Hi guys! In this video, I'm going to discuss PRP injections and what they are useful for. So,
we're going to look at how they create the PRP solution, or the platelet-rich plasma solution
that they inject into you. We're going to look at how they prepare it, what factors can influence
how effective it is. Then also, what the research has shown, what conditions is it useful for and
which ones it doesn't really work for. And then lastly, when you should maybe consider getting
a PRP injection – when can it be useful? So, my name is Maryke. I'm a physiotherapist from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment for
your injuries, all done via video call. Have a look at the description of this video if you want
the link to my website. Okay, so, let's jump right in. How do they prepare the PRP solutions? So,
PRP stands for "platelet-rich plasma". And it's your own blood that they draw, then they spin
it really fast, and by spinning it, they separate the blood into different layers. Because remember,
you've got loads of different cells in there and different things that they … some of them
they want, others they don't. And what they're looking for is that little layer of plasma that
has a concentration of your platelets in it, and that's the level that they draw off. Now,
I do apologise if you’re hearing a lot of banging, but they are building next door and
I can't do anything about it. So, they then take this layer of plasma that's full of your platelets
and they draw that off and they inject that into your injury site. Now, why do they do that? So,
platelets have the ability to secrete loads of things. So, some of the stuff that it can … why
do I want to say? … “release” is the word I'm looking for, not “secrete”. One of the things that
they release is growth factor. And growth factor, there's …well … loads of different type of growth
factor that they actually release, and that can stimulate the healing process, especially that of
collagen. And collagen is the building block of loads of muscular skeletal structures, tendons,
for instance, as well. Then, they also release pro-inflammatory and anti-inflammatory substances,
and that can help with pain management. So in essence, PRP is used either for pain management,
but mostly to stimulate healing in structures where healing has either not taken place or
where healing is really slow. Now, there's a load of different factors that can affect how
well your PRP injection works, because when we get to the research as well, you'll see that there's
a lot of studies that show that PRP is really effective for some conditions, and then there
are quite a few studies that show, no, it doesn't really work. And the reason for this is depending
on how … Well, it's twofold: Part of it depends on how they prepare the solution, part of it is,
it depends on the patient themselves. So, with regards to how they prepare the solution, that
can dictate how many platelets are actually in the substance that they inject into you. So, … And it
can also make a difference to how active these platelets are, because just because you've got
platelets that's being injected into you does not mean that they're actually going to release the
substances you want them to release. At the moment there's more than 16 different machines that they
can use to prepare your PRP solution, and what the research has shown is, each one of these
machines creates a solution with a different concentration of platelets in it. Then also,
they can either spin it once or they can spin it twice, and that will have an effect. Then,
they also sometimes put … add substances to it that allow the platelets to release their
bioactive components more readily, and you can use different types of substances to stimulate
them. And with some studies, they just don't use anything either. Then, what else can be different?
Oh yes! So, they often, and usually, inject anaesthetic into the site where they're going
to inject the platelets for you to help with the pain management. But, what they've shown in the
research is that anaesthetic can actually have an effect on the platelets, that they don't work so
well. So, depending on how much of the anaesthetic they inject, that can have an influence on how
well the injection works. Now, we just don't know at this point what the best way to prepare
and inject these things is – there's no clear-cut solution to that yet, or clear-cut guidance. So,
there's a lot of room for improvement in the research with regards to procedure. Then, there
are also factors in the patient themselves that can affect this. Because the interesting thing is,
even in studies where they drew the blood from the same patient and prepared it in exactly the same
way, it had a different effect on different days, and that's because depending on what you eat,
what you do, you can affect how many platelets you have and how well they function or how much
substance they've got left to release. So, things that can influence it, it's, interestingly enough,
mental and physical stress. Now, when we talk about mental stress, it doesn't even have to
be massive mental stress; it's the stress you feel when you have to speak in front of a lot of
people or when you've got to do a maths exam. What happens then is that your platelets release their
substances into your bloodstream to help you with what you've got to cope with at the moment. So,
if they then, shortly after that, go and draw your blood and prepare your platelets,
those platelets don't have as many growth factors or other bioactive components to
release for your injury. So, you’re essentially injecting starved platelets into the injury site,
which can't have the best effect. Same thing for physical stress. Physical stress is not even that
extreme, it's just a bout of exercise. So you can see, if you’re due to have a PRP injection,
it may be worth limiting those type of stressors a few days before they draw your blood. Then,
other things that can influence it is if you have a diet high in saturated fats and sugar
and simple carbohydrates; that's been shown to affect how well your platelets function. Caffeine
has an influence on it, also certain flavonoids that's present in things like onions, apples,
tea, and wine. Similarly, substances present in legumes, like chickpeas and soya beans. Then,
alcohol as well as smoking have a very negative effect on platelet function and also certain
medications, of which some of the main ones that a lot of us use are anti-inflammatories,
so, non-steroidal anti-inflammatories and the histamines that people use for hay fever, for
instance, and also certain antibiotics. So … And at the moment patients aren't really being given
guidelines with regards to managing these things before they go for a PRP injection. So again,
that can be part of the reason why the research is showing such varied results and that it works
for some people, and it doesn't work for other people. So, there's a lot of scope for improvement
with this technique. Okay, so then we get to what conditions the research is currently showing PRP
to be useful for. So, at the moment the guidelines are saying greater trochanteric pain syndrome,
also known as … So, it's pain around the lateral hip, usually caused by gluteal tendinopathy, so,
glute med tendinopathy type thing; the research is showing that, yep PRP injections can be useful
for these conditions. Patellar tendinopathy, plantar fasciitis, tennis elbow. Then also,
osteoarthritis of the knee, because if we think of osteoarthritis, you're getting permanent
and non-healing injuries of your cartilage and stuff, and the PRP can actually help
with the pain you feel from that and repairing that a little bit. So, for those conditions,
it's been shown that if you add PRP to the treatment process – so, not PRP on its own,
but combined with rehab processes and things like that that you would normally do – you get better
results. Now, there's limited evidence that PRP may be useful for rotator cuff tendinopathies,
osteoarthritis in the hip. Then also, sometimes when you have an ACL or anterior cruciate repair,
and they use your patellar tendon to do that, patients can get a lot of pain on the patellar
tendon where they've taken that part of the tendon, and PRP seems to help with that pain in
that patellar tendon. Also for high ankle sprain, so, syndesmosis injuries, that ... PRP can help
repair that type of injury. Now, conditions that the current research is showing that PRP is not
useful for: Surprisingly, Achilles tendinopathy. So, even though it helps all the other types of
tendinopathies, at the moment it doesn't seem to be helpful for Achilles tendinopathies. Also,
if you've had an acute fracture or you've got a fracture that doesn't want to heal,
PRP doesn't seem to be useful for that. Some surgeons have been injecting PRP solutions when
they do repairs of like cruciate ligaments or rotator cuff repairs or tendon repairs
in the hope that the PRP will stimulate that repair to help it heal better and more quickly,
and the research is showing that, nope, PRP doesn't actually help that either. So, I won't
say that you need to close the door totally on these conditions and that it will be ... Like
for instance, for Achilles tendinopathy, it may just be that they haven't perfected the
technique with Achilles tendinopathy yet. So, we'll keep an eye on the research. It may be,
as they get better with doing these types of injections and preparing the solution that it
does become useful for them. So, when should you consider having a PRP injection? Usually,
if you've tried at least 12 weeks of a proper progressive rehab program and you're just not
making progress or the pain is preventing you from actually starting your rehab program,
then I would say PRP is something that you could consider and discuss with your doctor. It's not
a magic fix, and it still needs to be used in combination with rehab, for instance for gluteal
tendinopathies and other types of tendinopathy and stuff, because you need to still strengthen
that tendon and stimulate it to heal further, but it can be a very good adjunctive treatment. So,
let me know if you've got any questions. If you need more help with an injury, you're also welcome
to consult me via video call – link to my website is in the description of this video. Take care!