Does PRP Help Acute Sports Injuries Heal Faster? PRICE vs RICE
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While the data that PRP helps chronic problems like knee arthritis is very solid at this point, a largely unanswered question is whether it can also help a fresh sports injury heal faster. Now a new study that used a unique approach supports the idea that a PRP injection, when applied correctly, can help athletes return to play faster. Let’s dig in.
What is PRP?
If you read this blog regularly, you know that PRP stands for Platelet-Rich Plasma. Basically, the doctor takes blood from a vein, spins it down in a centrifuge, and then injects the plasma which is concentrated in your platelets. To learn more, watch my video below:
Acute vs Sub-acute vs Chronic
In medicine, a fresh injury is called acute. If that injury lingers, then it’s called sub-acute. If it lasts for more than 3-6 months, it’s called chronic.
Acute injuries generally take as long as they take to heal. For example, the inflammation phase lasts a few days. This is where the body brings in cells to the area to break down the damaged tissue and begin the repair job. This time is marked by swelling and if the area is open to the environment, lots of white blood cells are brought in to kill bacteria. The next phase is proliferation. This often lasts weeks as your body uses these cells to build new tissue and repair the damage. This is also when the local stem and other cells “proliferate” to orchestrate the repair. Finally, the remodeling phase can last for 3-6 months as the disorganized tissue laid down in the proliferation phase is remodeled to become stronger via the day-to-day forces placed on the area.
The billion-dollar question here has always been whether PRP can help the proliferation phase move more quickly. For example, we know that platelet-derived growth factors can help cells proliferate in culture. If that also happened in the real world of patient injuries, then a PRP injection could help people get back to playing sports faster after an acute injury.
The Existing Research
The research on whether PRP injections into the area of an injury can help athletes return to play faster has been mixed to date. Because of that, when patients have asked me this question, I have always been cautious about recommending a PRP injection in that first week after an injury. However, like many things in PRP research, the data continues to be published and evolve, so it’s worth taking a deep dive into this today.
Pro Acute PRP Injection
There is a 2014 RCT that showed that patients with high-ankle ligament sprains (normally a difficult one to heal) got back to the field 1/3 faster after an ultrasound-guided PRP injection (return to play at 40 days versus 60) (1). A 2017 RCT looked at hamstring sprains (grade 1) and found that the PRP injection group returned to play at 21 days whereas the control group returned at 25 days (2). The PRP group was also less likely to have chronic pain after returning to sports. A 2020 study (not an RCT but a comparison group trial) in NFL athletes with grade 2 hamstrings injuries also showed a faster return to play time with fewer missed practices and games in patients receiving PRP injections (3).
Con Acute PRP Injection
Despite all of that positive research, a 2015 RCT that also looked at hamstring injuries concluded that PRP didn’t shorter recovery time (4). This study compared PRP to PPP and just rehab only. While the return to play was quicker for PRP over PPP and PPP over PT, the authors didn’t feel these differences were statistically significant. Another very small 2013 non-randomized study in professional athletes with larger hamstring injuries demonstrated no differences in return to sports (5).
The New Research
If you read this blog you’ve seen all of the differences in how PRP is used. Concentration versus patient age is critical. How the PRP is injected (guidance versus blind) is also a key factor in success. Another one I’ve discussed is draining a knee of any excessive fluid (effusion) before injecting the PRP to treat knee arthritis. Hence this new randomized controlled trial on ultrasound-guided PRP injections caught my eye because it was performed in acute injuries and because the authors first drained all of the blood from the injury before injecting PRP.
In the new study, 55 athletes with grade 2 acute hamstrings injuries were randomized to either aspirating the blood (hematoma) and PRP injection or just rehab and conservative care (6). The PRP group got back to play at 24 days versus 32 days for the control group. The recurrent hamstring tear rate was 4% in the PRP group versus 29% in the control!
As discussed, aspirating the blood in these injuries is likely similar to aspirating a swollen joint before injecting PRP to treat knee arthritis. If you’re injecting PRP blind (like many of the negative studies did), injecting PRP into a pocket of blood that you think is the tendon isn’t going to do much other than dilute out the concentration of the PRP. Hence, aspirating the blood first would seem to be a key step in getting this technique to work. That closely mimics what we would do at our clinic.
Time to Use PRP in Acute Injuries
I’ve held off on recommending this to patients for many years. However, it looks to me like there is now ample evidence to begin allowing patients to opt for a PRP injection in an acute tendon injury like hamstrings. Obviously, I’ll keep monitoring this research to see which direction it ultimately heads, but we have enough data now to show a clear direction.
The upshot? Many of us that use PRP every day have long wondered if these procedures could help our weekend warriors and athletes get back on the field faster and now it looks like the science has finally caught up! So I suspect in the future, the standard of care will morph from Rest/Ice/Compression/Elevation (RICE) to PRP/Rest/Ice/Compression/Elevation (PRICE)!
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(1) Laver L, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O. Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3383-92. doi: 10.1007/s00167-014-3119-x. Epub 2014 Jun 18. PMID: 24938396.
(2) Rossi LA, Molina Rómoli AR, Bertona Altieri BA, Burgos Flor JA, Scordo WE, Elizondo CM. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017 Oct;25(10):3319-3325. doi: 10.1007/s00167-016-4129-7. Epub 2016 Apr 16. PMID: 27085364.
(3) Bradley JP, Lawyer TJ, Ruef S, Towers JD, Arner JW. Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries. Orthop J Sports Med. 2020 Apr 17;8(4):2325967120911731. doi: 10.1177/2325967120911731. PMID: 32341927; PMCID: PMC7168779.
(4) Hamilton B, Tol JL, Almusa E, Boukarroum S, Eirale C, Farooq A, Whiteley R, Chalabi H. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015 Jul;49(14):943-50. doi: 10.1136/bjsports-2015-094603. PMID: 26136179.
(5) Rettig AC, Meyer S, Bhadra AK. Platelet-Rich Plasma in Addition to Rehabilitation for Acute Hamstring Injuries in NFL Players: Clinical Effects and Time to Return to Play. Orthop J Sports Med. 2013 Jun 24;1(1):2325967113494354. doi: 10.1177/2325967113494354. PMID: 26535233; PMCID: PMC4555507.
(6) Trunz LM, Landy JE, Dodson CC, Cohen SB, Zoga AC, Roedl JB. Effectiveness of Hematoma Aspiration and Platelet-rich Plasma Muscle Injections for the Treatment of Hamstring Strains in Athletes. Med Sci Sports Exerc. 2022 Jan 1;54(1):12-17. doi: 10.1249/MSS.0000000000002758. PMID: 34310495.
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