This week’s column addresses one of the most challenging injuries suffered not only by competitive athletes but also active adults – a hamstring injury. It can cause an active person to miss weeks from his sport or exercise. It can also put him at risk for suffering a repeat hamstring injury in the future. Can a fairly novel treatment help him recover from this injury faster?
I had a patient present to my office a few weeks ago who injured his hamstring playing soccer two days earlier. The back of his thigh had a huge area that was dark blue. He had pain when I pushed in the middle of the hamstring muscle belly in his mid-thigh, and he struggled to walk or extend his hip and knee comfortably. He asked me if a treatment he had heard that professional athletes were using would help his hamstring injury heal faster.
Treatment of a hamstring tear
Before I discuss PRP, let me briefly review our traditional approaches to hamstring injuries. Most treatment options for a hamstring injury within the muscle belly are nonoperative. Rest from the sport or exercise while the injury heals is critical. Other common treatments include anti-inflammatory medications, ice, compression and even limited weight-bearing with crutches. Still, orthopaedic surgeons have few options at our disposal to speed the healing of hamstring injuries, since we must wait for the patient’s body to heal the injury.
Platelet-rich plasma (PRP)
Platelet-rich plasma (PRP) is a fairly new treatment in which the physician draws a small amount of blood from the patient, spins it in a centrifuge to remove red blood cells, and reinjects the plasma concentrated with platelets. In theory, the platelets improve the body’s healing response by delivering cytokines and growth factors into the injury site.
As I have mentioned on my podcast and in blog posts on this site, I have been somewhat disappointed by the results from studies looking at the effectiveness of PRP. Recent studies have shown mixed results with PRP treatments for lateral epicondylitis (tennis elbow), Achilles tendinopathy and osteoarthritis of the knee.
In terms of hamstring injuries, though, we might have hope. A study published in the American Journal of Sports Medicine examines the effectiveness of single PRP injections for acute hamstring injuries.
PRP for a hamstring tear
Researchers collected data from 24 athletes determined by ultrasound to have suffered partial tears of the hamstring muscle fibers. Patients in the treatment group received a single injection of 3 mL of PRP injected directly into the injury site under ultrasound guidance. Patients in both the treatment and control groups underwent agility and trunk stabilization rehabilitation exercises.
The authors measured the effectiveness of PRP using one primary outcome – return to play. Specifically, the patient had to be free of pain to direct palpation and pain free with hamstring contraction. He had to show symmetrical range of motion compared to the opposite limb.
Finally he had to demonstrate strength within 10% of the uninvolved limb on isokinetic testing. Then the patient could resume full activities and increase training until reaching his preinjury level of play.
In this study, the patients who received PRP for acute hamstring injuries did return to play faster. The mean time for return to play in the PRP group was 26.7 days, compared to 42.5 days in the control group. Similarly, half of the patients in the PRP group reached a point of full recovery by 26 weeks follow up compared to 39 weeks for half of the control patients to do so.
Return to sports and exercise
While I have been skeptical of the effectiveness of PRP for many musculoskeletal injuries, I am encouraged by these results for a difficult sports medicine injury. And it’s good to see that the authors did not decide return to play simply by some gut instinct of the orthopaedic surgeon or physical therapist that the patient could try to return to sports again. They used pain assessment scores and objective findings on isokinetic tests.
It is important to note that this study looks mainly at short-term return to play. It does not follow the patients for a longer period to determine rates of reinjury. We know that an athlete who suffers a hamstring injury is far more likely to suffer another hamstring injury than someone who has never suffered one. It is unclear from this study whether PRP would have any benefit in decreasing the risk of recurrent injury.
The study does at least give orthopaedic surgeons and sports medicine physicians optimism that we can treat athletes with hamstring injuries more effectively and help them return to sports more quickly and safely.
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