What is plasma and what are platelets?

Plasma is the liquid portion of whole blood. It is composed largely of water and proteins, and it provides a medium for red blood cells, white blood cells and platelets to circulate through the body. Platelets, also called thrombocytes, are blood cells that cause blood clots and other necessary growth healing functions.

Platelet activation plays a key role in the body’s natural healing process.

What is injection therapy?

Injection therapy uses a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. The injection therapy is designed to use each individual patient’s own healing system to improve musculoskeletal problems.

The injections are prepared by taking anywhere from one to a few tubes of your own blood and running it through a centrifuge to concentrate the platelets. These activated platelets are then injected directly into your injured or diseased body tissue. This releases growth factors that stimulate and increase the number of reparative cells your body produces.

Ultrasound imaging is sometimes used to guide the injection. However, anatomical landmarks and physical exams are normally sufficient for adequate administration of the Injection.

Plasma filled with platelets has been found to significantly enhance the healing process, and using an injection for shoulder pain caused by rotator cuff tears, for Achilles tendon ruptures and for other soft-tissue injuries is becoming more common.

This injection therapy has also been demonstrated to improve function and reduce pain in people who have the following:

• chronic pain
• trigger points
• muscle strains
• tendon strains
• ligament sprains
• tendonitis or chronic tendinosis conditions such as tennis elbow or golfer’s elbow.

Some of the key advantages of this injection therapy is that they can reduce the need for anti-inflammatories chronic use of steroids, or stronger medications like opioids. Maintenance injections in chronically inflamed areas can postpone or even prevent radical and invasive surgeries. In addition, the side effects of this injection therapy is very limited because, since the injections are created from your own blood, your body will not reject or react negatively to them. Long term use of corticosteroid injections have been shown to actually further degrade the joint environment. So, although traditional corticosteroid injections can temporarily relieve pain in joints, bursa, etc., they only serve as pain relief that is short lived, especially when compared to this specific injection therapy. This injection therapy provides a safe and effective alternative to address musculoskeletal injuries–acute or chronic–and heighten the healing of an injured tissue at a supratherapeutic level.

The platelets contain healing agents, or “growth factors.” Let’s look at some of the growth factors and what they do:

• Platelet-derived growth factor (PDGF) is a protein that helps control cell growth and division, especially blood vessels. When more blood (and the oxygen it carries) is delivered to the site of a wound, there is more healing.
  Transforming growth factor beta (or TGF-β) is a polypeptide and is important in tissue regeneration.
  ● Insulin-like growth factors are signaling agents. They help change the environment of the damaged joint from diseased to healing by “signaling” the immune system to start rebuilding tissue.
  ● Vascular endothelial growth factor (VEGF) is an important protein that brings healing oxygen to damaged tissue where blood circulation might be damaged or inadequate.
  ● Epidermal growth factor plays a key role in tissue repair mechanisms.

Frequently Asked Questions About This Injection Therapy:

Is it indicated for me?
This injection therapy is indicated for injuries that have failed to heal despite traditional treatment options as well as for chronic degenerative conditions. It is a viable non-surgical option to help aid in healing tissue. It can be performed in any musculoskeletal structure, including muscles, tendons, and joints all over the body. Some examples include: partial tendon tears, muscle strains, articular cartilage injury, mild to moderate osteoarthritis, and chronic tendon injuries.
How is it made?
To prepare plasma which is very platelet rich, blood is taken from your arm with a special kit similar to a normal blood test. It is then placed in a special centrifugation machine that separates the platelets from the blood in order to be extracted in a concentrated form. The entire injection therapy takes about 45-60 minutes.
How many treatments are necessary?
This can vary depending on the condition which we are treating. For some conditions patients can achieve successful outcomes with only one injection. In some cases, a series of three injections is required to achieve significant results. Each injection is spaced 4 weeks apart. There is no limit to the number of treatments you can have; however, literature has shown that about 15% of patients do not see improvement with more than three injections a year and should consider other treatments.
Are there any side effects with the Injection therapy?
Since your own blood is used, there is no risk for transmitted blood-infections. This injection therapy has a strong antibacterial effect so risk of local infection is minimal. It is normal to have increased soreness or pain after the procedure for an average of three days. We will offer you a medication plan to help with this.
Will my insurance pay for this treatment?
Since this is a fairly new procedure, most insurance companies have not incorporated it yet to their list of approved procedures and do not consider this to be a reimbursable expense. While there is growing literature to support the use of the injection therapy as a viable injection therapy with patient improvements and benefits, the insurance companies still classify this treatment as “investigational” of “experimental” and thus will not cover.
What are the potential benefits of this treatment?
It stimulates healing of the injured tissue by activating your body’s natural healing capacity. Patients on average report more than 50% improvement in 6 weeks and up to 100% improvement in 12 weeks. This may eliminate the need for surgical interventions in some cases. In addition, the injection therapy is a minimally-invasive procedure that is done in the clinic; therefore, you go home the same day.
What can I do after my Injection? Can I resume exercises, sports, work?
While the injections are minimally invasive, non-surgical procedures, it is important to remember that this is still a procedure! In order to achieve the proper tissue healing response that the injections can provide they must be accompanied by the proper after care including initial rest, avoidance of NSAIDs and exercise, and the initiation of a dedicated physical injection therapy program about 1-2 weeks after the last injection. The healing response initiated by the injections needs to be accompanied by the correct rehabilitation plan to maximize full healing and achieve improved function. Ignoring the injection therapy after the injection will likely lead to suboptimal results. Remember this is not a quick-fix and will take up to 3 months to complete the rehabilitation process and see the full potential benefits.