Tennis elbow: It’s a nagging injury that makes even the most casual play painful. It can linger so long that many sufferers resort to surgery. But there’s a new treatment for tendinitis of the elbow that’s less invasive than surgery and more long-term than the anti-inflammatory cortisone. It’s called platelet-rich plasma therapy, and, according to Dr. Allan Mishra, an assistant professor of orthopedic medicine at Stanford and one of the method’s pioneers, it’s one of the only truly biological treatments in use today. It works by enhancing the healing powers of your body, and more specifically, your blood.
That may sound like science fiction, but the process is pretty simple. It goes like this: Doctors take about 30 cubic centimeters of your blood (roughly 1/16 of what you would give when donating blood) and put it in a centrifuge to separate the red blood cells from the white blood cells and platelets. After it’s done processing, about 20 to 30 minutes later, they numb the injured area and inject the plasma containing the platelets and white blood cells into the frayed and degenerated tendon. Then your natural healers—growth factors or proteins within platelets—get to work.
And based on Mishra’s research, they really do work. In 2006, he published a study in the American Journal of Sports Medicine on PRP’s efficacy in treating tennis elbow. He took 20 patients with tendinitis so bad that they were considering surgery (“these were the worst of the worst cases,” Mishra says), and gave 15 of them PRP therapy and the other five an anesthetic. After two months, there was 60 percent improvement in the PRP group and only 16 percent in the control group. Two years later, Mishra says, after that single procedure, over 90 percent of the PRP group were better.
After his patients have the procedure, Mishra advises that they start a gentle stretching program within a few days and then gradually work back to their activities. “The significant majority of patients are going to get better when properly selected,” Mishra says. He advises that patients get checked out before getting the treatment to make sure their elbow soreness isn’t referred pain from a pinched nerve in their neck or a rotator cuff injury. In those cases, a shot of PRP to their elbow won’t solve the problem.
The therapy isn’t just for tennis elbow, though. It was created about eight years ago, and is becoming more common for use with a variety of injuries. Professional athletes have tried it, too. Pittsburgh Steelers receiver Hines Ward had the therapy on his injured knee so he could be in playing shape in time for his team to win the Super Bowl. His teammate Troy Polamalu had it, too.
But is this akin to that backroom, mad-scientist procedure known as blood doping where you give blood, store it, then inject it back in before the big match so you feel like Superman? There are similarities, but also definite differences. The World Anti-Doping Agency’s website says they classify as blood doping techniques that increase your red blood cell count, allowing your body to get more oxygen to your muscles. If anything, Mishra says, PRP decreases your red count because the red cells that are separated out in the centrifuge are discarded. A New York Times story discussing platelet-rich plasma and blood doping brought up the fact that WADA bans a certain growth factor contained in platelet-rich plasma, but the agency declined to comment on whether PRP was a violation of their code.
Mishra makes the case that PRP is a treatment for injury, not for enhancing performance. “All we’re doing is concentrating what you already have in your blood and putting it in a tendon where the blood supply is poor,” he says. “We’re not storing it and reintroducing it at a different time. And probably most importantly, I haven’t heard of anybody who is some phenomenally better person for it.”
But recreational athletes typically don’t have to worry about doping code violations. And for those who have suffered with tennis elbow and tried everything from time off to cortisone, and even considered surgery, platelet-rich plasma might be something else to consider.
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