Can PRP Injection (Platelet-Rich Plasma) Effectively Treat Chronic Running Injuries?

In the past decade, several emerging treatments for chronic overuse injuries have been getting a lot of attention in the running community.  Chief among these is platelet-rich plasma injections or PRP, a procedure that attempts to use cells from your own blood to restart the healing process.

Platelet-rich plasma injections promise a new avenue of treatment for runners with longstanding recalcitrant injuries, which have failed standard treatment protocols like long periods of rest, custom orthotics, or rehab exercises prescribed by a physical therapist.  Although PRP is very new and is still considered an experimental treatment by most doctors, it is nevertheless being touted by less-cautious providers and has gained something of a following in the running community.

To get a better understanding of what PRP can and cannot do, we’ll turn to the scientific literature for some answers.

Platelet-rich plasma as healing aid

Platelet-rich plasma has been studied as a healing aid in several fields of medicine; its initial uses were in orthopedic surgery, where doctors found it boosted healing and decreased blood loss after invasive surgeries like total knee replacements.

By “spinning” samples of a patient’s own blood in a centrifuge, doctors could separate the red blood cells from the platelets, small cells which boost healing and help form clots. A second centrifuging concentrates the separated platelets and plasma, creating the platelet-rich plasma solution.

This liquid contains growth factors and proteins that are thought to jump-start the healing process in injured or degenerated tissue, and given the success of PRP in orthopedic surgery, it was investigated as a treatment for chronic overuse injuries in athletes.

As PRP is a fairly new treatment, there are only a handful of studies on using it to treat specific injuries.  Additionally, only a few of them have any of the features of a strong clinical trial: control groups, reasonably large sample sizes, and good experimental design.  As an example, we’ll look at a study carried out by Joost Peerbooms and colleagues at HAGA Hospital in the Netherlands.

PRP injection for running injuries

Though Peerbooms et al. looked at using PRP to treat lateral epicondylitis (tennis elbow) in this study, similar papers have examined using PRP to treat Achilles tendonitis, plantar fasciitis, and patellar tendonitis, all injuries of interest to runners.  Peerbooms et al. split a group of 100 patients with chronic tendon pain at their elbow into an experimental group and a control group.

The experimental group received a PRP injection into the painful tendon, while the control group received a similar injection of a corticosteroid anti-inflammatory drug.  After the injection, the patients received four weeks of physical therapy before being allowed to return to sport.

When the researchers checked in with the patients one year after the treatment, they found that 49% of the control group had made a successful recovery, compared to 73% of the group which received the PRP injection.

While similar studies—albeit mostly smaller and sometimes without a control group—have found PRP useful in the treatment of chronic Achilles tendonitis, patellar tendonitis, and plantar fasciitis as well, not all studies have had success.  One well-designed study by Robert de Vos and others at Erasmus University in the Netherlands assessed a group of 54 patients with Achilles tendonitis; half were treated with a PRP injection, while the other half got a placebo injection of saline solution.

While both groups had significant improvements in their Achilles tendon over the course of the 24-week study, there was no significant difference between the groups.

Administration and side effects

In the coming years, it is likely that we’ll see more large studies on PRP.  The amount of them which will show a benefit is unclear, but given the research done to date, it’s likely that platelet- rich plasma therapy will gain a place as a treatment protocol with at least some chance of success at rehabilitating chronic overuse injuries.

The biggest questions about PRP surround the specifics of how and when to administer the treatment, as well as how much it can be expected to help.  As discussed in a review article by Timothy Foster and other doctors at a range of hospitals across the United States, platelet-rich plasma injections show much promise as a future treatment for a range of injuries, but a lot more research is needed.

Foster et al. criticize a “rampant lack of standardization” of treatment protocols, meaning that different providers often won’t employ the same methods and dosages when injecting platelet-rich plasma!

They also caution that a PRP injection causes fairly dramatic inflammation at the site of the injection, and often causes the patient “discomfort”—though to what extent, they do not say.  The authors encourage liberal icing after a PRP injection, and note that most studies recommend a 6-8 week rehabilitation period before returning to sport.

PRP treatment’s reliability

To be clear, platelet-rich plasma injections are a promising but very much still experimental treatment. 

  • To date, the only running injuries that have shown some response to PRP treatment are Achilles tendonitis, patellar tendonitis, and plantar fasciitis.
  • Though PRP is generally regarded as a safe treatment (as it involves injecting an extract of your own blood), it can still cause significant pain and enough trauma to warrant a 6-8 week recovery period, and there are no studies possible long-term effects.

Because of this, and because of the limited number of high-quality studies demonstrating successful treatment of overuse injuries with PRP, it should be thought of as an intermediate step between conservative treatments like extended periods of rest, orthotics, and rehabilitation with stretching and strengthening exercises and more invasive treatments like surgery.

It’s highly unlikely that insurance will cover a PRP injection, and unfortunately the treatment protocol has not yet been standardized: there’s no guarantee that a local PRP injection provider that you find will employ the same method of treatment that is used in the most advanced scientific studies.

Runners with longstanding, recalcitrant overuse injuries in their plantar fascia, Achilles tendon, or patellar tendon which have not responded to eccentric exercise, rest, and other conservative treatments might consider getting a PRP injection, but you should be aware that even the most promising studies indicate that some patients do not respond to platelet-rich plasma injections.

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References

1. de Mos, M.; van der Windt, A. E.; Jahr, H.; van Schie, H. T. M.; Weinans, H.; Verhaar, J. A. N.; van Osch, G. J. V. M., Can Platelet-Rich Plasma Enhance Tendon Repair?: A Cell Culture Study. The American Journal of Sports Medicine 2008, 36 (6), 1171-1178.
2. Peerbooms, J. C.; Sluimer, J.; Bruijn, D. J.; Gosens, T., Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial: Platelet-Rich Plasma Versus Corticosteroid Injection With a 1-Year Follow-up. The American Journal of Sports Medicine 2010, 38 (2), 255-262.
3. Mishra, A.; Woodall, J.; Vieira, A., Treatment of Tendon and Muscle Using Platelet-Rich Plasma. Clinics in Sports Medicine 2009, 28 (1), 113-125.
4. Kon, E.; Filardo, G.; Delcogliano, M.; Presti, M. L.; Russo, A.; Bondi, A.; Di Martino, A.; Cenacchi, A.; Fornasari, P. M.; Marcacci, M., Platelet-rich plasma: New clinical application. Injury 2009, 40 (6), 598-603.
5. Barrett, S. L.; Erredge, S. E., Growth Factors for Chronic Plantar Fasciitis? Podiatry Today 2004, 17 (11), 36-42.
6. de Vos, R. J.; Weir, A.; van Schie, H. T. M.; Vierma-Zeinstra, S. M. A.; Verhaar, J. A. N.; Weinans, H.; Tol, J. L., Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy A Randomized Controlled Trial. Journal of the American Medical Association 2010, 303 (2), 144-149.
7. Foster, T. E.; Puskas, B. L.; Mandelbaum, B. R.; Gerhard, M. B.; Rodeo, S. A., Platelet-rich plasma From basic science to clinical applications. American Journal of Sports Medicine 2009, 37 (11), 2259-2272.

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17 Responses

    1. Hi Lou Ann Bakolia,

      I’ve been struggling with high hamstring tendonopathy for about 8 months now. I did 20 weeks of physical therapy and had two cortisone shots which worked for about 6 weeks each and then wore off. I decided to get my first shot of PRP one week ago from today and while I realize it is still very early, have not noticed any difference in pain. Would you mind telling me how long it took for you to feel pain relief and start running again? Also, how did you decide when to get the subsequent PRP injections?

      Thank you very much!

  1. The truth is the best data to date shows PRP no more effective then a sham. There is no data on PRP and running.

  2. Had PRP shots in both knees for patellar tendonitis. It took about 6 six weeks but I have almost fully recovered. It’s been 5 months now and it still seems to be improving on a daily basis. It may just be that confidence in my knees have returned but nonetheless, I’d do it again in a heartbeat.

  3. There are also studies on PRP being effective for high hamstring tendinpathies, not only achilles, patella and PF. I am 34 and had chronic high hamstring issues and also a tear and the PRP worked for me. I tried absolutely everything else beforehand to no avail.

      1. After several years of treatment for hamstring tear (noted in the referenced article) I had one treatment of PRP in both hamstring attachment sites May 2014. While there was some immediate pain post-injection and two weeks of very minimal activity level, I seemed to gain some relief from the chronicity of the hamstring injury. I was not able to have a second PRP injection, as recommended, due to family issues. My one-person perspective is that PRP has some beneficial impact, but the overall treatment plan (core strengthening exercises, slow and methodical return to running, continued deep massage therapy and lots of patience) is required for overall improvement in injury.

        1. Hi Patricia, thanks for sharing your experience. You are definitely right that the PRP injection may initially help, but there are some fundamental issues that need to be addressed to make sure it does not happen again, along with patience, like you mentioned. Thank you for your thoughts, i hope you enjoyed the post.

    1. Hi David,

      I have the same issue and just had my first PRP injection one week ago from today. I know it is very early but could you tell me how soon you started to feel an improvement in pain reduction and when you could start running pain free again?

      Thank you very much!

  4. As a runner, I have been dealing with chronic plantar fasciitis for over six months now. I have been stretching, icing, and intervals of rest 2-3 weeks at a time. It always becomes painful after I start running again. Spinning/cycling hurts as well. My doctor suggested PRP but I don’t know how long I should actively use conservative therapy (NO ACTIVITY) before looking at this alternative. How long should I totally rest my foot to allow natural healing before considering PRP? My goal is to get back to running without this injury returning again. Thank you!

    1. Hi Janie, it is almost impossible for us to give you a specific number as everyone is different and we cannot know about your case without actually seeing you. You would be best to listen to your doctor, telling him/her that you would like to try resting before you try a PRP. If your goal is running pain free, then take as long as it takes to heal off, and then make sure you build up slowly. It may be frustrating, but it is likely you will know in your heart if you are ready, and if a PRP is going to be worth a shot. Hope that helped!

  5. PRP injections are becoming more and more recommended as a form of treatment and therapy for injuries. I like how you made it clear that basically what works for some doesn’t for others. While going through this recovery you should avoid activity on the targeted area. I have also been told that cold compression should be avoided past the initial inflammation stage from the injection, as it will restrict the good blood flow to the area to help heal. Blood flow stimulation wraps can also help move this recovery along. It promotes the blood flow without causing additional strain on the area. These wraps have been used and recommended by some when going through PRP therapy. PRP is attempting to accelerate tissue regeneration which takes more oxygen and nutrients from optimal blood flow to do so.
    http://www.kingbrand.com/BFST-Home.php?REF=34PV16.291

  6. Thanks for the information. I am scheduled for my first PRP injection to both my high hamstrings. I have had two rounds of physical therapy, of which I have gained a lot of knowledge at strength activities, orthotics, time off running, massage, ART, all of which helps for a bit, but as soon as I start running again–tightness, pinching, pulling on my back, and lack of flexibility. I finally got refered for the PRP. I’m still a bit apprehensive, being that I am nervous if it makes me worse or they hit something causing damage? Any advice or more articles you can send my way prior to Nov 5 when I go for it, would be great!

    1. Hi Melissa! Can you tell how you made out with prp injections? I suffer from hamstring tendinopathy at the attachment. I’ve suffered with it for the past 17 years on and off! I originally hurt my hamstring in 2001 while waterskiing in which I had a partial tear at the attachment. PT works pretty well for me, especially eccentric strengthening! Rolfing, ART, acupuncture and massage therapy did not work so much. Have an appointment with orthopedic doc to discuss if i’m A candidate for PRP! But have same concerns about it that you had as far as making it worse! Let me know how you made out! Thanks!!!

  7. Have been struggling with Achilles tendinitis (with some retrocalcaneal bursitis) for a year and a half now. I have been participating in physical therapy for about a year and have most recently stopped running altogether for last 3-4 months, which has been tough. I have had a few procedures to fenestrare (poke) the tendon to try to promote healing. I’ve been doing eccentrics all along to no avail with some active isolated stretching. Thinking about doing another procedure with PRP since I seem to fall into the “longstanding, recalcitrant overuse injury” category. I know I can’t expect it to be a silver bullet solution, but at this point I’m hoping for something that might be able to jumpstart healing. It will certainly continue to be a kind of “hurt to heal” process, but will certainly update here if I try PRP and have any success. Thanks so much for the article and your responses to comments here.

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