Are PRP Injections Worth It? Don’t Get PRP Without Reading This First

Do They Work, What Are the Risks and How to Get Lasting Pain Relief

By Dr. Erin Boynton, MD, FRCS

Are PRP Injections Worth It Don't Get PRP Without Reading This First - thumbnail

Hey there, Dr. B here, orthopaedeic surgeon and Chief Medical Officer with Precision Movement. Many years ago, probably in the mid-90s, when I was working with the Toronto Blue Jays, the Argos, and the Maple Leafs, PRP injections became very popular. I was quite fascinated by the principle.

Some of the athletes got amazing results, and others weren’t so great. So, I started to delve into the research and the science behind PRP and what it was supposed to do. In this article, I’m going to share my thoughts on PRP because so many of my patients come to the office wondering if it’ll benefit them.

What is PRP?

PRP stands for platelet-rich plasma.

Platelets are little bags of growth factors that circulate in our blood. When you get an injury and/or a cut, platelets arrive at the scene of injury, and they secrete the growth factors that stimulate wound healing.

So, the whole premise of PRP injections is to stimulate the growth and healing of tissues that have been damaged. Tendons, cartilage, and muscle are prime examples where PRP has been used.

Does PRP Work?

When I dive into the literature to understand whether or not it works, I find the research varies in its conclusions on efficacy. It’s not that it’s flawed research. It’s that there are so many variables to control that make it very difficult to study the effect of PRP.

Let me give you some examples.prp injections centrifuge

PRP is harvested from your own blood. You go to the doctor, and the doctor will take some vials of blood. They take those vials of blood down the hall. they put the vial into a centrifuge machine, which spins at a very high speed. It separates the different components of our blood. The platelets form a very specific layer.

Here’s where some of the variables start.

  1. The speed of the centrifuge.
  2. How long you have the vial in the centrifuge.
  3. The number of platelets that you have in the blood sample versus the patient next door. One patient may have 50,000 platelets, whereas another patient may have 100,000 platelets.

Already, right from the get-go, we’re comparing apples to oranges when we’re thinking about the amount of growth factor that we’re actually injecting into the area that’s injured.

Other variables are patient factors such as the degree of tissue damage. Not all partial tears are created equally. You might have one millimeter of damage, and the patient next door may have 10 millimeters of damage. One patient may have more inflammation. One may have very little inflammation in the surrounding area.

Then, how that part of your body is being mechanically loaded is quite different between people.

There are a lot of variations in that patient in the PRP injection that make it extremely difficult to study, and when you do a PubMed search for PRP, hundreds of articles come up, and you can find one for and one against. You have to look very carefully at the research.

I would say that there’s probably some evidence that PRP is helpful for patients with degenerative arthritis of the knees [1]. It can possibly be helpful for gluteus medius in muscle injuries and tendon injuries around the hip [2].

However, PRP is not helpful for hip arthritis [3] and there are variable results for tennis elbow [4].

So, again, there’s a lot of variation.

The bottom line is I’ve had patients who come into the office, and they rave about it. They think it’s the best thing since sliced bread. And then I have others who come in and have had minimal effect. We don’t know whether their body was going to heal and whether they were going to recover, regardless of whether or not they got the injection.

But one thing makes me happy. If the patient’s happy, I’m happy.

I think that using a PRP injection to stimulate healing is a very good hypothesis. If you do get some pain relief from the injection and possibly some tissue regeneration in arthritis, that would be phenomenal. But you need to use that window of opportunity to change how you’re loading that part of your body so that it doesn’t break down again. That’s the bottom line.

Some Tips After PRP Injection

The one thing that we really do understand is how mechanical load will affect tissue.

If you have an injection and have that window of opportunity, use it to rebalance your body and gain a foundation for movement.

Downsides of PRP Injection

I think the major downside of a PRP injection is the cost. Otherwise, I don’t think that there’s any significant downside as far as leading to degeneration of tissue that you can see, say, with a cortisone injection.

There’s a minor risk of infection, and the side effects from an injection of bruising or a little bit more pain are obvious.

But the major downside would be the cost. I think it has to be a very individual decision and maybe based on your finances.

prp injections knee pain

Fixing the Root Cause of Your Pain

If you decide to have a PRP injection, that’s great, but you need to understand why that part of your body broke down in the first place. A PRP injection is really a bandage to help with regeneration. But if you don’t fix why your body broke, if you don’t change how you move after your injection, you’re going to break down again.

The major reason that I find people break down is because they don’t have a foundation for movement.

A foundation for movement consists of four pillars, and it’s like the four legs on a desk.

  1. Tissue quality (which we’re hoping will benefit from the PRP injection)
  2. Alignment of your body and the joints
  3. Activation of the deep core muscles
  4. Active range of motion

So those are the four pillars for pain-free movement. The PRP injection can help address tissue quality.

Now, with an exercise program, you can change your alignment and your muscle activation, and that will help with an active range of motion.

This [the Foundation for Movement Longevity] has been a great help in staying functional for my job and recreation. Even though I have strengths and endurance, as I get older it is so easy to be out of balance, lessened range of movement, less balance, and those movements that I don’t typically do much anymore start to get weak. Thanks!!! Like having my own physical therapist on my team. Loving it. So fun to slowly get functional on exercises that at first, I couldn’t do at all. Like going downstairs pain-free.

– Lynn

Summary & Next Steps

We’ve provided some links below with exercises for the common areas of your body where PRP can help. Remember, even if you decide to get the injection, to really recover, you’ll need to change how you’re loading your joints.

10 Exercises for Relief fro Knee Osteoarthritis Pain – get easy beginner and intermediate at-home routines to help ease your knee arthritis.

4 Exercises to Build Gluteus Medius strength & Decrease TFL Pain – weak glutes can cause hip pain and stiffness. Use these exercises to strengthen them and eliminate the pain.

If you’re not sure where to start, check out the Foundation for Movement Longevity Program. This program has been developed to address the five areas of our body that are most commonly dysfunctional.

Thanks for reading, and keep moving!

P.S. If you’re a better audio learner, here’s a YouTube video with all of the above information about PRP packed in.

About the Author

Dr. Erin Boynton, MD, FRCS is an orthopedic surgeon who was the team surgeon for the Toronto Blue Jays for 10 years and has worked with other professional teams and athletes from many different sports. She currently serves as the Chief Medical Director of the Rogers Cup WTA Tennis Tournament and is the ITF Canadian Champion in tennis for her age group (we won't say which group that is!).