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Has anyone had platelet rich plasma injections for Achilles Tendonosis? I have followed my othopedic doctor's advice by taking a break from running and wearing heal lifts. The next step he is recommending is a PRP injection. Obviously much better than an invasive procedure. The success rate seems to vary based on what study you read. Anyone with prior results that can share their experience or some other treatment that works?
PRP sounds like a promising therapy for many patients, but I wonder sometimes if other medical interventions have actually created a need for it.
Injecting platelets into injured tissue simulates what would happen during an episode of inflammation, since this would be a natural result of immune system activity. However, most medical interventions to date have centered around inhibiting the inflammatory response in order to prevent pain, and unfortunately were thought to benefit the healing process. Steroid and Non-Steroidal Anti-Inflammatory Drug injections and systemic anti-inflammatories including over-the-counter NSAIDs are examples of this strategy that are still commonly used today. http://www.podiatrytoday.com/article/6294 (note middle section on steroids/NSAIDs)
Since it has been found that steroids can actually increase the likelyhood of injury to the achilles tendon, and that NSAIDs actually inhibit the healing response, it amuses me to see the medical industry come up with an unnatural method of simulating the natural process that medical professionals have been at war with for so long. I'll admit that they've amplified the benefits by doing so, but a little red-faced humility is in order.
As you can see from the results of a study cited in the article above, it is evident that the activity of a needle alone appears to stimulate regrowth, regardless of what is being injected - if anything at all. I've seen other examples of "dry needling" being used for plantar fasciitis and other soft tissue maladies that can benefit from the inflammatory response. Prolotherapy is another pro-inflammatory approach that allows the immune system to do the heavy lifting it was designed to do by stimulating inflammation in the target area.
With PRP, we are by-passing the inflammatory process and cutting to the chase, by concentrating the platelets at the injury site. I say it's very clever, and about time... in more ways than one. Hopefully, you will recover faster and get back to training sooner, which is the only reason why I would spend my money on it.
Interesting article Jim. In fact I suspect nerve entrapment was causing my heel pain though the podiatrist insisted it was PF. I didn't think so because the pain didn't match any of the typical PF symptoms. And I "cured" it by moving toward a midfoot strike, thus taking much of the pressure off the heel.
I agree there is a problem with evidence for efficacy of PRP. Injecting platelets into an "osis" rather than "itis" seems like drenching an athlete with a bucket of his own sweat and congratulating him for the apparent intensity of his workout.
The unasked questions though, are:
(1) what is the value of this therapy when inflammation is actually present vs. not present? ie: when inflammation and PRP are both present, is healing accelerated, or has the problem already been taken care of by the immune system - making PRP unnecessary?
(1a) Are there inflammatory markers/cofactors without which healing is unlikely?
(1b) Are there inflammatory markers/cofactors that interfere with platelet activity regardless of platelet origin?
(2) When inflammation is not present in the target tissue, does it need to be induced, and in this case, will the target tissue benefit from PRP?
(3) Regardless of the answer(s) to the previous questions, is this true with normal individuals and/or for those with abnormal immune system response?
Hey Damien Howell, thanks for the link. It sounds like quackery to me, or at least buying into the massive pharmaceutical industry. I note that the original study (link by a previous poster) was funded by a pharmaceutical company. Perfect example of wasting health care dollars. Oh yeah, it probably isn't covered by insurance anyway...
Thank you to everyone for sharing information on PRP.
Prior to the injection, there was no pain or stiffness while running. However, after the run my achilles tendon would stiffen and I would need to walk it off for about 5 or 10 minutes. A few nights I would wake up with a burning sensation in my heel. I stopped my regular routine of running 35 miles a week and would try to run once a week to see if I would get any better. I was not making any progress and I opted to see an othopedic doctor. On the first visit he gave me heel lifts to wear nd discussed PRP and decided to re-evaluate in a month. The heel lifts helped in reducing the tenderness and pain at night. During the latter part of the month I tried to run for 30 minutes once a week but the stiffness would return afterwards. Hiking and even 18 holes of golf created stiffness in my achilles tendon along with some inflammation. That is when I decided to have my first injection.
I opted to have my first injection on June 30th. After the injection, I was instructed to wear a walking boot for a couple of weeks. After one week I was progressing fine and ditched the boot but limited my activity to just walking and swimming. I would also give my foot an ice water bath a couple of times a day. Two weeks later (July 13th) I had a follow-up evaluation and the tenderness had dramitcally decreased from a pain threshold of 7 to 2 1/2. We opted for one more injection. The doctor has been very helpful. This is a new procedure for his office as I am his second patient. He is very interested in tracking the results and did not charge me for the injection (the first injection was $350 instead of $800 for the procedure). I don't mind being the lab mouse and he had another Orthopedic Doctor observe along with a few nurses and the biomedical equipment technician from the manufacturer (Arthrex).
I believe the injection is helping but it is difficult to tell at this stage. Wearing a walking boot for a week certainly minimized the stress on my achilles tendon and it is difificult to ascertain the impact that has had toward my recovery. I will give it a few weeks before resuming running. In the interim, I will see how it goes and plan to get on the bike in a week or so.
How is your achilles doing? I just had the same treatment done a week ago and am wondering how your's is progressing.
One week after the shot, the swelling from the shot is gone and my achilles does feel better.I used crutches for 3 days afterwards to get around and have stuck to lifting weights as my only form of exercise for the past week. This week, I intend to swim and lift and, if I feel bold, jog.
I chose to get the shot because I had one tender spot remaining. I had been jogging 9 minutes, walking 1, every other day for 30-40 minutes. My time is a bit longer, however. I have not ran since the Monument Avenue 10K in March. I tried rest, saw a doctor for heel lifts, and have been moving through a progressively increasing active rest. I built the running up slowly and have also been getting regular massages as well as working on my flexibility and been on the foam roller like it's a religion.
Best of luck,
It has been 10 days since my second injection. I had the walking boot for 48 hours. I have not resumed running as the Doctor recommended giving it a rest for four weeks. I have been cycling and swimming and in the past couple of days, walked 18 holes on the golf course. The tenderness is gone--mild pain if I press real hard with my thumb. I still have stiffness in my achilles when I walk --it comes and goes. I know I can't run on it and will not even attempt it. Before the injections I was usually ok in walking off any stiffness in 5 minutes. Right now it seems to stay with me a lot longer and I am starting to get concerned on why it is that way. I will give it another week without any increases in physical activity to see how it responds. The doctor did mention to start stretching it out a bit and that is why I walked the golf course one day--I plan to get some regular stretches on a daily basis too. Keep me posted on your progress