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

Best Initial Knee Exercise: The QuadCrunch (TM) (Knee OA Part 2)

There are dozens of knee exercises you can do to strengthen the muscles around your joint.  One crucial muscle to strengthen is the quadriceps or "Quad".  Too often, however, this muscle simply does not cooperate.  We need a simple way to get started.  We need an exercise than can be done anywhere, anytime without any equipment.  Now, we have one, the QuadCrunch (TM).  

The QuadCrunch (TM) helps initiate and reinforce the contraction of the most important component of the Quad---the Vastus Medialis Obliquus or VMO for short.  

QuadCrunch (TM) Video

Simply, straighten out your leg and place your fingers over the inside portion of your thigh just above your knee.  This is where the VMO lives.   With your leg fully straight and your heel on the ground, push your leg toward the ground and try to contract the muscle.  If you are successful, you will see your kneecap move.  The reason to put your fingers on your muscle is to help your brain know it is contracting the muscle.  This helps reinforce the contraction.  

I recommending doing a set of 5 contractions, holding each contraction for 5 seconds, 5 times per day.  

This elementary exercise is often ignored but serves as the foundation for more advanced strengthening programs.  It can be helpful for people who want to strengthening their legs for any reason.  It may also be useful for patients with knee arthritis, patellofemoral pain, knee tendonitis and even meniscus tears.  (Always check with your doctor before beginning any exercise program)

Good luck and get started today.  Remember, this exercise can be done in shorts, pants and almost anywhere.  Simply place your fingers on your quad muscle and straightening your knee with your heel on the ground.  It is best if your are sitting on the edge of a chair.  

It is best to record how many sets per day you do.  That will help you be compliant with the exercise.  We will discuss exercise compliance more in a later post.  

Post any questions, comments or suggestions below.

AM

TotalTendon

Therapeutic Use Exemption for PRP in Muscle Injuries

It has been unclear in the media and in the literature if the World Anti-Doping Agency has banned platelet rich plasma for intramuscular injection.  There is a need to better understand their position.

Via BloodCure sources, we have definitely determined that PRP is LEGAL to be used via the intramuscular route with a therapeutic use exemption, also known as a TUE.  To my knowledge there is NO data suggesting PRP is anabolic for skeletal muscle injuries in humans.  If there is any specific data out there please post it here.

Athletes of all kinds need to know PRP may be an option for them if they apply for the appropriate exemption.  As always, check with the governing body of your chosen sport and consult with your physicians to best determine if it is appropriate.

AM
Total Tendon

PRP Improves Muscle Function

Platelet Rich Plasma in a study just published in the American Journal of Sports Medicine was found to significantly improve muscle function. This was in a high repetition injury model. This is excellent evidence to enable a human trial of PRP for muscle injuries.

AM
Total Tendon

Use of autologous platelet-rich plasma to treat muscle strain injuries.

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

Am J Sports Med. 2009 Jun;37(6):1135-42.

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.

PRP and Muscle Tears

Several people have emailed asking about using PRP for muscle injuries. Platelet rich plasma may eventually be a valuable treatment for this type of connective tissue problem. However, to date no significant data has been published or presented to guide physicians or patients. If a patients presents with either an acute or chronic muscle injury PRP may be an option but so far there isn't any specific study to support its use.

This research is rapidly evolving so watch this blog for updates.

ApexPRP.com