Many injuries to various parts of the body will heal on their own. In some cases, however, the damage can remain or grow worse over time and cause chronic pain and restricted movement. This is common in joints such as the knees, hips, elbows, and back. A promising new treatment for sports injuries is platelet rich plasma (PRP) therapy. PRP for tennis elbow, in particular, is used to enhance the body’s own healing capabilities to restore function and alleviate pain from this common sports injury.
How could PRP for tennis elbow work?
Tennis elbow is a painful condition that is not always related to swinging a racquet. Those who have not experienced it may not realize how serious it can be, making jokes about what caused the injury to occur. While tennis elbow may show up as the punchline, there is nothing funny about this painful condition. Tennis elbow can be debilitating, affecting everyday life in ways both major and minor.
PRP therapy, on the other hand, can improve our own body’s natural healing systems. It’s also minimally-invasive with little side effects. Because tennis elbow is such a common condition, it requires therapies that complement daily living and help you get back into the game.
Doctors at Arizona Pain explain the basics behind PRP therapy. From there, we’ll look at what causes tennis elbow in order to examine how PRP for tennis elbow could help patients suffering from this condition.
What is tennis elbow?
The elbow is a joint constructed of three bones: the humerus in the upper arm and the radius and ulna in the lower arm. The humerus has two bony protrusions known as epicondyle. These epicondyle come together with connective tissue and ligaments and the bones of the lower arm to form the joint.
Each part of bone that connects is covered with cartilage that helps the bones move fluidly. In addition to this cartilage, the elbow is also lubricated by synovial fluid that helps movement as well. The entire joint is stabilized with connective tissue and cartilage.
Tennis elbow occurs when the epicondyle on the outside of the elbow joint becomes torn or inflamed. This can be as a result of repetitive motion causing wear and tear on the joint, or it can be caused by improper use of the joint.
A related condition, golfer’s elbow, is generally diagnosed as such because the pain occurs in the epicondyle on the inside of the elbow.
Tennis elbow symptoms
Tennis elbow has a number of different symptoms that can range from mild to severe. They include:
- Pain in the joint
- Swelling and redness
- Radiating pain, either up or down the arm
- Weakness in the joint or arm
- Stiffness in the morning
- Numbness or tingling in the arm, elbow, or fingers
People with tennis elbow sometimes report difficulty making a fist. This affects everyday activities, including opening doors, lifting objects, or shaking hands. PRP for tennis elbow has the opportunity to help patients reduce or even avoid these symptoms entirely.
Tennis elbow risk factors
Tennis elbow is most common in athletes who repeatedly tax the elbow joint. Although this injury can have a sudden onset, it is most commonly diagnosed as a repetitive motion injury. Over time, even casual players can develop this injury.
But this injury is not restricted to athletes, either professional or amateur. Occupations that strain the muscles of the forearm – plumbing, painting, and carpentry – also experience high rate of tennis elbow. PRP for tennis elbow may be especially helpful for people whose livelihoods depend on their body’s ability to work.
The most common diagnostic tool for tennis elbow is an in-depth patient interview that looks at types of activities and onset of pain. Other diagnostic tools include a physical examination of the area to find any tender spots. MRIs and X-rays may be ordered to rule out other potential diagnoses, but they are not required to make a diagnosis of tennis elbow.
How does PRP therapy work?
PRP therapy begins by drawing some of the patient’s own blood. This blood is placed in a special type of centrifuge and spun until it separates into three layers. The top layer contains only plasma with very few cells. The bottom layer contains concentrated red blood cells — cells responsible for transporting oxygen and nutrients throughout the body.
In between those layers is a middle layer containing concentrated platelets. This middle layer — called platelet rich plasma — is separated from the other components of the blood in the centrifuge.
Does PRP work?
Platelet rich plasma was first used during open heart surgery in 1987. Since its development, PRP has been applied in many fields of medicine, including:
- Cosmetic surgery
- Sports medicine
- Pain management
Platelets are best known for their role in wound closure. When you get cut, platelets help stop the bleeding so that long term healing can begin. Platelets are also important to long term healing. Platelets contain biologically active proteins, including many involved in the regeneration of tissues. PRP also contains growth factors that support the growth of new tissues.
Together these proteins and growth factors are responsible for healing various injuries. By concentrating them in platelet rich plasma and then injecting this concentrate at the site of an injury, we are delivering a concentrated dose of the body’s healing ability where it is needed the most.
The effectiveness of PRP for tennis elbow and other chronic pain conditions depends on the overall health of the patient at onset, the particular area of the body being treated, and whether the injury is an acute one or due to a longer term chronic condition.
Research on PRP therapy
Research studies have found PRP to be promising for alleviating certain chronically painful conditions, but more research is needed on the specific conditions it can treat. With further research will come a better understanding of how PRP therapy for tennis elbow may work for patients.
One study of 14 patients with knee osteoarthritis receiving a series of PRP injections found that these patients had reduced pain and improved knee movement. Another study of 91 patients treated with PRP for degenerative cartilage lesions and osteoarthritis of the knee found that after treatment, patients experienced reduced pain, improved knee function and quality of life. These improvements remained at 12 months after treatment.
A University of Alberta study from 2016 reported that patients saw better pain and mobility after using PRP injections. While it was a smaller study, these results did show clinical relevancy and could encourage more research into PRP therapy.
Doug Gross, author and interim chair of physical therapy at the Faculty of Rehabilitation Medicine, noted that:
“Based on MRI findings before and after the injections, we saw improvements in the tissue six months later in five of seven patients undergoing PRP and an appropriate rehabilitation program. The healing in the tissue appeared to correspond with the reported improvement of the pain and also with the clinical assessment of function.”
Tennis elbow treatments
PRP for tennis elbow isn’t the only treatment option you can try. We’ll look at a few options–ranging from at-home remedies to more interventional treatments like surgery.
At-home treatments for tennis elbow
The first line treatment for tennis elbow is truly prevention. Utilizing proper form in all activities can help prevent this condition from occurring. If it does occur, however, there are other at-home remedies for treatment.
- Rest: For mild cases of tennis elbow, rest may be all that is needed. This can include minor, supported stretching of the joint but generally avoids any strenuous activity. You may also choose to use hot and cold therapy to help speed up healing.
- Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS): Over-the-counter non-steroidal anti-inflammatory drugs are usually diagnosed in conjunction with periods of rest. Because excessive use of NSAIDS over a long period of time can have severe gastrointestinal side effects, it is important to work closely with your doctor to monitor whether or not these drugs are helping.
- Physical therapy: As the injury progresses in severity, physical therapy may be necessary to safely and properly exercise and strengthen the muscles surrounding the joint to provide better support and stability.
- Supportive braces: Braces can be used while in recovery and then also during more strenuous activity. This is often recommended for those who have just recovered from tennis elbow as a preventative measure against re-injury.
PRP for tennis elbow
While more research is needed, anecdotal and emerging research is looking towards PRP for tennis elbow as a possible treatment option for more severe or chronic cases. In these cases, PRP injections are generally administered on an out-patient basis. The entire procedure takes less than an hour, with much of that time spent extracting platelets from the patient’s blood.
Once the injection area is cleaned and sterilized, the injection is made. Typically, patients should avoid strenuous activity for up to 24 hours after the injection, but they can participate in daily activities almost immediately. Pain relief may be instant, with results lasting up to three to six months, based on latest research findings.
Other treatment options for tennis elbow
For even more chronic cases of tennis elbow, or tennis elbow that doesn’t respond to PRP injections, there are other options.
- Elbow steroid injections: For tennis elbow that does not respond to less-invasive treatments, injections at the injury site may provide relief from pain and reduction in inflammation. These injections generally utilize a steroid to minimize inflammation as well as an analgesic such as lidocaine for pain relief. While these types of injections are considered minimally-invasive, they are best reserved for refractory pain that does not respond to other treatments.
- Surgery: In the most severe cases of tennis elbow, surgery to remove the affected muscle tissue may be the only treatment option that provides relief.
There is some evidence that acupuncture can offer relief for joint pain. Many who experience persistent or refractory pain due to tennis elbow would be well-advised to give this complementary therapy a try in conjunction with more traditional treatments. Many pain doctors are beginning to work with qualified acupuncturists to address tennis elbow in a more holistic manner. Because of this, many insurance companies now provide some level of coverage for a number of acupuncture sessions.
PRP side effects
PRP for tennis elbow side effects are mild, since the patient is receiving their own blood. Side effects may include slight pain or bruising at the injection site following the procedure.
The risk of side effects for other treatments of tennis elbow are also generally minimal, even in the case of injections and surgery. Injection-related side effects may include redness and soreness at the injection site. Surgical risks are the greatest, and can include infection, tissue damage, and loss of strength or range of motion in the elbow joint.
Talk to your doctor about PRP for tennis elbow
Your doctor can help you learn more about the different treatment options you have if you suffer from tennis elbow. Tennis elbow pain doesn’t have to take away from your quality of life, or the game. There are treatments that can help. Talk to a certified pain management doctor today to see what at-home treatments or interventional strategies could help you.