PRP in the Treatment of Injury
Platelet Rich Plasma PRP therapy West Palm Beach by Dr Jenn
When we get injured, our bodies know best of how to fix itself. That being said, injuries sometimes need a small nudge in the right direction to heal appropriately. There are many different injuries from a torn rotator cuff, exercise induced injuries to paresthesia and spasticity from a stroke. While the cause of the injury can differ dramatically from person to person, the bodies reaction remains constant. Any penetrating injury or hypoxic insult causes damage to the underlying tissue which causes the release of cytokines into the blood and surrounding tissues. These cytokines cause a reaction to occur that starts with white blood cells and platelets. The platelets have receptors on them call integrins that detects an injury and causes the platelets to hon into the area of damage. White blood cells and platelets come to the area as well to prevent any foreign material or bacteria from entering the bloodstream, and clot any active bleeding along with secreting Interleukin (IL-1, IL-6, IL-8) and Insulin Growth Factor (IGF–1). The effects of these cytokines are recruitment of satellite and progenitor cells which start the rebuilding process.
Once the stromal component are damaged, the cells go to work to rebuild and regenerate the area. With injury, transforming growth factor (TGF)-B1 stimulates myogenic cells and muscle-derived stem cells to differentiate into myofibroblast which synthesize a type of collagen that leads to fibrosis. While fibrosis helps to strengthen the integrity of the tissue injured, it can also cause limitations such as contractions or spasticity not to mention the skin puckering visual effect of a scar.
In some cases during tissue injury, our body does not mount the required response to adequately address all the components and we are left with chronic pain or paresthesia. Most of us throughout our lives will have some kind of chronic pain. Whether it is tennis elbow, lifting joint injuries, muscle tear, stroke or something more insidious such as certain daily repetitive movements, the best way to correct the problem without having a “band aid” that will have to be repeated often is through our stem cells which ultimately are responsible for correcting the damage innately.
One of the way stem cells know where to go and what to do is through cytokines and growth factors. These are chemicals and proteins that get released either from direct damage to a cell causing the cells contents to leak into the surrounding tissue or through a certain stimulation of a cell causing it’s granules holding the cytokines to release their package. Platelets role in wound healing now becomes very important due to the amount, and types of growth factors in their cytoplasmic granules.
Platelets Rich Plasma role in Therapy
Platelets role in healing has been emerging out of medicine slowly as we gain better understanding of the properties their chemicals and proteins possess. Platelet Derived Growth Factor (PDGF) is the evolutionary Sentinel growth factor that is involved in nearly all aspects of wound healing. There are three different forms of the growth factor (PDGFaa, PDGFbb, and PDGFab). Although we know there are three forms, we are still unclear on each one’s different capabilities. Once these growth factors are released and active, they bind to it’s target stem cells’ membrane and cause an intracellular reaction which ultimately goes to the nucleus causing a certain gene expression. This new gene expression on stem cells that are capable of healing stimulates mitogenesis (cell replication). It also stimulates partial differentiated progenitor cells (osteoprogenitor cells) which is a part of connective tissue-bone healing.
The other important activity that PDGF does, is causes endothelial cells to be replicated leading to angiogenesis (formation of new capillaries) which supplies the area with the nutrients, and oxygen it needs to survive.
Within platelets, another growth factor is called Transforming Growth Factor-Beta1 (TGF-B1) and Transforming Growth Factor-Beta2 (TGF-B2). These growth factors signal the target cells much like PDGF. After the target cell expresses the expected gene; it creates another cascade effect leading to wound healing. This growth factor targets many different progenitor cells that are responsible for matrix formation within tissues. The cells include fibroblasts, endothelial cells, osteoprogenitor cells, chondroprogenitor cells and mesenchymal stem cells. When fibroblasts are stimulated they produce collagen which is the natural filler under our skin and creates a matrix of sorts. Osteoprogenitor and chondroprogenitor cells stimulate bone and cartilage formation respectively. The mesenchymal stem cells provide a large group of cells responsible for wound healing.
Another growth factor that platelets are responsible for is Vascular Endothelial Growth Factor (VEGF). This is a potent angiogenic factor that has the ability to summon vascular endothelial cells, which creates new vasculature in the respective area. If there is increased vascularity, the injured tissue has the ability to gain strength through the delivery of nutrients and oxygen.
Platelet Rich Plasma Therapy – West Palm Beach FL – Dr. Jenn
In West Palm Beach, we offer Platelet Rich Plasma (PRP) therapy to treat a variety of different issues. On initial consultation, we determine if pain or injury in question is a candidate for PRP therapy. Then we do a thorough examination to find the root cause of the pain. There are many different cofactors to consider when assessing a patient with chronic pain. One of the most important aspects to the exam is determining where the pain is stemming from. Although many times the pain is exactly where the injury is (ie joints and muscle tears), many time the injury is more centrally located causing a radiating pain in a different area (ie herniated disc and pinched nerve). Once this determination is made and the likelihood of a positive result is discussed, we continue onto the PRP treatment.
This process starts with a simple blood draw from the arm. The blood is then spun in a centrifuge so we can separate out the red blood cells and discard them. Once this is done we are left with the serum of the blood. Red blood cells have great function in delivering oxygen to the body’s cells, but in the case of PRP therapy it is of no use. Then the serum is spun again by a centrifuge in order to obtain the highest concentration of platelets possible. All of our laboratory work is done by hand to ensure that the concentration of platelets are as high as possible in order to elicit the wanted effect.
During the processing of the blood, the area or areas to be injected are numbed with a topical anesthetic and cleaned to aseptic standards. Sometimes there may be the need for trigger point injections. “Trigger point injection” is a technique of injecting lidocaine or saline into a spastic muscle or a continuously contracted muscle (knotted muscle) to allow that area to relax. The purpose of these injections is to relax the area enough so blood can flow freely into the area which allows a greater chance of the platelets to elicit the needed response.
Platelet Rich Plasma Procedure
Once the target area for the PRP is identified, and the blood has been processed, the injections begin. There are many different variables with injuries and how to administer PRP. A few considerations to keep in mind are the number of injections that need to be done, the severity of the injury and the tolerance of the patient. This therapy is not unbearable, but can be uncomfortable. One of the biggest talking points with patients is the timeline involved. Today most things are instant gratification, but this procedure is not. Even though this treatment is aiming at fixing the injury or curing the pain, it takes time for your body to go through the steps of regenerating new tissue, and degrading old tissue.
By using platelets to stimulate satellite and resident stem cells in the area, the same effect as infusing stem cells is achieved, without the exorbitant cost. PRP therapy has been used successfully in hips, shoulders, knees, elbows, nearly every skeletal muscle, sexual health, aesthetic medicine and stroke rehabilitation to name a few. At MedClub by Dr. Jenn we aim to create the highest level of client satisfaction in the business, by helping our clients reach an otherwise unattainable goal of pain free living. We hope you have found this article to be informative and helpful, our goal is to inform patients so they may make the best decision possible concerning their overall health. We believe everyone is entitled to the absolute best medical care they can afford. We are always open to answer questions and comments on our blog, YouTube channel, Twitter, and Facebook pages.
If you would like to schedule a concierge physician house call with Dr. Jenn in West Palm Beach please visit our website at DrJennPB.com or email us @ jennguthriemd @ medclubpb.com.
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