By Tom LeCarner
If you followed my ongoing column “Project Pruitt” last year, you know that I have had a nagging knee injury (pes anserine tendonitis) that has lasted nearly two years. I’ve had three 3-D fit sessions at the Boulder Center for Sports Medicine to get my bike fit right; it’s perfect now. I’ve gone through weeks of physical therapy, massage, and have also had two cortisone injections.
Through all of these efforts, my knee has improved tremendously. I can now ride my bike, mountain or road, pretty hard for more than two hours before feeling anything. And while these improvements are certainly encouraging, I still can’t go out on a Saturday and ride for four or five hours like I used to. After speaking with BCSM’s Andy Pruitt about the possible next steps, he said, “I think you’re a perfect candidate for a PRP injection.” “A what?” I said.
PRP – There will be blood
If you have never heard of PRP (Platelet-Rich-Plasma) injection therapy, that will likely change very soon. PRP therapy is on the forefront of sports medicine and orthopedics and is poised to make great strides in the very near future as technological advances are making the procedure more affordable and staff members at top sports medicine facilities are being trained in the procedure.
What is PRP therapy? It’s a relatively simple procedure actually. The first step is to take out some of your own blood; in my case, approximately 60cc. The blood is placed into a specialized separation container —which is a euphemism for a Tupperware cup. The container is then placed into a centrifuge.
The blood is then spun at 400-500Gs for 14 minutes. The spinning separates the blood into red blood cells, plasma, and platelets. The result looks something like this image.
After the platelets and plasma have been separated out, a needle is inserted into the container and the platelets, in my case approximately 1 billion of them, are extracted with a little bit of plasma into a syringe (the plasma is what makes it possible to reinject the platelets into my body). After the spinning was done, my very own platelet-rich plasma was reinjected into my knee—approximately 8ccs. It wasn’t a painless injection; I’ll leave it at that.
What’s the big idea here?
The science behind this therapy concerns the properties of the platelets themselves. When the platelets are activated, (i.e., injected) into the body, they release healing proteins called growth factors. By increasing the baseline concentration of platelets in the patient’s blood, the process triggers a massive healing response in the affected area. Early studies have shown dramatic improvement in patients suffering from tendon injuries in various areas including the knees, elbows, and ankles, among others.
As the New York Times reported just last February, “two of the Pittsburgh Steelers’ biggest stars, Hines Ward and Troy Polamalu, used their own blood in an innovative injury treatment before winning the Super Bowl. At least one major league pitcher, about 20 professional soccer players and perhaps hundreds of recreational athletes have also undergone the procedure.” Tiger Woods had the procedure done last year on his knee, but that’s as far as the comparisons between the Tiger and myself will go.
In many cases, PRP has aided in actually regenerating ligaments and tendon fibers, which obviously shortens rehab time out of the saddle for us cyclists; it can even obviate the need for surgery in some cases. By introducing blood platelets in areas that have low blood circulation, like tendons, the result is often a dramatic shortening of the healing process.
Platelet concentration could be key
What the New York Times article failed to mention, however, is the disparity in the way PRP therapy has been conducted. The Times claims that the process introduces “high concentrations” of platelets, which it considers to be between three and 10 times higher than a patient’s baseline. This is where the disparity comes in. The vast majority of centrifuge machines on the market today produce these types of numbers. The very latest machines, however, like the one used at the BCSH, produce figures as high as 700-800 times higher than baseline. This is critical because recent studies have shown a direct correlation between the number of platelets and the rate of success.
Because the injection is autologous, there is virtually no risk of rejection or allergic reaction. And while the procedure remains, at the moment, “off-label” or “experimental” that will likely change as more and more studies are coming forth showing the benefits of PRP.
While Boulder Community Hospital has done many PRP procedures, I was the very first patient to have the procedure done at the Boulder Center for Sports Medicine, which has just recently invested in the most advanced equipment available for PRP therapy. I will likely be off the bike for two, possibly three weeks, after which time I can begin light rehab training that will eventually ramp up. I will be documenting my progress here on VeloNews.com, so stay tuned for more on this exciting new area of sports medicine.
Editor’s Note: The issue as been a topic of discussion at the World Anti-Doping Agency since last year, when the practice began to gain wider acceptance in medical circles. WADA has made a distinction between the use of platelets for localized therapy and the infusion of red-blood cells for performance-enhancement. According to the latest revisions to WADA’s banned substances and practices list (effective January 1, 2010):
“The status of platelet-derived preparations (e.g. Platelet Rich Plasma, “blood spinning”) has been clarified. These preparations will be prohibited when administered by intramuscular route. Other routes of administration will require a declaration of use in compliance with the International Standard for (Therapeutic Use Exemptions).”
Riders who are subject to the provisions of the World Anti-Doping Code are advised to contact their respective national anti-doping agencies for information regarding compliance with the Code and the steps necessary to acquire a TUE before beginning such treatment.