T Nation

Prolotherapy with PRP


#1

I went to my orthopedist this morning. I have been having quite a bit of pain in my right knee but specifically just above my knee in my quad. He did a few tests for mobility and also a few x-rays but found no structural problems. He got his ultrasound out and looked at the muscle and found a void with some calcification already in place. He wasn't sure if that was from when I tore the quad in Aug/Sept or if that happened years ago and I just re-aggravated it.

He also found that my medial meniscus is possibly torn as well but I will be getting an MRI for everything to find out. He pointed out that the meniscus problem could be hamstring tightness as well but the MRI will confirm that or not.

He recommended platelet rich plasma therapy for the tear if my insurance will cover it. He said that they have been getting a better response from insurance companies lately over covering this therapy as opposed to surgery. He said that is the meniscus turns out to be torn, then he can do the surgery for that and do the PRP at the same time for the quad and insurance will cover it all but for just doing PRP then they have to approve it beforehand.

My question is has anyone received any PRP and how successful or not successful was it? If there are any Doctors reading this, what is your opinion of PRP? I did some prelim research and found just one article in the JAMA that stated there was no proof that it did in fact help any more than salt water. But that was on chronic achilles tendinopathy, which is notoriously hard to treat anyway.


#2

From the athlete's I've worked with who have ended up getting the PRP, I've seen mixed results. Some have responded well to it, others have not. I think a lot just depends on the severity of your condition and what exactly is wrong with the tendon.

If your insurance covers it and your physician is recommending it, I'd say go for it. If the insurance doesn't cover it, that's your call as it is your money.


#3

Mixed results seems to be the norm. A patient of mine had PRP for her adductor tendon and had great results, then later had it in her achilles and had no benefit. Most of the research that I have read has been varied, just like with Prolo.

My theory is that if you get proper manual therapy, corrective exercise and load management after PRP or prolo you will get the best results. Most of the research I am familiar with has been done in isolation, which I think is why you see the mixed results.

If insurance covers it, great, if not you might have to make the cost/benefits analysis on your own to see if its worth paying for out of your pocket. I highly doubt it would make much of a change with the existing calcification, but that is just speculation, haven't seen research one way or another. Typically though calcific tendinitis takes longer than 3 months to develop. So then you have to ask the question, is the tear there because it is fresh, or is it due to the fact that you have calcification and a degenerated tendon that was and will be predisposed to tearing?


#4

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#5

Thank you sir...btw just reading the BBB worship thread, I'm from the States what exactly is an osteomyologist, how does it differ from a physio/osteo/chiro?

OP- Sorry for the brief thread hijack


#6

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#7

Thank you for the information. The calcification is actually in the muscle itself. I tend to believe that the muscle was actally torn years ago and healed to the best that it could and I have not put enough pressure on it to aggravate/damage it again. The Doc wants to try PRP in the muscle itself. Now that I have had a day to think about it, what do I do about the calcification itself in the muscle? I'm assuming with that question that the PRP will not break up the calcification. Obviously if it will then that's what I want but I don't see how it would do that.


#8

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#9

ART has a provider lookup, just put in your town and it will give you the closest providers http://www.activerelease.com/providerSearch.asp

That or try graston...not sure how effective either will be at necessarily breaking down the Ca, but in theory if you remove the tension from the muscle, and your body doesn't feel that it needs the Ca to protect itself from further injury it should reabsorb it for needed functions.


#10

Thank you BBB. When the fam and I are in your part of the world next year, I'll have to look you up. I'll buy the first round.

I had ART a few years ago for my lower back for similar problems with the muscles being pulled and calcium deposits being formed. You are correct about the pain levels. Sweating profusely and clinching of teeth were involved. But I've had very few problems since then. I'm a big proponent of ART.

I'll use that lookup Face to find someone local here to work me over. I appreciate the help fellas. After my MRI and such I may come back with some more questions depending on the results.


#11

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