PSR January 2025

Hey PS+R Crew! Happy New Year!

PS+R is excited to launch our new website (www.performancesciencerehab.com) with full explanations of services, testimonials, and evolution over the past 3-years. Be sure to check it out!

“Goals are for people who care about winning once. Systems are for people who care about winning repeatedly.” -James Clear

What’s your system for the new year to meet your health and wellness potential?  What barriers are keeping you from optimizing your health?  

If you are experiencing barriers to reaching your health goals, PS+R is here to help you reach new levels in 2025 and beyond!

We’ve been getting more questions in the clinic about “adjunctive” therapies for chronic conditions.  We call them adjunctive as the mainstay of treatment for most musculoskeletal problems is movement and exercise! But for some stubborn conditions, adjunctive treatments can be incredibly helpful to move past a persistent injury.  The three most common therapies we are asked about are shockwave therapy, PRP injections, and stem cell therapy.  This month, we review these procedures and the evidence for their use in different musculoskeletal conditions.

Shockwave therapy

Shockwave therapy uses a soundwave transmitted through ultrasound gel.  It was originally used for breaking up kidney stones but somewhere along the way it made a jump to musculoskeletal applications- particularly with painful tendons. Shockwave therapy does appear to help with pain in soft tissue injuries but we aren’t sure the mechanism why.  The research shows promising results in pain levels however there is a lack of randomized control trials to support its use.  It seems at the moment that the main downside to shockwave is the expense of repeated sessions.  Anecdotally, in people with achilles tendinopathy- especially the most difficult type where it inserts at the heel and the blood supply is poorer and healing is slower- 3-6 sessions of shockwave therapy appears to have a beneficial effect on recovery in conjunction with an appropriate loading program.  Shockwave is likely not helpful as a standalone treatment but rather an adjunctive treatment to traditional exercise based approaches to tendon rehabilitation.

Platelet-rich plasma (PRP)

PRP is an injectable created by the patient’s own blood. First, blood is drawn and then spun down in a centrifuge to acquire the plasma aspect of the blood draw.  The advantage of plasma is that it has a platelet count that is higher than in standard blood.  Platelets release growth factors and proteins that can stimulate repair of tissue and decrease inflammation so the goal of a PRP injection would be to accelerate the healing process in a tendon, ligament, muscle or joint.  PRP has positive evidence to support its use in tennis elbow (lateral epicondylitis) over a steroid injection however the effect seems to be delayed for up to two years after the injection.  There is also evidence that PRP is effective in reducing pain in rotator cuff tendinopathy and patellar tendinopathy however less evidence to support its use in achilles tendinopathy.  A preparation of PRP called “L-PRP” that has white blood cells called leukocytes and a network of low density fibrin molecules (the building blocks of scar tissue) seems to be the most effective in trials investigating PRP for tendinopathy.  PRP is also used for joints and appears to show improvements in joint related pain for about a year after injection. These results appear to benefit younger people with early onset OA more than the general population. ¹

Stem Cell Therapy

Stem Cells are a type of cell that has the ability to differentiate into different types of cells in the body. Because of this, they have drawn a lot of interest for regeneration of tissue in the body when there is an injury. For people with musculoskeletal pain, the main area of interest and application is to repair or grow new cartilage in a joint as a treatment for arthritis.  Since cartilage has been one of the most difficult tissues to successfully repair or regenerate, the promise of stem cell therapy in conditions like knee osteoarthritis is great.  The procedure requires that the cells be taken from the patient, or perhaps from a donor bank, and are then prepared and injected or placed back into the region of damage, sometimes in a surgical procedure and other times as an injection.  The most recent evidence we have on this topic is a systematic review that includes 420 patients who underwent treatment with their own stem cells.  Because there are still quite a few differences in how the cells are harvested (from a patient’s own bone marrow, fat, or blood), prepared, and placed, its not possible to compare the current studies we have available.  Although the evidence is not robust yet, early results are suggesting a positive effect of stem cell therapy including improved knee function and pain, and either a slowing of the rate of cartilage degeneration or an increase in cartilage thickness on imaging studies.  All of these findings are very exciting to treat cartilage injuries and perhaps help people prevent or delay a knee replacement.  Regenerative medicine will certainly be interesting to watch in the future! In the meantime, techniques for using this therapy can differ greatly which may impact the outcomes of the procedure.²

1. https://eor.bioscientifica.com/view/journals/eor/6/4/2058-5241.6.200017.xml?utm_source=hs_email&utm_medium=email&_hsenc=p2ANqtz-_mG-6CZ-94o6uZEbXNClLWc6kqPwbF8YVZ0If4RwUb_9JRwESD8wzZiFSsaAFYutm3UDJ- ↩︎
2. 
   https://bjsm.bmj.com/content/bjsports/early/2021/05/25/bjsports-2020-103671.full.pdf?casa_token=rasl_sbPZ24AAAAA:h8WAXxIy-EM8q5Xw0Xo735hpI53wxeo92acpCBldgDi-csTSbmV-RoyWmkdj5CRdyxLuQC-CtnE ↩︎

PS+R In The News | January 2025

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