Regenerative Injection Therapies are also known as Prolotherapy or PRP therapy. These are injection treatments of ligament, tendon, and joints. As part of reconstruction therapy a natural substance is injected causing local inflammation and a normal controlled inflammatory cascade. The triggered wound-healing cascade leads to production of the body's natural growth factors and, consequently, to deposition of new collagen. New collagen shrinks over time, tightens the ligament that was injected, and makes it stronger. Autologous Platelet Rich Plasma - PRP is separated from your own body's blood and it is the ultimate natural substance. PRP injection method has matured and progressed from surgical rooms into outpatient medical clinics and has revolutionized regenerative procedures.

PRP has been used for years in surgical centers to improve the success of healing in open heart surgeries, in bone grafting in dental surgery, and by cosmetic surgeons for speeding healing time and decreasing the risk of infection. Only in the past few years have doctors been injecting PRP for the treatment of chronic pain. Tennis elbow, Achilles tendonitis/tendonosis, rotator cuff tears, meniscal tears, osteoarthritis, and chronic low back and neck pain are all being treated with the injection of PRP with the goal of regenerating dysfunctional connective tissue.
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Prolotherapy is an injection therapy. Injections are placed into injured ligaments/tendons areas. This is one of the successful forms of treatment for chronic pain of injured ligaments/tendons, arthritic joints, etc. We select an injection substance that is best suited for a particular individual and a particular injury. The injections are well tolerated and the results can be seen usually in six weeks. The procedure is repeated to enhance the recovery of the injured area. 

The tissue of the injured ligaments responds through a process called inflammation. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen - the material that ligaments and tendons are made of. New collagen shrinks as it matures. This strengthens the ligaments and improves their elasticity leading to better function. Prolotherapy has the potential of being 100 percent effective at eliminating chronic pain due to ligament and tendon weakness. This improvement in function leads to reduction in pain.
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If you have a tendon, ligament injury, or osteoarthritis and traditional methods have not provided relief, then PRP therapy may be the solution. The procedure is less aggressive and less expensive than surgery. It will heal tissue with minimal or no scarring and will alleviate further tissue degeneration. The initial evaluation and tests if necessary will determine if PRP therapy is appropriate treatment for you.
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Tendons and ligaments connecting tissues are made up of the collagen fibers. Overuse of these tissues, sport related injuries, and degenerative damages to tendons over a long period of time may cause the formation of small tears, a condition called tendinosis. Osteoarthritis is a condition of damaged joint cartilage which overtime contributes to a significant redistribution of the load around the joint due to the pain in the area. Damage most often occurs in the knee, ankle, shoulder, elbow, wrist, biceps, calf, hamstrings and Achilles tendons. Ligaments hold bones together, stabilizing joints and controlling the range of motion. A damaged ligament is no longer able to provide support, weakening the joints and shifting the burden of support to muscles which should primarily act as movement engines. 

Tendons and ligaments have poor blood supply particularly where they connect to bone and they do not easily heal from the damage caused by sprains, strains, and repetitive motion. If damaged tissues do not heal easily the damage may progress with the stress of day-to-day activities. This is more so in the knee as it is the largest joint that carries the brunt of the body's load. As a result the tendons and ligaments become inefficient, the muscles are over-taxed causing chronic pain and weakness and further damage. Medical intervention may be necessary.
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The repair response of musculoskeletal tissues starts with the formation of a blood clot and de-granulation of platelets, which releases growth factors and cytokines at the site. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins, including growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing: bone, tendon and ligament regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process. This microenvironment produces chemotaxis of inflammatory cells as well as the activation and proliferation of local progenitor cells resulting in fibroblastic tissue formation. The following growth factors can be found in the environment of a blood clot: transforming growth factor beta (TGF-b), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), vascular endothelial growth factors (VEGF), epidermal growth factor (EGF), fibroblast growth factor-2 (FGF-2)
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To prepare PRP, a small amount of blood is taken from the patient. The blood is then processed and concentrated Platelets are separated. The entire of PRP separation takes less than 15 minutes and increases the concentration of platelets and growth factors by 500%. Prepared PRP is then injected into the painful area.
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This treatment is not a "quick fix". The patients start feeling improvement in their conditions in 6 to 8 weeks interval. Sometimes the procedure should be repeated to further enhance the healing. The process of PRP requires time and rehabilitation to allow the injured tendon to heal. The research [1,2] demonstrated that tennis elbow improves 80% on the pain score after six months and almost 95% after 1-3 years post PRP therapy. Dr. Popova will discuss with you therapeutic and rehabilitative process post PRP procedure which may include exercises, medical massage, and other physical therapy modalities suitable to your specific condition.
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Initially the procedure may cause some localized soreness and discomfort. Most patients only require some extra-strength Tylenol to help with the pain. It is rarely that patients experience pain, infection, blood clot, nerve injury, scarring, allergic reaction, skin discoloration, or no relief of symptoms. Should you experience any problem mentioned above contact our office or your doctor.
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Many insurance companies partially reimburse for the procedure after receiving pre-authorization except Medicare
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1. "Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma", Allan Mishra,* MD, and Terri Pavelko, PAC, PT, From the Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California
2. "Use of platelet growth factors in treating wounds and soft-tissue injuries Report", a Review, P Rozman and Z. Bolta, Acta Dermatoven APA, vol 16, 2007, No 4
3. An extensive collection of papers related to PRP research and PRP application has been assembled by the Harvest Technologies and can be found here

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