145. Understanding Platelet Rich Plasma (PRP) in Physical Therapy

In this episode of PT Snacks Podcast, we discuss the essentials of Platelet Rich Plasma (PRP) for physical therapists and students. Learn about the creation and types of PRP, its intended effects, and practical applications in treating various conditions such as osteoarthritis, ligament injuries, and tendinopathies. We also dive into the evidence supporting PRP's effectiveness and provides insights on how to communicate this information to patients. 

00:00 Introduction to PT Snacks Podcast
00:45 Today's Topic: Platelet Rich Plasma (PRP)
01:39 Understanding PRP: What It Is and How It's Made
02:50 Types of PRP: Leukocyte Rich vs. Leukocyte Poor
03:31 Mechanisms of PRP: How It Works
05:37 Effectiveness of PRP: When Does It Work?
07:25 Further Learning and Resources
08:35 Conclusion and Contact Information

1. Middleton K et al. (2012). The Iowa Orthopaedic Journal – PRP in soft tissue injuries.
2. Zhang N et al. (2013). The Scientific World Journal – Bone healing mechanisms.
3. Park HB et al. (2011). Korean Journal of Hematology – Cytokine profiles and MMPs.
4. Woodall JW et al. (2008). Biomedical Sciences Instrumentation – Inflammatory modulation.
5. Zhou Y et al. (2017). Journal of Tissue Engineering – Tendon-bone interface and PRP.
6. Chalidis B et al. (2023). Int. J. Mol. Sci. – PRP in tendon/ligament regeneration.
7. Kobayashi Y et al. (2020). Journal of Experimental Orthopaedics – Angiogenesis and collagen in tendon healing.
8. Hada S et al. (2024). Cureus – PRP in ACL injuries.
9. Kalbkhani M et al. (2014). Applied Soft Computing – PRP in experimental OA.
10. Gobbi A et al. (2014). PRP in Early OA of the Knee.

Transcript

0:32

Hey everybody. Welcome to PT Snacks podcast. This is Kasey, your host, and if you're tuning in for the very first time, what you need to know is that this podcast is meant for physical therapists and physical therapist students who are looking to grow your fundamentals in by sci segments of time. Now today what we're gonna talk about is platelet rich plasma or PRP, but before we do, if you've listened to at least three episodes and you found the show to be really helpful for you, it would mean the world to me if you stopped and wrote a review really quick wherever you're listening to the podcast, because this really makes a big difference in helping the show grow. And if you've already done so, thank you so much. I really appreciate you. But now into today's topic. So obviously I'm a physical therapist or maybe that's not obvious, but I am a practicing physical therapist. I'm not someone who's administering PRP injections but this is something that a lot of our patients will get. So it's helpful to understand just what the theory is behind it, what it's supposed to do, and so far what our research says about what it accomplishes or not. We're gonna talk about how PRP is made different types of PRP, what it's supposed to actually do. And when does it actually start to work? So again, this is a bite-size episode. If you are working with someone who specialize in this, I think this could be a great discussion launching point as well as a launch point for you to continue to conduct your own research. So with that being said, we'll dive in PRP. What is it? So it's basically a biological treatment made from a patient's own blood and in specifically in orthopedics. It's used for a wide range of conditions. For osteoarthritis, ligament injuries, meniscal injuries, muscle strains, tendinopathies, and even spine issues in research now. PRP is made essentially by drawing a sample of the patient's blood, and a lot of times it's done in office and then it is processed using centrifugation. So this separates out and concentrates the platelets with this process, it allows there to be a ton of growth factors in cytokines that are important for tissue repair. So depending on the technique, you can get platelet concentrations ranging anywhere from 1.5 to eight times the normal level in blood. Now there is variability in how it's prepared. So things like the presence of white blood cells or how many spins are used can impact the final product. So just know that there's some variability and if you're reading your own research, Check the methods section to see how exactly they did it so that you can make sure you're comparing apples to apples. Now there are two main categories of PRP. There's leukocyte rich, PRP, and leukocyte poor PRP. So Leukocyte rich PRP, or L-R-P-R-P includes more white blood cells and tends to have a lot more of a pro-inflammatory effect. So it's quoted as seen more beneficial for tendinopathy, whereas leukocyte poor PRP or LP PRP has fewer white blood cells and may be more appropriate for osteoarthritis. Now, why would someone actually get PRP, who, who's getting this, what is it actually supposed to accomplish? And this is something that our patients are often asking us too, should I get this or not? Now with PRP, there are several mechanisms that it is supposed to accomplish. So number one is growth factor release and cellular proliferation. So PRP is rich in growth factors such as P-D-G-F-T-G-F, beta, VEGF, eeg, F, IGF one, and FGF. These stimulate cells such as fibroblasts stem cells and endothelial cells, which are all really crucial for tissue regeneration. It also PRP also helps with angiogenesis, so it delivers VEGF and PDGF, which help promote the formation of new blood vessels and improving blood flow to the injured area. And if you think back to PT school or college, or wherever you learned about the healing process, having formation of new blood vessels is very important for being able to generate good quality tissue repair. Number three. So we had growth factor release and cellular proliferation as number one. Two is angiogenesis, three, collagen synthesis and matrix remodeling. So PRP helps to upregulate collagen production and it also stimulates fibroblasts to organize new tissue structure. Also, it also regulates MMPs, which are enzymes that are involved in the extracellular matrix turnover. And number four. Last one that I have is inflammation modulation. So PRP is supposed to be able to suppress excessive inflammation early on, and then later support a more controlled inflammatory phase. I'm gonna have to say this slowly'cause I've been struggling saying this. PRP may also have an anti apoptotic and antimicrobial effect, though the evidence here is moderate, the best evidence is really towards like the growth factor release and proliferation on it actually doing that. Let's talk about when is PRP supposed to actually work?'cause again, a lot of our patients, maybe they've already had their PRP and they're like, I don't know if they worked or not. This depends on the type of tissue and injury, but this is what the research suggests. So for things like an injection for osteoarthritis in the knee. Improvement is expected around two to four weeks with a peak benefit around three to 12 months, so definitely a delayed effect for tendon and ligament injuries. Onset of improvement around one to two months, and then peak at three to six months. For cartilage regeneration, it starts to improve around one to three months and peak effect at six to nine months. And then more specifically in research around return topo post ACL injury typically around four months. So BRP is definitely not a quick fix and it may help accelerate and enhance healing, especially in tissues that are notorious, slow to recover. But I also think it's important to. Consider with a lot of these populations, it's really hard to isolate that and research on all these conditions. A lot of times these patients are also doing other things like physical therapy, exercise other concurrent treatments. So keep in mind, research, it's really hard to do a really good quality research study. But. This is something I think we're gonna just continue to see more and more research centered around. So if you are seeing patients with PRP, hopefully today's episode, you've got either some talking points that you can consider on how that applies in your own practice and with your patients, or even just some launch points on which you can conduct Your own further research if you wanna take a deeper dive. There is a course on Med Bridge called Orthobiologics and Regenerative Medic Medicine Rehabilitation Implications, and it's a one hour CE course that's taught by Dr. John o' Hallin. So this course more specifically dives into the application of PRP alongside stem cells and visco supplementation in non-operative treatments for osteoarthritis, including rehab implications for clinicians. There are specific chapters around PRP that you can check out if you wanna deeper dive. And speaking of which, med Bridge is actually offering listeners over a hundred dollars off of their year subscription to Mid Bridge. And if you're not familiar with that, med Bridge has thousands of courses webinars, even specialty exam prep, and depending on what level of subscription that you want. They also have a HEP builder, so home exercise program builder where you can put together videos for your patients and that patient can watch videos on how to do them. So super nice. But if you're interested, might as well take the promo code down below for a discount and if you're a student, there's an even better one for you also in the show notes. But that is it for today, guys. If you have any questions, feel free to reach out at PTs Snacks podcast@gmail.com. Otherwise, I hope you guys have a great rest of your day.