Platelet Rich Plasma (PRP) Injections can help treat both chronic injuries and acute orthopaedic conditions.

PRP Injections involve taking a patient’s own blood, separating the components using a centrifuge, isolating the desired PRP and Growth Factors, and precisely injecting them to the damaged tissue.

1. What are Platelets?

Platelets are one type of cell found in blood. The other major types being red blood cells and white blood cells. Platelets are specialized cells that have many functions, including helping blood clot when you are bleeding, providing a ‘scaffold’ for tissue healing when injured, and producing ‘growth factors’ that help the body heal itself once injured.

Growth factors are compounds that are made by platelets (and other cells), examples of which include Platelet Derived Growth Factor (PDGF), TGF-B (Transforming Growth Factor-Beta) and VEGF (Vascular Endothelial Growth Factor). These compounds are important in attracting other cells that aid in healing, stimulating new blood vessel formation, and promoting regeneration of damaged tissue.

Processing the blood into PRP results in high concentration of these factors (2 to 20 times the amount of Platelets and Growth Factors). Thus, when injected into the damaged tissue, an influx of healing compounds help the regeneration of damaged tissue, decreases inflammation, and promotes natural healing.

2. When are Platelet Rich Plasma injections used?

PRP injections are used to help a variety of orthopaedic conditions. They can be applied to conditions that require biological regeneration, or when you may want to speed up healing beyond the average timeframe that most people experience (eg. faster recovery from Hamstring injuries).

Tendon injuries, ligament injuries and cartilage damage are all potential targets for PRP and Growth Factor injections. Conditions like arthritis, muscle tears, ligament tears and cartilage tears may all respond to PRP Injections.

Common conditions we currently treated with PRP Injections:

  • Arthritis (Knee, Hip, Ankle, Foot, Shoulder, Elbow, Wrist, Hand, Back, Neck)
  • Chronic pain syndromes (Fibromyalgia, Trigger Points, Low Back Pain, Neck Pain, etc.)
  • Plantar fasciitis (Heel Spurs)
  • Tendonitis/Tendinosis/Tears (Achilles, Rotator Cuff, Patella, etc.)
  • Tennis/Golfers Elbow
  • Frozen Shoulder
  • Ligament sprain/strain (Sprained Ankle, Elbow, etc.)
  • Labral Tears (Hip, Shoulder)
  • Meniscus Tears (Knee)
  • Keloid Scars, Fibromas, Post-Surgical Scars
  • Bursitis (Knee, Shoulder, Ankle, Hip, Pelvis, etc.)
  • Synovitis (Joint inflammation)
  • Muscle tears
  • Ulcer healing (Diabetic feet, Pressure sores)

It has been shown that PRP can help speed up regeneration of tissue healing in some conditions, such as muscle tears (Hamstring tears) and ligament tears (Achilles tendonitis), and for athletic patients seeking faster recovery, PRP treatment is a powerful option to help in faster regeneration and natural healing.

3. How long has PRP injections been around?

The earliest work with PRP began about 20 years ago, and in orthopaedic/sports care approximately 15 years ago. PRP was (is) used to aid in surgical healing, and it’s application has expanded to non-surgical conditions in the past 15 years. These days, PRP is most commonly used for orthopaedic conditions that do not require surgery and can sometimes prevent the need for surgery if adequate regeneration is achieved.

Current PRP Systems used in our practice

Arthrex ACP PRP ® – 15 ml of blood is drawn from the patient’s arm and spun in a centrifuge for 5 minutes. This system typically generates 5-6 mls of PRP (PRP concentration is typically 2 to 6 times your normal range)

Arthrex Angel PRP ® – 40 to 180 ml of blood is drawn from the patient’s arm and spun in a centrifuge for approximately 17 to 25 minutes. This system generates highly concentrated PRP (2 – 20 times normal values) and can be customized to the specific damaged tissue. Depending on the number of sites of injections, damaged tissue and patient factors, this system can customize the output to produce a more precise injection. In addition, this system isolates the Platelet Poor Plasma (PPP) which contains numerous Growth Factors that can be used to help in the regenerative treatment.

4. How does this differ from a corticosteroid injection?

Corticosteroid injections can provide a strong and immediate relief of inflammation and pain, without regeneration and has potential for side effects. In contrast, using your own PRP has the added benefit of regeneration and natural healing. While PRP is a slower process for pain management, it has longer term benefits compared to corticosteroid injections, without the potential side effects of corticosteroids.

5. Are PRP Injections guided by Ultrasound?

Ultrasound guided injections offer a precise and accurate administration of any injection to the damaged tissue. Research has shown that using an ultrasound guided injection improves outcomes by allowing a more precise injection to the desired target (joint, tendon, ligament, bursa, fascia, labrum, meniscus, etc.). We offer advanced image guided injection in our clinic and we recommend that this be done for all injections to improve outcomes.

6. How many PRP Injections are required?

Current research is showing that PRP has variable potency between patients. Younger people seem to have more platelets and “healther” platelets, while older people seem to have less platelets and “less healthy” platelets. Furthermore, research is indicating that different conditions require a different amount of PRP, for example, the amount of PRP required for plantar fasciitis versus knee arthritis is different. These are some of the factors that play a role in determining how many PRP injections are required. At our clinic we start with a single injection of PRP specific to the condition and customized for the patient, we then see the patient back every month until the symptoms are resolved. With our customized approach, our patients seem to have significant improvement after 3 injections. Younger patients seem to recover faster, while older patients seem to take a little longer, but on average we see improvement after 3 injections. For chronic conditions, such as arthritis or chronic pain, we recommend a maintenance program of PRP injections after the initial treatment regime.

7. What conditions can be treated with PRP?

Many conditions can be treated by PRP injections. At our clinic we treat the following conditions:

  • Arthritis (Knee, Hip, Ankle, Foot, Shoulder, Elbow, Wrist, Hand, Back, Neck)
  • Chronic pain syndromes (Fibromyalgia, Trigger Points, Low Back Pain, Neck Pain, etc.)
  • Plantar fasciitis (Heel Spurs)
  • Tendonitis/Tendinosis/Tears (Achilles, Rotator Cuff, Patella, etc.)
  • Tennis/Golfers Elbow
  • Frozen Shoulder
  • Ligament sprain/strain (Sprained Ankle, Elbow, etc.)
  • Labral Tears (Hip, Shoulder)
  • Meniscus Tears (Knee)
  • Keloid Scars, Fibromas, Post-Surgical Scars
  • Bursitis (Knee, Shoulder, Ankle, Hip, Pelvis, etc.)
  • Synovitis (Joint inflammation)
  • Muscle tears
  • Ulcer healing (Diabetic feet, Pressure sores)

8. Is PRP painful?

While everyone’s pain tolerances vary, patients report a range of discomfort from mild to moderate with PRP injections. A needle is used to draw blood from a vein in the arm initially and then small needles are used to perform the actual injection(s). Most patients tolerate the injections very well with minimal pain.

Protocol after the injection

We recommend rest, ice, compression and elevation of the injected site to minimize swelling & pain after the injection. Immediately after the injection you should rest for 10-15 minutes before resuming your day. Once you are medically stable, you will be discharged.

Increased pain at the site of injury may result for 48 – 72 hours post injection. Rest of the affected tissue during this time is recommended. Tylenol can be used to manage pain post injection, as well as activity modifications.

On average, after 7 to 10 days patient’s can gently continue their rehabilitation and exercise program to assist with tissue healing.

9. How long does PRP injection take to perform?

Depending on the number of areas being treated, most procedures will be completed in 30 – 45 minutes. The entire procedure is done during your clinic visit.

10. How long can I expect before I can see the benefits from a PRP injection?

PRP is a regenerative treatment, which takes time. Depending on the quality and quantity of PRP, in addition to patient’s medical comorbidities (eg. Diabetes) and condition being treated, the amount of time until our patients see benefit varies from weeks to months. On average, we find that most patients show improvement after 3 to 4 months from first treatment.

11. How long does the effect from PRP last?

This is different for everyone. Much depends on the underlying disease process and whether there has been a recurrent injury to the affected area. It is impossible to predict if and when further treatments will be needed for a specific condition. In some cases, patients do come back months or years later for repeat PRP injections. On average we find that most conditions can be improved for months to years.

12. Is PRP covered by OHIP or insurance?

PRP is not covered by OHIP.

PRP is typically not covered by extended health benefits. If your insurance plan has a “health spending account” or an “executive plan” then those funds can be used to cover your treatment.

WSIB, MVA and Medico-Legal cases have been approved for PRP treatments on a case-by-case basis.

13) What are the possible side effects?

As with any type of injection, there is a small risk of infection, injury to blood vessels, nerves, tendons or ligament and a small risk of bleeding and/or bruising. While not truly considered a side effect, many patients will experience increased pain or discomfort for a short time following the treatment. If you are sick, discuss this with the physician before considering this type of treatment. If you have inflammatory arthritis that is currently active, PRP injection should be delayed until the inflammatory process is more controlled.

14. Should I stop or continue taking NSAID (Advil/Ibuprofen, Aleve/Naproxen, Celebrex, Prednisone, etc.)

If you take any NSAID or Steroid on a regular basis, it should be stopped 4 to 6 weeks prior to PRP treatment and held off until PRP treatment is completed 4 – 12 weeks after the injection. However, if you take any NSAID or Steroid on a non-regular basis (i.e. once in a while), it is ok to continue taking it as needed. Ask your physician about your particular situation.

For more information and research on PRP injections, please go to our research tab.