is an important time to avoid anti-inflammatories (such as Ibuprofen, Naprosyn, Diclofenac, Aleve), as inflammation promotes healing.
The second phase, the proliferative phase, occurs over a period of weeks. During this time, cellular material forms in a layered approach, and new blood vessels form. The layers of differentiated cells form a matrix that strengthens the injured tissue. This is the phase of healing when tissues are most prone to re-injury. It is important to moderate activity to avoid re-injury during this time.
The third phase of healing is called the remodeling phase. This lasts up to a year. During this period, collagen continues to develop and gets deposited in layers, adding strength to the tissue.
Each of the 3 stages are necessary for full healing. Interruption of any part of healing by a second injury, or by the use of anti-inflammatories, can cause incomplete healing, leading to chronic injuries (defined by an injury that lasts 6 or more weeks).
Chronic injury to the supporting ligaments of a joint can lead to arthritis. Chronic injury to a tendon leads to tendinopathy. In both situations, the tissue quality is compromised, as is blood supply, further detracting from healing.
PRP is used to treat injured ligaments, tendons, and capsules around a joint to improve joint stability and improve healing in, for example, knee and hip arthritis, as well as back pain and most other joint pain. Injuries to ligaments, tendons and capsules cause about 60% of the pain people experience around their knees. It is important to understand that prior to pursuing surgical treatment, as not all pain will be resolved by surgery and sometimes treatment of these ares prior to surgery can improved the success of the surgery.
PRP can also be injected into joints to assist with repair of the articular cartilage and meniscus. The addition of bone marrow and or fat stem cells may be important in these situations to augment healing, depending on the degree of damage.
The injection of PRP is done under direct visualization, such as ultrasound or fluoroscopy, to guide the needle into the specific area that was injured. The skin and deeper middle tissue are numbed prior to injecting PRP, which lessens - but does not fully eliminate the discomfort.
The risk of treatment with PRP includes allergy to the anesthetic and injury or puncture of a deeper structure or nerve. Both can be avoided by the interview process, and with skilled use of ultrasound. Bruising to the injected area can be expected . There is a low risk of infection.
PRP is the second tier to regenerative procedures. The first is prolotherapy, and the third is stem cell treatment. The decision to use one therapy over another is determined by the degree of injury and other health conditions.
Bracing, orthodics, or taping may be needed to augment healing in the correct anatomical position.
Supplements and hormonal balance therapies may also assist with healing. Physical Therapy is often paramount to full recovery.
I met Dr Jen on my one year anniversary of a downhill ski accident that left me basically confined to crutches and a wheelchair, even after 6 surgical procedures and over 140 physical therapy visits during the previous year. The original surgeon said I would be skiing within a year and here I wasn’t even walking. Outside of the fracture healing, there wasn’t any improvement in my leg function. I felt hopeless and was seriously considering amputation as a way of having some sort of semblance of a life.
Dr. Jen immediately recognized from a picture of an x-ray on my phone that I had dislocated my knee, in addition to the tibial plateau fracture. What?!?!? None of the other doctors that I had seen throughout the year had diagnosed this. She explained that the dislocation would have left my ligaments stretched and my leg unstable . She continued on to do a thorough exam, using ultrasound in addition to the physical exam. The examination lasted well over an hour, with explanations along the way, unlike the 5-10 minutes exams that many of the orthopedic surgeons would do. She offered a treatment plan that included the use of PRP (platelet rich plasma) injections. She said upfront that this would help progress me along my journey of recovery, but it would not solve all of my problems, and that due to the severity of my injury, I would require more than one treatment.
Over the course of the next several months, I received PRP injections and within a month of each treatment, I saw substantial improvement. My despair started to dissipate. Eventually when I had reached a plateau with the PRP, Dr Jen utilized her extensive regenerative medicine network to find the appropriate stem cell doctor for me and she helped me navigate the next steps that were right for me, acting as a sounding board and helping me evaluate options.
At the time of this writing, I am not done on my road to recovery, but I am thrilled that about 18 months after meeting Dr Jen, I was able to hike a mountain in NH with my young daughter - a feat I only dreamed of during the past 2.5 years. What is amazing too is that the day before I met Dr Jen, one of the surgeons told me that I needed yet another surgery, which did not feel right in my gut. On top of that, he said that PRP did not work. I think he needs to see me now and how far I came, without a surgery (which I am sure would not have progressed me).
It's true that some PRPs might not work but that's because not all PRPs are created equal. I know doctors that I respect, who perform PRPs, but they do not use ultrasound to guide where to inject. They just guess. They also then stay more superficial. And finally they use a kit to process the platelets, giving them a lot less PRP to work with, than Dr. Jen uses. Many doctors are jumping on the bandwagon of PRPs and regenerative medicine, but go with one that knows their stuff and actively participates in Regenerative Medicine conferences. It is not worth it to go with anyone less than the best.
In conclusion, Dr Jen's qualities include (but are not limited to):
I am so thankful that I found Dr Jen. She was my saving grace (and the saving grace of a few friends that I had also recommended her.
For a few months I could not walk, stand, or lie down without severe pain in my left hip as well as all the way down my left leg. Sitting was my only position of comfort and use of a wheelchair or a walker was the only way I could move around without pain. This condition came on suddenly and lasted for months. I was not excited to use drugs that would just temporarily relieve the pain. My primary-care physician recommended that, in addition to PT (which was essential but alone did not eliminate the pain), I made an appointment with Dr Jennifer Stebbing, who, she said, was doing some interesting work that might be helpful. I finally followed her advice and good advice it was!
Dr Stebbing was, indeed, helpful!! Some immediate relief of pain came from her release of trigger points that had developed in my left thigh and leg. That relief was most welcome, but I knew it was temporary until the cause of those trigger points was resolved. Then came the real magic!! After examining multiple images of my spine and hip, Dr Stebbing pinpointed signs of degeneration and weakness in a number of ligaments, tendons, and muscles that support my spine as well as some in the hip. Degeneration sounded pretty hopeless to me, but I had not heard of Regenerative Therapies.
She told me it was possible to improve many degenerative conditions using prolotherapy and platelet rich plasma (PRP), both of which involved injections in the area of weakened ligaments and tendons. Like most, I am not fond of injections but felt the procedures were well worth a try if they worked and put an end the pain I had been experiencing.
IT WORKED!! First I had prolotherapy in the hip region that lead to reduction in pain in that area. A few weeks later, I had prolotherapy injections near the lumbar region of my spine. Following this latter procedure, the pain disappeared completely for a full week followed by some minor discomfort off and on after that week. Finally, I had a PRP treatment in the same area around the lumbar region of my spine and since that treatment I have had NO MORE PAIN and no return of trigger points.
It is now well over a month after that final treatment; I have had no more treatments, and all of the pain is still gone! I can again walk without pain and unassisted (the wheelchair and walker are in storage). The focus of the approach was to regenerate tissues that were causing the pain (in conjunction with exercises from PT to strengthen my core). Amazing and very exciting to me!! No drugs, no surgery with replacement parts—just regeneration of my own tissues.
Oh yes, did I mention that I was almost 86 years old when I had this done? Thus, this seems to be a procedure that can help some of us in our later years and is not only for the young or for active athletes.
I am delighted that I found Dr Stebbing and that I learned about Regenerative Therapies. I would consider this again for the same structures, if needed, or for any other degenerative tissues in my body that hinder my ability to live an active yet pain free life and for which this procedure has been helpful! Thanks to Dr Stebbing and her staff and to those who have enveloped and continue to develop such Regenerative Techniques.
I was originally diagnosed with a labrum tear in my right hip and told I need surgery. At 57, my primary doctor told me I was too young. After months of pain and not knowing where to turn, I scoured the internet for answers. I discovered that many had success with PRP treatments and found Dr. Stebbing.
After trigger point treatments and osteopathic manipulations, along with some great physical therapists that Dr. Stebbing recommended, my hip was finally working.
Then, my left hip started locking up. After an MRI, the diagnosis was chrondromalacia. An orthopedic doctor told me I should never do any weight bearing exercises and limit myself to a pool or exercise bike. He highly recommended a hip replacement.
Again, my primary did not agree. Dr. Stebbing recommended PRP treatments. I have now had two treatments done by Dr. Stebbing and could not be happier with the results. I suffered from debilitating pain and could not stand up out of a chair or roll over in bed when trying to sleep. The treatments were amazing! I am back at the gym working into my routines.
The most impressive thing about Dr. Stebbing is the time she takes with her patients and the knowledge she shares. I have never left her office without feeling I had learned something about my body and how things work and that my healing was her number one priority.
In my years of experiences with doctors and I have had my share, multiple surgeries etc. I can honestly say Dr Stebbing is one of the best doctors out there!
In October 2016, at the age of 37, I found out that I had a congenital cam lesion on the head of my right femur, along with a bone spur and osteoarthritis in the hip joint. My physical activity came to a screeching halt from the pain that I was experiencing. I was an avid runner and felt lost without the physical activity. I had trouble lifting my leg to get into the car, and putting on socks and shoes were incredibly frustrating.
Conventional orthopedic doctors that I saw, suggested cortisone shots and physical therapy as the solution. Beyond that, I was told to wait until I was in so much pain that I couldn’t take it anymore, and get a hip replacement.
I knew there had to be other options.
That’s when I came across regenerative medicine through Dr. Jonathan Fenton. He recommended additional consultation with Dr. Jennifer Stebbing. These doctors gave me hope that I could have a good quality of life without surgery. Through the use of prolotherapy, PRP, autologous stem cell treatment, and trigger point release, I have been able to resume my physical activity. I now enjoy multi-day hikes in the White Mountains, downhill skiing, and getting into my car without pain.
When I do encounter muscle imbalances and tightness, Dr. Stebbing gets me back on track quickly. She is intuitive and gifted in her understanding of body mechanics. Her approach to healing and correcting issues is second to none and I have not met another doctor who seeks out solutions like she does. She has improved my quality of life.
Dr. Stebbing has taught me along the way how my body works and what I need to do to keep it working right. If you’re looking for a treatment for the cause and not just the symptoms I highly recommend seeing Dr. Stebbing.
I first met Dr. Stebbing in my search for knee pain relief. We worked together on my options - the depth of knowledge she had was incredible and she patiently worked through every question I had. As our time progressed she began helping me understand other areas of pain and found the origins - something no doctor had ever taken the time or effort to do! She truly becomes an ally and advocate for each and every patient that enters her office. I can't thank her enough for caring for me as a person and not just a patient. My life has been changed for the better because of her care!
How does PRP injections compare to prolotherapy?
Many of the same principles apply. See prolotherapy FAQs. PRP is not comfortable and requires anesthesia. Nerve blocks and local anesthesia are done to give local relief. Because PRP is viscous and there are other pain pathways, besides nerve pain, there continues to be some injection discomfort. Injecting PRP slowly improves pain tolerance. In certain patients, oral medications can be used to assist with pain. Nitrous oxide is available in some offices. In addition, we welcome having patients bring in their own music. Tapping, meditation and other techniques are helpful. That being said, the benefit is significant. See above testimonials. The pain compared to having joint replacement is days, not weeks.
What should be expected post procedure?
The inflammatory response is greater with PRP, so 3-5 days of increased swelling with or without pain is normal. Some people have little to no swelling or pain after 24 hours and others have more. Use of crutches for 1-3 days to avoid weight bearing is suggested for treatment of the lower body. Sling for the upper body is helpful. Compression of the joint is helpful. Avoidance of heat during the first 24 hours helps reduce the inflammation that would be increased as blood vessels dilate. Ice slows down the inflammation, which is used at times with people who experience a lot of discomfort.
When would Physical Therapy start?
Typically, PT is started at the earliest 2 weeks after the last PRP session. Care is taken to prevent injury from being "pushed" too fast or too early... before healing has occurred fully. For this reason, some doctors who treat patients with regenerative injections, will not send their patients to PT until after the treatment is done.
Is there any safe exercise?
Aerobic exercise in the form of elliptical machine or stationary bike or swimming can be continued depending on the injured area.
Stabilization exercise, such as pilates, gyrotonics and some forms of yoga work well. We want to keep the tissue pliable, but not overstretched, which can happen if you aren't careful while doing yoga.
Avoid strength training until you have painless full range of motion and have built up some of the stabilizer or core muscles of the joint. Resistive bands are a good way to build up stabilization of a joint, start with yellow bands and progress thru the rainbow. Exercises using your body weight as the resistance is a further progression of stabilization into strength exercises. Typically the earliest strength training would occur at 6 wks to 2 months.
Hip Pain with PRP combined with Trigger Point injections, Osteopathic Manipulation and Prolotherapy.
Treatment of Knee Osteoarthritis in someone who could not have surgery done.
Knee Osteoarthritis pretreated with PRP followed by bone marrow stem cell by a colleague.