FREQUENTLY ASKED QUESTIONS

WHAT IS REGENERATIVE INJECTION THERAPY (RIT) USING PLATELET RICH PLASMA (PRP)

RIT, (also known as prolotherapy) using PRP is based on the premise that much of chronic musculoskeletal pain is caused by the degeneration of connective tissue secondary to both macro trauma (injury) and micro trauma (repetitive movement). The tissues affected and targeted by this treatment are ligaments, tendons, and joints. The most commonly treated conditions are:

• Arthritis
• Tendonosis
• Low Back Pain
• Neck Pain
• Headaches
• Sports Injuries (rotator cuff tear, ACL tear, chronic ankle sprains, chronic shoulder dislocations, Achilles tendon, plantar fasciitis, hamstring tears, etc)

RIT with PRP is the precise injection of PRP using ultrasound guidance into damaged tissue which stimulates the body's natural healing mechanisms to lay down new collagen fibers. The injection of PRP ‘tricks’ the damaged tendon, ligament, or joint surface into thinking that it has undergone an acute, severe injury, however there has been no true tissue insult. As a result, the platelets release bioactive proteins responsible for signaling tissue regeneration and new collagen begins to develop. As this collagen matures it restores health to tissues, tightens and strengthens tendons and ligaments, and regenerates joint surfaces. This process does not create scar tissue; it eliminates scar tissue.

PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins including growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process.

To prepare PRP, a small amount of blood is taken from the patient. The blood is then placed in a centrifuge that automatically produces the PRP. The entire process takes 15 minutes and increases the concentration of platelets and growth factors up to 500%.

No. Studies have shown that cortisone injections actually weaken connective tissue and accelerate the degenerative process. Cortisone shots frequently provide temporary relief of pain, but they disallow normal tissue regeneration to occur. RIT with PRP can actually be curative rather than palliative.

The goal of treatment is to actually heal damaged tissue which can significant decrease pain and increase activities of daily living and quality of life. RIT with PRP may eliminate the need for long term drug therapy and/or surgery.

The main risk is that it won’t help. In that case chances are the diagnosis was incorrect and therefore the true cause of the pain was not treated. Beyond that, there are very few risks involved. RIT with PRP is a conservative approach to treating pain unlike surgery which might help, but it might make it worse. You can always have surgery, but you can’t un-have it. RIT with PRP will not make your condition worse unless the practitioner is not properly trained.

While responses to treatment vary, most people require 2 to 4 sets of injections to achieve the desired result. Each set of treatments is spaced approximately 4 to 6 weeks apart and then you may require an additional single ‘tune-up’ treatment once per year.

While the treatment itself is not very painful because local anesthetics are used before the PRP is injected, after injection, you will have localized soreness and discomfort. Most patients find over the counter medications sufficient to help with the pain.

The first week after the procedure, patients will typically start a rehabilitation program with physical therapy. However, aggressive physical activity is discouraged.

PRP therapy helps regenerate tendons and ligaments but it is not a quick fix. This therapy stimulates the growth and repair of tendons and ligaments requiring time and rehabilitation. Typically, patients notice improvement after two weeks and continue to notice continual improvement months after the last treatment.

Studies have shown that when performing intra-articular injections of the shoulder and hip ‘blind’ (without any type of imaging), orthopedic doctors have a miss rate of around 70%. When injecting under ultrasound, accuracy is greatly improved because the doctor can see the joint, see the needle entering the joint, and see the fluid entering the joint. The conventional needle-guidance imaging for intra-articular injections is fluoroscopy (3-dimensional motion x-ray). The disadvantages of fluoroscopy are that it’s expensive, it’s more of an ordeal (lots of people standing around in blue and machines that go ‘beep’), it involves exposure to radiation, and one cannot see the fluid enter the joint as in ultrasound.