Chiropractor Chandler AZ
Can PRP Prevent Knee Arthritis from Worsening
Arthritis is the inflammation of one or more joints of the body. Any joint of the body can be affected by arthritis, but the knee joint is the most commonly affected joint. Knee arthritis affects the daily life of the patient, making it difficult to perform normal activities like standing, walking and climbing stairs. It is the major cause of work loss and disability.
There are more than 100 different types of arthritis and the most common types are osteoarthritis and rheumatoid arthritis. According to the National Health Interview Survey, in 2012, more than 52 million people were diagnosed with arthritis. Its prevalence is more common in women than men. It is a disease of aging people and people above the age of 60 are more susceptible to it.
Anatomy of Knee Joint
The knee is one the largest and strongest joints in the human body. It is a synovial joint, made up of bones, cartilages, tendons and ligaments. Its function is to provide mobility to the lower leg.
BONES: The knee joint is made up of three bones: Femur, Tibia, and Patella
ARTICULAR CARTILAGE: The ends of the femur and Tibia and the back of Patella are covered by articular cartilage.
MENISCUS: Two wedge-shaped pieces of meniscal cartilage act as "shock absorbers" between the femur and tibia.
LIGAMENTS: There are four knee ligaments that bind the bones in the knee joint to each other. These ligaments are divided into two groups: two Collateral Ligaments and two Cruciate Ligaments.
TENDONS: Tendons connect muscle to the bone. Quadriceps tendon, also called patellar ligament, is a major support for the knee joint. The Patella bone lies within this tendon.
SYNOVIAL SHEATH: The inner surface of the joint is lined by a thin synovial membrane except where there is articulate cartilage. This produces synovial fluid which lubricates the joint cavity.
Types of Arthritis
Osteoarthritis:
Osteoarthritis is the most common type of arthritis that affects people above the age of 50. It is a degenerative disease which develops when the cartilage in the knee joint gradually wears away. Due to this, the bone ends become bare and the friction between the bones increases which causes pain and damages the bone over the long period of time. Osteoarthritis develops slowly and the pain worsens with time.
Rheumatoid arthritis:
Rheumatoid is an autoimmune disease. It affects multiple joints throughout the body and it affects both the knee joints simultaneously. In this type of arthritis, the synovial membrane of the knee joint swells and causes pain. The immune cells attack the knee joint ligaments, tendons, and bones and weaken them.
Post-Traumatic Arthritis:
Post-traumatic arthritis is a type of arthritis that is developed after an injury to the knee. A broken bone, ligament or tendon can put extra stress on the knee which can lead to the onset of arthritis later in life.
Symptoms of knee arthritis
Pain and inflammation are the main symptoms of knee arthritis. Other symptoms can be:
- Knee joint can become stiff and swollen, making it difficult to bend the knee
- Increased knee pain in the morning or after sitting for long period of time
- Increased knee pain after intense activity
- Knee lock
- Increased knee pain in rainy season
Diagnosis of knee arthritis
Physical examination:
During the physical examination, the physician will look for the joint swelling and redness, instability of the joint, knee joint tenderness, pain when weight is put on the knee and arthritis symptoms in other joints.
Imaging test:
An X-ray creates the detailed picture of the knee joint structures. An arthritic knee X-ray will show narrowing of the space between joints, changes in the bone and osteophytes formation. MRI, computed tomography or a bone scan may be needed to determine the bone condition of the knee. In the case of rheumatoid arthritis, a blood test can be helpful in diagnosis.
Treatment for Knee arthritis
There is no cure for arthritis in conventional treatment. Only the symptoms of arthritis can be treated to relieve pain and avoid disability.
Nonsurgical treatment:
The initial treatment for arthritis is nonsurgical options. The doctor can recommend the following treatment options to relieve pain and minimize the damage:
Lifestyle modification:
Basic changes such as minimizing activities that put a strain on the knee, reducing weight and switching from high impact activities to lower impact activities can be helpful in reducing the pain.
Physical therapy:
Physical therapy helps in increasing the range of motion and strengthens the muscles in the knee joint.
Other options include using assistive devices such as a cane and wearing shock absorber shoes can be helpful. Using ice, heat and pain-relieving ointments can be helpful in relieving pain in the knee.
Medication:
For arthritis, the first medicine of choice is non-narcotic pain relievers and anti-inflammatory medications. NSAIDs, such as ibuprofen and naproxen, are also prescribed for knee arthritis pain. Corticosteroids are injected into the knee joint in case of extreme pain to relieve it, but its effect is short term and it has several side effects.
Surgical treatment:
If the non-surgical treatments fail to relieve the pain and arthritis starts to cause disability, different surgical treatment options are suggested.
Cartilage grafting:
In this procedure, the healthy cartilage tissues from the other knee are used to fill the hole in the cartilage. This is suitable for only younger patients who have small areas of cartilage damage.
Synovectomy:
The damaged joint lining is removed to relieve pain in the rheumatoid arthritic knee.
Arthroplasty:
The damaged surface of cartilage or bone is removed and replaced with a metal or plastic structure to restore the normal structure of the knee.
Alternative options:
For arthritis, a treatment is needed that has the ability to repair the damaged bone, cartilage, tendon and ligament and restore the structure to relieve pain. An alternative treatment option known as Platelet-rich Plasma Prolotherapy is known to promote the self-healing properties of the body to repair the damaged part. It is a type of Prolotherapy that uses the platelet-rich plasma derived from the patient's blood to initiate and accelerate the self-healing at the site of injury.
In platelet-rich plasma (PRP) Prolotherapy, the blood is drawn from the patient under sterile conditions. The blood is then centrifuged to separate the platelet-rich plasma from rest of the components. It is then injected back at the site of injury. The major role of platelets is in blood clotting, but they contain alpha particles that are rich in growth factors, thus platelets also play an important role in tissue repair. After the PRP is injected into the body, it goes through following stages to repair the damage:
- INFLAMMATION PHASE that lasts for 2-3 days. In this phase, growth factors are released.
- PROLIFERATION PHASE that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
- REMODELLING which lasts over a year. In this phase, collagen is matured and strengthened.
Side effects associated with this method are minimal. There is no risk of blood-borne disease transfer and allergic reaction since the patient's own blood is used. The only risks involved are an infection, no relief of pain, neurovascular injury, and scar tissue formation. The loss of limb or death is rare, but possible.
PRP Prolotherapy works by repairing the damaged part, relieving the pain and restoring the normal structure of the joint. Theoretically, it is an ideal treatment option for knee arthritis as it helps in preventing the situation from getting worse by repairing the damaged parts instead of just masking the symptoms.
A study performed in 2013 showed that PRP injections might slow the progression or worsening of osteoarthritis. The average arthritic knee can lose up to 5% of cartilage per year. The same study showed that there was no further cartilage damage in knee arthritis in more than 70% of the patients after one year of PRP injections.
In another research performed on 5 patients with knee arthritis, the x-ray results showed an improvement in the knee cartilage in all 5 patients treated with PRP injection.
When the PPR was injected into the arthritic knee, the patients who were resistant to conventional treatments showed improvements in pain and stiffness, thus improving the quality of life.
PRP Prolotherapy was proved to be more effective in treating early arthritis as compared to advance arthritis in a stage III research.
Evidence showed that PRP Prolotherapy can be helpful in treating arthritis and prevent it from getting worse, but it is more effective during the early stages of arthritis. At the advanced level of arthritis, PRP Prolotherapy can offer little help when the whole knee structure is completely damaged. It is a good idea to treat the arthritic knee with PRP injection at the early stage to prevent it from getting worse.
Conservative Treatments to Combine with PRP:
While PRP and stem cell treatments are enhancing the tissue repair and regeneration, conservative treatments can enhance healing, strengthen the muscles, and stabilize joint movements to maximize your recovery.
Cold Laser Therapy Treatments:
- ACCELERATED TISSUE REPAIR AND CELL GROWTH
- FASTER WOUND HEALING
- REDUCED FIBROUS TISSUE FORMATION
- ANTI-INFLAMMATION
- PAIN RELIEF
- INCREASED BLOOD FLOW
- INCREASED REPAIR AND REGENERATION
- NERVE FUNCTION AND REPAIR
- INCREASED ENERGY PRODUCTION - ATP
Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.
Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.
Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.
Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.
Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.
Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensations. Overall, laser therapy reduces painful nerve signals and reduces your perceived pain.
Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.
Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.
Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.
ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have the ability to heal and repair.
Soft Tissue Treatments:
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.
Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries are common because of weakness and poor stabilization of the leg and hip muscles. The combination of muscle weakness, poor coordination, and altered gait mechanics produce excessive strain on the soft tissues.
The lower extremities works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.
Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments foot pain and exercises.
References
Heidari, B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med, 205–212.
Jang, S. J., Kim, J. D., & Cha, S. S. (2013). Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. European Journal of Orthopaedic Surgery & Traumatology, 573–580.
Kamat, Y. D., Patel, N. G., Galea, A., Ware, H. E., & Dowd, G. S. (2014). Platelet-rich plasma injections for knee pathologies: a review. European Orthopaedics and Traumatology, 341–347.