Harness the Power of Protein Concentrate Added to your PRP

We are always finding innovative ways to help our patients, especially those with osteoarthritis. Platelet-Rich Plasma injections have been very successful, yet now we have another option to boost the benefits of PRP. We call this “Protein Concentrate.” By filtering the additional plasma after your blood is centrifuged, we are able to trap a high concentration of proteins that can also significantly relieve the symptoms of OA and potentially slow the deterioration of the cartilage in the joint. Two of these proteins are Alpha-2-Macroglobulin (A2M) and Interleukin-1 Receptor Antagonist Protein (IL-1ra).

A2M is the key to slowing the progression of osteoarthritis. A2M is a powerful chemical in destroying proteins that cause arthritis that captures and inactivates the three major chemicals that lead to joint breakdown and cartilage damage. It is also reported that A2M can act as a powerful anti-inflammatory and aid in pain management.

Research on IL-1ra has shown that it also plays a role in slowing the progression of osteoarthritis in joints.  

Who should consider adding Protein Concentrate to their PRP injections? We believe that those with repetitive swelling in the joint are the most likely to benefit from the addition of the protein concentrate to the PRP.

Want to know more about PRP?

Learn about the key details of PRP here

How is PRP simple and not-so-simple? Read here

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

“Blood” (PRP) Versus “Gel” (Hyaluronic Acid) Injections: How to Choose

The two most popular and common injections we offer patients for knee osteoarthritis are platelet-rich plasma (PRP), utilizing a patient’s own blood, and hyaluronic acid injections, commonly known as the gel, rooster comb, or viscosupplement injections.

Let’s compare the two and discuss pros and cons of each:

Both would be considered “natural“ injections with PRP obviously coming from your own blood and hyaluronic acid is a substance already in your joint, but depleted in joints that have osteoarthritis.

We often describe PRP as that big 100,000 mile service you do on your car, and hyaluronic injections are more like the oil change. Thus, PRP is more comprehensive.

PRP Injections

PROS

-most effective long-term injection we offer patients. Benefits typically seen for 6–24 months, and then PRP can then be safely repeated when necessary.

-very likely disease–modifying, meaning we are stopping or slowing the deterioration of cartilage in the knee. These give patients the greatest opportunity to either delay or avoid knee replacement.

-other than weight loss, probably the best long-term medical and financial nonsurgical investment in the health of your knee.

CONS

-not covered by insurance. See our blog regarding this here

-works gradually, with greatest benefit likely seen 4-6 months after the injections.

-anti-inflammatories of any type as well as blood thinners need to be stopped before and after the PRP procedure for a specific period of time.

Hyaluronic acid Injections

PROS

-authorized by most insurance plans, meaning the cost of these is fully covered, partially covered, or can be applied towards your deductible.

-excellent safety profile.

-the majority of patients see a benefit, often for 4 to 12 months.

-like PRP, injections are not particularly painful when given into the knee joint under ultrasound guidance and only require a few days of rest afterwards.

CONS

-may have an indirect benefit on the long-term health of the knee joint, but are not considered “disease–modifying” like PRP.

-benefits of pain and swelling reduction along with functional improvements do not last as long as PRP.

-although they work a bit more rapidly than PRP injections, typically it takes 6 to 8 weeks after the final injection to see the greatest benefit.

-most brands require a series of 3–4 total injections, given one per week.

Want to know more about PRP?

Learn about the key details of PRP here

How is PRP simple and not-so-simple? Read here

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

PRP For Knee Pain: Almost A No-Brainer

Knee pain is often caused by a meniscus tear, osteoarthritis, patellar tendinopathy, low-grade ACL or MCL sprain or some combination of these.

Don’t want surgery, don’t need surgery or already had surgery with a less than satisfactory outcome?

Platelet rich plasma (PRP) has been a star in the world of orthopedics, particularly as it pertains to knee conditions.

Once considered experimental, this innovative, minimally-invasive treatment using your own blood and concentrated growth factors is now is becoming a standard-of-care treatment for many knee conditions.

Over 45 studies have demonstrated clinically significant benefit in the treatment of knee osteoarthritis (OA). The overwhelming majority of studies demonstrate that PRP is more effective in the long-term when compared to steroid or hyaluronic acid injections for knee OA.

Want something safe, natural, effective, and a disease-modifying intervention that will relieve pain, improve function, provide stability and/or healing for tissues that can be done in the office? Then PRP can be a great option for you.

I've been giving ultrasound-guided PRP injections for 15 years. I’ve spent countless hours on the educational process, training and fine-tuning of techniques to make this a excellent option for our patients. I’ve been a patient myself, receiving PRP for shoulder and knee conditions and I've experienced the success firsthand.

Want to know more about PRP?

Learn about the key details of PRP here

How is PRP simple and not-so-simple? Read here

If you think you may be a candidate or want to discuss further, then

come see us. We are always happy to help!

F. Clarke Holmes, M.D.

Do I Need a Knee Replacement?

Your 55 year-old knee is hurting and your brain immediately asks the question, “Do I need a knee replacement?”

An x-ray demonstrates moderate to severe osteoarthritis and thus, it’s time for a knee replacement, right? Not necessarily. It’s amazing how many patients have severe findings on their x-rays but minimal to mild pain and excellent function. Therefore, we always say, “Treat the patient, not the x-ray.”

Ok, now your pain has been running 5-7 out of 10 for weeks to months. Therefore, it’s time for a knee replacement, right? Well, pain is certainly a factor in this decision; however, we have many nonsurgical tools in the toolbox that will reduce or eliminate pain for extended periods of time.

Finally, you’ve been episodically limping now for several weeks. You suppose it’s time for a replacement, right? Persistent dysfunction is another reason to have a knee replacement, but function can often be significantly improved without the need for surgery.

To overcome the symptoms and dysfunction of knee arthritis, three factors can be addressed: the environment, the biomechanics and the structure. Only surgery can change the structure, yet significant improvements in the environment and biomechanics can often delay or eliminate the need for knee replacement.

How do we do this? The environment is best changed by injections such as platelet-rich plasma, an anti-inflammatory pattern of eating, supplements and occasionally medications.

The biomechanics can be improved through physical therapy, certain forms of exercise, bracing and changes in footwear.

So in summary, knee replacement can be the right option for many patients and produce successful outcomes in most patients, yet in 80-90% of the patients that walk (or limp) into our office, nonsurgical treatment will be quite effective.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

When It Comes to Osteoarthritis, PRP is the Winner!

Although platelet-rich plasma (PRP) injections remain innovative and the science behind and techniques when using them are evolving, they are trending towards the injection of choice, especially in the case of osteoarthritis. Once considered “experimental,” there are now at least 45 studies validating the success of PRP in the treatment of knee osteoarthritis. So simply put, why would you choose PRP over a steroid injection or hyaluronic acid for knee osteoarthritis?

-Safer and more natural

-Longer-lasting relief of pain with often 6 months to 2 years of benefit for knee OA

-Most likely PRP is disease-modifying, meaning it is slowing the deterioration of cartilage in your knee

How about a study or two demonstrating these points made above:

PRP and Knee OA- Article 1

PRP and Knee OA- Article 2

Want to know more? Here are a couple of our previous blogs on the topic:

https://www.impactsportsnashville.com/blog/2024/2/16/7826kg4vvyebmp8bt2aph72i704hmc

https://www.impactsportsnashville.com/blog/2023/6/17/insurance-companies-say-prp-is-experimentalwe-sigh

As always, we are here to help! Let us know if we can be of assistance to you.

F. Clarke Holmes, M.D.

Proactive Versus Reactive: Which One Are You Choosing?

We strongly encourage our patients to be proactive with their musculoskeletal health over just being reactive.

Let’s list some examples of the two different approaches:

Proactive

  1. You’re trying to remain in great shape, yet your knee is starting to ache due to mild osteoarthritis. No surgery is necessary, but you want to do something that not only reduces symptoms, but also protects the knee in the long term that is likely disease-modifying. Thus, a series of platelet rich plasma (PRP) injections will meet those goals. PRP injections are one of the best treatment options for the management of osteoarthritis.

  2. You’re starting to have heel pain when you first get out of bed. You suspect plantar fasciitis. Instead of ignoring the symptoms or simply relying on Dr. Google, you decide to consult with a sports medicine physician, so a comprehensive diagnostic and treatment plan can be constructed and customize for you. You realize an inexpensive ultrasound in the office can confirm this diagnosis, determine severity and help with prognosis. At that visit, you’ll be given numerous treatment options and successfully guided on your ability to continue exercising to maintain good health.

  3. You have daily aches and pains, early arthritis and stiffness, but really don’t want to go on daily medications to manage the symptoms. However, you need some help making lifestyle choices as a pertains to diet, supplements and exercise choices. You understand that friends, family, and the Internet are not the optimal resources. Therefore, you decide to move forward with a physician consult so you may receive advice in great detail regarding the best supplements to choose for your particular situation, how to approach exercise and dietary choices. You understand that it is your physician’s to help you decide between what is fact and what is myth.

Reactive

  1. Your heel starts to hurt after some longer walks, especially when you first get out of bed. You talk to friends who recommend rolling the heel, stretching the toes and obtaining non-customized orthotics. You continue to walk, but three months later your heel pain is worse and you limp into the doctor’s office wondering what happened. Bottom line, you now have advanced plantar fasciitis. Unfortunately, the advice you’ve received from well-intentioned others has not been the best for you. Presenting to the doctor when the symptoms first developed would’ve given you a much better outcome, as an entirely different set of treatment options would have been suggested.

  2. Your arthritic knee starts to hurt and you see a bit of swelling, but you decide to keep going to the gym, rubbing Biofreeze on it and you add in some heavy yardwork over several weekends, Ultimately, you can barely bend your very swollen knee, and you’re thinking about canceling that trip to see grandkids. Of course, we are here to help you, but we could’ve avoided this major flare if we would have proactively started some treatment as soon as your knee started to ache.

So we ask the question: are you going to be proactive or reactive? Not every little ache or pain that last hours to a few days should prompt a visit to the doctor. However, do not ignore symptoms and instead, do realize that early treatment usually provides better outcomes than waiting until symptoms rise to a moderate or severe level.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

PRP: The Simple and Not So Simple

Many of you are either very familiar or somewhat familiar with platelet-rich plasma injections commonly known as PRP. These are great options for osteoarthritis of a joint, a chronic tendon problem as well as some ligament and fascia problems. Our top conditions treated with PRP include knee osteoarthritis, tennis & golfers’ elbow, plantar fasciitis, rotator cuff tears and Achilles tendon conditions.

When it comes to PRP, here are the simple and not so simple :

Simple

-This is an office procedure, that from start to finish, only takes 45 minutes or less

-A simple blood draw from an arm vein is typically painless

-For a joint injection, pain afterwards is typically very mild

-Risks are exceedingly low as abnormal bleeding, infection, a blood clot or nerve damage are basically nonexistent.

Not So Simple

-We have been performing PRP injections for nearly 15 years. Literally hundreds of hours have been poured into training and fine-tuning the knowledge and skill set it takes to be highly competent to perform this procedure

-Some of our patients have very small veins. Fortunately, we have developed a skill set of ultrasound-guided venipuncture, making blood draws much more successful and less painful on those more challenging patients

-Ultrasound guidance, in our opinion, is a must when giving PRP injections. If you want these growth factor rich platelets to make it to the intended location with great accuracy, then ultrasound guidance is necessary. This is a skill set we have developed over the past 16 years

-With some soft tissue PRP injections, such as partial tears of tendons, we have to prepare our patients that there will be a spike in pain after the procedure, often for one to two weeks. Fortunately, the pain is typically not as significant as it would be if you had a surgery

-Finally, patients have to be patient! PRP exerts its positive effects very gradually. Most patients are seeing a benefit within one to two months, and the maximum benefit often is seen between 6 and 12 months. Thus, we have to advise our patients that with many orthopedic conditions, there is no “quick fix”

Ultimately, PRP can be simple and not so simple, depending on your perspective. Generally speaking, we leave the simple part up to the patient, and we will handle the not so simple aspects of the procedure.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.