River Bridge Distances
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP)
by Gary Fogelbach
Perhaps you've seen the advertisements for PRP injections in local magazines. The person in the ad is John Howland, local runner (with an impressive resume) and JCRR member. The physician who helped John is Brad Sloan, local sports medicine specialist and JCRR member. I was just about ready to give up hope. A nagging injury had progressed to the point where running was no longer any fun, and barely possible. I remembered seeing the magazine ad and asked the doctor who was treating me in December 2009 if this PRP would help. He said it's worth a shot and referred me to Brad. My injury was not a specific traumatic event that occurred, but rather an insidious, tightening of my left hamstring muscles and tendons. The pain was right where the three hamstring muscles coalesce and attach to the sit bones, an area called the ischial tuberosity. Over time, this caused gradual tightening of the hamstring all the way down to behind my knee. This all began years ago, in the mid-nineties. I messed around with this for the better part of fifteen years.
Massage, physical therapy, chiropractic, yoga, stretching, all the traditional therapies, you name it, I had probably tried it. The more I ran the worse it got. Finally in 2009 it hurt too bad to continue. From January through December 2009, I had 19 chiropractic visits, 4 physical therapy visits, one MRI, multiple x-rays, two visits to an orthopedist, one nerve test and three steroid injections. While the steroid injections addressed some nagging sciatica, there was still no relief for the chronic hamstring. Every time my left foot came off the ground (the heel lift in a normal stride) I would feel a pull at the ischial tuberosity. Then as my leg continued forward through the gait cycle, the pain felt as if there was a fish hook attached to my butt that someone behind me was tugging on. This severely restricted my normal range of motion and resulted in weakness and compensatory damage. For example, my left leg does not swing as freely as my right. My left hip flexors, quad and IT band are extremely tight. Bending over, tying shoes, going up steps, driving, were literally a pain in the butt.
Brad Sloan's area of expertise is non-surgical orthopedics, which is something that seemed particularly attractive to me. I was not interested in getting cut on. Especially since my injury was at the left ischial tuberosity. Who knows how much damage could occur cutting through those muscles?
After a thorough examination I had been told by an orthopedic surgeon that minimally invasive back surgery would fix my problem. The problem with back surgery was simple, my back didn't hurt. So I ruled it out even though I received diagnoses of scoliosis, spondylolisthesis, degenerative disks and piriformis syndrome. A surgery recommendation is what I should have expected from an orthopedic surgeon. The new back procedure is called "X-lif." You may have heard of it. It may have worked, but I just wasn't ready for it. Surgery is the last of last resorts.
After an initial evaluation by Brad Sloan at his clinic on Southwest Boulevard I had my first injection a year ago, in January of 2010. While the injection can start the healing process, Brad is a big proponent of physical therapy to address the underlying causes. So I continued with PT throughout 2010. It was near the end of January, right after the injection, that I gave up running on the advice of my physical therapist. Basically, it's hard to assess if we're making any progress if I'm continuing to do damage.
The first injection did not help much. Then again, it is difficult to pinpoint the exact site of the injury when a very small needle is being inserted. Here's how it works. When you go in for a PRP injection two small vials of blood are drawn from which the plasma is obtained. Brad asks you to pinpoint where the pain is, then inserts the needle. He guides the injection by ultrasound, but when there is a significant amount of damage it can be difficult to hit the exact location, or to cover all of the damage. There is some slight discomfort that only lasts a few seconds and that's it. Then there are follow up visits to assess the results of the procedure.
After being referred to a PT who is a hip and back specialist, the physical therapy began to give me some relief, though temporary, from massage, ultrasound and stretching. I was also getting a bit stronger as I was performing my PT exercises in place of running. Brad scheduled my second injection in April. This injection also did not provide the relief I was seeking. Typically, it takes a period of a few weeks for the effectiveness of the injection to take hold. After more follow-up, Brad decided to try one more injection. This one, in mid-June, did the trick. Within a few days the pain in my hamstring began to subside. Brad was not sure what was helping: If it was the cumulative effect of three injections, or if he finally hit the right spot. At any rate, for the first time in years I was able to flex my left knee without a sharp pain in my butt. Brad suggested I continue with the PT, and that when I start to run again to mix brief periods of slow, gentle running with walking breaks. Something I was definitely not used to, but which really adds to the enjoyment of running.
I'm sure that the last injection stopped the pain. Nothing else worked. Every time I raised my left heel off the ground it hurt. Now it doesn't. The ultrasound and massages I received in PT helped, but the pain always returned within a day or two. It has been seven months and the significant pain has not returned. Now I am primarily concerned with not undoing the affects of the injection and reinjuring my hamstring. Running slowly and continuing to do my PT exercises to strengthen and stretch my hamstring, hips and pelvis is helping. There is what I would call a shadow pain. Something that is likely attributable to the tightness in my hamstrings and the misalignment of my pelvis, hips and legs. It is not the same, however, as the pain that was in my hamstring.
The weakness in my left leg was substantial and it is taking a lot of work to strengthen. If you've ever seen a leg curl machine, where you lie on your stomach and use your hamstrings to pull weight toward your butt, I could not curl ten pounds one time with my left hamstring. It was very weak and painful. I also used to get some severe cramps in my hamstring, particularly after a long run. Now, I can do 15 reps of twenty pounds for three sets.
One other thing that helped is that my PT recommended that I have a podiatrist fit me for new orthotics, to support my feet and keep my hip and leg from falling in. All in all I had a total of 34 PT visits in 2010. The PTs at Capital Region Medical center certainly facilitated my healing process through many of the treatment modalities mentioned above, but most importantly in suggesting, demonstrating and reinforcing leg, hip, back and core exercises to correct imbalances and strengthen weaknesses to prevent recurrence.
Over the course of 2010 I did not miss running at all. All things considered, it was just too painful to continue. In effect, I substituted PT exercises, gym work outs and some bike riding for running. Something I should have done more of during my less than illustrious running career.
Throughout the treatment Brad Sloan was confident and enthusiastic that I'd be back to running, but emphasized running slowly while continuing with the exercises. Needless to say, I would highly recommend a visit to Brad if you are experiencing a long term injury that is not responding to conventional treatment. You don't have to run with pain.
If you would like more information on the PRP injections, the therapy or the various types of treatments I went through in an effort to obtain an accurate diagnosis, please contact me at firstname.lastname@example.org.
You may also want to visit the Sloan Clinic website for more information: http://www.thesloanclinic.com/.
This article is written as a basic guide for your training decisions and is not intended as a substitute for professional medical or training advice. As with all fitness programs, consult your doctor’s approval before you begin.