BUFFALO, N.Y. (WIVB) – Bills quarterback Josh Allen indicated last week that he received a PRP injection to help recover from his right elbow injury. The procedure helped him stay on the field, not missing a single game after reportedly spraining his ulnar collateral ligament.
What is a PRP injection? Dr. Jason Matuszak, a sports medicine physician with Excelsior Orthopaedics who specializes in non-surgical care, spoke with News 4 to explain the procedure. He estimated he has performed over a thousand PRP injections in his career.
Allen suffered an elbow injury late in a game against the Jets on Nov. 6. He said doctors initially wanted him to sit out 2-4 weeks, “but I kind of had my own plan and basically told them this is what we’re doing,” Allen said on a podcast. “Let’s get that PRP shot at the end of the day, let’s not throw all week, and Saturday I’ll see how it’s feeling. And I have a strong feeling that I’ll be able to go this next week.”
Allen did end up playing the week after the injury. The Bills lost that game to the Vikings in overtime but won their next four. Allen’s production has dipped from his usual MVP caliber, but he has done enough to help the Bills regain the #1 seed in the AFC.
So, what is the procedure that might have helped save the Bills season? Dr. Matuszak helped answer questions about PRP injections below. Some answers have been lightly edited for clarity.
What is a PRP injection?
PRP stands for platelet-rich plasma. Platelets are a component of blood that helps our body with the process of repairing damaged tissue. A PRP injection is a procedure in which a patient has platelets from their own blood injected directly into a damaged tissue to help promote the natural healing process.
The procedure starts with the patient having blood drawn. Then the blood is spun rapidly in a centrifuge to separate the substances in blood, with the heavier red blood cells sinking to the bottom and platelets rising to the top. Doctors can then take the platelets and inject them exactly where they are needed, often guiding themselves with an ultrasound machine or similar device to ensure they are as accurate as possible. The whole process takes about an hour.
“When we’re trying to heal damaged tissue, having at least some degree of inflammation is necessary to get good tissue healing,” Matuszak said. “So what we’re trying to do is separate out the portions of the blood that help with the tissue healing, and really kind of take those pieces and inject them into the areas that are deficient in healing, or might be able to use a boost in healing.”
How much does a PRP injection help?
A professional athlete usually has different goals for a PRP injection than the average patient, Matuszak said. The pros usually use PRP injections to speed up recovery while looking to return to play as soon as possible. But for the average patient, he said, PRP is only used down the road if traditional recovery methods are stalling.
“Most of our athletes, they’re going to heal just fine even without the platelet-rich plasma,” Matuszak said. “You might be talking about accelerating the healing process for something like an elbow by a matter of days or at most a week or so. But depending on the stakes that are involved, that might make a decision for you. That might [make you] say, listen, there’s very little downside to this. Yes, it might be able to heal it a little faster – 20% faster, 30% faster, 50% faster. Then sometimes you might make that judgement.
“For many of our [non-professional] athletes, to come back one week sooner or five days sooner and add an out-of-pocket cost, that’s a different value judgement.”
How soon can you play after a PRP injection? Does a PRP injection hurt?
The answers to these questions may be connected. Matuszak said he generally does not require patients to “stay off” the site that received the PRP injection … but patients should expect discomfort following the procedure.
“It is helpful to know, these are painful injections,” Matuszak said. “If you think about it, we’re trying to generate a bigger inflammatory response. [Having inflammation] is important for tissue healing, but it’s very painful. We’re talking about taking essentially a week’s worth of inflammation and injecting it into damaged tissue in about 15 minutes. It can be a bit intense.”
But if you can get past that hurdle, returning to action quickly may be possible – as Josh Allen showed.
“The whole process can take a few months to complete,” Matuszak said. “The first 7-10 days are generally the most painful, then the next 2-3 weeks are still painful but functionable, and then after that it’s building and strengthening that tissue more.
“The first 7-10 days is the time the body is trying to do the most with the tissue healing, with developing swelling in the area and moving cells in there that are supposed to be laying down tissue fibers. Over the next several weeks, it’s actually building out the tissue fibers and it continues remodel that tissue and get rid of the stuff that’s not necessary to be there and lay down more tissue fibers that are oriented the way you want them to be.”
Matuszak also noted that the pain can’t be avoided with local anesthetics. “Things like Lidocaine or Novocaine can actually de-activate the platelet-rich plasma and make it less effective,” he said. “We don’t want to break that inflammatory cascade that’s happening, the whole cycle that happens inside the body that recruits all the cells that are so important for tissue healing. So we tell people afterwards, we don’t want you to ice, we don’t want you to use any anti-inflammatory medications; we want this stuff to work.”
Is a PRP injection safe?
While the devices and techniques used in PRP injections are standardized, Matuszak stressed that the procedure is still considered to be an experimental treatment that does not have direct FDA approval. As such, it is usually not covered by insurance.
“The evidence is still developing in this field,” Matuszak said. “Even though the devices we use to separate the platelet-rich plasma are FDA approved, and all the techniques we use are standardized techniques, these are not FDA-approved treatments for any injury that exists right now. There’s not an FDA approval process to use your own blood to treat your own [injury]. These are still considered to be experimental, so they’re not generally covered by insurance companies or anything like that. But they can be a useful tool in situations where other stuff isn’t working or isn’t working fast enough for what we’re trying to do.”
What body parts can receive PRP injections?
PRP injections have been used on most soft tissues, Matuszak said, including tendons, ligaments, meniscuses, and labrums inside the shoulder.
“We also sometimes use it within joints themselves if we’re dealing with cartilage injuries,” he said. “It’s even been used around nerves; in the literature, there’s good reason to think it might help some nerve injuries as well.”
PRP injections have been used in muscles, too, though they may not always be best.
“Here’s the thing with muscles: They generally do pretty well because they’re rich in blood supply,” Matuszak said. “If they have rich blood supply they often heal well. One of the things we run into with muscles is more often they develop too much scar tissue. The body always heals rips and tears and damaged tissue with scar. That’s our jack-of-all-trades. But it tends to hold things very tightly, too. For some things like a ligament or tendon, that can be good because those are pretty tight structures. But for a muscle, that might not necessarily be a good things because muscles need that elasticity to be able to contract and relax again. So when you have more scar tissue inside muscle, that can actually impede some function. Doing something like a PRP injection, while it can help simulate a healing process inside a tendon or ligament, that’s primarily healing with some scar tissue and building up that way. Universally injecting PRP into muscle tissues, it may help or it might actually create more scarring and create more problems for an athlete too. But it has been used in muscle injuries.”
How common are PRP injections? Are they growing in popularity?
“That’s a great question,” Matuszak said. He’s been doing the procedure for about 10 years and “would’ve expected it to be at higher levels by now,” though he added Western New Yorkers receive the procedure every week.
“There’s not a big market for people trying to get back one week sooner or two weeks sooner,” he said. “Many of the non-healing injuries, we’ve become much more adept at dealing with those — better techniques, physical therapy, or other targeted techniques that are sometimes insurance-covered. … We talk with patients about it most days and we end up doing them a couple times a week. They’re still out there, they can be a useful tool in the right patient. Where it’s going from here, I don’t know.”
How is a PRP injection different from a stem cell injection?
Matuszak: “The difference is where you’re getting the stuff, and the stuff that you’re getting. A stem cell injection, in the orthopedics world, we’re primarily using adult-derived stem cells from the person that’s there being treated. We’re not using fetal stem cells or anything like that.
“There’s a couple places we can get those from in people, one is inside the bone marrow. That’s one we do in my office where we’ll drill into somebody’s bone marrow and use that. In addition to the platelets we’re looking for, it also contains some cells that are ‘progenitor’ cells for the things that help to build cartilage and tendon, things like that.”
A stem cell injection is “a step up from PRP in terms of effectiveness – rapidness of effectiveness, degree of effectiveness, how often they’re successful,” Matuszak added. “But they’re probably a few degrees up in terms of cost. It’s a much more involved process to drill into somebody’s bone marrow in the backside of their pelvis or liposuction the fat cells you’d need to do this.”
How is a PRP injection different from a cortisone injection?
“180 degrees opposite,” Matuszak said. “Cortisone, we use that to break an inflammatory cascade, or to settle down inflammation, or to allow the body to work past or problem or ignore that it’s there.
“They’re still useful. That’s what we use most often to treat many injuries. But the PRP works in reverse, that’s to stimulate the healing process and try to move things along.”
Is a PRP injection blood doping?
No. The withdrawal of blood is used in both procedures, but a PRP injection is not blood doping.
“Blood doping refers specifically to increasing the oxygen-carrying capacity of the blood, which means the red cell portion we get rid of [in a PRP] – that’s what they want,” Matuszak said. “That’s what determines how your muscles can work. That’s a different thing entirely. This is using the healing stuff that’s already in your blood to heal damaged tissues; that is a performance-enhancing thing that’s done using the red blood cell portion to cheat in sports.”
Can you donate platelet-rich plasma?
“It should be your own,” Matuszak said. “It’s not like donating plasma and having it be used for medical purposes somewhere else. One of the reasons this is very, very safe for people to do inside an office setting is because we’re using your own stuff.”
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Nick Veronica is a Buffalo native who joined the News 4 team as a Digital Executive Producer in 2021. He previously worked at NBC Sports and The Buffalo News. You can follow Nick on Facebook and Twitter and find more of his work here.