Platelet-Rich Plasma Therapy in Physical Therapy: Enhancing Recovery and Healing

Exploring the effectiveness of Platelet-Rich Plasma (PRP) treatment in combination with physical therapy for various musculoskeletal conditions like tendinopathy, ligament injuries, muscle strains, and osteoarthritis. The audience will gain insights into the benefits of PRP injections, suitable patient populations, and the impact on treatment outcomes based on studies focusing on conditions such as TMJ osteoarthritis, rotator cuff repair, and hamstring injuries.

• PRP therapy
• Physical therapy
• Musculoskeletal injuries
• Recovery
• Regenerative medicine

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1. PHYSICAL THERAPY POST-PLATELET RICH PLASMA TREATMENT Keerat Chawla, SPT

2. OBJECTIVES The audience will be able to understand about injuries and soft tissue structures in the body that respond well to PRP injections The audience will learn about which patient populations would be appropriate for and may benefit from a PRP injection with continues PT after. The audience will learn about the implications that PRP treatment will have on a patient s course of therapy.

3. 1

4. PRP Treatment is appropriate for 2,3: Tendinopathy Ligament injuries Muscle strain Cartilage When all conservative approaches failed Early Chronic conditions Osteoarthritis

5. TMJ OSTEOARTHRITIS 4 Effect of platelet- rich plasma injection combined with individualized comprehensive physical therapy on temporomandibular joint osteoarthritis: A prospective cohort study (Liu SS, et al.): Assessed: Pain intensity Maximum mouth opening TMJ sounds Jaw Functional Limitation Scale (JFLS) Imaging Findings: Pain intensity, maximum mouth opening, & TMJ sounds improved in both groups Mouth opening better in combined group TMJ sounds better in PRP only group Pain improvement was greater in the combined group at 3 & 6 months JFLS scores were higher in the combined group at 6 months

6. SURGICAL ROTATOR CUFF REPAIR 5 Supporting PRP use: (Randelli et al.): Utilized a PRP group vs no PRP application VAS pain score was lower in the PRP group at 3, 7, 14, & 30 days post-surgery PRP group had higher SST scores and greater external rotation strength at 3 months post-surgery Not Supporting: No significant difference in outcome measures at 6, 12, & 24 months post- surgery

7. HAMSTRING INJURY 6,7 Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial (MSA Hamid): Assessed: Effectiveness of a PRP injection to treat grade 2 hamstring injury Methods: 28 patients with acute hamstring injury randomly given either PRP + rehab or only a rehab program Findings: 1 PRP injection + rehab program was significantly more effective in treating the injuries than a rehab program along Return to play: 26.7 7.0 days (PRP group) 42.5 20.6 days (Rehab group) PRP group reported lower pain severity throughout the study.

8. PATELLAR TENDINOPATHY 8 Conservative treatment approaches: Physical therapy: eccentric and concentric loading of quadriceps Bracing Transdermal nitroglycerin patches Heat therapy Chronic tendinopathy occurs from repetitive loading of a tendon crossing a joint May result in increased pain with loading and impact activities, which can negatively effect performance *Many studies have been done of the effectiveness of PRP injections in treating patellar tendinopathy Difficult to draw conclusions due to conflicting evidence Some studies show improvement in pain with PRP therapy Some showed no profound benefit from treatment with a PRP injection + PT program; and others did

9. REHAB GUIDELINES POST- PRP INJECTION 9 0 7 days post-PRP No PT Immobilization of joint/ protect the area; No NSAID use PROM, AAROM, AROM 7-14 days post-PRP PT 1-2x/wk Discontinue immobilizing device Low resistance activity, isometrics, light stretching 2-4 weeks post-PRP PT 2-3x/wk Joint and STM as needed to restore ROM and joint mechanics Low resistance, DO NOT overstress, lift heavy objects, exercise with weights or perform high impact activities Achieve full ROM, pain free & decrease pain with ADLs.

10. REHAB GUIDELINES POST- PRP INJECTION 9 4-6 weeks post-PRP PT 2-3x/wk Progress isometric strengthening to concentric & eccentric strengthening as tolerated Start balance and proprioception activities No pain with ADLs 6-8 weeks post-PRP PT 2-3/wk High resistance, balance and proprioception exercises Avoid: high velocity, high amplitude, high intensity exercise, heavy lifting 8-12 weeks post-PRP PT 1-2x/wk Add more sport-specific exercise Balance and proprioception exercises Pre-plyometric exercise progressing to plyometric exercise as tolerated Return to sport pain free

11. POSSIBLE SIDE EFFECTS 12 Pain Infection Allergic reaction Nerve injuries and tissue damage POSSIBLE CONTRAINDICATIONS 10,11,13 Anemia, hemodynamic instability Unstable angina, Sepsis Infection Systemic disease Bone marrow pathology Thrombocytopenia Systemic steroid use Anticoagulation therapy

12. INFORMING PATIENTS Procedure performed by: Sports medicine physicians, regenerative medicine specialists, Orthopedists Not covered by insurance May be no improvement in symptoms Goal of accelerate healing Possible earlier return to activity Still a lot of research happening on this procedure More conservative treatment approaches should be attempted before considering PRP injections

13. SUMMARY 2, 14,15 Many cases have positive outcomes from PRP injections Increased healing rates are not guaranteed Many unanswered questions remain: Dosing, timing, frequency of injections, optimal physiologic conditions for injections, location of delivery, age of individual, etc. Thus, deeming the procedure as experimental and not covered by insurance. There is ongoing research on this topic with new evidence being found Prevent/ treat infections Promote nerve regeneration

14. QUESTIONS? QUESTIONS?

15. RESOURCES 1. Platlete Rich Plasma (PRP) Integrative Health & Wellness. Accessed June 8, 2022. https://integrative-health.com/functional-medicine/platlete-rich-plasma-prp/. 2. Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J. 2012;32:150-163. 3. Cole BJ, Seroyer ST, Filardo G, Bajaj S, Fortier LA. Platelet-rich plasma: where are we now and where are we going? Sports Health. 2010;2(3):203-210. doi:10.1177/1941738110366385 4. Liu S-S, Xu L-L, Fan S, et al. Effect of platelet-rich plasma injection combined with individualised comprehensive physical therapy on temporomandibular joint osteoarthritis: A prospective cohort study. J Oral Rehabil. 2022;49(2):150-159. doi:10.1111/joor.13261 5. Schneider A, Burr R, Garbis N, Salazar D. Platelet-rich plasma and the shoulder: clinical indications and outcomes. Curr Rev Musculoskelet Med. 2018;11(4):593-597. doi:10.1007/s12178-018-9517-9 6. A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LPC. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42(10):2410-2418. doi:10.1177/0363546514541540 7. Poudel B, Pandey S. Hamstring Injury. In: StatPearls. StatPearls Publishing; 2021. 8. Jeong DU, Lee CR, Lee JH, et al. Clinical applications of platelet-rich plasma in patellar tendinopathy. Biomed Res Int. 2014;2014:249498. doi:10.1155/2014/249498 9. Clare D, Desai M. Platelet-Rich Plasma Protocol. Accessed June 8, 2022. https://releasept.com/wp-content/uploads/2019/05/PRP-Protocol_Release-final-.pdf 10. Luzo ACM, F varo WJ, Seabra AB, Dur n N. What is the potential use of platelet-rich-plasma (PRP) in cancer treatment? A mini review. Heliyon. 2020;6(3):e03660. doi:10.1016/j.heliyon.2020.e03660 11. Jain NK, Gulati M. Platelet-rich plasma: a healing virtuoso. Blood Res. 2016;51(1):3-5. doi:10.5045/br.2016.51.1.3 12. Latalski M, Walczyk A, Fatyga M, et al. Allergic reaction to platelet-rich plasma (PRP): Case report. Medicine. 2019;98(10):e14702. doi:10.1097/MD.0000000000014702 13. Yaari L, Dolev A, Haviv B. [platelet rich plasma injection as treatment for rotator cuff tendinopathy and as an augmentation for rotator cuff repair]. Harefuah. 2019;158(6):395- 397. 14. Zhang W, Guo Y, Kuss M, et al. Platelet-Rich Plasma for the Treatment of Tissue Infection: Preparation and Clinical Evaluation. Tissue Eng Part B Rev. 2019;25(3):225-236. doi:10.1089/ten.TEB.2018.0309 15. Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci. 2011;121(4):176-180. doi:10.3109/00207454.2010.544432