Explaining Britton’s PRP

I’ve gotten a lot of questions regarding the news today that Orioles lefty Zach Britton received two rounds of platelet rich plasma (PRP) therapy, a procedure that could help heal the inflammation in his left shoulder that has plagued him since August. The procedure was recommended to Britton by Dr. James Andrews in Pensacola, Fla., who he met with Wednesday morning.

So, what exactly is PRP? Well, I’m not an expert so I contacted one in Milwaukee Brewers team physician, Dr. Mark Niedfeldt, who was kind enough to dumb things down and explain the procedure a little more. (With a hat tip to injury expert, Will Carroll.) Niedfeldt said PRP is becoming increasingly common in athletes at all levels. In fact, he’s doing two procedures on Thursday.

Here are some of the questions I had answered, and hopefully it can help explain things a little better. It’s by no means a definitive report, but it does clear up many of the questions I had and I received from all of you today…

What exactly does this procedure entail?

The procedure consists of putting the patient’s blood through a special centrifuge to isolate platelets and growth factors, which are than injected back into the injured area. In Britton’s case, this was done twice.

“It’s done to heal tissue that’s not healing for whatever reason, the tendon is not a vascular area so there’s not very good blood supply, to areas such as the knee or in the rotator cuff,” Niedfeldt said. “The thought is you are injecting the substance into the area in an attempt to spur healing. One, is there is bleeding in the area every time you stick the needle in, so your body is going to rush to heal that, then you are putting in the PRP into the area. I look at this as sort of a fertilizer that you are putting around something you want to heal. You are taking the body’s own healing factors, concentrating it and hoping to spur that.”

What are the side effects?

None.

“There’s not really a downside to this, in the sense of it would be unusual to make anybody worse,” Niedfeldt said. “There’s often a bit of a flare-up after the injection, but you want the inflammation, you want the body to heal itself. You are trying to spur a healing response. Since it’s the patient’s blood, there’s not a problem with any type of rejection.”

Why not just get a Cortisone injection?

A Cortisone injection calms down the inflamed area, while PRP encourages inflammation to try to spur healing. Basically with Cortisone, you are trying to take away the discomfort with the injection, while the thought here is trying to get rid of it altogether. The upside with Cortisone, however, is a player is typically only sidelined a few days, while PRP takes much longer.

How long does this process take?

Dr. Andrews told Britton to prepare for a “six-week or more” process and Niedfeldt agreed.

“The downside is, it’s not a quick fix. It’s something [where] you can’t rush the biology of healing,” he said.  “When you are doing these things you are trying to get the body to heal itself, but the body can’t do that itself in a week or two, it typically takes 4-6 weeks. Things that were chronically damaged may take 8-12 weeks.”

Niedfeldt said he’s had patients who didn’t see any improvement for 12-16 weeks even.

“It’s highly variable and really based on the individual, [and] what area of the body you are treating,” he said.

Will it work?

Maybe.

“It’s not a magic bullet by any means,” Niedfelt said. “In some cases this is something that can heal the problem, and in some it doesn’t. There are various degrees of success.”

Britton will be shut down for at least 7-10 days, allowing the PRP to stay in the area, and his progress will be closely monitored for the next few weeks to see how the procedure does.

“That’s pretty typical, to shut somebody down completely for the first couple weeks, then see how they feel, then you start into lower level rehab after that,” Niedfelt said.

Right now, the procedure is typically done with chronic issues, such as Britton’s, although there is thought to trying it for more acute injuries as well. Niedfelt said they are starting to learn where it won’t work –on surgically repaired rotator cuffs, for example — although a lot of research and experimenting with this is still in the early stages.

“We are still learning where it’s working,” he said.

Britton said today he was made well aware of the longer recovery process and weighed his options before making the call to have PRP.

“[Dr. Andrews] had some pretty good success with it in the past. He’s been doing it for a while now,” Britton said.

“I’m not going to rush back and have the same issue crop back up. It’s just a process that I’ve got to take. I’m frustrated with it, but if it’s going to help me pitch and have a long career, that’s the most important thing. Not necessarily being ready to pitch in April.”

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