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Blood Sport 03/11/2009 - 4:40 PM

BloodTennis 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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Posted by Blake 03/11/2009 at 09:58 PM

Wow.. very interesting article. So, with does this mean in time I could try this treatment on my dodgy right knee and hopefully see some improvement? ;)

Posted by Tom Mendenhall 03/12/2009 at 04:51 AM

I had the PRP therapy in early February 09. Dr Lazaar in Fort Laudedale. My injury was moderate tendon tear inside elbow. Prior to therapy I was unable to play. 6 weeks post I am playing without a brace and the elbow continues to improve. Not covered by insurance but cost is reasonable. Alternative was 1 inch incision to repair and 9 months physical therapy. Highly recommend!

Posted by bubba 03/12/2009 at 11:24 AM

This sounds like rip off " Prolotherapy " in many way ie. the only difference being they use your own blood as the irritant / protagonist

Posted by Dng 03/12/2009 at 01:13 PM

Tom - what was the ballpark cost for your procedure? Was it in the low hundreds or in thousands? Just curious.

Sarah - thanks for the article. Very interesting indeed. My 67-yo mom who suffers from worn out knee tendons experiences pain when she walks too much like when traveling or exercising. Will this PRP procedure help her? Or is it totally a different type of problem than tennis elbow or dodgy knee?


Posted by JimF 03/12/2009 at 02:45 PM


One data point: I understand it costs about $1,000 for an injection.

There are few practitioners, insurance does not yet cover it; and since my problem wasn't severe, merely chronic, a doctor was reluctant to give me a referral until I tried other treatment.

Posted by Ikie 03/12/2009 at 08:28 PM

Where in south africa can one get this threatment? I would really love to know as i always suffer from left knee tendanitis

Posted by Kevin 03/13/2009 at 11:59 AM

so why isn't nadal doing this?

Posted by Doug Abeles New 03/13/2009 at 11:21 PM

Interesting article. Any chance this might be an effective treatment for rotator cuff injuries?

Posted by Ryan 03/17/2009 at 12:59 PM

Blake: Yes this will work for your knee. Doug: we have been treating minor rotator cuff tears using ultrasound guidance, we have had great success. Insurance will cover partial during ultrasound usage. Using ultrasound will also provide accurate data to evaluate success. Please visit our site and fill out the info under human division for more information on PRP injections and usage for sports medicine. OroGen Bio-Sciences Inc.

Posted by Health Remedies 05/29/2009 at 11:24 PM

Take control of your health, first identify the problem with professional lab tests online, then start feeling better with high quality natural health remedies and nutritional supplements.

Posted by Lucy 06/20/2009 at 05:11 AM

It's so painful. After a skiing accident - my friends shoulder was never the same and has hurt right out to each finger. But we did finally find the exercises that helped so much after being offered surgery - but while I know that tennis elbow hurts, I can only say make sure to get the right exercises, before even considering surgery.

Posted by Blue Eyes 06/29/2009 at 01:40 AM

very nice post!!!

Posted by Be Creative 07/01/2009 at 10:33 AM

My injury was moderate tendon tear inside elbow. Prior to therapy I was unable to play. 6 weeks post I am playing without a brace and the elbow continues to improve. Not covered by insurance but cost is reasonable. Alternative was 1 inch incision to repair and 9 months physical therapy.

Posted by Pediatric Physical Therapy 09/25/2009 at 05:49 PM

Hello!! My name is Jane.
Where can I find that study?

Posted by Viagra Online 09/30/2009 at 12:09 PM

Very interesting therapy.Thanks for your information.

Posted by Generic Viagra 09/30/2009 at 12:19 PM

Interesting information very useful for me thank you

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Posted by Global Knives 10/12/2009 at 03:25 PM

Good article Sarah! I am amazed at what science can do these days!

Posted by Dental Research 10/26/2009 at 01:31 PM

Interesting therapy, thanks for sharing the process.

Posted by Senior Communities 10/30/2009 at 04:04 PM

Interesting post about healthy player because I play tennis and I have a blood test yesterday, and I really enjoyed this information.

Posted by Online Pharmacy 11/03/2009 at 12:08 PM

What is Tennis Elbow ?
Tennis elbow is an injury to the muscles and tendons on the outside (lateral aspect) of the elbow that results from overuse or repetitive stress. The narrowing of the muscle bellies of the forearm as they merge into the tendons create highly focused stress where they insert into the bone of the elbow.

Signs and Symptoms

* difficulty holding onto, pinching, or gripping objects
* pain, stiffness, or insufficient elbow and hand movement
* forearm muscle tightness
* insufficient forearm functional strength
* point tenderness at or near the insertion sites of the muscles of the lateral or medial elbow

Posted by Generic Viagra 11/03/2009 at 05:33 PM

Tennis elbow is a condition where the outer part of the elbow becomes sore and tender. It is a condition that is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody.

The condition is more formally known as lateral epicondylitis ("inflammation to the outside elbow bone"), a misnomer as histologic studies have shown no inflamatory process. More accurate diagnostic terms are lateral epicondylosis, or simply lateral elbow pain.

Runge is usually credited for the first description in 1873 of the condition which we today call lateral epicondylosis.The term tennis elbow was first used in 1883 by Major in his paper Lawn-tennis elbow

Posted by Cheap Online Pharmacy 11/04/2009 at 05:19 PM

Lately I've had several problems with my elbow, it would be nice if I could give more information on the subject

Posted by Viagra 11/10/2009 at 09:26 AM

I recently underwent surgery because I don't know that exist this method is a shame not to have known before.

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