Aching joints and the ath­lete

Look­ing at platelet-rich plasma ther­apy ... what when and why

Multisport Mecca - - Column - Kate Gaz­zard Sports medicine doc­tor, phys­io­ther­a­pist and ath­lete

OS­TEOARTHRI­TIS is a com­mon chronic joint dis­ease, caus­ing large amounts of dis­abil­ity and pain.

There are a num­ber of risk fac­tors for os­teoarthri­tis in­clud­ing joint in­jury, ge­net­ics, ex­cess weight, repet­i­tive kneel­ing or squat­ting and repet­i­tive heavy lift­ing.

Platelet-rich plasma ther­apy, some­times called PRP ther­apy, at­tempts to take ad­van­tage of the blood’s nat­u­ral heal­ing prop­er­ties to re­pair dam­aged car­ti­lage, ten­dons, lig­a­ments, mus­cles, or even bone.

Al­though not con­sid­ered stan­dard prac­tice, a grow­ing num­ber of pa­tients are turn­ing to PRP in­jec­tions to treat an ex­pand­ing list of or­tho­pe­dic and sports medicine con­di­tions, in­clud­ing os­teoarthri­tis and tendinopa­thy.

It is most com­monly used for knee os­teoarthri­tis but may be used on other joints such as the hip. It may also be used for long-stand­ing ten­don de­gen­er­a­tion that has not re­sponded to other in­ter­ven­tion.

The thoughts cur­rently on PRP are that it may help to:

■ Re­duce pain

■ Im­prove joint func­tion

■ Pos­si­bly slow, halt, or even re­pair dam­age to car­ti­lage

So, what is it?

Ba­si­cally, we take a sam­ple of your own blood and spin it down to ex­tract the platelet rich plasma – the liq­uid com­po­nent of blood. It is made up of mostly wa­ter but also in­cludes pro­teins, nu­tri­ents, glu­cose, and an­ti­bod­ies, among other com­po­nents.

Platelets alone do not have any restora­tive or heal­ing prop­er­ties; rather, they se­crete sub­stances called ‘growth fac­tors’ and other pro­teins that reg­u­late cell di­vi­sion, stim­u­late tis­sue re­gen­er­a­tion, and pro­mote heal­ing.

The re­search

Sev­eral good qual­ity tri­als are emerg­ing show­ing a trend with pa­tients un­der­go­ing PRP in­jec­tions for knee os­teoarthri­tis hav­ing re­duced pain at three, six and 12 months post in­jec­tion when com­pared with placebo or other ther­a­pies.

Some MRI stud­ies have even shown a halt in the pro­gres­sion of fur­ther car­ti­lage.

In the clinic

While there is no sil­ver bul­let ther­apy that works for ev­ery joint or ten­don prob­lem, in­creas­ingly we are see­ing the ben­e­fits of PRP for arthritic hip and knee pa­tients who want to re­main ac­tive.

Last week I re­ceived an email and phone call from a 55-year-old avid ten­nis player with hip arthri­tis who was so thrilled he wanted to shout from the rooftops af­ter his PRP. He was com­pletely pain free and back play­ing ten­nis and golf. His story is be­com­ing in­creas­ingly com­mon.

With tendinopathies, how­ever,

the main­stay of treat­ment re­volves around load man­age­ment (re­duc­ing train­ing load), in­creas­ing ten­don strength and shock­wave ther­apy. I will con­sider PRP when other meth­ods have failed in long­stand­ing ten­don prob­lems.

Stay­ing ac­tive as we age is crit­i­cally im­por­tant, not just for car­dio­vas­cu­lar well-be­ing, but for bone health, joint health and men­tal health. PRP may be a ben­e­fi­cial ad­junct to a com­pre­hen­sive plan from your sports medicine team in­clud­ing strength train­ing, ac­tiv­ity mod­i­fi­ca­tion, med­i­ca­tion and re­ha­bil­i­ta­tion to keep you ac­tive and achiev­ing your goals.

PHOTO: BLYJAK

Platelet-rich plasma ther­apy may be a ben­e­fi­cial ad­junct to a com­pre­hen­sive plan from your sports medicine team.

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