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3879 Views 8 Replies Latest reply: Jul 25, 2010 4:25 PM by Ganthon RSS
Ganthon Rookie 3 posts since
Jun 24, 2010
Currently Being Moderated

Jun 24, 2010 5:55 AM

Achilles Tendonosis and Platelet Rich Plasma Injections for Treatment

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?

 

http://www.docguide.com/news/content.nsf/news/852576140048867C852576E900664D86http://http://www.docguide.com/news/content.nsf/news/852576140048867C852576E900664D86

  • JamesJohnsonLMT Legend 1,154 posts since
    Aug 23, 2009

    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.

  • lenzlaw Community Moderator 10,377 posts since
    Jan 18, 2008

    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.

     

    Len





    Len

  • Damien Howell Legend 312 posts since
    Feb 27, 2008

    Take a look at Science Based Medicine Blog review of Platelet Rich Plasma Injections.

    Damien Howell PT, DPT, OCS - www.damienhowellpt.com

  • JamesJohnsonLMT Legend 1,154 posts since
    Aug 23, 2009

    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?

  • runningdreamer Amateur 26 posts since
    Mar 1, 2009

    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...

  • WyssJF Rookie 1 posts since
    Jul 24, 2010

    Greg,

     

    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,

     

    Jay

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