FanPost

What's the Story On Platelet-Rich Plasma?

FYI: I am not a medical doctor, but I am in the medical field as a physical therapist and at least did my research before writing. Take the information and attached opinion how you will.

Platelet-Rich Plasma (PRP) injections are becoming all the rage these days in athletics as teams look for ways to have their players return to action more quickly and in a manner that costs the franchise less money. Shocking, I know.

Pittsburgh had their own version of these success stories a few years back when both Troy Polamalu and Hines Ward had the treatment done for injuries (a calf strain and a Grade II MCL sprain, respectively) and saw impressive results with their ability to return to game action in a pretty darn short period of time. So what exactly is PRP?

Well, for one thing, PRP is the umbrella term for a number of slight variants as well as the original, but the concept for all is the same. Doctor Awesome, your treating physician, draws a sample of your blood. He then takes that blood and centrifuges out the blood cells from the plasma (where all the proteins are) and platelets (who do healing business at wound sites). He takes that condensed product, puts it into a needle, and injects the components directly into the injury site (damaged muscle or ligament, what have you).

The idea is that, in areas of the body like ligaments where healing is generally slow due to little or no blood supply, a protein and platelet "booster shot" can jump-start and/or catalyze the healing process and allow the injured person to recover more quickly and more cheaply than if they went under the knife.

But what has actually been shown about this treatment? There are only two currently published studies that take a look at PRP injection therapy (I'll call it PRPIT henceforth) as its own isolated event (some evidence already exists for PRPIT successfully decreasing post-operative recovery time when used in conjunction).

In those two studies, I won't bore you with the details, but the evidence is very weak. The only conclusions that can truly be drawn from that small amount of evidence are the following, very diluted statement: in patients who have seen no improvement in their persistent, significant elbow pain after at least six months of traditional conservative therapy, PRPIT shows significantly greater and faster alleviation of pain than doing nothing, however it could take up to 1-3 years for pain to alleviate fully.

That, depending on who you ask, falls somewhere between "worth investigating further" and "luck." And those studies, which only involved a total of 50 people, have a lot of holes - there is barely any control group for comparison; we have no clue if any of them were athletes at all, let alone professionally; and we have no idea if they controlled for other variables besides the effects of the injections.

The only baseball example we have, as you saw above in the NY Times piece, is that of former Dodgers reliever Takashi Saito. He was in a similar position to our buddy Wandy Rodriguez right around the All-Star Break in 2008. He received the injection rather than having surgery and then proceeded through the standard protocol of resting, icing, anti-inflammatory drugs, and eventual return to gradual strengthening. He was able to return to action two months later for the last two weeks of the regular season, and pitched pretty effectively at the major league level for another three seasons before unravelling last season.

Then again, even this example has its caveats. For one thing, Saito could be seen as an outlier himself - at the time of his procedure he was a 38-year-old reliever who had already logged roughly 1500 innings at the professional level between the US and Japan, so he had already had what might be seen as an unusually long career (at least by US standards).

Additionally, even the very doctor who gave Saito the injection admitted that there is no way to know whether the injection was the reason for his recovery, since fully 25% UCL strains heal on their own, and the injections themselves have somewhere between a 20 and 40% failure rate (aka no improvement in symptoms).

So what I am seeing is that we have a procedure that is so new (both in terms of how long it has been used and how much it has been researched) it is still experimental. It has anywhere from a 20 to 40% chance of doing absolutely nothing but delaying surgery, and even what benefit it has been shown to have clinically thus far is partially anecdotal and more long-term than short-term (and those short-term perks are what those who use it these days seem to be gunning for).

I'm aware that every medical decision is up to a player and their medical staff, but I think that anyone (including Wandy or the Pirates) who is hoping to utilize PRPIT instead of Tommy John surgery - especially if they are hoping to have a quicker return to peak performance - is largely engaging in wishful thinking.

Hopefully this at least leaves you more informed about the discussion, even if you don't agree with what I've said.

This is a FanPost and does not necessarily reflect the views of the managing editor (Charlie) or SB Nation. FanPosts are written by Bucs Dugout readers.

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