By Dr. Steve Derrington, board-certified in physical medicine and rehabilitation
Had PRP and didn’t get the result you hoped for? It’s natural to wonder what to do next. Before anyone repeats an injection, I think a few things deserve a careful second look.
1. Was the diagnosis right?
Getting the diagnosis right comes first. It takes years of training and experience to develop the diagnostic skills to determine what’s actually causing your pain. Ideally the person evaluating you is orthopedic-focused, a physician with that training.
A thorough evaluation, including a hands-on exam, tells me more than an X-ray or MRI report alone.
2. What was injected, and at what dose?
Not all PRP is the same. There are about fifty different systems out there to create PRP, and a similar number that create some kind of bone marrow concentrate, with a wide range in how well each does the job.
With PRP, I want to know how much blood was drawn, what concentration was given, and what dose of platelets and growth factors was delivered. If a clinic can’t tell you about its system and the numbers it delivers, it’s hard to know whether the preparation was therapeutic. PRP prepared the right way, at the right dose, can be very therapeutic.
3. How was it delivered?
A lot of times we’re treating very small problems, sometimes millimeter-sized. If you can’t see where you’re going, you can’t place what you’re injecting in the right place with certainty. Depending on the problem, that means ultrasound or live X-ray, both for the therapeutic value and for safety, because some areas have blood vessels and nerves nearby.
My guide to choosing a PRP or bone marrow clinic covers these same three questions: diagnosis, what is being injected, and how it is delivered.
4. What is going on with your overall health?
For years, when we did these procedures, we didn’t look closely at what a patient was dealing with systemically. A lot of the data out there shows that even patients who are obese, inflamed or otherwise metabolically unhealthy can still do really well. But a small number of patients don’t respond well, and we’ve been asking how to help them and what factors might contribute.
So I now pay closer attention to each patient’s overall metabolic health. Metabolic health includes nutrition and what you eat, and it also includes sleep.
- Sleep and nutrition can be improved, and supplements that help modulate inflammation may mean you don’t need ibuprofen on an ongoing basis.
- Weight matters too. I’ve had patients who were too heavy to have hip or knee replacement surgery. We felt it was more appropriate to get some weight off, reduce the stress and inflammation, make dietary changes, and then treat. Many of those patients have done really well.
What to do next
Physical therapy and how you move stay part of the plan. If you’ve already had PRP, bring what you know about it to your visit: what was done, the area treated, and how it went. You can also read about how I choose between PRP and bone marrow concentrate, and learn more about PRP at my practice.
I see patients at my Carlsbad office (5806 Van Allen Way, Suite 101, Carlsbad, CA 92008) and on Tuesdays at my Laguna Hills office (25411 Cabot Rd, Suite 116, Laguna Hills, CA 92653). You can call (760) 721-4000 or request an appointment online.
Frequently asked questions
Why might PRP not work for some people?
There can be several factors: the diagnosis, the preparation and dose, how it was delivered, and overall metabolic health, including nutrition and sleep. A small number of patients don’t respond well, and I look at each of these.
Does sleep or nutrition affect how I respond?
Yes. Metabolic health includes nutrition and what you eat, and it includes sleep, so I look at both.
Should I just repeat the injection?
I’d first review the diagnosis, what was injected and at what dose, and how it was delivered.
This article is general education and does not replace an exam or medical advice for your situation. Results vary from person to person.
