Earlier this week, I took the plunge and got a Platelet Rich Plasma (PRP) injection for my chronic hamstring tendon injury.
A Platelet Rich Plasma injection involves drawing your own blood, separating the plasma, then injecting it into the injury site, so the growth factors in the plasma promote healing. It’s helpful in chronic injuries, especially tendonitis, and areas that get little blood flow.
Many of my real life friends have never heard of PRP, and others confused it with a cortisone shot, so I wanted to discuss it. Plus, I had to “couch potato” for a few days post injection, and writing this blog post gave me something to do (besides work) while I was laid up.
As always, I’m not a doctor and I don’t play one on the internet. Your doctor is seeing your MRIs or ultrasounds, doing physical examinations of your injuries, and treating YOU. Every person and injury is different, so don’t take internet anecdotes too seriously.
If you’re dealing with high hamstring tendinopathy or a small/partial tear, know you’re not alone. Treating an injury- especially a chronic one- can be scary, and it’s good to hear from someone else in your shoes.
The Case for PRP
After the Kiawah Island Half Marathon, my lower glute/upper hamstring didn’t recover quickly. I had pain in this area in the weeks after. I took some weeks of running, then ran a bit, trying to take it easy. I saw my general practitioner in February, who sent me back to PT and recommended dry needling as well as sports massages and cupping. I continued those therapies and laid off hard running, but I still ran, including the Oak Island 5K and Catch the Leprchaun 5K. I didn’t run through pain, but I didn’t run comfortably, either.
As athletes, we are often told to push through discomfort and remind ourselves that if we didn’t run every time we felt a little “off”, we’d never run. Having the wisdom to know when to back off is harder than training. I try, but I don’t always have that wisdom. I wish it was possible to always know what’s best and never get injured.
The dry needling seemed to help, and I thought the worst was over, so I started increasing my mileage. Not training, just mileage. A few weeks in, I noticed that my gait was off, especially when running outdoors, and some friends noticed as well. My general practitioner referred me to an orthopedist, who along with his Physician Assistant, examined my hip. They disagreed on the diagnosis (either high hamstring tendinopathy or piriformis syndrome), so I was sent for an MRI. Shortly after the MRI, I stopped running entirely because of how my gait was affected.
A few weeks after the MRI, my follow up revealed a “low-grade, partial tear of the hamstring origin tendon”. That ortho suggested spending a few more weeks on PT and possibly an ultrasound guided PRP injection. I was shocked that my doctor didn’t call me with the results sooner, and after reading about PRP- and how it’s not covered by insurance- I sought a second opinion.
A week later, I saw a different ortho for a second opinion. He looked at my MRI, sided with my first doctor, and I agreed to finish out PT, then opt for the injection. I decided to get the injection on Monday. My real job in technical writing is busy with three upcoming software releases, so I wouldn’t have time for much besides work anyway. Plus, I’m going on vacation in a few weeks, and having a few weeks between the injection and vacation would give me time to recover and address any complications, if that happened.
Preparing for PRP
I did as much research as I could before my Platelet Rich Plasma injection, which meant reading the few studies out there and perusing Facebook groups and a blog posts from other runners. I searched Instagram as well, which was interesting because I learned that PRP is now used to regrow hair for men. Here’s to hoping I won’t grow hair near my proximal hamstring.
The primary ways I prepared were by not taking any NSAIDs for a few weeks pre-injection and hydrating really well the night before and day of the injection. I kept my Tervis by the bed and drank every time I woke up during the night, and I drank several tumblers full of water that morning. Nurses often have trouble getting my blood, so I wanted to make it as easy as possible.
Along with that, be prepared to be on the couch for awhile. Buy groceries before, resist the urge to clean or nest in your house, and load your DVR or Netflix queue with fun TV shows and movies. Getting my injection on a Monday gave me the weekend to do that.
It’s PRP Time
Clay took the morning off work to drive me to the doctor’s appointment, which I really appreciated. We gave ourselves plenty of time to get to the appointment, and we were 30 minutes early- which is what happens on the rare occasion that Charleston and Mt. Pleasant don’t have traffic. This was a good thing because my doctor had a full schedule that day.
The first step was drawing blood from my arm. I laid down and despite my best attempts to hydrate, the nurses tried the veins in both arms and didn’t get enough blood. After both tries, one nurse got these amazing warming pads and taped them to my veins to warm up the area. She left for around five minutes, came back with a new syringe, and was able to get all the blood needed. I’m not sure of the amount of blood taken, as I tried not to look and I didn’t ask about the measurement, but it definitely wasn’t as much as when you donate blood.
Once my blood was collected, the nurses took it to the centrifuge to spin it and separate the platelets, which would be injected into the injury site to promote healing. They also brought in the ultrasound machine and syringe with platelets in a few minutes later.
Soon, the doctor came in to talk to me before the injection. While my doctor used an ultrasound to guide the injection, he also asked me to physically point to the area that bothered me the most- once the procedure ended, he said that where I pointed and where the ultrasound showed the small tear were the same place. I appreciated that- because physical examinations and patient feedback are as important (if not more important) than imaging.
The injection itself wasn’t painful- I felt the pinch of the needle, which was a little worse than a typical shot, and I felt the platelets going in. The cold numbing spray and cold ultrasound gel seemed to help any pain. I’ve read mixed feedback on how painful PRP injections are, and for me, it was uncomfortable, but I wasn’t wincing in pain or gripping the table. I imagined myself on the beach in Grand Turk, since I’ll be there in a few weeks anyway.
Once the doctor finished with the injection, he came back in to talk about recovery over the next few weeks. It takes up to six weeks to see the full benefits of PRP, and it’s important that I don’t take any NSAIDs during this time. In addition, his guidelines of not doing any jumping or explosive movements still stand, and he advised me to continue not running. I’m absolutely okay with that.
Recovery from any medical procedure varies from person to person, but I was able to
walk hobble out of the doctor’s office and to the car with no problems and no crutches or wheelchair. It did take me a little extra time to get into the car, and I sat on a pillow for the ride home. My minor tear is in my right hamstring, which is my driving leg, but I recommend having a driver if possible, no matter where your injection is. Medical procedures are stressful enough without having to deal with traffic and driving, so it’s good to relax after.
I also took the injection day off work. I work from home, so I can usually avoid missing work for illnesses or appointments, but it was nice to lay around and relax after spending almost half a day driving to and from Mt. Pleasant and having the injection. Even if you work from home, take the day off work and rest! Sometimes a day off helps healing, too.
As for now, I’m taking it really easy. PRP is not a magic bullet to get back to running or workouts. In fact, the injury site pain was worse in the two days after the injection- and hurt worse than it did prior to treatment. The PRP induces an inflammatory response, and NSAIDs and ice are not allowed. Over the last few days, I’ve some record low FitBit step counts and major #RestDayBrags, and hoping it will be worth it in the end.
As my friend Sarah put it, it’s like the saying “trust your training”, but when you’re injured, you have to “trust your treatment”.
Here’s to getting our software releases out the door, preparing for a vacation, and a speedy recovery!