PRP Injection

Month 4

2012-09-11T13:34:00.002-07:00

The healing seems to have plateaued. There are definitely more good days than bad, and the pain seems to shift from one knee to the other. Still not at a level of running of where I want to be, but I seem to be making progress. According to studies the platelets are still active in both tendons, so there should still be some degree of healing still taking place, even 4 months after the initial PRP Injection.

I have continued taking the following supplements daily:

MSM (I feel this is helping the most)
Fish Liver Oil (good at keeping the inflammation down)
Chondroitin
Glucosamine
Knee supplement that has all of the above including:

Flax seed oil
Boron
Manganese
Collagen Type II (2)
Mangosteen Extract
Vit C
Vit E
Vit B1
Vit B2
Vit B6
Vit B12
Pantothenic Acid
Zinc
Selenium
Silicon

Multi-vitamin

I have been doing foam rolling on my quads, calves, glutes and ITB for 10 mins every night before bed as well as stretching.

I have also been stretching these areas of my body.

Progress is slow. Whenever the knees feel good I attempt a run and seem to take a step backwards. I believe the key is patience and consistency

How have you found your PRP Injection experience? Has it helped you? What rehab protocol are you following? What has and hasn't worked for you? Do you think I should go for another shot? I am get lots of support and positive feedback and I would love to hear from you and hear about your experiences...

Month 3

2012-09-06T12:56:00.000-07:00

This was the month where I slowly experienced a noticeable difference. The bad days became fewer and good days became more regualr. One thing that I felt that had been different from the past 2 years of patella tendonosis, was when I sat, straightened my leg and flexed my quad muscle as hard as possible I would always get a sharp pain in the tendon, however this slowly went away and I no longer exprience this at all.

Pain going up stairs lessened each week, and I currently have no pain when going up stairs. There is however some discomfort when going down stairs. Before the PRP Injection, I could not sit at my desk with my knees bent for longer than 15 without my knee starting to burn. This uncomfortable burning sensation diminished greatly by month 3.

My knees were still not 100%, but had come quite a way in 3 months. I did, however, not go for another shot. I decided to wait and see if they would contiune to make positive progress in time with the stretches, strenghtening and eccentric dips, until I spent more money.

By this stage I started my usual exercise routine of lifting upper body weights 3 times a week, and cycling quite rigorously (mountain biking) 2 - 3 times a week 10 - 20km. During the first few kms my knees would feel a bit niggly, but after a while they would warm up and feel fine, and then if I pushed too hard they woud start hurting again.

All about finding the balance between rest and recovery, and strenghtening!

Month 2

2012-09-03T13:10:00.000-07:00

After 2 months my left tendon felt very similar to how it felt prior to the PRP Injection. It was still quite painful and niggly. That inital tightness and feeling of being pain free when jumping or running on th spot, had gone. It appeared as if the tendon had returned to its normal state, without being full of fluid. This was quite strange, as from what I had I read of past patients experiences, their tendon was more pianful after the first few weeks but there was a noticeable improvement after 2 months. Surely I would be able to notice some benefit by this stage?

I had a had shot to my right knee a month earlier, based on the initial success of the PRP Injection in my left tendon. However, my right knee seemed to be in the same boat as the left knee- not much better, but not worse.

I continued to take it easy. I wore a patella tendon strap (cho-pat strap), to support the knees while doing light exercise or walking up and down stairs. I continued with my rehab program of strenghtenin my glutes, hamstrings, calves (I will do another post on this at a lter stage, of my exact rehab protocol- primarily based on Mike Robertson's Bulletproof Knees), I also continued doing light eccentric dips, this was deterined on how my knees were feeling. If they were feeling tender or painful I would rest them and skip the eccentric dips, if they were feeling good I would do sets of 15 until they started hurting.

It was around this two week mark that I started to notice a slight change. I had periods of approx. 3 days were my knee would feel really good, and then a period where it felt really bad (worse than before). Prior to this- the injection- my knee had experience a consistent type of pain. Now this pain started fluctuating between very sore to minimallt marginal.

Week 4

2012-06-21T11:13:00.001-07:00

This has been an interesting week. I've had some good days and some bad. At the moment my left knee feels a bit stiff and tender in comparison to the right. It's got a kind of constant ache, perhaps this is due to the inflammation and the biological changes taking place within the tendon?

I attempted an easy 1km run today, the left tendon flared up a bit after a few 100 metres. However, the left tendon is not sore in comparison to the right when going up or down stairs and no longer seems to have the 'sharp' pain that has bothered me for the past 1.5 years.

The tendon as at it's most painful first thing in the morning and then once it warms up a bit it feels better than the right knee. I've had periods when there is absolutely no pain in the left knee and periods where it's noticeably more painful than the right knee. This could be the 'roller-coaster' effect I mentioned in Week 3.

I have continued with the Eccentric protocol on my right knee- 3 x 15 sets of one-legged squats on slant board at night. I have now reached 3kgs in the backpack. I have been doing about 10 dips on the left leg every second night, without any weights. My reasoning was that this would help direct the alignment of the collagen fibres in the tendon as it repairs.

I bought a foam roller yesterday, I have done a bit of this, but I'm now going to try and do 3 mins of rolling on each leg every second night.

I have currently been taking:

MSM
Glucosamine
Chondroitin
Fish Liver Oil
Vitamin C
Gellatine

In Week 2 I discussed the testimonial about the patient who was dissappointed and complained to his Doc that the PRP Injection did nothing after one month, and by 2 months he was completely healed and his knee felt 100%. So I'm going to give it more time and try take it easy. The Platelets are active for 6 weeks and the healing benefits of PRP continue for up to 6 - 9 months.

I'm PRP shot to my right knee on Monday.

Week 3

2012-06-13T13:03:00.002-07:00

My tendon has continued its positive healing progress, and I've only had one bad day this week. Currently my knee feels better than it did before the PRP injection and there hasn't been any regression in pain. Its basically gone from the 70% it was at previously to 80%. When I straighten my leg and flex my quad muscle there is minimal pain, whereas before this would have caused a sharp pain sensation in my left tendon. The tendon itself still feels quite hard and doesn't seem to have as many bumps (I think this is the scar tissue and misaligned collagen).

I have done a few light sets of eccentric single-legged squats on a slant board and these are still quite uncomfortable on my knee. I also went for a fairly strenuous 8km mountain bike on Monday and my knee didn't feel too bad, not completely healed, but not painful.

When I tried a light 300m jog today my left knee felt alright while my right knee had the familiar sharp pain sensation that I had before on the left knee whenever I pushed off from the ground or landed. One thing that I have noted is that my left knee feels a lot tighter and stiffer in comparison to the right, perhaps it's due to a bit of inflammation or the healing process happening in the tendon? However the chronic sharp pain I used to experience running or going upstairs seems to have subsided in the left knee.

The progress is slow and gradual as I expected, but if it continues I will be happy. I am going to go for a PRP shot in the right knee in 2 weeks. And then a follow up the PRP injection in my left knee in a month's time.

I hope that if you are considering a PRP Injection for a tendonopathy or are currently recovering from one, that you are finding this blog useful. If you have any questions, queries or comments feel free to post them below or email.

(Rafa Nadal just won Roland Garos after pulling out of the Miami Open in April due to knee pain, for which he had a PRP Injection. It seemed to sort him out again!)

Week 2

2012-06-04T11:56:00.000-07:00

Two whole weeks have passed since my own blood was sucked out, spun around and then injected back into my left tendon. The first week my tendon felt a bit swollen, but strangely not too painful. The injection is supposed to take from 2 - 6 weeks to work, and at 2 weeks post-PRP injection my tendon feels kind of where it was before the injection. I have had some good days and some bad days, I have read that this 'roller'coaster' effect is to be expected and slowly there are gradually more 'good' days. My left tendon definitely feels alot harder and firmer than it did before and in comparison to the right tendon. This leads me to believe that some structural change is happening, that the tendon is strengthening and that the collagen is reorganizing correctly. However, after the initial pain relief and the regression back to my previous level of pain I feel slightly disappointed. Although I know I need to give it time and can't make a call on it's success just yet.

I just stumbled on this testimonial on the net, which has given me some hope and encouragement to be patient...

I saw the doctor 4 weeks post procedure and I told him I was very disappointed. I told him that I did not feel any improvement and my patella tendon still felt weak. At the 8 week appointment I told him it might be better but I wasn’t sure. He told me that sometimes it could take up to 6-9 months. He was exactly right. My knee is now 100% better than it was. About 6 months post the injection is when I really noticed the improvement in my knee. I no longer had pain upon jumping or running. I went from not being able to run without pain or discomfort to now I try to run twice a week 3-6 miles and play basketball once a week. It has been a truly amazing turnaround for me that I never thought would happen. For 2 years I dealt with this chronic injury and I never thought I would feel better. I had seen many doctors and lost hope until I found Dr. Michael Shepard.
[source: http://prptreatments.org/category/patient-experiences/]

I have been trying my best not to exercise too heavily, just some swimming and light upper body weights, along with some gentle leg rehab. I will go for a relaxed cycle tomorrow afternoon and see how it feels.

Testimonial

2012-05-31T13:38:00.000-07:00

Week 1

2012-05-28T13:18:00.000-07:00

This time last week I had my first PRP injection. The swelling and tightness has gone quite significantly over the past few days. There is minimal pain, except when I attempt to squat or jump. However, the pre-injection pain has changed and is not as intense. I used to experience a sharp pain in my left tendon when I straightened my leg and flexed my quad muscle, this pain is almost non-existent. There is supposed to be noticeable pain relief between 2 - 4 weeks post PRP injection, which is supposed to continue for up to 6 - 9 months. I already have a reduction in symptoms and at one week I am happy with the results and hope that they will continue to progress.

I have patella tendonosis in both knees, but had the PRP shot in the left knee in order to use the right knee as a control for the purpose of this blog (and science!). I decided on the left knee as the tendinitis was worse in this knee. After the PRP injection the left knee currently feels better than the right knee. The great thing about this is that any pain relief is a direct result of tissue healing and not some other substance (Cortisone, ibuprofen, etc.) simply masking the pain.

My plan is to give it a month and monitor the left knee's tendon's improvement and then have the right knee injected. I will then follow these up with another injection if needed. The challenge for me now will be taking it easy and not pushing it too hard- something I really struggle with, but I have layed off the exercise for the entire week. I will doing some physio rehab and swimming tomorrow. And I have continued to do eccentric dips with the right leg.

Day 3

2012-05-23T13:40:00.001-07:00

There is a bit of swelling around the front of the knee. Feels like a bit of fluid surrounding the tendon. The knee isn't too painful, its more of a tender stiffness. And there is no discoloration. I'm not going to upload a pic as the knee looks pretty much the same as it did in Day 1.

I haven't attempted any form of exercise as the tendon stills feels quite weak. I'm going to give it a full week before I try some swimming.

I also went for a B12 shot yesterday as this is said to help in tendon healing and the formation of new collagen. I had one couple of a few weeks in order to build up my immune system for winter and I noticed that my tendonosis felt a bit better a few days after the shot.

I am currently taking MSM, Glucosamine, Chondroitin, Fish Liver Oil and Vitamin C supplements. My thinking is to give my body all the building blocks it needs to effectively heal the tendon.

If it worked for Rafa, it should work for me.

Day 1

2012-05-21T12:46:00.001-07:00

This morning I went in for my first PRP injection to my left tendon. The whole procedure took around 40 mins. The doctors used ultrasound to determine how much scar tissue had built up around my knee and whether the PRP Injection would be effective in treating my patella tendonosis. They then drew 4 little units of my blood- pretty painless. My blood samples were then sent off to the lab to be spun around in a centrifuge in order to separate the Platelet Rich Plasma. The docs then injected my tendon under the guidance of ultrasound. This is supposedly the most effective way of administering the injection.

After all the testimonials I'd read I was expecting the pain to rival child birth, however even without local anesthetic the shot wasn't too bad. Painful and uncomfortable, but the Cortisone shot I had to my tendon was actually worse. I was able to walk to my car and drive to work without much of a problem. As the day has progressed my knee has been feeling increasingly painful. However, at 9pm the pain seems to have leveled out and is very manageable. I definitely don't need any painkillers. Which is just as well as it's recommended that you avoid all anti-inflammatories after the PRP Injection for at least a week.

My Knee - Day 1

I'm really surprised at how little swelling and bruising there is. Let's hope this works, fingers crossed.

What is a PRP Injection?

2012-05-20T12:40:00.001-07:00

According to Wikipedia:

Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair. The platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induces the release of these factors from alpha granules. The growth factors and other cytokines present in PRP include:

[Source: http://en.wikipedia.org/wiki/Platelet-rich_plasma]

According to Ortho Healing Centre:

RP therapy offers a promising solution to accelerate healing of tendon injuries and osteoarthritis naturally without subjecting the patient to significant risk. PRP is an emerging treatment in a new health sector known as ”Orthobiologics.” The philosophy is to merge cutting edge technology with the body’s natural ability to heal itself. Blood is made of RBC (Red Blood Cells), WBC (White Blood Cells), Plasma, and Platelets. When in their resting state, platelets look like sea sponges and when activated form branches. Platelets were initially known to be responsible for blood clotting. In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors. There are many growth factors with varying responsibilities, however cumulatively they accelerate tissue and wound healing. Therefore after increasing the baseline concentration of these platelets, we are able to deliver a powerful cocktail of growth factors that can dramatically enhance tissue recovery.

PRP is virtually a cocktail of many proteins that collectively stimulate repair and regeneration. However there are some proteins included in PRP that we can now selectively isolate to promote anti-inflammatory effects and pain reduction. Scientists have now developed natural/homeopathic based tools to selectively isolate the cells/growth factors within PRP that meet our needs of customizing the treatment by reducing inflammation and simultaneously stimulating repair.

As recognized international experts following 5 years of performing thousands of PRP injections and publishing numerous articles; we have learned that many factors can limit or assist healing. Because PRP utilizes your own blood to heal, we have learned that each patient is unique and a “one size fits all” approach is not ideal. At the Orthohealing Center we integrate the latest innovations like photomodulation, cytokine therapy, and specific supplements for tendon and cartilage to compliment PRP therapy. With the incorporation of these adjuncts and our skilled technique utilizing ultrasound guidance we are seeing improved results with much less post injection pain. We have trained physicians from all over the world utilizing our advanced techniques.
Orthohealing’s published comprehensive review of published literature
Conditions Treated
Frequent Q + A
PRP Live Demonstrations
PRP Publications
Case Studies + Testimonials
PRP Spine
Photomodulation

[Source: http://www.orthohealing.com/plateletrichplasmatherapy-prp/]

And according to the Mayo Clinic:

Platelet-rich plasma (PRP) is injected directly into the ailing tendon. Plasma is the liquid portion of the blood that transports red and white blood cells and platelets through the blood vessels. It's derived from the patient's own blood, a process that involves spinning a blood sample at high speeds. One byproduct is plasma, which contains a high concentration of platelets — thus the name platelet-rich plasma.

Doctors have found that about 70 percent of those receiving PRP therapy showed improvement. Early research suggests that PRP injections:
Attract healing cells to tendon tissues that have deteriorated
Stimulate new growth of tendon cells
Stimulate production of tendon collagen — the building blocks that give tendons their strength
[Source: http://www.mayoclinic.org/news2010-mchi/5702.html]

Intro

2012-05-15T13:04:00.002-07:00

Around August 2010 I started feeling a slight twinge in both my knees about 10 minutes into my runs. As I hadn’t run much in the past 6 months and with the typical ‘runners mentality’ I decided to run through the pain. Big mistake. A month later I had full blown Patella Tendonitis. This stubborn flare up refused to heal, and after not resting my knees sufficiently the tendonitis became patella tendonosis. Any way you look at it, or whatever you want to call it, I had severe tendonopathies of both of my knees. A sport injury which is notoriously tricky to kick.

Fast forward to May 2012. Its been over a year and a half (21 months to be precise) and my knees are around 90% better but I’m still nowhere near to the level I was running before my tenonopathy. I have tried practically every available treatment- from eccentric strengthening exercises, to massage, to orthotics, to patella straps, to low level laser light therapy to MSM, fish oil, glucosamine and chondroitin supplements until I eventually went for surgery on both knees in August 2012- Patella tendon debridement/shaving.

Each of these treatments I feel have somehow improved my knees incrementally. Although I do feel the surgery could have been avoided and I would have made the same progress (it has a 50% success rate, not great, but I decided to take the gamble and I don’t regret my decision as my knees are now, after 9 months, better off than they were before).

In order to finally push my knees to that 100% mark and get down to some real running I have decided to try a PRP (Platelet Rich Plasma) Injection(s) into my left tendon. The treatment is widely publicized and highly talked about yet there is limited concrete medical evidence of its effectiveness- some patients claim it’s cured them while others claim no benefit. So as means to help out anyone in a similar to position to myself, I have decided to document my experience with PRP Injections for Patella tendonopathy here.

I will also document the other treatments I have and currently make use of- and give you some idea of their effectiveness. This blog is purely here to help anyone in the same situation as myself- those who love running or being active but have had their sporting performance significantly impacted by this misunderstood, complicated and debilitating injury. I hope this blog helps you in some way. Feel free to leave comments and I will try my best to reply to you.

I go for my first PRP Injection Monday 21 May 2012.