PRP. It’s a real pain in the butt

Seventeen years now. It’s been roughly 17 years that I’ve struggled with intermittent hip pain / hamstring tightness / sciatica, blah-ba-de-blah, etc. It comes and goes, and while it has never stopped me from running, it has stopped me from running well. My latest flare-up, which began about six months ago, has been the worst – and most stubborn – yet.

THE VERDICT

Having completely run out of patience babying my achy butt, moderating my speed and gingerly prancing up hills to avoid overstretching my immobile hamstring, I finally saw an orthopedist and pushed for an MRI. Verdict: chronic partial tearing, scarring and tissue thickening along the hamstring, most severe at its origin near the ischial tuberosity; essentially high-hamstring tendinopathy. It’s anyone’s guess when the degeneration began, but the tendon clearly isn’t healing itself. After an unwelcome lecture pointing out that my aging body is only going to further weaken (I’m 32 for god’s sake!), that my vegetarian diet is not suited for athletes (curious how he’d explain these ultra-runner and ultra-athlete veggie legends), that my bare feet need “support” and that I should really just stop running so much, my doctor finally offered a rational alternative: PRP, or Platelet Rich Plasma. I eagerly agreed, desperate to try anything that might nip this butt-pain in the bud and finally restore strength and functionality to my weakened tendon.

THE PROCEDURE

As a relatively new technique, PRP protocols vary considerably across practices. My doctor advised a series of three injections, spaced 7-10 days apart, although he reported the number of necessary treatments can range anywhere from one to five, depending on the injury and patient. And in some cases, the treatment isn’t effective at all. The procedure is actually quite simple and takes under an hour. They first draw blood which is then centrifuged and processed for several minutes to yield a solution rich in platelets. This provides a concentrated source of factors that support healing, like growth factors and cytokines. The goal is to induce an inflammatory response to promote tissue repair. Next, the doctor identifies the target site by manually probing around until he hits the “hot spot” of pain. After preparing the skin with some disinfectant (and a mysterious cooling liquid), he inserts the needle, guided by ultrasound, and injects the platelet-rich plasma. In my case, the pain was relatively diffuse, so he injected at several different locations of my hamstring origin, to cover all bases.

Platelet_Rich_Plasma_PRP-Therapy-IMAGE

I will not lie, the procedure isn’t fun. There were some painful moments, although never intolerable. I’ve read that many physicians will use local anesthetics during the procedure and prescribe pain-killers for pain management, although mine did neither. I guess I just look that tough. 😉

As a relatively novel, borderline experimental treatment, PRP isn’t covered by all insurance plans. Mine fortunately covered it fully. Otherwise, each injection may put you back $1000 or more.

THE AFTERMATH

The doctor indicated that I’d be fine to drive afterwards, which was far from true. For the next couple of days, sitting – especially on hard surfaces or while driving – was extremely uncomfortable. There was a constant deep, dull ache and the sensation of a severe bruise at the injection site. Since the therapy relies on a strong inflammatory response, ice and anti-inflammatory medications (which I avoid anyway) are not allowed. Each day the pain subsides slightly, and today, four days post-injection, I feel 90% normal (not healed, just 90% of my pre-PRP state).

ACTIVITY

My doctor gave very limited guidelines for my activity levels during the recovery period. He in fact skirted the issue, indicating that my activity depended on my “need” to run, and my healing goals. On one hand, he said, he’s had athletes compete hard just a few days after the treatment and manage a full, successful recovery. On the other hand, any amount of irritation to the tissue could delay healing and set me back. A confusing, unsatisfactory response. Being both a strong believer in active recovery, and one who spirals rapidly downwards when I can’t run, I opted for the more aggressive recovery trajectory.

After two days of near total rest (excepting some very light yoga), I ventured out on a test run. I set a mental limit of three miles, acknowledging that attempting a run so soon was pushing the envelope already. So of course, I accidentally ran six instead. To my great surprise, my hamstring felt no worse than pre-PRP. Sure, it was tight. Yes, it was achy. But the discomfort level was the same as while resting or walking, and did not progress throughout the run. Today – the day after this test run – the hamstring continues to improve. So I’m treating myself to another easy run, of no more than 4 miles. I promise.

MY BOTTOM’S BOTTOM LINE

So what’s the verdict on PRP? It’s far too early to tell. For one, it’s admittedly painful. And at only four days into the therapy, it’s far too early to tell whether it’s working. Purportedly, symptoms may start to improve anywhere between several days to months after treatment. But the underlying science is logical, and the immediate resulting deep ache confirms that an inflammatory response is indeed underway. This is enough to give me hope, and hope is enough to keep fueling my runs.

Have you gotten PRP or are you considering it? I’d love to hear your experiences and questions!

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16 thoughts on “PRP. It’s a real pain in the butt

  1. Hubster says:

    Update: it was 6 miles again 😛

  2. I came upon your blog while trying to find other runners who are suffering from hht and also had prp to see if it helped with their recovery. I just had the PRP December 12th. I’ve had hht and sciatic/piriformis issues for more than a decade of running but it never kept me from consistent high mileage weeks and ultra marathons until really about 8 months ago. Finally around 4 months ago I had to almost stop running altogether except for a few 4 or 5 mile runs each week in the hopes of healing. After four months, the rest seemed to finally be having a positive effect but not nearly enough to completely heal which is what I am trying to do so that I can run competitively again. My doctor told me to not do any running for 4 weeks which I am abiding by but was interested to see that you had done some light running. How has the running gone in the past week? Have you continued to improve? Do you think the PRP has led to significant improvement? I have read positive medical material on PRP but have trouble finding runners who can just say positively that it ”cured” their hht. By the way, here is a link to my running blog with more of my hht troubles and thanks for sharing your experience! http://mtntrailrunner.blogspot.com/

    • Emilie Reas says:

      Tommy, I’m sorry to hear you’re dealing with the same injury – it’s certainly the most stubborn injury I’ve experienced. As an update, I’m 2 weeks into the PRP and just got my 3rd injection today. I’ve definitely noticed an improvement, however it’s impossible to know whether it’s from the PRP or the relative rest. I’ve still been running, but have cut my mileage roughly in half and am taking it really easy – short, flat and slow. Since starting the PRP, I’ve been managing about 25 miles/week.

      I know it’s only been a few days, but have you noticed any effect? It’s helpful to hear from another runner going through the same thing, especially since there’s so little info out there on PRP.

      • david says:

        Hello, im Also struggling with bilateral pht in your opinion PRP worth a try? It helped you? Thanks

  3. Yes it is good to finally hear from someone going through the same thing. It’s been 8 days since my injections (there were two because it was bilateral) and most of the soreness has worn off though I do still feel quite a bit of localized soreness at the site of the injections. I still have not run so it is hard to say whether the injection has helped. I’m going back for a follow up appointment in 3 more weeks and I expect to be given the green light to resume some light running presuming that all of the pain has gone away. In the meantime I’ve just been doing some light stretching especially of the hamstrings because they are so tight and always have been. But sometimes I read conflicting information on whether to stretch or not to stretch so that is why I am taking it really easy. I had hoped to do some ultra trail runs in Jan and Feb that I have done every year for over ten years but I am going to skip those. I am suppose to pace the Little Rock Marathon in March but will likely have to skip that as well. My goal now is to heal up completely because this summer I want to do Jemez 50 in NM and San Juan Solstice 50 in Colorado which I have done in the past as well as some thru hiking. So I am trying to set my goals further down the road and really focus on recovering completely from this injury and hopefully be done with it. That being said, if I do not heal 100% by March or April, I am going to do those events any way and will just have to assume that it will never completely heal. That’s what makes this injury tough. I could run today if I wanted but I can not run fast and there is a lot of discomfort while running which takes away from the fun. Please keep me up to date on your recovery because if you find things that work well for you, I may try them as well. Why three injections? Did the doctor feel that was the best way to heal it? Thanks again and good luck!

  4. […] occasional niggle, along with a few days of forced rest to recover from a foot infection and PRP injections for a chronic hamstring […]

  5. […] covered the procedure is detail previously, but to summarize, I received three injections into the injured hamstring, […]

  6. Emilie Reas says:

    Hi David. Sorry to hear about your injury. Yes, the PRP was quite helpful for me – see more about my recovery here: https://emiliereas.com/2015/01/04/prp-a-shot-full-of-miracles/

  7. Just had PRP in PHT two days ago. Oddly not sore now–the procedure was decidedly unpleasant, however. I’m wondering if maybe it’s not so sore since I was relatively pain free on the day of the procedure and have been slowly getting stronger since onset of this insidious horribly frustrating injury 10 weeks ago. Thoughts?

    • Emilie Reas says:

      Hi Theroadback – So sorry you’ve been dealing with this for so long! I understand your frustration, but that’s great news you’re starting to feel stronger. For my injections, I noticed the aftermath was relatively pain free if I was getting better or the doctor couldn’t find the injury focal point. I think the pain is caused by injecting into damaged tissue and inducing inflammation, so if you’re not feeling much pain that may be a good sign you’re far into your healing. Best of luck with your recovery!

  8. Kayle says:

    Hey! I’m a dancer and fitness instructor who’s been dealing with this pain for YEArs and it’s gotten out of control.
    I am considering it for BOTh of my hamstrings since both are terrible and now my back is too,
    Did you do pT as well? Thinking of getting the PRP shots then taking off completely for 2 months yo try and get back to stretching and sitting pain free. Sitting, sleeping, yoga, dance, squats and all type of activity hurt me. I’m so helpless at this point. My insurance doesn’t cover it but at this point I’m desperate.

    • Emilie Reas says:

      Hi Kayle, I’m sorry to hear about your condition! I have been going to PT regularly for a few years now and it’s definitely helping to keep my hamstrings healthy. Specifically, developing my core and glute strength is making a big difference. Best of luck!

  9. keri mayo says:

    Did you ever get a full recovery?
    I had a PRP 4 weeks ago
    Same injury
    Have had it off and on for 7 years
    I just took 3 weeks off from running- it’s no better… thinking if getting second injection
    Curious if you recovered? Tx!

    • Emilie Reas says:

      Yes! I’m fully recovered. You might need another injection. I needed three and I understand it’s quite common to need multiple. Good luck!

  10. 4 Days post RPR – OOOOOOOOOOOUUUUUUUUUCCCCCCCCHHHHHHHH!!!!!!!!!!!

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