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.
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.
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.
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 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).
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!