Platelet-Rich Plasma (PRP) injections have gained significant attention in recent years as a promising treatment for various musculoskeletal, soft tissue, and joint injuries. The technology has improved so much over the last decade, and research is also showing this.
As a naturopathic doctor, I love PRP injections because you are using your body’s own platelets to heal yourself. I’m going to touch on some frequent questions I get in my practice, and hopefully help you learn a bit more about this regenerative injection.
How Does PRP Work?
PRP is produced by drawing a small sample of your blood and spinning it in a centrifuge to concentrate the platelets. Platelets, which are blood cells essential for healing, are separated from other blood components through this high-speed spinning process.
PRP is typically quantified by the total platelet count delivered (usually in billions) or by the fold increase compared to baseline. This is calculated by dividing the platelet concentration per milliliter in the PRP by the platelet concentration in the patient’s native blood. Generally, a minimum of 1 billion platelets per milliliter is desired, with an average target of at least 1.5 billion per milliliter. For patients aged 55 and younger, aiming for a 7- to 10-fold increase over baseline is recommended, while those over 55 may benefit from a 15-fold or higher increase. A more concentrated PRP delivers a larger number of platelets and growth factors to damaged tissues, enhancing the natural healing process. Simply put, a higher platelet dose correlates with better clinical outcomes.
At Agile Integrated Health, We use the technology to get these higher platelet concentrations over baseline.
When injected into an injured area, activated platelets release growth factors and proteins such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF). These growth factors stimulate tissue repair by enhancing cell proliferation, new blood vessel formation (angiogenesis), and collagen production. Essentially, PRP boosts the body’s natural healing process to facilitate tissue regeneration and recovery.
Indications Best Treated With PRP
Chronic tendon injuries (e.g., tennis elbow/lateral epicondylitis)
Osteoarthritis, especially of the knee
Achilles tendonitis and tendinopathy
Patellar tendonitis (jumper’s knee)
Rotator cuff tendon tears and tendinitis
Plantar fasciitis
Hamstring injuries
Ligament sprains and partial tears
Muscle strains and tears
Chronic tendinosis and degenerative tendon conditions
Cartilage degeneration and damage
Inflammatory joint conditions not responsive to other conservative treatments
Post-traumatic joint pain and inflammation
Joint instability or chronic joint pain related to soft tissue and ligament involvement
Who Are Good Candidates?
In the acute phase of an injury (freshly injured), PRP is often timed to coincide with the body's healing stages about 1 to 2 weeks after injury or surgery.
In the chronic phase of an injury, good candidates for PRP are those who have experienced persistent pain or injury for several months (typically 3-6 months or longer), who have not fully responded to conservative treatments such as physical therapy or NSAIDs, and who prefer to avoid or postpone surgery.
Patients should also be in generally good health without severe anemia, blood disorders, active infection, or cancer, as these conditions can affect the quality and safety of PRP therapy.
How to Prepare for a PRP Injection
I put people on a special diet prior to receiving a PRP injection. I recommend following this for at least 10 days, if not for 4-6 weeks before the procedure. It is best to follow a balanced, nutritious diet to optimize healing and platelet function, as well as optimize other lifestyle factors that greatly imact the quality of your blood.
4-6 weeks before the injection
Eat a diet rich in fresh vegetables, fruits, whole grains, and high-quality proteins to support overall health and tissue repair.
Focus on nutrients that promote blood and cell health, such as iron (found in leafy greens, beans, and lean meats), vitamin C, and vitamin B complex.
Avoid alcohol, caffeine, and nicotine before the procedure as these can impair platelet function and blood flow.
Stop anti-inflammatory medications like NSAIDs and aspirin about 1 week prior, as they interfere with platelet activity (always consult your doctor first).
Avoid highly processed, sugary, and fried foods that may promote inflammation and slow healing.
Adhere to a plant-based diet or reducing animal fats 24 hours before to reduce inflammation and improve blood quality.
Address stress, axiety and depression to the best of your ability by making time for relaxation, meditation, prayer. Seek joy in the weeks leading up to your procedure.
Prioritize getting good quality sleep leading up the procedure, aiming for at least 8 hours per night.
Maintain good hydration by drinking plenty of water in the days leading up to the procedure, which helps circulation and blood collection.
Day of procedure:
Go for a 4-minute bout of high-intensity exercise 30-minutes before drawing blood for the platelet-rich plasma injection. A short, high-intensity bike or jog/sprint can increase the total platelet count and TGF-β concentration.
Eat and drink before the procedure. Come well hydrated!
What to Expect During the Procedure
A general assessment including your vitals will be performed. Your blood will be drawn and in under 20 minutes, your platelet-rich plasma is prepared.
The injection will be performed under ultrasound guidance, and it isn’t uncommon for the injection itself to be uncomfortable. We will discuss this at length prior to the procedure.
It’s a good idea to have someone to pick you up and take you home after the procedure in case you are too uncomfortable to do so. Many people, however, choose to drive themselves. It’s also generally a good idea not to have something planned later that day in case you need the additional rest.
Potential Risks
While PRP is considered relatively safe because it uses a patient’s own blood, there are still potential risks. Mild to moderate complications may occur at injection sites, including pain, swelling, and rarely infections. More serious complications such as infections or allergic reactions, have been reported but are rare.
What to Expect After the Procedure
Some soreness is normal for a few days after your treatment. This pain is caused by the inflammation triggered by the platelets, which is part of your body’s healing process.
Rest and take it very easy for the first several days.
Pain may fluctuate during the first 2–3 days, and then should gradually improve. You may have days with more or less pain—this is a typical part of healing.
You may use Tylenol (take 1 or 2 tablets every 4–6 hours as needed) to help with discomfort.
Apply heat to the area for pain relief.
Do not take any non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or full-strength aspirin, for at least 3 to 7 days. These medications can interfere with the healing effects of the PRP by blocking necessary inflammation.
For activity:
During the first 2 days, keep moving with light activities such as short walks, but avoid formal exercise.
On day 3, begin gently moving the limb or joint through its full range of motion without resistance.
Between days 7 and 14, start isometric exercises with the limb and slowly increase resistance as tolerated. Gradually increase your activity level—movement helps healing if done carefully. For cardio, try cross-training activities such as swimming, deep water running, stationary bike, elliptical, or walking as you are able.
Continue working with your physiotherapist to maximize progress.
A Final Recap!
PRP injections leverage concentrated growth factors from your own blood to stimulate healing in tissues. It’s best suited for chronic tendon and soft tissue injuries, certain types of osteoarthritis, and people seeking alternatives to surgery. While generally safe, PRP treatments carry risks that require careful patient selection and procedural sterility. As research evolves, the indications and protocols for PRP continue to be refined to maximize benefits and minimize harm.
This emerging treatment is a great example of harnessing the body’s natural healing capabilities for orthopedic and sports medicine. Those considering PRP should have a thorough discussion with their healthcare provider to understand if it is appropriate for their specific condition and health status.
