Chiropractor Chandler AZ
PLATELET RICH PLASMA PROLOTHERAPY FOR KNEE PAIN
Platelet-rich plasma therapy is an alternative treatment method in which the patient's own blood is used to repair the injury by activating the body's own healing mechanism. In this method, blood composition is reversed and the healing property of platelets is manipulated. It is used to heal ligaments, tendons, muscle and bone injuries. To prepare PRP injections, the patient's own blood is drawn and centrifuged to separate the different blood components. The layer containing platelet-rich plasma is separated and the rest of the material is discarded. When this PRP is injected at the site of injury, these platelets get activated and release alpha granules which activate the patient's own growth factors which then trigger epithelial growth factors (EGF). EGF induces the cell migration and replication at the site of damage, stimulating damaged tissue to heal through following stages:
- 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. The only risks involved are an infection, no relief of pain, neurovascular injury, and scar tissue formation. The loss of a limb or death is rare, but possible.
PLATELET RICH PLASMA PROLOTHERAPY FOR KNEE PAINThe knee is the largest joint in the human body and it is the most complicated one too. The knee provides stability to the body while standing and it allows the legs to bend and straighten. The knee also helps in walking, running and jumping. Any injury to the knee can make it difficult to perform basic functions such as moving, standing and running. As the knee is used so extensively throughout the day, the chances of knee injuries are greater than any other part of the human body. A study from Sheffield showed that the knee joint is the most commonly injured joint of the body due to sports related injuries. Knee injuries not only require immediate surgery but also months of rehabilitations after the surgery which causes permanent incapability to work. A large study from Scandinavia found that that the most common cause of permanent disability following a sports injury was an injury to the knee. In 2010, 10.4 million people had common knee injuries such as a fracture, dislocation, sprains and ligament damage.
ANATOMY OF THE KNEE JOINTThe 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 bone: 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.
CAUSES OF KNEE PAINKnee pain affects men, women, and children equally. It occurs in people from all ethnic and age groups. The causes of knee pain can vary, but the following are common causes of knee pain:
ARTHRITIS: Arthritis is the inflammation of the knee joint. Osteoarthritis is the most common type of arthritis in the knee. It affects people aged 50 and above. In osteoarthritis, the cartilage in the knee joint gradually degrades. The primary symptoms are swelling, pain, and stiffness. It develops slowly and the pain worsens with time. The pain may increase during the rainy season. Diagnosis includes physical examination, history of the patient, X-ray, MRI and CAT scans, and blood tests. There is no treatment for arthritis, only the symptoms of arthritis can be treated. Treatment options are painkillers such as aspirin and acetaminophen, anti-inflammatory drugs such as ibuprofen and non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and knee replacement surgery.
CHONDROMALACIA PATELLAE: Also called as Runner's knee, it is caused by a softening of the kneecap cartilage. It is caused by overuse, trauma, and muscle injury. It is common in athletes and people who have flat feet. Symptoms include pain, cracking sensation, swelling, and redness in the knee. Diagnosis is done by physical examination by a physician, X-ray, MRI, and arthroscopic exam. Treatments include rest, icing, anti-inflammatory drugs, physical therapy, and Arthroscopic surgery.
MENISCUS TEARS: The meniscus is a C-shaped cartilage that acts as a cushion between the femur and tibia. Injuries to meniscus are common in athletes and older people. It is easily injured if the knee is twisted while holding weight. A meniscus tear can be treated by physical therapy, rest, activity modification, and, in severe cases, surgery is required.
KNEE SPRAIN: An injury to an anterior cruciate ligament or posterior cruciate ligament is called a knee sprain. Anterior cruciate ligament is damaged by a sudden twisting movement. A posterior cruciate ligament sprain is caused by an automobile accident or sports injury. A knee sprain is treated by ice, exercises, brace, and surgery.
OSGOOD-SCHLATTER DISEASE: It is a common cause of knee pain in younger people. It is inflammation of the area below the knee. Symptoms include knee pain, swelling, and muscle tightness. Diagnosis is done by physical examination and X-ray. This condition is treated by stretching exercises and non-steroidal anti-inflammatory drugs. As this condition occurs mostly in girls around age 14 and boys age 16, surgery is only recommended in extreme cases.
OSTEOCHONDRITIS DISSECANS: This condition occurs when the blood supply is insufficient to a part of the bone under the joint. This causes the bones and cartilage in the knee joint to loosen and cause pain. The exact cause is not known. Pain, swelling, and joint lock are the symptoms of osteochondritis dissecans. Diagnosis is done by physical examination, X-ray, MRI, or ultrasound. It heals with proper rest and, in some cases, the doctor can recommend splints and surgery.
PLICA SYNDROME: Plica is an extension of the synovial membrane which is found in about 50% of the population. It is thought to be the remnants of embryonic connective tissues that failed to fully absorb during fetal development. Mostly it is asymptomatic, but sometimes due to injury or overuse, it is inflamed and can cause pain in the knee. It is diagnosed by a physiotherapist. X-ray cannot identify this condition. MRI is performed to diagnose the inflamed plica. This condition is treated by pain medication, ice, rest, and a cortisone injection. Plica is removed surgically if other treatment options fail.
PLATELET-RICH PLASMA PROLOTHERAPY FOR KNEE PAINPlatelet-rich plasma Prolotherapy is an alternative treatment option to treat the different causes of knee pain. It can be used to stimulate and accelerate the soft tissue regeneration and repair. PRP is effective in treating the conditions related to tendon and ligament damage.
A research study on rats showed an increase in the number of collagen fibres and fibroblasts in the early healing phase after tendon damage. PRP injections stimulate 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.
A study showed significant functional betterment in the patients with knee cartilage pathology and its effects lasted at least 12 months.
In 2012, in a meta-analysis, the efficiency of steroid injection and PRP Prolotherapy were compared for knee osteoarthritis. The results showed that the effect of steroid injections was very short term as compared to PRP injection, but PRP needs more research to determine the duration of efficiency.
PRP Prolotherapy is used for the treatment of muscle injuries, but limited studies have shown PRP effectiveness in muscle injuries. Research done by using human cells has shown the efficiency of PRP in muscle repair, but no research is available on humans.
In the U.S, the cost of PRP treatment varies. In Florida, a single PRP injection for knee pain costs $800. In New York, cost varies from $1000-$2000 per injection.
PRP Prolotherapy has shown some promising results in some studies, but more evidence is required to establish full trust on this technique. It is more effective when combined with physical therapy or other alternative treatment methods, but double-blinded research is required to evaluate the efficacy of PRP Prolotherapy in humans.
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:
Griffith , C. J., & LaPrade, R. F. (2008). Medial plica irritation: diagnosis and treatment. Curr Rev Musculoskelet Med, 53–60.
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.