CINCINNATI -- When it comes to running, Rick Finn is always up for a challenge.
Rick is a real-estate agent who grew up in Cincinnati and now lives in Hyde Park. Over the years, he has run more than 40 marathons, including an ultramarathon -- 50 miles.
For Rick, running is more than just the thrill of competition; he truly enjoys it.
"Running is a stress release for me. I run with my brother and quite a few friends," he said.
However, a few years ago, the enjoyment fizzled. The physical stress of running led to issues with Rick's Achilles tendon.
The Achilles tendon, the largest tendon in the body, connects the calf muscles to the heel bone. We use it when we walk, jump and run. And it was hurting Rick.
"It was a dull pain. I could run with it, but it was pretty painful. I tried all sorts of fixes -- physical therapy, acupuncture," Rick said.
Searching for pain relief -- Platelet-Rich Plasma injections
In search of relief, Rick inquired about a treatment called PRP -- platelet-rich plasma.
PRP treatment is a regenerative injection that uses a patient's own blood to promote healing and relieve pain in the tendons, ligaments or joints.
"Platelet-rich plasma is a concentrated form of platelets that is harvested from the whole blood of your body," explained Edward Marcheschi, M.D., a sports medicine specialist with Mercy Health. "PRP can create a healthier environment, which leads to decreased pain and increases function of that joint."
Famous athletes, such as professional golfer Tiger Woods and tennis star Rafael Nadal, have reportedly used platelet-rich plasma injections to help heal various sports injuries.
And now, Marcheschi said, these regenerative treatments are becoming more mainstream in orthopedic and sports medicine to help heal overuse injuries and other painful conditions.
Before Rick's PRP treatment, Marcheschi performed an ultrasound to evaluate Rick's painful Achilles tendon. The ultrasound revealed a buildup of scar tissue, which was probably the cause of the pain.
Marcheschi decided that Rick was a good candidate for PRP treatment.
"By injecting PRP into the tendon, we're stimulating the body to regenerate new tissue," explained Marcheschi. "At the same time, we are introducing growth factors in high concentrations in these platelets, basically creating the perfect environment for the tendon to heal itself."
What is platelet-rich plasma? And how does it reduce pain?
PRP is plasma with a high concentration of platelets.
Platelets are tiny cells found in the blood, along with red cells, white cells and a liquid called plasma.
The platelets are important for clotting blood, and they also contain proteins called growth factors, which help to heal injuries.
To develop PRP, the doctor draws blood from the patient, then uses a process called centrifugation to separate the platelets from the other blood cells and increase their concentration. The rich concentration of platelets is combined with the remaining blood. The doctor injects this platelet-rich plasma into the site of the patient's injury or pain.
Marcheschi said the PRP injection jump-starts the healing process. In arthritic joints, PRP acts as a potent anti-inflammatory.
Potential candidates for PRP injections
Potential candidates for PRP are patients who have chronic pain due to:
- Tendon disease
- Ligament and muscle injuries
- Degenerative joint disease
Marcheschi uses PRP injections to treat tennis elbow, golfer's elbow, jumper's knee and hip tendon and rotator cuff tendon disease.
Typically, these patients have tried more conservative treatments first without improvement.
Customizing PRP injections for the patient's injury
To get the best results, doctors are now learning how to customize the concentration of the platelets in the platelet-rich plasma based on the patient's injury or condition.
"Its application for use in tendons and joints is now widespread," explained Marcheschi. "And we are learning that customizing the PRP product depending on the location and type of injury is of great importance to its successful use."
PRP success rates vary according to the tendon and the severity of disease. Marcheschi said that for tennis elbow (which involves the most studied tendon in the body), PRP has a success rate of 90% -- roughly equivalent to surgical treatment.
After PRP treatment for Achilles tendon pain, Rick's recovery went smoothly. Marcheschi prescribed a rehab plan designed to ease him back into running after six or seven weeks.
"I really had no issues whatsoever," Rick said. "Today, I have to think hard about which Achilles it was."
PRP treatment costs about $800. Typically, it is not covered by insurance.
Ultrasound option uses "jackhammer" effect to treat painful tendons
When the patient's injury is so great that the tissue does not heal with PRP or other conservative treatments, another option is available -- percutaneous tenotomy.
It's an innovative, minimally invasive ultrasound procedure that can help heal painful tendon disease by breaking up the scar tissue.
During the procedure, Marcheschi inserts a device called the Tenex TX MicroTip into the damaged tissue.
"The tip produces ultrasonic energy that creates a jackhammer effect, breaking up scar tissue, and at the same time, suctioning the scar tissue out of the body," explained Marcheschi. "The removal of scar tissue stimulates the body to rebuild and heal … the frayed or damaged fibers in the tendon that caused the pain."
After Tenex treatment, Marcheschi said, patients can start stretching exercises right away, and they experience pain relief within two to three weeks.
Tenex is a short, outpatient procedure. Generally, it is covered by insurance.
BothTenex TX MicroTip treatment and platelet-rich plasma injections are for patients who did not find relief with other treatment methods -- rest, medication, bracing and physical therapy.
Meanwhile, Rick, who received the PRP injection, enjoys running again. He runs 30-40 miles a week, and finished the half-marathon at the Flying Pig in 1:34:37.
"PRP was a great option for me. I highly recommend it," said Rick.