prp platelet rich plasma for sports injuries

orthotics vs arch supports the controversy continues

2011-02-24T14:52:00.000-08:00

Most drivers don’t think much about spark plugs and carburetors. They just want their vehicles to run, leaving the details to their mechanics. Most homeowners trust electricians to worry about voltages and alternating currents. They just want their lights to come on. In the same way, most patients who use medical devices just want the devices to work. Knowing how they work is the domain of clinicians and researchers. Unless, that is, the medical device is a foot orthotic.

According to Benno Nigg, professor of biomechanics and codirector of the Human Performance Laboratory at the University of Calgary in Alberta, even medical experts aren’t sure exactly how orthotics relieve pain or prevent injury. “Orthotics can work and can have fantastic effects, but we don’t know how they work,” says Nigg.

The growing orthotics market could reach annual sales of US$4.7 billion by 2015, according to Global Industry Analysts, Inc. (www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2011/01/13/prweb8061575.DTL). Orthotic devices are used by the public primarily to relieve pain, and by athletes to prevent injury. It is also a diverse business, including everything from custom products made from high-tech materials to inexpensive insoles.

Though prescribed in large numbers by podiatrists and orthotists, clinicians still struggle to determine which type of orthotic will work for a particular patient. In his new book, Biomechanics of Sport Shoes, Nigg describes sending a long-distance runner to five orthotics makers to seek help correcting a problem with pronation. Each made a very different type of insert, varying in thickness, hardness and other ways.

“What this means is that specialists come to completely different conclusions on what to do,” says Nigg. “It also shows that we don’t really understand what we do.”

One hypothesis is that orthotics correct skeletal alignment problems, though Nigg says there is no evidence to support that proposition. Rather than moving bones around, it is more likely that orthotics affect muscle activity, he says. Figuring out how they affect muscle activity — and how to correct activity that is causing pain or injury — could lead to more consistent prescribing of orthotics.

“Maybe we should not think of pushing the skeleton around, but rather about finding ways to give signals to the body to do the right thing,” says Nigg.

Dr. Michael Nirenberg, a podiatrist in Crown Point, Indiana, says he is not surprised by the lack of consensus on how orthotics work. “There isn’t even a consensus on what an orthotic is,” he says, noting that the term is used to describe both pricey custom-made inserts and cheap insoles available at any drugstore.

Determining which orthotic will work best for a patient is difficult, says Nirenberg, because so many factors come into play. Even if two patients are similar in many ways — weight, gait, foot structure — they may still experience very different outcomes after using similar orthotics. “You can’t guarantee anything is going to work for everyone, because people are so variable,” he says. “Orthotics can do amazing things for many people, but not for everyone.”

The basic function of an orthotic is to put the foot into a better position, which alleviates pain, says Nirenberg. If a muscle is strained or hurting, a properly chosen orthotic will do some of the muscle’s work for it, thereby reducing its workload and bringing relief. Of course, giving muscles a permanent vacation also has a down side.

“When you brace the foot, that may alter the function of the foot for the better, but in doing so it negates the need for many of the muscles in the foot to do anything,” says Nirenberg. “Common sense tells us that if you don’t use a muscle, it’s going to weaken.”

When visited by a patient in pain, Gordon Ruder, a practising orthotist and the coordinator of the prosthetic and orthotic programs at George Brown College in Toronto, Ontario, won’t prescribe orthotics right away. First, he will recommend such things as better shoes, strength training, stress reduction or lifestyle changes that could alleviate the problem. Sometimes, however, these things aren’t enough.

“You might have chronic pain that can’t be managed by other means, and you still need to work 12-hour shifts, and you can’t change jobs to one that will stop you from spending time on your feet,” says Ruder.

In such cases, Ruder will recommend orthotics, though, like others in his field, he warns that picking the right type for a patient is not an exact science. “It’s not as simple as replacing brake pads on a car after they’ve worn out,” he says. “The human body doesn’t work like that.”

As a researcher, he would like to see more resources put into studying orthotics. Existing research has been lacklustre, mainly because it is difficult to quantify the biomechanical changes that result from wearing orthotics. There is a need for more-sensitive tools that are capable of detecting these subtle changes, says Ruder. “I very much want to see research become a bigger part of what we do.”

Bruce Werber DPM, FACFAS

10900 N. Scottsdale Rd, Suite 604

Scottsdale, AZ 85254

480-948-2111

www.inmotionfootandankle.com

arch supports, plantar fasciitis

2011-02-24T14:47:00.000-08:00

The extent to which stretching and strengthening exercises successfully address plantar fasciitis continues to be a matter of debate among practitioners. Variables known to be associated with the condition include obesity, reduced ankle dorsiflexion, and work-related weight-bearing.

A 2008 study in Skeletal Radiology, however, added atrophy of the abductor digiti minimi muscle to the list, although it remains unclear whether the atrophy was the cause of fasciitis or its result. Similarly, a 2003 study from the University of North Carolina found that subjects with fasciitis had weaker toe flexors than did controls, but the cause and effect was unclear.

An author of that study, Michael Gross, PT, PhD, a professor of physical therapy, explained the dilemma.

“If someone already has fasciitis, and they’re guarding so that they don’t push off forcefully, that could lead to weakness of the toe flexors,” he said. “On the other hand, if they have a preexisting weakness, that could contribute to the onset of fasciitis.”

And although no controlled trials demonstrate the efficacy of exercises, Gross believes a case can be made for stretching of both the plantar fascia and the Achilles tendon for some patients.

“Heel raises will strengthen the extrinsic muscles of the foot,” he said. “The intrinsic muscles may benefit from toe grasping, which you can do by putting your foot on a weighted towel, then repeatedly curling your toes to drag the weight and the towel toward you.”

Walt Reynolds, CSCS, CPT, a personal trainer in Lansing, MI, who has written on the Web about exercises for fasciitis, still uses them occasionally with patients but has moved toward a more holistic approach.

“I work with a lot of runners, and the issues they face are largely form-related,” he said. “As a result, I now approach training on the ’5S’ model—speed, strength, stamina, suppleness, and skill.”
Reynolds said athletes with fasciitis may experience pain in the affected foot, but the root of the problem often lies elsewhere.

“Stretches may deal with the fasciitis to a point, but they won’t address the problem that actually drives it,” he said.

When Reynolds does suggest stretching, he favors a rotational hamstring stretch, a tri-plane Achilles stretch, and a rotational plantar fascia stretch. (Detailed descriptions can be found at www.sportsinjurybulletin.com/archive/plantar-fasciitis-exercise.html.)

“When you add a rotational component, you get a more functional stretch,” Reynolds said. “Most people consider the ankle joint as working primarily in the sagittal plane, but all motion is ultimately in all three planes, and transverse-plane motion may be the most significant.”

Strengthening can simply be a matter of gait. Researchers from the German Sport University in Cologne reported at the 2005 International Society of Biomechanics conference that runners who warmed up for a few minutes with minimalist footwear increased the strength of their metatarsophalangeal joints and the cross-sectional area of their flexor hallucis, flexor digitorum, abductor hallucis, and quadratus plantae muscles.

“My theory is that we have conditioned our feet to be lazy by the overuse of arch supports,” said Irene Davis, PT, PhD, former director of the Running Research Laboratory at the University of Delaware and now with the department of physical medicine and rehabilitation at Harvard Medical School.

Although Davis recommends the usual exercises—toe grasping and heel raises (she finds the latter particularly effective if done on stairs, so that the subject begins with the heels lower than the forefoot)—she considers walking at least as important.

“One of the best exercises is to use your foot in a functional way,” she said. “If people place greater demands on their feet in a slow, progressive way, I think we can reduce the incidence of plantar fasciitis.”

yes stretching is extremely important, utilizing appropriate orthotics is also important, buying arch supports at the store when not fitted for your foot is a waste of money.

If arch supports/orthotics are working correctly they will help strengthen your foot, but if you buy poorly fit orthotics then you are wasting your time and hurting your fee.

Bruce Werber DPM, FACFAS

10900 N. Scottsdale Rd Suite 604

Scottsdale, AZ 85254

480-948-2111

www.inmotionfootandankle.com

diabetic ulcers

2010-11-12T08:13:00.000-08:00

According to the CDC, almost 24 million Americans have diabetes, and it is estimated that six million of those individuals are undiagnosed.¹ In 2007, financial costs attributed to diabetes totaled $174 billion.² Additionally, comorbidities linked with diabetes may lead to serious complications and create additional economic and individual burdens. The development of diabetic foot ulcers (DFUs) is one such complication.

DFU treatment utilizes a considerable portion of health-care dollars and may also lead to significant disability and a decrease in quality of life. Patients with diabetes have a 15%-25% lifetime risk for developing a foot ulcer.^3,4When ulceration occurs, the risk for infection is present and may range in severity from a superficial area to one that pervades the bone. About 25% of diabetic foot infections will extend to deeper subcutaneous tissue or bone, and up to 50% of those individuals will have a recurrent ulcer within the next few years.⁵ Infection is the leading risk factor for amputation among those with DFUs.⁶

Considering the prevalence of diabetes, it is conceivable that most primary-care providers (PCPs) will encounter patients with foot ulcers. Practitioners treating patients with diabetes must focus on prevention of ulcerations, prompt diagnosis, treatment initiation, and appropriate referrals to preserve optimal functioning. Given the number of uninsured or underinsured individuals, adhering to this seemingly straightforward strategy can prove difficult. Lack of access to primary care leads many patients to delay care, which prevents detection or delays diagnosis until the advanced stages of disease.

The following case illustrates the challenges faced by many PCPs when caring for an underinsured patient with type 2 diabetes mellitus (DM) and a DFU.

Case study

Mr. J, aged 45 years, was hospitalized for two weeks with cellulitis and a left plantar foot ulcer. Incision and drainage (I & D) revealed three purulent sinus tracts extending from the superficial to the deep space of the left foot involving the first and second metatarsal heads. An MRI established the presence of osteomyelitis, but fortunately the bone was viable, and amputation was avoided. Culture was positive for group B Streptococcus and methicillin-susceptible Staphylococcus aureus, and the patient was treated with antibiotics for six weeks. Ankle-brachial indexes (ABIs) and toe waveforms were within normal limits. On admission, Mr. J's blood sugar was 312 mg/dL and hemoglobin (Hb) A1c was 12.9%. He was diagnosed with type 2 DM and started on insulin therapy. Mr. J achieved good glycemic control, extensive diabetes education was provided, and he was discharged to follow-up in the primary-care setting.

Post-hospitalization follow-up

Over the next six months, Mr. J lost 83 lbs, his HbA1c dropped to 5.5%, and his foot ulcer healed. He kept regular appointments with a podiatrist and maintained routine foot care. A small blister was discovered near the site of the previous left plantar DFU (Figure 1). Antibiotic therapy was ordered along with an OTC antimicrobial ointment to be applied to the wound site. While the culture showed no infection and x-ray did not reveal osteomyelitis, the ulcer continued to extrude a small amount of nonodorous serosanguinous drainage. After caring for Mr. J for two months, the PCP referred him to a hospital outpatient wound-care clini

high heels are harmful?

2010-11-12T08:11:00.000-08:00

Nearly three million women suffer high-heels related injuries which need medical attention, a recent study suggests. The Sun reported that 3000 women in the age group of 18 to 65 were studied by Hot Shoes, makers of comfort footwear.

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REUTERS
A model displays a creation as part of the Prada Fall/Winter 2010/11 women's collection during Milan Fashion Week February 25, 2010.

Most women twisted an ankle or tore a tendon but there were serious cases also of smashed teeth, broken bones and nasty falls. Yet, even this is not enough to dissuade 60 per cent of those interviewed for the study who said that they will continue wearing heels.

Almost 90 per cent of participants reported discomfit and ruined nights because of high heels. And 61 per cent reported sitting the night out due to the pain.

Only two per cent of those interviewed said that they did not wear high heels. Medical reports suggest that high heels could lead to foot deformities, posture problems, neck injuries and permanent damage in some cases. A 2001 Harvard study also found that high heels can set the stage for osteoarthritis of the knees.

Another study done by the shoe firm MBT claims high heel-induced injuries like twisted ankles, bunions and ingrown toenails cost the UK £29 million a year. The MBT study that included 1,000 women found that four in 10 women suffered an injury in their heels, such as falling over or twisting their ankles from wearing glamorous footwear.

A worrying trend is that women are getting cosmetic surgeries to fit into their Manolo Blahniks and Jimmy Choos. More than half of the 175 members of the American Orthopedic Foot & Ankle Society who responded to a recent survey by the group said that they had treated patients with problems resulting from cosmetic foot surgery.

The society will soon issue a statement condemning the procedures, said Rich Cantrall, its executive director.

Celebrities routinely undergo such surgeries as they more than anyone develop foot problems and ugly bunions and toes due to constant wearing of high Heels. Victoria Beckham was recently in the news for such a surgery.

High heels have been in fashion as far back as 1000 BC. They were a social status symbol. Women in the 16th and 17^th century took it to great heights and teetered around in 5-8 inches high shoes. They had attendants to help them move and sometimes carried stylish canes to support them. It is only in the 20^th century that demand for comfortable, fashionable shoes came from liberated women. Whatever the evidence to the contrary, it is still very difficult to separate women from their high-heels as history relates.

ESWT High Energy Shockwave Therapy

2010-10-28T07:40:00.000-07:00

It is now available for low cost at InMotion foot and ankle specialists

The EPOS Extra Corporeal Shockwave device is available for those with heel pain, achilles pain, neuroma pain that has not responded to injections, cortisone, orthotics, platelet rich plasma, physical therapy, night splints and rest.

Want to wake up pain free, try this revolutionary therapy that has been shown to be highly effective in treating heel pain, and achilles tendon pain.

Call now for evaluation and treatment

InMotion Foot and Ankle Specialists
Dr. Bruce Werber DPM, FACFAS

www. inMotionFootandAnkle.com

480-948-2111

2010-10-28T07:39:00.000-07:00

Calling all Diabetics!

Even though you’re a “number” when it comes to counting those with the disease, you
are an important individual and you have to power to take steps, no matter how big or
small,

Diabetes is a disease that affects your entire body. Risk of heart disease, stroke, kidney
disease,
not
as those in a car accident) result from complications of diabetes. If you have diabetes,
you
imperative to reducing and preventing irreversible damage to your feet, as well as the
rest of your body.

In addition to seeing your doctors, you can take ownership in your health by taking
these action steps:

1.
doctors to ensure your blood glucose levels remain steady at an appropriate
level,
notice
if
diet!

2. Get active! When you see your doctors, don’t just discuss your medical conditions
and
appropriate for you, you can begin or continue to work toward achieving and
maintaining

3. Look at your feet every day! By taking the time to inspect your feet, you can catch
harmful changes early, making treatment easier and often more successful. If
you can’t see the bottom of your feet, ask someone you know or use a mirror to
see
any of these, make sure to see a podiatrist about them.

4. Wash your feet every day! Simply standing in the shower while you wash your
hair
soap to wash your feet. Then it is important to dry your feet completely. If you
wish,
can help prevent blisters.

5. Protect your feet! Instead of going barefoot, wear socks and shoes to avoid
injuries.
nerve

6.
toenails
ingrown

7. Wear properly fitting shoes! Many people (especially women) wear shoes that are
too
fitted
we age.

8.
over 7 years of training to become skilled in the diagnosis and treatment of
all
aspects
can
diabetes.

Bruce Werber DPM, FACFAS
InMotion Foot and Ankle Specialists
www.inmotionfootandankle.com

480-948-2111

stem cell therapy for PAD

2010-10-22T11:25:00.000-07:00

Ronald Davis can move again after seven long years. Plaque clogged the artery carrying blood to his leg, which cut off oxygen flow. It's called Peripheral Artery Disease. Left alone, it can cause ulcers, gangrene and even lead to amputation.

Ronald began a last-ditch stem cell therapy at Duke University. His leg was marked for 30 injections, totaling millions of stem cells. For him, there was no other choice.

Cells are taken from the placentas of Israeli women who've given birth. Once injected, they secrete proteins, which boost additional cell growth. Then, it's believed those cells may contribute to the growth of additional vessels around the plaque, circumventing the blockage.

Three days after injections, Ronald was walking, and doctors say the oxygen level in his leg tissue jumped from 43 percent to 67 percent. This specific type of stem-cell therapy is currently involved in a phase-one clinical trial. P-A-D affects up to 20-percent of people over the age of 65.

BACKGROUND: Peripheral artery disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. When a person develops PAD, his extremities -- usually the legs -- don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking.

SYMPTOMS: According to the Mayo Foundation for Medical Education and Research, the following symptoms are signs of PAD:
1) Painful cramping in the hip, thigh or calf muscles after activity such as walking or climbing stairs (intermittent claudication).
2) Leg numbness or weakness.
3) Coldness in the lower leg or foot, especially when compared to the other leg.
4) Sores on the toes, feet or legs that won't heal.
5) A change in the color of legs.
6) Hair loss or slower hair growth on the feet and legs.
7) Slower growth of toenails.
8) Shiny skin on the legs.
9) No pulse or a weak pulse in the legs or feet.
10) Erectile dysfunction in men.

STEM CELLS: According to the article, The Potential of Stem Cells: An Inventory, stem cells are found in all multicellular organisms. They are characterized by the ability to renew themselves through mitotic cell division and differentiate into a diverse range of specialized cell types.

BREAKTHROUGH: A recent research study determined the safety and possible effectiveness of various doses of stem cells. Investigators tested to see if the injection of stem cells would help in creating new collaterals and provide the vital conduit for blood flow to the parts of the leg below the block in patients with PAD. The cells, which were taken from pregnant women's placentas, were delivered with a needle into regions of the leg with claudication. The study, known as Autologous CD34+ Stem Cell Injection for Severe Intermittent Claudication, showed 39 out of 44 patients (approximately 89 percent) with severe PAD who were treated with stem cells had their legs saved from amputation.

inMotion foot and ankle Specialists

10900 N. Scottsdale Rd

Suite 604

Scottsdale, AZ 85254

480-948-2111

www.inmotionfootandankle.com

Dr. Bruce Werber

wound healing,

2009-04-12T16:22:00.001-07:00

Platelet rich plasma for treatment of heel pain, tendon injuries:

Tendon and ligament injuries are common in the lower extremity due to the forces exerted on the lower extremity during walking, jogging, running or performing daily activities. The foot and ankle are no exception. Ligaments and tendons are poorly vascularized and therefore once injured are difficult to heal. This, coupled with the difficulty of resting the foot and ankle in an active person when an injury occurs, makes treating tendon injuries quite difficult.

Surgical intervention has long been the method of treatment for moderate to severe tendon injuries. However, this treatment option is invasive and requires a lengthy post-operative recovery period. A recent non-surgical alternative treatment for tendon and fascial injuries has emerged which involves injecting the patient’s own plasma into the injured area.

Platelet rich plasma (PRP) is simple to obtain and is created by obtaining a small amount of the patient’s blood and spinning the sample at high speed (centrifuging). This separates the red blood cells from the plasma which contains many platelets. This portion of the sample is collected and prepared for injection.

Platelets produce and supply platelet-derived growth factor which is essential in the repair of connective tissue and stimulates the formation of new blood vessels (angiogenesis), providing increased vascularity to these otherwise poorly vascularized areas. In conjunction, PRP has been shown to speed healing time and possibly eliminate the need for surgery.

Bruce Werber, DPM, FACFAS
www.arizonafeet.com

Platelet Rich Plasma, treating heel pain, tendon injuries

2009-02-16T20:12:00.000-08:00

Athletes’ Own Blood Could Nurse Them to Health

Dr. Werber has been a leader in the field of platelet rich plasma, initialing utilizing this technology 7 years ago for diabetic wounds / ulcers and over the last few years utilizing it for the treatment of heel pain, and tendon injuries.

As published in Podiatry Today (November 2008) recently, I discussed that most fascial and tendon injuries are rarely inflammatory and that they are a result of incomplete and poor healing of the tissue and we need to use methods to reinitiate the inflammatory process and angiogensis ( revasculaize) the injured tissue to get it to heal correctly.

Platelet rich plasma is one method, another method is ExtraCorporeal Shockwave therapy and the last is Radio Frequency coblation.

Visit my website www.inmotionfootandankle.com
or email inmotionfootandankle@gmail.com
Dr. Bruce Werber

The article in the New York Times by Alan Schwartz tells the story below :
"By ALAN SCHWARZ"

Pittsburgh Steelers’ biggest stars, Hines Ward and Troy Polamalu, used their own blood in an innovative injury treatment before winning the Super Bowl. At least one major league pitcher, about 20 professional soccer players and perhaps hundreds of recreational athletes have also undergone the procedure, commonly called platelet-rich plasma therapy.

Doping Implications of Platelet-Rich Plasma Therapy Remain Unclear (February 17, 2009)

Experts in sports medicine say that if the technique’s early promise is fulfilled, it could eventually improve the treatment of stubborn injuries like tennis elbow and knee tendinitis for athletes of all types.

The method, which is strikingly straightforward and easy to perform, centers on injecting portions of a patient’s blood directly into the injured area, which catalyzes the body’s instincts to repair muscle, bone and other tissue. Most enticing, many doctors said, is that the technique appears to help regenerate ligament and tendon fibers, which could shorten rehabilitation time and possibly obviate surgery.

Research into the effects of platelet-rich plasma therapy has accelerated in recent months, with most doctors cautioning that more rigorous studies are necessary before the therapy can emerge as scientifically proven. But many researchers suspect that the procedure could become an increasingly attractive course of treatment for reasons medical and financial.

“It’s a better option for problems that don’t have a great solution — it’s nonsurgical and uses the body’s own cells to help it heal,” said Dr. Allan Mishra, an assistant professor of orthopedics at Stanford University Medical Center and one of the primary researchers in the field. “I think it’s fair to say that platelet-rich plasma has the potential to revolutionize not just sports medicine but all of orthopedics. It needs a lot more study, but we are obligated to pursue this.”

Dr. Neal ElAttrache, the Los Angeles Dodgers’ team physician, used platelet-rich plasma therapy in July on a partially torn ulnar collateral ligament in the throwing elbow of pitcher Takashi Saito. Surgery would have ended Mr. Saito’s season and shelved him for about 10 to 14 months; he instead returned to pitch in the September pennant race without pain.

Dr. ElAttrache said he could not be certain that the procedure caused the pitcher’s recovery — about 25 percent of such cases heal on their own, he said — but it was another encouraging sign for the nascent technique, which doctors in the field said could help not just injuries to professional athletes but the tendinitis and similar ailments found in the general population.

“For the last several decades, we’ve been working on the mechanical effects of healing — the strongest suture constructs, can we put strong anchors in?” Dr. ElAttrache said. “But we’ve never been able to modulate the biology of healing. This is addressing that issue. It deserves a lot more study before we can say that it works with proper definitiveness. The word I would use is promising.”

Platelet-rich plasma is derived by placing a small amount of the patient’s blood in a filtration system or centrifuge that rotates at high speed, separating red blood cells from the platelets that release proteins and other particles involved in the body’s self-healing process, doctors said. A teaspoon or two of the remaining substance is then injected into the damaged area. The high concentration of platelets — from 3 to 10 times that of normal blood — often catalyzes the growth of new soft-tissue or bone cells. Because the substance is injected where blood would rarely go otherwise, it can deliver the healing instincts of platelets without triggering the clotting response for which platelets are typically known.

“This could be a method to stimulate wound healing in areas that are not well-vascularized, like ligaments and tendons,” said Dr. Gerjo van Osch, a researcher in the department of orthopedics at Erasmus University Medical Center in the Netherlands. “I call it a growth-factor cocktail — that’s how I explain it.”

Dr. van Osch and several other experts said they had used the procedure as a first option before surgery for reasons beyond its early results. There is little chance for rejection or allergic reaction because the substance is autologous, meaning it comes from the patient’s own body; the injection carries far less chance for infection than an incision and leaves no scar, and it takes only about 20 minutes, with a considerably shorter recovery time than after surgery.

Because of those apparent benefits, the consensus among doctors is that the procedure is worth pursuing. However, several doctors emphasized that platelet-rich plasma therapy as it stands now appeared ineffective in about 20 to 40 percent of cases, depending on the injury. But they added that because the procedure costs about $2,000 — compared with $10,000 to $15,000 for surgery — they expected that with more refinement, insurance companies would eventually not only authorize the use of PRP therapy but even require it as a first course of treatment.

Dr. Mishra said that he was particularly encouraged by PRP therapy’s effectiveness on chronic elbow tendinitis, or tennis elbow. For a 2006 study published by The American Journal of Sports Medicine, he used the treatment on 15 of 20 patients who were considering surgery; the five others received only anesthetic. Two months later, the patients receiving PRP therapy noted a 60 percent improvement in pain measurements, compared with 16 percent for the control group.

Skip to next paragraph

Doping Implications of Platelet-Rich Plasma Therapy Remain Unclear (February 17, 2009)

Dr. van Osch is performing a double-blind, randomized study on 54 patients with Achilles’ tendon injuries, while doctors in the United States, India, Sweden and elsewhere are performing formal trials on PRP therapy’s performance with rotator-cuff shoulder strains, partial knee-ligament tears and bone fractures. Studies also are examining PRP therapy’s possible use in conjunction with surgery, which a group in Spain used on Achilles’ tendon ruptures and found recovery time reduced.

“The guy who plays softball on weekends, the woman who runs a 5k race every now and then, they suffer very common injuries,” said Samir Mehta, the chief of the orthopaedic trauma service at the Hospital of the University of Pennsylvania who has performed PRP therapy on nine patients. “It’s for those people that we hope that this therapy’s uses can be more apparent.”

The possibilities of platelet-rich plasma are certainly apparent to the Steelers. Mr. Polamalu, an All-Pro safety, had the procedure for a strained calf after a playoff game and, although the injury was not considered particularly serious, he returned healthy enough the next Sunday against the Baltimore Ravens to return an interception 40 yards for a touchdown.

The technique played its most glaring role with Mr. Ward, a receiver who left that Baltimore game in the first quarter with a sprain of the medial collateral ligament in his right knee. The next day, he was injected with a form of PRP therapy called autologous conditioned plasma, which features different proportions of platelets and other cells. Along with strenuous rehabilitation and hyperbaric oxygen therapy, Ward recovered enough to make two catches in the Super Bowl, in which the Steelers beat the Arizona Cardinals.

“I was next in line, the next guinea pig,” Mr. Ward said, referring to Mr. Polamalu’s experience with platelet-rich plasma. “I think it really helped me. The injury that I had was a severe injury, maybe a four- or six-week injury. In order for me to go out there and play in two weeks, I don’t think anyone with a grade-2 M.C.L. sprain gets back that fast.”

Professional sports teams have great financial incentive to pursue decreasing athletes’ rehabilitation even one week. Last year, Major League Baseball’s 30 teams had 519 players spend 28,602 days on the disabled list — representing $455 million in total salary sitting idle — according to data compiled by Baseball Prospectus.

“Let’s say a soccer player is out six weeks — if you can cut a week or two off, that equates to two, three, four games,” said Dr. Michael Gerhardt, the team physician for Major League Soccer’s Chivas USA and Los Angeles Galaxy clubs. He said that he had administered PRP therapy to about 20 players with medial collateral ligament injuries and had found an average decrease in recovery time of 25-30 percent.

But most doctors said that if platelet-rich plasma was scientifically proven to be safe and effective, its largest effects would be on the amateur, weekend-warrior athletes for whom sports was recreation and healthy lifestyle. Stanford’s Dr. Mishra said: “It’s not just the professional athlete who needs to get back to their game. Everyone wants to get back to what they do for play or for work.”

prp platelet rich plasma for sports injuries

orthotics vs arch supports the controversy continues

arch supports, plantar fasciitis

diabetic ulcers

Case study

Post-hospitalization follow-up

high heels are harmful?

ESWT High Energy Shockwave Therapy

stem cell therapy for PAD

wound healing,

Platelet Rich Plasma, treating heel pain, tendon injuries

Athletes’ Own Blood Could Nurse Them to Health

Doping Implications of Platelet-Rich Plasma Therapy Remain Unclear (February 17, 2009)

Related

Doping Implications of Platelet-Rich Plasma Therapy Remain Unclear (February 17, 2009)