Today’s patient is the world’s strongest man...
Yes, Eddie Hall is an absolute tank. But even someone who has managed to
make a living out of superhuman feets is susceptible to injury.
A couple months ago, Eddie uploaded a video that he filmed while in the consulting office of Dr.
Suresh Sudula at the Harley Street Specialist Hospital in London. Dr. Suresh is a consultant
physiotherapist who specializes in Musculoskeletal Ultrasound & Medicine. Eddie reveals that one
month prior to the appointment “just during sparring [he] pulled [his]
back a little bit,” and that he had been nursing the injury since then.
The consult is for a PRP injection or platelet-rich plasma therapy.
Doctors use this type of injection to encourage healing and reduce inflammation. It is a
relatively simple procedure, but does involve drawing blood from the person being treated. Now
generally, PRP is deemed as a panacea (a cure-all whose administration isn’t that effective for most
things). But Eddie Hall has previous experience with PRP and claims that when he detached his
bicep in 2019, the injections (also administered by Dr. Sudula) “made a big difference”.
Platelets are blood cells that play several roles within the body; such as promoting blood clotting,
and carrying proteins that help wounds heal. The theory is that by injecting an injured area with
extra platelets, the cells will do their natural job and accelerate healing.
In a sense, they are the specialized task force, tactically inserted right at ground zero.
The blood sample taken from the patient is spun in a centrifuge at very high speed;
a process that separates platelets from other components in the blood. This process must be
repeated each time the patient is to receive a new dose, in most cases:
3 times at two week intervals. In Eddie’s video, Dr. Sudula points out that PRP does
not compromise the tissue integrity as compared to traditional steroid injections. After all,
these are your own cells that are being isolated and reintroduced at the point of injury.
In Eddie’s case, this site of injury was between the L2 and L5 vertebrae of the lower spine.
As Dr. Sudula says this is a typical strain of the interspinous ligaments, common in
people who lift heavy weights, especially when fatigue sets in and their form begins to slip.
Eddie was lucky not to have compromised the integrity of the spine,
and this is an injury from which he (and other patients can expect a full recovery).
An injury like Eddies would usually take about 6-8 weeks to heal and is
typically treated in an non-operative way with a program of progressive exercise and therapy.
At the time the video was filmed, Eddie had only one week left to recover before he was scheduled
to film a “World’s Strongest Man” special for CBS. He was receiving the third dose (out of three)
which had been administered at two week intervals which is common practice with PRP. He started the
treatment soon after the time of injury. One week from the time that the video was uploaded,
he was set to begin an intense 12 week training camp preparation for
The Heaviest Boxing Match in History vs Hafþór Björnsson. As you can tell by now,
there isn’t much room for error with a schedule as busy as Eddie Hall’s.
But is PRP really all that it’s cracked up to be? The results of the studies are varied:
In a meta-analysis of the available scientific literature on the efficacy of PRP injections
following acute grade I-II muscle injuries published in the Journal of Arthroscopy in 2018,
there was an approximate 5.5 day reduction in the “time to return to sport” metric
with PRP injection versus control intervention (placebo, physiotherapy).
Interestingly, when subanalyzed by hamstring injuries only,
statistical significance was lost. The rate of Return to sport was still shorter following
PRP injection, but the difference compared to control did not reach statistical significance.
And this just means that the difference was not large enough to be anything other than
pure chance. So Eddie is lucky he didn’t hurt his hamstring. What this finding suggests is
that PRP may be more beneficial for some types of muscle tissue than for others.
In the same study, it was found that rate of reinjury did not significantly differ between
PRP and control interventions. So while a round of PRP injections may help you recover more quickly,
it has not been shown to improve the strength or the quality of the healed tissue.
This study also notes that only 5 trials were used in this meta-analysis,
which reflects the small body of literature currently available on the topic.
STUDY 1:
https://myorthoevidence.com/AceReports/Report/10070
Another study published in PM&R: The Journal of Injury,
Function and Rehabilitation examined patients with symptomatic degenerative
lumbar disease over an 8 week period after a single PRP intervention. Unlike Eddie,
these were not acute injuries, but chronic degenerative injuries in which age-related wear
and tear on a spinal disc caused low back pain. At least this time, we’re talking about the low back.
In this study, intradiscal injection of platelet-rich plasma was associated with
a significant effect on patient-reported outcomes of function and best pain,
as well as greater satisfaction, when compared to injection with contrast
agent over 8 week follow-up. Unfortunately, we can’t take too much stock in this trial
either as it was stopped early due to time and financial constraints.
STUDY 2: https://myorthoevidence.com/AceReports/Report/8507
Finally, a third study published in the American Academy of Orthopedic Surgeons
found again that PRP expedites return to sport after acute muscle injury. In this study,
75 athletes with a grade II strain of the hamstrings, quadriceps, or gastrocnemius
muscles were randomized to a rehabilitation program with or without the addition of a
platelet-rich plasma injection. Similar to the findings of the aforementioned meta-analysis,
athletes who received the PRP injection demonstrated statistically significantly
shorter time to return to sport compared to the control group by approximately 4 days.
It should also be noted that pain severity scores were lower in the PRP group throughout
the study AND that there were no differences in recurrence rate observed between the two groups.
STUDY 3: https://myorthoevidence.com/AceReports/Report/9542
Fortunately for people interested in the use of PRP injections to accelerate recovery,
there is some evidence that suggests its efficacy;
both in treating acute and chronic injuries to various muscles. But as of yet it would
be unwise for me to say definitively that it is a great treatment option as we still
have very little scientific literature on the subject. To my knowledge there isn’t
even a study that addresses the specific spinal strain that Eddie treated with the injections.
Another thing to consider when deciding if PRP is right for you,
is the cost. Each dose will run you approximately $500 - $1000, and depending on your own specific
timeline and needs this may or may not be worth your while. In the case of a
professional athlete with months of physically demanding commitments already in the calendar,
shaving 5 days off of recovery time may be essential. But the same is not necessarily
true for someone without as intense a schedule. Either way, rehabilitation
and maintenance work after the patient has recovered is important no matter who you are.
In the end, Eddie Hall is a professional athlete so if he can afford it,
he can do it. Especially if there is no harm. But for the average person, with the possibility
of a full recovery even without PRP, the cost benefit ratio may not be favorable.
If you feel like it works, giddy up!
Thanks for watching. That's been a word from Dr. Chris, not your everyday ortho.