Signing of the Stars and Coach Jim Harbaugh

What I learned from the University of Michigan Signing of the Stars and Coach Jim Harbaugh

by Allan Mishra
@bloodcure

Seek a unique perspective.
Harbaugh and his expert production team took a rather mundane event (signing of high school football players) and turned it into an Oscar-like event.  The day inspired not only the Michigan football program but the entire university.

Embrace diversity.
The crowd supporting the newly signed Michigan players included Tom Brady, Derek Jeter, Denard Robinson, Jordon Kovacs, Charles Woodson, wrestler Rick Flair, world champion poker player Phil Hellmuth, rap group Migos, Owen Wilson, Vince Vaughn, Coach Mike Ditka, and many others.  The collective value of the group to the signees and audience was staggering.

Sometimes you just have to ask.
Former Notre Dame Coach Lou Holtz helped carry the event with excellent one liners.  Why did a coach from another school come to a Michigan football event?  Simply because Jim Harbaugh asked him.  To the new Michigan players Holtz said:  "You didn't just make a four year decision, you made a 40 year decision"  He understands and articulated how the new players would be part of Michigan for the rest of their lives---a powerful message.

"Some people think less is more, I believe more is more."---Jim Harbaugh
Jim Harbaugh doesn't like meetings and discusses strategy on the field with this players and coaches during marathon four hour practices.  We all should have less meetings and execute instead of engaging in perpetual discussion.

"Those who stay will be champions"-----Coach Bo Schembechler
Harbaugh added a corollary to that famous Michigan axiom.  "Try hard and you will stay".  He has written this above the exit sign from the Michigan locker room.  The implication is clear.  Work as hard as you can and you will stay.  Stay and you will be a champion.  Embracing this mindset could help all of us in our chosen professions.


"Attack each day with an enthusiasm unknown to mankind."---Jim Harbaugh 
Harbaugh and his team gave a swag bag full of gear emblazoned with his motto to all the presenters.  After the star-studded event was over around 1 pm, Harbaugh, true to form, was quoted by the Michigan daily as saying:  “We’ll be back to work at 2.30.”  Translation---have some fun but then return to the relentless pursuit of being one of the leaders and best.

Video montage of the event produced by VisionVideo360




AM
@bloodcure
TotalTendon

PRP enhances healing after Achilles Tendon Rupture

PRP being added to an Achilles Tendon Repair

If you rupture your Achilles tendon, new data suggests platelet rich plasma can enhance the healing.  In an abstract published by the journal Lancet, researchers from England discussed how they treated patients who had ruptured their Achilles with either PRP or a placebo.  Six weeks later, they biopsied the healing tendons under ultrasonic guidance.  In the study, they found improved cell content, better tendon fiber structure and more normal collagen (type 1) in the tendons treated with PRP.  The study included 20 patients (10 PRP, 10 Control) and is the first investigation in humans showing the significant value of using PRP to help treat Achilles tendon ruptures.  Of course, more data will be needed to confirm these important findings.  For years, I have been adding PRP to my achilles tendon repairs and if I ever rupture my own, I will certainly request that PRP is included in the treatment protocol.

AM 

Total Tendon

Concussions and the Michigan Football Program

Was he briefly knocked out?

It is appalling what happened on the Michigan football field last weekend.  A young man, quarterback Shane Morris, already suffering from an ankle injury, gets absolutely rocked by a blitzing defender.  The video shows how Morris's head snaps back and he falls to the ground like a rag doll.
(Detroit Free Press Article with videos)

It is absurd to excuse anyone on the Michigan sidelines for not knowing that Shane Morris may have had a concussion on that play because a major roughing the passer penalty was called.  He was also clearly staggering.  I am a double Michigan alumni (BS, MD) and love the school and its athletics.  I have also been on the sidelines of many high school, collegiate and professional football games as one of the team physicians.  The reason the physicians are there is to watch the game and scan the players for any real or potential injuries during or after each play.  It is difficult to understand why a serious roughing the passer penalty was not a clear indication for Morris to be evaluated especially before reinserting him into the game.

It is equally amazing that Hoke did not know about the potential extent of the injury the day after the game.  He may be incompetent as a coach given Michigan's record over the last few years but he is clearly dangerous when it comes to executing his responsibilities to protect his players.

What is even more telling than the even the video are still shots from the video.  

Initial Hit

Head Snaps Back

Clearly he sustained some head trauma

At the very least, Michigan needs better injury procedures in place and a coach that isn't frankly dangerous to his players' short and long term health.

AM

TotalTendon

Hamstring Injuries Treated with Platelet Rich Plasma Return to Play Faster than Rehab Alone

Hamstring muscle injuries are very common in a variety of sports including track, soccer, football and basketball.  A recently published study in the American Journal of Sports Medicine (AJSM) found athletes that were treated with platelet rich plasma (PRP) injections returned faster to their sport when compared to rehabilitation alone.  In the study, the PRP patients returned at an average of 26.7 days compared to 42.5 days in the control group (P = .02).  (reference) This greater than two week difference in time to return to play after this common injury is clinically and competitively important.

Another recently published in the New England Journal of Medicine (NEJM) found no difference between PRP injections (2 injections spaced about a week apart) and a control group.  Interestingly, both groups in this study returned to play at 42 days, very similar to the control group in the AJSM study.  (reference)

Why are these results conflicting?

One important difference between the two studies is the type of PRP used to treat the patients.  In the study that did show a difference, white blood cell enriched PRP (leukocyte enriched PRP) was used.  In the study that did not show a difference, white blood cell  poor PRP (leukocyte poor PRP) was used.  This is a clear example of why PRP formulation matters.

The data published in elite, peer reviewed journals suggests leukocyte enriched PRP helps return athletes more than two weeks faster than rehabilitation alone after an acute hamstring injury.  No difference in return to play can be expected if leukocyte poor PRP is used in this patient population.

As PRP and other cell therapies continue to evolve, it will become increasingly clear that formulations much match indication.  Patients, researchers, and clinicians need to realize not all PRP is the same.

AM
TotalTendon

NFL grants $100,000 to study PRP and Stem Cells for Tendon Disorders

The National Football League recently granted $100,000 to the Hospital for Special Surgery to study the effects of platelet rich plasma and stem cells on tendons.  The research will be conducted by Dr. Scott Rodeo, associate team physician for the New York Giants.  The focus will be to better understand the effects of different formulations of PRP in a preclinical model.  Specific evaluations of how PRP influences the tendon structure will be done.

This is important research that should help answer multiple questions.  Clinical studies to date have been variable in their outcomes.  The best available data today supports the use of PRP with white blood cells injected in an unactivated form for chronic tennis elbow.  We need to better understand the mechanisms underlying various forms of PRP in order to best apply it clinically.

We will all be most interested in following the results of their investigations.

See full article about research grant. 

Allan Mishra
TotalTendon
@BloodCure

Stanford Football Player may start after PRP San Francisco Chronicle

Tom Fitzgerald of the San Francisco Chronicle wrote an article about a Stanford football player who may start after being treated with platelet rich plasma.  To read more, click here.

There is now mounting evidence that a specific type of PRP that contains increased concentrations of platelets AND white blood cells has value in the treatment of chronic tendinopathy.  Several studies are underway and some will soon be published. 

To view more about PRP and sports medicine videos, go to HalfDome.tv

AM
Total Tendon

WADA to Approve PRP

The World Anti-Doping Agency (WADA) just decided to allow the use of PRP for most problems. They will still prohibit its use via an intramuscular injection. This is an interesting and important development. I know that significant analysis went into this decision. Fortunately, elite athletes can now have access to the same valuable treatment that has been used on weekend warriors.

"The agency addressed platelet-derived preparations, commonly referred to as platelet-rich plasma or “blood- spinning," (...a process in which the platelets are removed from the blood and reinjected at the site of an injury for speedier healing). The preparations are prohibited when administered by the intramuscular route. Other methods of administration will require a declaration of use." (Reported by Nancy Kercheval from Bloomberg, See Full Article)

AM
Total Tendon
Apex PRP.com (PRP Videos and Photos)

NFL Player Platelet Rich Plasma

Another NFL player has documented success using platelet rich plasma for elbow tendonitis.

See story in Philadelphia newspaper.

This is a recurring pattern of elite athletes being treated with PRP. The evidence is, however, unfortunately weak. We need formal studies to prove these results are valid. If the NFL, MLB, NBA or other leagues sponsored formal trials or at least prospective studies we would better be able to determine the true value of PRP. We could also hopefully answer questions about what formulation of PRP is best.

AM
Total Tendon

ApexPRP.com

Platelet Rich Plasma presented at the NFL Sports Meeting

Platelet rich plasma was discussed today at the NFL Sports Medicine meeting in San Francisco. It was presented in the "alternative" therapies session. No data or specific recommendations were outlined. It is clear we need to actually study the use of PRP in elite athletes before drawing any specific conclusions. It is also important for clinicians and patients to understand that not all PRP is the same. When studies are designed and evaluated, actual platelet counts and white blood cell counts should be included. Only then will we be able to truly define the value of the formulation of PRP derived from any specific machine.

AM
Total Tendon

ApexPRP.com

Platelet Rich Plasma at Elite Meetings

Platelet rich plasma is on the agenda for several elite meeting in the next month. The NFL team physician meeting, the American Medical Society for Sports Medicine and the International Cartilage Research Society all have PRP presentations. BloodCure will report on these meetings including the discussions. Post any questions you may have on this blog and we'll try to get the answers. This level of attention by these established academic conferences means PRP is close to becoming a mainstream treatment.

AM
Total Tendon

Platelet Rich Plasma for Muscle Injuries

This study supports the use of PRP for acute muscle injuries. PRP treated animals recovered faster and the authors suggest PRP may stimulate myogenesis. A prospective, randomized trial of PRP for acute severe strains is warranted.

AM
Total Tendon
ApexPRP
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Use of Autologous Platelet-rich Plasma to Treat Muscle Strain Injuries.

Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM.

American Journal of Sports Medicine

BACKGROUND: Standard nonoperative therapy for acute muscle strains usually involves short-term rest, ice, and nonsteroidal anti-inflammatory medications, but there is no clear consensus on how to accelerate recovery. HYPOTHESIS: Local delivery of platelet-rich plasma to injured muscles hastens recovery of function. STUDY DESIGN: Controlled laboratory study. METHODS: In vivo, the tibialis anterior muscles of anesthetized Sprague-Dawley rats were injured by a single (large strain) lengthening contraction or multiple (small strain) lengthening contractions, both of which resulted in a significant injury. The tibialis anterior either was injected with platelet-rich plasma, was injected with platelet-poor plasma as a sham treatment, or received no treatment. RESULTS: Both injury protocols yielded a similar loss of force. The platelet-rich plasma only had a beneficial effect at 1 time point after the single contraction injury protocol. However, platelet-rich plasma had a beneficial effect at 2 time points after the multiple contraction injury protocol and resulted in a faster recovery time to full contractile function. The sham injections had no effect compared with no treatment. CONCLUSION: Local delivery of platelet-rich plasma can shorten recovery time after a muscle strain injury in a small-animal model. Recovery of muscle from the high-repetition protocol has already been shown to require myogenesis, whereas recovery from a single strain does not. This difference in mechanism of recovery may explain why platelet-rich plasma was more effective in the high-repetition protocol, because platelet-rich plasma is rich in growth factors that can stimulate myogenesis. CLINICAL RELEVANCE: Because autologous blood products are safe, platelet-rich plasma may be a useful product in clinical treatment of muscle injuries.

Platelet Rich Plasma New York Times Article

The New York Times just published an article about the use of Platelet Rich Plasma for professional and weekend warrior athletes.

NY Times PRP Article

Check it out and post your comments here.

AM
Total Tendon

ApexPRP

Super Bowl Platelet Rich Plasma Treatment

Pittsburgh Steeler wide receiver Hines Ward did in fact have a platelet rich plasma (PRP) treatment. This was confirmed by BloodCure.com late Monday. He was apparently treated with PRP for a medial collateral ligament (MCL) sprain. The specific form of PRP has yet to be declared but it is apparent that he was treated with plasma that contained an increased concentration of platelets. This by the definition proposed by Dr. Marx, is indeed platelet rich plasma.

Previously, PRP has been used to treat the same injury in major league soccer players. On the second play of the game, Mr. Ward caught a 38 yard pass and contributed significantly to the Steelers' Super Bowl win.

The reporting on the novel treatment by NBC just prior to his important catch was excellent timing. Good work! For more information about PRP, please visit: ApexPRP.com

AM
TotalTendon.com

Platelet Rich Plasma helps Treat Achilles Tendons

The published and presented data supporting the use of buffered platelet rich plasma continues to grow. PRP has now been shown in a small study to help treat chronic achilles tendonitis (tendinosis).

AM (Total Tendon, ApexPRP)

Guelfi et al recently presented a series of 16 cases of non-insertional achilles tendonitis at a recent meeting in Brazil. They used unactivated, buffered platelet rich plasma prepared using the Biomet Recover System, also known as the GPS. Significant improvement was found in all 16 of their patients via imaging. They also reported the patients returning to sports at six months with a high degree of satisfaction.

MRI Prior to PRP

4 months after PRP

"International Federation of Foot and Ankle Societies", , Third Triennial Scientific Meeting, Costa do Sauipe, Bahia, Brazil September 18-20, 2008. (The case shown is from AM)

Stanford Football Player returns after PRP

A Stanford football player who had chronic severe patellar tendonitis has returned to play this year after being treated with platelet rich plasma by Dr. Mishra.
Click here to read the full story.

Total Tendon

Apex PRP.com

San Francisco Chronicle Article: "Miracle Cure"

The San Francisco Chronicle calls platelet rich plasma a "Miracle Cure". To read the full story, click here.

Join the FREE Total Tendon Network to interact with patients and providers familar with platelet rich plasma as a treatment.

For more information:

Total Tendon, ApexPRP, Tendon Tips.com

Pioneer PRP Story on ABC TV

ABC TV in San Francisco just aired a story about the pioneering of platelet rich plasma for tendon related problems such as tennis elbow or patellar tendonitis.

Link to ABC TV Story about Stanford Football Player

To learn more about PRP visit: ApexPRP

Join the Total Tendon Network to have the most up to date information and interact with other patients and providers.

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