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Month: September 2015

PRP / Prolo for Whiplash

· Prolotherapy · No Comments

 Prolotherapy for Post-Traumatic Neck Pain Caused by a Whiplash Type Injury

 

 

 

Over 2.3 million people were injured on U.S. roadways in 2013.  When looking at injuries sustained from nonfatal crashes, whiplash is among one of most commonly reported injuries.  Whiplash can also occur from other traumatic events including falls, sports injuries, physical violence and work related accidents.

 

The term “Whiplash” is actually a generic term referring to a rapid forward then backward motion of the head and head.  The true definition of whiplash debateable.  In medical terms, this is a hyperflexion – hyperextension or acceleration-deceleration type injury.  With the forces that cause this type of injury, the cervical spine is believed to go beyond its normal range of motion and has the potential to injure the surrounding soft tissue structures (ligaments) and discs. As a protective mechanism, the neurological system attempts to stabilize the area by contracting the surrounding muscles. There are several known factors (and some unknown) which may determine the extent of injury. This includes prior level of health, physical condition, posture or position of neck at the time of impact, and awareness of pending impact.

 

Commonly reported symptoms of a whiplash type injury include immediate or a delayed onset of neck pain with or without referred pain to the upper back and shoulders, tingling and numbness to the upper extremities, headaches, dizziness, and blurred vision.  Often patients will complain of referred pain to the arm(s) which may include tingling and numbness, yet clinically there may be no loss of strength, sensation, or function.

 

Treatment for whiplash injuries has also been all across the board.  Some focus on rest and immobilization of the neck while the general consensus for treatment for those with a whiplash type injury (without neurologic deficit) has been promoting an active lifestyle. Specific treatments may include non-steroidal anti-inflammatory medication and physical therapy.

 

Taken from a 2008 systematic review and meta-analysis of the literature, Kamper et al looked at 37 published articles focused on acute whiplash injuries.  The findings from this showed that a significant proportion of those injured recovered in the first three months following an accident.  The authors concluded that pain and disability tends to reduce most rapidly during the initial 3 months but after that time period, little improvement occurs. 

 

There are many inconsistencies in looking at what factors are important for determining the prognosis.  Some of the postulated factors found in the literature associated with a poor recovery include high pain levels, disability levels, depression, and neck range of motion, mechanical hyperalgesia, and the presence of post-traumatic stress symptoms.

 

So what treatment options exist for those who do not improve initially and develop chronic pain? Some are told to live with the pain while surgery may be recommended for others.   Prolotherapy may be a reasonable option for this subset of patients.  While the literature is very limited in regards to studies involving prolotherapy for post-traumatic neck pain or whiplash, reports from as early as the 1960’s published in the literature, showed treatment success in the range of 90% for this specific application. An observational study published by Hauser et al (2007) showed significant improvements in pain levels, cervical range of motion, and disability levels for the study population.  Hooper et al (2007) reported on 18 patients treated with dextrose Prolotherapy. The findings from this study were similar to Hauser et al.  Significant improvements were seen in pain scores and disability measures. Limited conclusions can be drawn based on the methodology and outcomes of these types of studies, however, the results do show the potential for prolotherapy as a viable treatment for those with chronic neck pain from a whiplash type injury.

 

 

 

 

 

References:

 

U.S. Department of Transportation. NHTSA. Traffic Safety Facts. December 2014.

 

Kamper SJ., Rebbeck TJ., Maher CG., McAuley JH., Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008 Sept 15; 138(3): 617-629.

 

Hackett G. Prolotherapy in whiplash and low back pain. Postgraduate Medicine. 1960. pp 214-219.

 

Hauser RA, Hauser MA. Dextrose Prolotherapy for Unresolved Neck Pain. Practical Pain Management. 2007.

 

Hooper RA, Frizzell JB., Faris P. Case Series on Whiplash Related Neck Pain Treated with Zygspophysial Joint Regeneration Injection Therapy. Pain Physician. 2007 Mar; 10(2): 313-8.

 

 

 

 

 

Update on Achilles Tendiopathy

An update to the use of PRP in the treatment of Achilles Tendinopathy

In an update to our recent post regarding the use of PRP for Achilles Tendinopathy, a retrospective analysis of 26 patients was published this past month in Foot and Ankle Specialist (Oloff et al 2015). One of the authors has used PRP to treat Achilles Tendinopathy for both those patients who have needed surgery and for those treated non-operatively for the condition.  Outcomes were based on the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire and evaluation of pre and post treatment MRI images. There was a statistically significant degree of improvement seen on pre and post MRI images. Both groups (surgical and non-surgical) improved to a similar degree. 

One criticism is that this is a level IV study (evidence based medicine) and is based on a case series.  It adds to the current body of literature which has shown that PRP may be helpful for Achilles Tendinopathy.  Certainly, data from larger well controlled clinical trials is needed to determine effectiveness of PRP therapy and to define more specific treatment protocols.

References:

Oloff L., Elmi E., Nelson J., Crain J. Retrospective Analysis of the Effectiveness of Platelet-Rich Plasma in the Treatment of Achilles Tendinopathy: Pre-Treatment and Posttreatment Correlation of Magnetic Resonance Imaging and Clinical Assessment. Foot Ankle Spec. 2015 Aug 7.

 

PRP in Professional Athletes

· Platelet Rich Plasma (PRP) · No Comments

If PRP injections are used to treat professional athletes, could I benefit from them?

Are Platelet Rich Plasma injections effective for various soft tissue injuries and joint complaints or is it marketing hype with nothing to back it?  As has been discussed on our website and at various places across the web, the use of PRP to treat musculoskeletal conditions has accelerated during the current decade.  More and more studies are being designed, conducted, and published looking at the efficacy of PRP injections.  Admittedly, there are many unknowns at this point. Data from high quality, randomized clinical trials using PRP is beginning to grow. Add to that many anecdotal or case reports, and the common theme is that PRP may be effective in the treatment of conditions such as tennis elbow, Achilles tendinitis, hamstring injuries, and other tendon disorders.  

PRP has been used amongst professional athletes for many years with increasing frequency.  Many of these players are paid millions of dollars to perform, often on a daily basis. Their ability to recover expeditiously from an injury is vital to their future and often to that of their team. 

Using major league baseball as a good example,  more than two-thirds of the season has now past and just within the last 6 weeks, a handful of starting players (some well-known), have been injured and treated with PRP.   Here are the latest based on news reports:

Boston Red Sox pitcher, Clay Buckholz, was given a PRP injection several weeks ago for a strained flexor muscle in his right elbow.  Based on published reports from earlier this week, his is supposed to be seeing orthopaedic surgeon, Dr. James Andrews, for evaluation and to be released back to throwing.  This same type of injection was given to pitcher Chris Sale of the Chicago White Sox. We was placed on the disabled list for nearly 5 weeks, but he been one of the best pitchers in baseball since his return.

Jesse Hahn, of the Oakland A’s, was shut down from pitching in mid-July for a forearm strain. He received at least one PRP injection.  It is reported that he is still feeling stiffness with strengthening exercises. His time to return is unknown at present.

Pirates star pitcher, A.J. Burnett was placed on the disabled list last week for a flexor strain in his right elbow. It was expected that he would be out for four weeks. He was given a PRP injection to the elbow and based on reports is making faster than expected recovery. He has already began catching.

Dustin Pedroia, second baseman for the Boston Red Sox was also recently treated with PRP. He suffered a re-aggravation of a hamstring injury in late July.  He is currently looking to return to the lineup in mid-August based on report.

Atlanta Braves first baseman, Freddie Freeman was put on the disabled list in late June with a right wrist contusion.  He received a PRP injection to “help with the healing process.”  The team leader in home runs returned to the lineup after 5 weeks, but unfortunately recently ended up on the 15 day disabled list with a right oblique strain.

This is just a highlight of how PRP is being used amongst professional baseball players with some of the  observed results.  Even for those of us who do not go to bat or are required to pitch on a daily basis, but do suffer from soft tissue injuries,  PRP injection therapies are something that you will continue to hear more about and appear to be promising for certain musculoskeletal problems.