Platelet Rich Plasma Injections for Chronic Musculoskeletal Conditions

Plantar FasciitisPlatelet rich plasma injections are becoming a more common and popular treatment for chronic musculoskeletal conditions. Chronic foot and ankle conditions, such as plantar fasciosis and Achilles tendinosis typically begin with the classic inflammatory process. Initially, the area becomes red, inflamed and swollen. Patients will describe a sharp, stabbing pain with weight bearing and tenderness to palpation. After a repetitive stress injury, it’s normal for the body to increase blood flow to the injured area and send cells to clean up damaged tissues and initiate the healing process. But, it’s been shown that in chronic plantar fasciosis and tendinosis, there is a suppressed inflammatory response and the normal repair process is not functioning properly. The goal of platelet rich plasma injections is to stimulate the body’s natural healing response. Platelets are most commonly known for their clotting ability, but they also contain growth factors and both the clotting and growth factors will stimulate the inflammatory cascade and jump-start the healing process.

A walking boot and heel lift are sometimes used after the injection and stretching exercises are generally resumed soon after. It’s important to note that if the underlying cause of the condition (abnormal mechanics of the foot, poor quality shoes, tight calf muscles) is not addressed, the outcome will not be as good.

There have not been many controlled clinical trials of platelet rich plasma injections in chronic injuries, but the research to date has been encouraging. A laboratory study found that platelet rich plasma stimulates cell growth and collagen production in tendon cells (Am J Sports Med June 2008 36:1171-1178). In a study of 140 patients with chronic elbow tendonitis who were considering surgery, the patients with platelet-rich plasma injections had a 60% improvement at 8 weeks and an 81% improvement at 6 months (Am J Sports Med November 2006 34:1774-1778). In a small study of 26 patients with elbow tendonitis, 79% had complete relief of symptoms after autologous blood injections. The average follow-up was 9.5 months (J Hand Surg Am. 2003 Mar;28(2):272-8).

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