The use of a structured exercise program following Platelet-Rich Plasma Injection

Platelet-rich plasma (PRP) injections are used for the treatment of tendinopathy with the aim of inducing healing in areas of degeneration. ‘The intention is to augment the natural healing process at the site of pain through the action of growth factors to promote matrix synthesis and wound healing’, Kaux et al (2012).

 

Kaux et al (2014) reported that it has been demonstrated on rat tendons that a mechanical stimulation optimises the healing process of a tendon after PRP use and that eccentric training is more efficient than concentric training to improve tendon biomechanical properties. It is also stated that this mechanical stimulation should be initiated as soon as possible after PRP infiltration, in the early phases of tendon healing process.

 

The necessity of a rehabilitation program following the infiltration of platelet-rich plasma (PRP) for tendinopathy has been emphasised in a series of research, however a specific standardised rehabilitation program has not been identified.

 

Kaux et al developed a standardised rehabilitation program following the review of appropriate literature, which commenced after 5 to 7 days of relative rest post infiltration of PRP. It involved a progressive sub-maximal eccentric program supervised by a physical therapist, 3 times a week for 6 weeks, followed by independent auto re-education for 6 more weeks, followed by maintenance exercises (2 times a week) up to 1 year.

 

Assessment of outcomes was obtained using VAS (pain scale), IKDC (assessment of symptoms and function in daily living activities) and VISA-P (an index of severity of symptoms) questionnaires. The results show VAS decreased significantly with time, from before infiltration, at 6 weeks, at 3 months, and at 1 year. The IKDC and VISA-P scores also improved significantly over the same time period.

 

Several points are worth noting from the development of this protocol and looking at outcomes obtained:
• Treatment began one week after the injection to allow for local inflammatory reaction and/or increase of pain responses to infiltration prior to exercise commencing
• The protocol is progressive, allowing for graded increased resistance and repetitions over time within pain free parameters.
• Compliance to the protocol was considered good.
• This protocol shows ongoing continual improvement over the period of one year.

 

This study by Kaux et al indicates that the addition of a structured exercise program post PRP injection may provide greater benefits that PRP alone. Supplementary research at this time would be beneficial to compare PRP alone to PRP and alternate forms of exercise intervention.

 

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Ref: Kaux JF, Forthomme B, Namurois MH, Bauvir P, Defawe N, Delvaux F, Lehance C, Crielaard JM, Croisier JL. Description of a standardized rehabilitation program based on sub-maximal eccentric following a platelet-rich plasma infiltration for jumper’s knee. Muscles Ligaments Tendons J. 2014 May 8;4(1):85-9.
Kaux JF, Drion PV, Colige A, Pascon F, Libertiaux V, Hoffmann A, Janssen L, Heyers A, Nusgens BV, Le Goff C, Gothot A, Cescotto S, Defraigne JO, Rickert M, Crielaard JM. Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats. Wound Repair Regen. 2012 Sep-Oct;20(5):748-56.

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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

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