Testimonial

Week 1

This time last week I had my first PRP injection. The swelling and tightness has gone quite significantly over the past few days. There is minimal pain, except when I attempt to squat or jump. However, the pre-injection pain has changed and is not as intense. I used to experience a sharp pain in my left tendon when I straightened my leg and flexed my quad muscle, this pain is almost non-existent. There is supposed to be noticeable pain relief between 2 - 4 weeks post PRP injection, which is supposed to continue for up to 6 - 9 months. I already have a reduction in symptoms and at one week I am happy with the results and hope that they will continue to progress.


I have patella tendonosis in both knees, but had the PRP shot in the left knee in order to use the right knee as a control for the purpose of this blog (and science!). I decided on the left knee as the tendinitis was worse in this knee. After the PRP injection the left knee currently feels better than the right knee. The great thing about this is that any pain relief is a direct result of tissue healing and not some other substance (Cortisone, ibuprofen, etc.) simply masking the pain.


My plan is to give it a month and monitor the left knee's tendon's improvement and then have the right knee injected. I will then follow these up with another injection if needed. The challenge for me now will be taking it easy and not pushing it too hard- something I really struggle with, but I have layed off the exercise for the entire week. I will doing some physio rehab and swimming tomorrow. And I have continued to do eccentric dips with the right leg.

Day 3

There is a bit of swelling around the front of the knee. Feels like a bit of fluid surrounding the tendon. The knee isn't too painful, its more of a tender stiffness. And there is no discoloration. I'm not going to upload a pic as the knee looks pretty much the same as it did in Day 1.

I haven't attempted any form of exercise as the tendon stills feels quite weak. I'm going to give it a full week before I try some swimming.

I also went for a B12 shot yesterday as this is said to help in tendon healing and the formation of new collagen. I had one couple of a few weeks in order to build up my immune system for winter and I noticed that my tendonosis felt a bit better a few days after the shot.

I am currently taking MSM, Glucosamine, Chondroitin, Fish Liver Oil and Vitamin C supplements. My thinking is to give my body all the building blocks it needs to effectively heal the tendon.

If it worked for Rafa, it should work for me. 

Day 1

This morning I went in for my first PRP injection to my left tendon. The whole procedure took around 40 mins. The doctors used ultrasound to determine how much scar tissue had built up around my knee and whether the PRP Injection would be effective in treating my patella tendonosis. They then drew 4 little units of my blood- pretty painless. My blood samples were then sent off to the lab to be spun around in a centrifuge in order to separate the Platelet Rich Plasma. The docs then injected my tendon under the guidance of ultrasound.  This is supposedly the most effective way of administering the injection. 

After all the testimonials I'd read I was expecting the pain to rival child birth, however even without local anesthetic the shot wasn't too bad. Painful and uncomfortable, but the Cortisone shot I had to my tendon was actually worse. I was able to walk to my car and drive to work without much of  a problem. As the day has progressed my knee has been feeling increasingly painful. However, at 9pm the pain seems to have leveled out and is very manageable. I definitely don't need any painkillers. Which is just as well as it's recommended that you avoid all anti-inflammatories after the PRP Injection for at least a week.

My Knee - Day 1

I'm really surprised at how little swelling and bruising there is. Let's hope this works, fingers crossed.

What is a PRP Injection?

According to Wikipedia:

Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair. The platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induces the release of these factors from alpha granules. The growth factors and other cytokines present in PRP include:

[Source: http://en.wikipedia.org/wiki/Platelet-rich_plasma]


According to Ortho Healing Centre:

RP therapy offers a promising solution to accelerate healing of tendon injuries and osteoarthritis naturally without subjecting the patient to significant risk. PRP is an emerging treatment in a new health sector known as ”Orthobiologics.” The philosophy is to merge cutting edge technology with the body’s natural ability to heal itself. Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. When in their resting state, platelets look like sea sponges and when activated form branches. Platelets were initially known to be responsible for blood clotting. In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors. There are many growth factors with varying responsibilities, however cumulatively they accelerate tissue and wound healing. Therefore after increasing the baseline concentration of these platelets, we are able to deliver a powerful cocktail of growth factors that can dramatically enhance tissue recovery.

PRP is virtually a cocktail of many proteins that collectively stimulate repair and regeneration. However there are some proteins included in PRP that we can now selectively isolate to promote anti-inflammatory effects and pain reduction. Scientists have now developed natural/homeopathic based tools to selectively isolate the cells/growth factors within PRP that meet our needs of customizing the treatment by reducing inflammation and simultaneously stimulating repair.

As recognized international experts following 5 years of performing thousands of PRP injections and publishing numerous articles; we have learned that many factors can limit or assist healing. Because PRP utilizes your own blood to heal, we have learned that each patient is unique and a “one size fits all” approach is not ideal. At the Orthohealing Center we integrate the latest innovations like photomodulation, cytokine therapy, and specific supplements for tendon and cartilage to compliment PRP therapy. With the incorporation of these adjuncts and our skilled technique utilizing ultrasound guidance we are seeing improved results with much less post injection pain. We have trained physicians from all over the world utilizing our advanced techniques.
Orthohealing’s published comprehensive review of published literature
Conditions Treated
Frequent Q + A
PRP Live Demonstrations
PRP Publications
Case Studies + Testimonials
PRP Spine
Photomodulation

[Source: http://www.orthohealing.com/plateletrichplasmatherapy-prp/]


And according to the Mayo Clinic:

Platelet-rich plasma (PRP) is injected directly into the ailing tendon. Plasma is the liquid portion of the blood that transports red and white blood cells and platelets through the blood vessels. It's derived from the patient's own blood, a process that involves spinning a blood sample at high speeds. One byproduct is plasma, which contains a high concentration of platelets — thus the name platelet-rich plasma.

Doctors have found that about 70 percent of those receiving PRP therapy showed improvement. Early research suggests that PRP injections:
Attract healing cells to tendon tissues that have deteriorated
Stimulate new growth of tendon cells
Stimulate production of tendon collagen — the building blocks that give tendons their strength
[Source: http://www.mayoclinic.org/news2010-mchi/5702.html]

Intro

Around August 2010 I started feeling a slight twinge in both my knees about 10 minutes into my runs. As I hadn’t run much in the past 6 months and with the typical ‘runners mentality’ I decided to run through the pain. Big mistake. A month later I had full blown Patella Tendonitis. This stubborn flare up refused to heal, and after not resting my knees sufficiently the tendonitis became patella tendonosis. Any way you look at it, or whatever you want to call it, I had severe tendonopathies of both of my knees. A sport injury which is notoriously tricky to kick.

Fast forward to May 2012. Its been over a year and a half (21 months to be precise) and my knees are around 90% better but I’m still nowhere near to the level I was running before my tenonopathy. I have tried practically every available treatment- from eccentric strengthening exercises, to massage, to orthotics, to patella straps, to low level laser light therapy to MSM, fish oil, glucosamine and chondroitin supplements until I eventually went for surgery on both knees in August 2012- Patella tendon debridement/shaving. 


Each of these treatments I feel have somehow improved my knees incrementally. Although I do feel the surgery could have been avoided and I would have made the same progress (it has a 50% success rate, not great, but I decided to take the gamble and I don’t regret my decision as my knees are now, after 9 months, better off than they were before).

In order to finally push my knees to that 100% mark and get down to  some real running I have decided to try a PRP (Platelet Rich Plasma) Injection(s) into my left tendon. The treatment is widely publicized and highly talked about yet there is limited concrete medical evidence of its effectiveness- some patients claim it’s cured them while others claim no benefit. So as means to help out anyone in a similar to position to myself, I have decided to document my experience with PRP Injections for Patella tendonopathy here.

I will also document the other treatments I have and currently make use of- and give you some idea of their effectiveness. This blog is purely here to help anyone in the same situation as myself- those who love running or being active but have had their sporting performance significantly impacted by this misunderstood, complicated and debilitating injury. I hope this blog helps you in some way. Feel free to leave comments and I will try my best to reply to you.

I go for my first PRP Injection Monday 21 May 2012.