PRP: The Details Matter. Give Us 3 Minutes

More practices than ever are offering platelet-rich plasma (PRP) injections to their patients, especially those with osteoarthritis, tennis and golfer’s elbow, partial rotator cuff tears, Achilles and patellar tendonopathy and plantar fasciitis, just to name a few.

We often say, “not all PRP is the same.” There are so many details that go into the success rate of the injections. On that subject, how do you define success? Less pain, better function, healing of damaged tissue and/or the slowing of the deterioration of cartilage, especially in osteoarthritis. PRP can truly be a disease-modifying treatment, not just something to make you temporarily feel better.

Now, what details really matter?

• Experience of the physician: how long has he/she been giving PRP injections

• Accuracy of the injection: ultrasound-guidance is paramount

• Amount of blood used to produce the PRP: we’ve learned that a higher volume of blood is likely necessary to produce the optimal number of platelets

• Creation of the PRP: constructing the optimal amount of PRP to inject for each condition. Creating a mixture either rich in leukocytes (white blood cells) or poor in leukocytes

• Providing the best recommendations regarding what medications and supplements should be temporarily stopped before and after the injections

• Providing the best recommendations regarding restrictions (use of a boot, crutches, bracing, type of rest) after the PRP

• Deciding upon the optimal number and frequency of injections to give

• Working with a physician who is frequently involved in medical education on the topic of orthobiologic injections, including PRP

• Working with a physician who is transparent and communicative regarding outcomes, expectations and cost

If truth be told, only a few physicians in Middle Tennessee implement all of these details when it comes to PRP injections.

So, if you think you are candidate for this very natural, quite effective, and minimally-invasive treatment, then come see us!

F. Clarke Holmes, M.D.

Why Me? Why So Many Tendon Problems?

If you are 40 years old or above, it’s probably not “if” but “when” you are going to have a tendon problem. Tendons connect our muscles to bones, but as we age, they become problematic. Common tendon problems include/involve the rotator cuff, tennis and golfer’s elbow, Achilles tendon, posterior tibialis tendon and then the plantar fascia, which behaves like a tendon but technically is a ligament.

Thus, these conditions are usually a disease of the middle-aged and older. What are the causative factors for what we call tendonopathy?

-acute injury to the tendon

-overuse activities

-genetics

-inflammation

-diet

-biomechanics

-weight

So, to treat tendonopathy, we have to address these factors with genetics being an exception, as this can’t be changed.

Thus. we have to modify activities, either temporarily or permanently, especially avoiding overuse situations.

We want to reduce inflammation, and this can be achieved multiple ways: medications, steroid injections, supplements and an improved diet can all play a role. Medications and steroids can be very helpful in the short term but are not always a long-term solution. Platelet-rich plasma injections can be a great option to promote long-term management of inflammation and the actual healing of a tendon.

Biomechanics are often improved through changes in movement patterns, improved flexibility and strengthening. At times, footwear changes and orthotics can play a role as well.

As we often preach, early treatment of a tendon problem usually produces better outcomes than late treatment, but either way, we’ve got you covered. Don’t be discouraged if you have one or more tendon problems, knock on our door and we’ll be more than happy to share our expertise!

F. Clarke Holmes, M.D.

Five Simple Reasons You Should Consider Platelet-Rich Plasma Injections For Your Tendon Or Joint Pain

Let’s make this one quick and easy. Some blogs, we may hit with you great details, information rich in scientific data and opinions full of medical jargon. Today, let’s share some simple information regarding why platelet-rich plasma (PRP) injections should be on your radar if you have OSTEOARTHRITIS, TENNIS OR GOLFER’S ELBOW, ACHILLES TENDONOSIS, PLANTAR FASCIITIS, LATERAL HIP, PATELLAR AND ROTATOR CUFF TENDONOSIS, just to name a few.

1) Most of the time, it works: let’s be real, nothing in medicine works all of the time. If we see a significant benefit in 75% of patients or more, then we are all pretty happy with a treatment. In our patient population, PRP meets this criteria.

2) Most medical studies suggest a clinically significant benefit: do a “pub med” search for PRP as it relates to orthopedic conditions. Although some studies always will be too small or of lower quality, once you start to pool the data, you find that PRP is not really “experimental” any more. There are now hundreds of studies looking at patients receiving PRP for arthritis and chronic tendon problems, and the majority of these studies demonstrate a clinically significant benefit with PRP.

3) It’s both natural and safe: PRP is derived from your own blood. It’s designed to concentrate your platelets that contain your growth factors. These growth factors have many positive effects, ranging from inflammation reduction to slowing down the deterioration process within a tendon or joint. Major side effects are extremely rare, and when compared to steroid injections, prescription medications and surgical intervention, PRP is a safer treatment option with fewer adverse effects.

4) It’s a relatively quick office procedure: 5 minutes to set-up and draw the blood, 5 minutes to transfer the blood to the centrifuge system, 10 minutes to spin the blood, 3 minutes to further separate the blood components and capture the PRP, 2 minutes to prep the patient, and 1 minute to give the injection. In some instances, we may first inject a numbing medication (anesthetic) and then give that 10 minutes to work. So, in total, 36 minutes for this procedure done in the office, all in one sitting.

5) Although typically not covered by insurance, it’s likely a wise investment in your health and may save you money in the long run: the days of insurance always covering the best and most innovative procedures for orthopedic conditions are over. If PRP works for you like we expect it to, then you will potentially save money on doctor’s visits, medications, physical therapy, surgical interventions and other treatments. Not to mention that if you have not yet met your deductible, you will pay out-of-pocket for all of the other treatments “covered by insurance” that may be less effective than PRP.

In an nutshell, PRP is not for everyone and every orthopedic condition. We carefully select those patients who we think can “win the battle” with their orthopedic condition with one or more PRP injections. 20+ years of experience in sports medicine and orthopedics and 10+ years utilizing PRP have given us the knowledge to determine what patients may truly benefit from PRP injections. Come see us if you are curious!

F. Clarke Holmes, M.D.

Impact Sports Medicine and Orthopedics

Five Mistakes to Avoid with Plantar Fasciitis

Plantar Fasciitis is the most common cause of heel pain, most commonly seen in middle-age individuals. There are numerous treatment options, yet with our decades of experience in treating this problem, we’ve found many pitfalls, and thus, here’s a list of what NOT TO DO!

1)      Stretching the bottom of the foot. An example is when you pull the toes back towards you. Most cases of PF involve inflammation and/or tearing of the fascia. Stretching damaged or inflamed tissue is often counterproductive

2)      Pushing through the pain with exercise. If you have PF, you have to relatively rest, which may mean temporarily discontinuing running, walking, jumping, etc. or at least, reducing your distance or frequency of these activities.

3)      Skimping on shoes and/or orthotics. The old adage, “you get what you pay for…” applies here. Think of purchasing high-quality athletic and everyday shoes as well as orthotics (inserts) as an investment in your health and quality of life. At times, the more expensive orthotics are worth the extra cost.

4)      Having multiple cortisone/steroid injections. It’s probably best to avoid steroid injections altogether for PF, yet a one-time steroid injection can occasionally be indicated for the patient that is miserable due to severe heel pain. Repetitive steroid injections often result in long-term worsening of this condition.

5)       Not being patient. PF resolves in 95% of individuals with the proper customized treatment, yet it often is a 6 to 12-month process. Don’t give up on certain treatments too soon, as most interventions work gradually over weeks to months, including footwear changes, night splints, relative rest, physical therapy, orthotics and orthobiologic/regenerative injections.

If you are struggling with plantar fasciitis, then we are here to help!

Clarke Holmes, M.D.