Inconsistency in PRP Doesn’t Indicate Quackery

Platelet-rich plasma injection of the knee

The Internet’s explosive growth has given us access to tons of information never before available in the public arena. That’s good on the one hand, but bad on the other. Take the question of platelet-rich plasma (PRP) therapy. You can search the topic broadly and find literally millions of results rife with inconsistency. Yet inconsistency does not indicate quackery. It simply indicates a lot of conflicting information.

You can run a search on the phrase ‘PRP for hamstring injuries’ and get back tens of thousands of pages to choose from. Some of the articles are decidedly in favor of PRP therapy; an equal number are solidly against it. There are stories of great successes, stories of abject failures, and still other stories written by authors that cannot seem to decide one way or the other.

So why is there so much conflicting information? The New York Daily News’ Dr. Lewis Maharam, also known as the Running Doc, says there are four things in play:

1. Different PRP Kits

Doctors who utilize PRP therapy purchase equipment and kits from companies like Utah-based Apex Biologix. Not all these kits are identical. The kits Dr. Maharam uses combines the platelet-rich plasma with lymphocytes to produce a more effective outcome. Maharam explains that different kits produce different results.

2. Incorrect Injection Procedures

PRP therapy needs to be performed correctly to get the best results. It is no different than any other medical procedure. At Apex Biologix, doctors are trained by an expert medical staff consisting of doctors that have already used the therapies successfully in their own practices.

Maharam says that ineffective results are linked to improper injections. Therefore, it is imperative that doctors receive expert training before offering PRP therapy.

3. Treatment Regimens Are Different

Just like each patient undergoing cortisone shots for knee pain reacts differently to those shots, PRP patients react differently to their injections. To assume every patient will achieve the best possible outcome using the same number of treatments is to defy everything we know about medicine. As Maharam explains, soft tissue injuries can usually be addressed in one treatment while severe injuries and chronic conditions like osteoarthritis require multiple treatments.

4. Improper Post-Injection Protocols

Lastly, improper post-injection protocols can completely mitigate any benefits that otherwise would be realized from PRP injections. Maharam cites one particular example of a study published by the British Journalist of Sports Medicine in which researchers did a double-blind study that included physical therapy (PT) within 24 hours of the injections. The researchers declared that PRP therapy was unsuccessful.

Maharam explains that introducing PT so soon was a mistake. Researchers should have given more time – up to five days – to allow the platelets to do what they do before beginning PT. Additionally, Maharam says that post-injection protocols are not static. Protocols have to be determined by the individual patient, the purpose behind the injections, and how that patient reacts to the injections.

In Summary

The long and short of Dr. Maharam’s explanation boils down to the simple understanding that PRP therapy and other regenerative medicine procedures are still relatively new as compared to something like cortisone shots. There is plenty of inconsistency in how the therapies are delivered at the current time. Those inconsistencies lead to mixed results. However, inconsistency does not indicate quackery.

PRP therapy is showing very good promise for orthopedic injuries and chronic problems like osteoarthritis. As we develop more consistency and standardization, we should also see a more unified position that promotes PRP therapy as an effective and alternative treatment for some patients.