Chiropractor Chandler AZ
PLATELET-RICH PLASMA PROLOTHERAPY FOR KNEE INJURIES
The knee joint is the most complex joint in the body. It provides stability to the body while standing and bending. It is used during the most important daily activities such as walking, running, and climbing. Being the most widely used joint in the body makes it susceptible to injuries. The most common cause of a doctor's visit is a knee injury. Common knee injuries such as a fracture, dislocation, and a sprain are the reason why 10.4 million people visited a doctor in 2010. It is also the most widely injured joint due to sports injury.
The knee joint is a synovial hinge joint which is made up of bones, cartilage, ligaments, and tendons. Its function is to allow the flexion and extension of the lower leg. The range of motion of the knee is 120 degree of flexion. A special characteristic of the knee that differentiates it from other hinge joints is that it allows a small degree of medial and lateral rotation when it is moderately flexed.
BONES: The knee joint is made up of three bones: the 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. The Quadriceps tendon, also called the 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 articular cartilage. This produces synovial fluid which lubricates the joint cavity.
The knee joint is made up of many structures which can get injured. A knee fracture is the most common knee injury. Knee dislocation, sprains, and ligament tears are also common knee injuries. More than one structure can be injured within the knee at the same time. The most common symptoms of a knee injury are pain and inflammation.
FRACTURESThe knee cap is the most commonly fractured structure of the knee. The femur and tibia end that constitute the knee joint are also susceptible to fracture. The cause of a knee fracture is a direct hard blow to the knee such as during a fall or car accident.
DISLOCATIONDislocation occurs when the bones in the knee joint are either completely or partially misplaced. The main cause of dislocation is an abnormal knee structure. In people with a normal structure, knee dislocation can be caused by trauma, car accident, and sports injuries.
ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIESThese ligaments are mostly injured during sports such as soccer, football, and basketball. The ACL ligament can be damaged due to a sudden change in direction or landing incorrectly from a jump. The ACL ligament can also be damaged due to injury to other structures of the knee joint such as articular cartilage, meniscus, and other ligaments.
POSTERIOR CRUCIATE LIGAMENT INJURIESIf the knee is hit when it is bent, it can lead to a posterior cruciate ligament injury. It is most common during car accidents and sports related injuries. It is a partial tear that has the potential to heal on its own.
COLLATERAL LIGAMENT INJURIESIf the knee is pushed sideways, it can damage collateral ligaments. These injuries are less frequent as compared to other knee injuries.
Meniscal tears can be caused by sports injuries due to twisting or being tackled. It can also be caused by arthritis or aging.
TENDON TEARSQuadriceps and patellar tendons can be torn due to running or jumping, especially in elderly people. Common causes of tendon injuries are falls, a direct blows to the knee, and landing awkwardly after a jump.
DIAGNOSIS OF KNEE ARTHRITISPhysical examination During the physical examination, the doctor will look for the following signs to diagnose the knee injury:
- Knee joint swelling and redness around the knee
- Knee joint tenderness
- Pain when pressure is exerted on the knee
- Other symptoms
A detailed picture of the knee joint structure is created by using X-ray. It helps to diagnose the knee injury.
MRI, computed tomography, or a bone scan are helpful in determining the bone condition of the knee.
TREATMENT OF KNEE INJURIESTo speed up recovery from a knee injury, the RICE method is recommended: Rest, Ice, Compression, and Elevation.
If pain persists after RICE, then the doctor will recommend treatment that will depend on the severity of the injury, the age of the patient, general health of the patient, and activity level.
NONSURGICAL TREATMENTNonsurgical treatment is used to treat different knee injuries. Common nonsurgical treatments are:
- Immobilization: Immobilization of the knee is helpful in the case of bone fractures as it keeps the bone in place while it heals. Crutches are also helpful in keeping the weight off the knee.
- Physical Therapy: Specific exercises are helpful in increasing the knee muscle strength and flexibility that supports the knee.
- Non-steroidal anti-inflammatory medicines: Medicines like aspirin and ibuprofen are helpful in relieving the pain and inflammation in the knee.
Not all injuries can be treated with nonsurgical treatments. Some injuries and fractures require surgical treatment to fully repair the damage. Arthroscopy is performed in some cases like ACL tears where a small camera and instruments are inserted into the knee through a small incision. Some injuries require open surgeries in which a large incision is made to directly see the injury and correct it.
ALTERNATIVE TREATMENTPlatelet-rich plasma (PRP) Prolotherapy is an alternative treatment option to treat the different knee injuries. It can be used to stimulate and accelerate the soft tissue regeneration and repair process. PRP is effective in treating the conditions related to tendon and ligament damage.
None of the surgical/nonsurgical techniques use the body's own natural healing mechanism to initiate and accelerate the repair process. Some work is being done in this field and platelet-rich plasma prolotherapy is being used to treat such problems with the help of body's own repair machinery. PRP Prolotherapy is a part of a new branch of medicine known as Regenerative Medicine. It uses the body's healing ability to repair the damage and relieve the pain and inflammation. The platelet-rich plasma Prolotherapy works on a very simple principle: "when the platelet concentration is increased in a certain area of the body, it accelerates the healing process." Platelets contain many chemicals known as:
- Glycogen
- Lysosomes
- Alpha granules
- Beta granules
Alpha granules contain growth factors and they are the main focus of platelet-rich plasma therapy. There are three stages of healing after a platelet-rich plasma Prolotherapy injection and different types of growth factors are involved in driving different stages:
- Inflammation Phase: It lasts for 2-3 days. In this phase, growth factors are released.
- Proliferation phase: It lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
- Remodeling phase: It lasts over a year. In this phase, collagen is matured and strengthened and injury is healed.
20-30 mL of blood is used to make platelet-rich plasma. The blood is spun for 15 minutes at 3,200 rpm in a centrifuge machine. This step separates platelet-rich plasma from platelet-poor plasma. 3 mL of platelet-rich plasma is obtained from 20 mL of blood. The platelet-rich plasma is added to half mL of sodium bicarbonate to neutralizes its pH. The injection is administered with the help of a dynamic musculoskeletal ultrasound with a transducer of 6–13 Hz to maximize the location accuracy for the injection. The injection is administered directly at the site of injury.
Since the platelet-rich plasma Prolotherapy technique uses the patient's own blood, the chances of an immunogenic reaction or the transfer of blood borne diseases are completely eliminated.
The growth factors attach to the cell surface and not the nucleus of the cell, thus the chances of tumor growth are also eliminated. As the platelet-rich plasma Prolotherapy is an injection-based procedure, the risks involved in the procedure are:
- Anaesthesia allergy
- Infection
- Neural Trauma
- Organ trauma
- Needle breakage
Mode of mechanism in PRP Prolotherapy is repairing the damaged part, relieving the pain, and restoring the normal structure of the joint. Theoretically, it is an ideal treatment option for knee injuries as it not only restores the natural structure of the knee, but also relieves the pain.
A research study on rats showed an increase in the number of collagen fibers and fibroblasts in the early healing phase after tendon damage. PRP injection stimulates the synthesis of hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) production in the tendon cells which increases the proliferation and vascular regeneration. Research has reported that PRP injections alone are not sufficient to repair anterior cruciate ligament injury after 14 weeks in an animal model.
In chronic jumper's knee patients who had failed nonsurgical and surgical treatments, PRP injections showed higher scores on all the criteria, but its result showed no statistical significance when compared to the control group.
PRP Prolotherapy is a promising treatment option that needs more research to establish its effectiveness.
CONSERVATIVE TREATMENTS TO COMBINE WITH PRPWhile 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 sensation. 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.
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 exercises 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 work 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.
BIBLIOGRAPHY:
Park, Y. G., Han, S. B., Song, S. J., Kim, T. J., & Ha, C. W. (2012). Platelet-Rich Plasma Therapy for Knee Joint Problems: Review of the Literature, Current Practice and Legal Perspectives in Korea. Knee Surg Relat Res, 70–78.