James M. Fox, MD Synergy Performance Health
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Is Platelet-Rich Plasma an Effective Healing Therapy?

From Scientific American, December 2009. By Carina Storrs

Athletes such as Tiger Woods and the Pittsburgh Steelers's Hines Ward have undergone
platelet-rich plasma therapy, but is there evidence that the treatment really speeds the healing
of injuries?

What are the alternative therapies?
Rest, modification of activity and then ultimately some type of rehabilitation program with
stretching and strengthening.

How long would patients have to try these other things before you think PRP
therapy is a good option?

A good general rule would probably be at least two to three months of failing other therapies.
And many people that we use PRP for, it's longer than that. It is a big out-of-pocket expense
for patients. Insurance doesn't cover it. The price ranges anywhere from $500 to $2,000. I
don't think it's in the patients' best interest to do it early on.

I've seen reports of people saying that it started to hurt at the site of injection.
Have you had any patients telling you about pain following the treatment?

Definitely. A good example would be that gentleman I was talking to you about with the
Achilles problem. After his first injection he was calling me almost daily saying that it was
much worse than it was before the injection. So there's no doubt that they can be very sore for
upwards of even a couple of weeks. It's already a very sensitive tendon and now all of sudden
you're taking a needle and you're sticking it into that tendon and pushing this extra fluid in
there. You're increasing pressure and irritating the tissue which can lead to worsening pain
early on. But the pain goes away after a couple of weeks.

Tiger Woods had several injections for his patella tendon. Can one injection
have a healing effect or are multiple injections usually needed?

There is a study out there where, for patellar tendonitis, they've done one injection a week for
three weeks. And the study says that they had good response but we don't even know how that
compares to just one injection. Theoretically, if I'm truly enhancing the body's healing
response, if I do the injection once and I give the body four to 12 weeks, then maybe it could
heal with just the one injection. We know that [the condition] is chronic, it's degenerative. The
body certainly can't heal such a condition in one week.

Have you done multiple injections for your patients?
I have [for] a few patients with Achilles tendon and patella tendon problems. I've never done
more than two injections. The second injections have helped. Anyone that I've done a second
injection for, it's been at least two to three months [after the first injection].

Are you involved in any of the clinical studies going on now?
We are. At the N.Y.U. Hospital for Joint Diseases orthopedic department we are in the middle
of some studies, especially on the rotator cuff. For the rotator cuff we're comparing placebo,
corticosteroid [anti-inflammatory] and platelet-rich plasma. We're probably at least one year
away from having results.

Why is PRP not restricted for athletes in a way that human growth hormone
(HGH) is?

Athletes use HGH as a performance enhancer even though there's no good evidence that it does anything to enhance performance or improve strength or endurance, etcetera. And
there's nothing that says that HGH enhances healing. Now PRP is certainly not in any way a
performance enhancer. It's more about enhancing the body's own healing response. Soneone
who's had PRP therapy is not at some kind of competitive advantage over someone who hasn't
had it. The platelets secrete completely different growth factors than HGH.

Do you think the results of the clinical trials that are coming out over the next
year could change how PRP is used or how much it is used?

One way or the other, I think over the next six to 12 months it'll significantly change the way
we use PRP. That could be either in a positive way or in a negative way. Maybe that study is
going to come out that says, yes, you do need a second injection or a third injection. Right
now it's very subjective how we all use it. Ongoing studies will determine proper usage,
including timing and dosage.

The bottom line is that we don't know enough about PRP therapy. It is safe. We're using it.
Anecdotally it certainly seems to have some positive effects. How much we'll be using it in the
future or what we'll be using it for, those are all questions that really remain to be answered.



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