by Dr. Erin Carr, December 7, 2020
Hard to believe it has already been 5 years since last writing a blog on physical therapy after PRP. As time has passed, more and more patients are seeking these conservative treatments for their injuries. As more research, evidence and advancements in these treatments continue to evolve for the better. Seeing and experiencing the changes as patients come for physical therapy post PRP and various types of other injection treatments has shown the advancements in these therapeutic treatments.
What has changed?
Platelet Rich Plasma
PRP, platelet rich plasma, has been a method of treating torn muscles, tendons, ligaments, arthritic joints, nerves, etc. Although considered experimental, PRP treatments have been around for some time now. This is a great alternative to cortisone injections or more invasive surgery.
Working with many doctors who specialize in treating patients with PRP and other forms of it, while providing physical therapy post PRP. Advancements and techniques have evolved for the better. Depending on the injury site, whether acute or chronic. Platelets can be manipulated in different ways in order to treat and maximize tissue healing.
In general, PRP is platelet rich, and has an inflammatory effect after treatment. You may not feel instant relief after receiving these injections. Rather, you may feel like you just re-injured yourself. There will be more pain, inflammation, limited range of motion and overall discomfort. This is a normal response. The point of PRP is to trigger your body’s healing response. First inflammation sets in from all the blood cells that have flooded the injured area. And like any injury, after several days, this inflammation will start to subside. Within a few weeks you will feel less pain, inflammation and have improved mobility. Today, doctors will often do a series of 2-3 PRP injections over the course of several weeks to heal a torn tendon or ligament. One injection treatment is often not enough.
Platelet Poor Plasma
Platelet poor plasma (PPP) is another way of treating an injured area of the body. It often has a more of an anti-inflammatory effect. Not all injuries are created equal. They do not need the power of PRP to heal, so requires a gentler approach. PPP has less platelets compared to PRP. The areas of your body that may already be inflamed may benefit from PPP instead of PRP. As PRP may be too powerful causing more inflammation and irritation impeding on the healing process.
Another mild form of PRP, is called PRP lysate. This breaks down the platelets and is used to treat nerves more so than tendons and ligaments. This too also has an anti-inflammatory effect reducing pain and discomfort in a shorter period of time.
Stem Cells Advancements
Aside from the varying types of PRP, there have also been advances in stem cell treatments. They not only use stem cells from bone marrow, but the FDA has recently approved obtaining stem cells from fat. What’s the difference? Areas of the body may need more cushion or support, something fat stem cells may provider more so than bone marrow stem cells. If you had an injury to the meniscus in your knee, more cushion needs to be added. You may benefit more from fat stem cells than bone marrow stem cells in this case. Compared to utilizing bone marrow stem cells to repair a torn tendon or ligament requiring more strength.
Often, both bone marrow or adipose stem cell treatments are paired with PRP boosters. What does that mean? Often a singular stem cell injection is not enough to heal an acute or chronic injury. Re-injecting the area with PRP 3-6 weeks after the stem cell injections can help add more strength and provides additional healing to the original injections. Often times, patients will receive 2 boosters after bone marrow or fat stem cell therapy. Not all injuries are alike. A more advanced or complex injury often has greater benefit when receiving a combination of stem cells and PRP. A more acute straight forward injury may only need a few rounds of PRP.
Why Physical Therapy?
Physical therapy post PRP is extremely important. Physical therapy helps restore mobility, strength, coordination, endurance and power post PRP. Although the injections are healing the actual tendon, ligament, joint or nerve. Your whole body may need retraining in order to regain overall function. Creating healthy patterns of moving while removing old habits from an old injury. Rehabilitation does require more time and dedication than going in for a few injection treatments. However it can keep you from needing further injections or even surgery down the line.
As mentioned in the earlier physical therapy after PRP blog, the early stages of healing after these injections is slow. Physical therapy starts within the first 7-10 days post PRP. The body’s natural healing process takes about 4-6 weeks to see and feel improvements from PRP. This is the amount of time it takes for you body to start recovering from any new injury. This is why doctors do a booster shot within the first 4-6 weeks. As your body is still in the early stages of healing, and has a better chance of making further improvements. Compared to waiting several months to do follow up injections.
Physical Therapy Recovery
If you have torn a tendon or strained a ligament, the early stages of physical therapy are conservative. Contrary to traditional injuries, you will often abstain from icing, taking an NSAID or other natural anti-inflammatory in the first 10-14 days. As the point of the injections is to create inflammation. This helps boost the long-term healing.
Focusing on gentle movements of the involved body region to restore range of motion is essential. As well as introducing isometric and gentle strengthening of the muscle groups in areas above and below the injured sight to help support, stabilize and re-educate your muscles and nerves.
Knowing that you may have a booster shot within this time frame, it is important to note, you may take a step back after the second booster shot. You may see a mild reduction in mobility as well as an increase in pain. This too, is normal in the regenerative process. I often tell patients it is like a dance. You take 2 steps forward and 1 step back in healing until your dance is complete. It is important to note when receiving physical therapy post PRP or other regenerative treatments, introducing aggressive range of motion, stretching or strengthening too soon can be detrimental to your healing. There is a balance of not doing enough and doing too much. As it is with any injury.
From the beginning to end of injection treatments it may take over an 8-12-week time frame. By now, you are in the midst of physical therapy post PRP. You may have had 1 or 2 booster shots. And you are on your way to restoring strength, stability, and are able to do more on a day to day basis. While having a significant reduction in pain and inflammation. Working towards your daily exercise, recreational or athletic goals. And even after 12 weeks, the PRP, stem cells or combination of both are still working hard. Tissues continue to heal and repair themselves for the next 6 to 12 months! That mean you can continue improving the health of your muscles, joints, ligaments, tendons and nerves. Making gains in range of motion, strength, endurance and stability.