RICE & MICE will periodically review injuries that are common, uncommon or just plain unique in hockey. I hope to provide some insight to the “how’s, why’s, and when’s” of the injuries that might keep players out of the lineup.
Yeah you know me! Who’s down with PRP? This whole party! Ok, forgive me for the corny Naughty by Nature reference. PRP, or platelet rich plasma, is something that is becoming ever so popular in the world of sports medicine. It is used more and more in professional sports in order to accelerate healing of soft tissue injuries. It has been used in the medical setting throughout the 1900’s, but its use in sports medicine is fairly new, only around 10 years. You may remember last season when Brian Boucher, Danny Briere, Simon Gagne and Michael Leighton all received injections of platelet rich plasma at different times for a variety of injuries. More recently in the NHL, Marian Gaborik has again elected to help speed recovery from injury PRP injections. The most recent injury is a shoulder separation, but Gaborik has also benefitted from PRP injections for both hamstring and groin injuries. The recent increase in utilization of PRP is not exclusive to hockey. PRP therapy has also been used in football, golf, tennis, baseball, basketball, and distance running; pretty much anywhere a sports-related injury is possible.
It is worth mentioning that Gagne also sought out prolotherapy treatments when he was battling his concussion issues. Whereas prolotherapy utilizes organic substances (commonly dextrose – a sugar solution) that are injected into the injured area to act as irritants that cause the body to activate the inflammatory response to spark healing; PRP skips the middle man (the irritant) and gets right to business.
Blood is made of red blood cells, white blood cells, plasma, and platelets. Platelets are best known for their activity in blood clotting, but there is more to them. Platelets are responsible for forming a sort of foundation for new tissue growth; they also flip the on switch for proteins involved in healing, called growth factors to cue cells to replace and repair the damaged tendons, ligaments and even bone.
After injury, blood naturally flows to the injured sites to help healing; this is why there is considerable swelling as a result from most soft tissue injuries. The idea behind the increased blood flow is to activate the platelets and get them involved in the healing process. PRP injections deliver a dense concentration of platelets to the injured area to accelerate and enhance healing.
For hockey players, speed of healing is necessary if an injury is to have the least possible impact on a player’s season. Hockey demands such a high level of conditioning that even a small amount of time spent on the shelf rehabbing an injury can be detrimental. Treatments begin, with a sample of blood, 30 milliliters, or 6 teaspoons, from the patient. The blood spins in a centrifuge to separate the platelets from the red blood cells. Ultrasound guidance is then used to re-inject the platelet rich plasma into the injured area.
Soft tissue injuries are the most responsive to PRP. This includes tendonitis, tendon tears, ligament sprains or tears, loose ligaments, and muscle tears. Most of these soft tissue injuries are slow to heal because of poor blood supply to most tendons and ligament so the body has a difficult time healing. PRP has also been effective at treating cartilage degeneration such as arthritis as well as labrum tears in joints. Unlike cortisone shots, which suppress the immune system, including inflammation and swelling in order to decrease pain, PRP actually heals the injured region.
The injection itself is not painful because the site is often anesthetized first; however there is considerable soreness and selling in the initial 48 hours after an injection. Pain medication is used instead of non-steroidal anti-inflammatory medication (Motrin, Aleve, etc.) because the whole idea of the PRP injection is to induce and speed up the inflammatory response of the body, thus speeding up the healing process. Ice is used as needed. Physical therapy and rehab are started within a week of the injection and benefits are in as little as a week after PRP. Injections can be repeated every 4 weeks or so, but most people will only need one or two injections.
PRP injections are not yet a mainstream solution for the common Joe; studies are currently being done to accurately measure its effectiveness. Though not a concern for most professional athletes, the treatment is not for the frugal-minded and could cost up to $1500 per injection. Still, I wonder if PRP injections could be used periodically to slow the wear and tear on a hockey player’s hips or knees. The body knows best how to heal itself and platelet rich plasma injections might just be the future of sports medicine.
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