This article recently caught my eye.
A Utah doctor told assembled colleagues at the annual meeting of the American Society of International Pain Physicians that studies are showing the efficacy of platelet-rich plasma (PRP) therapy for various conditions, including knee osteoarthritis.
Dr. Richard Rosenthal cited for example a paper showing that patients (the subjects were age 45 to 85) had a significantly smaller chance of reinjuring their rotator cuff after a massive tear if they received PRP gel. A different study demonstrated a salutary outcome for lower back pain sufferers.
Caveats are in order of course, as the article notes. PRP is still a relatively young procedure. Issues remain to be sorted out, from the proper protocol for treatment to identification of differences among some 40 products currently on the market.
One voice of caution, Wellington Hsu of Northwestern’s school of medicine, notes that there are “holes in the evidence for PRP in the management of osteochondral lesions and knee osteoarthritis.”
So, expect further studies. The good news is, if PRP continues to shine in clinical trials, insurers may agree to pick up the tab for the procedure -- some $750 per injection -- which (at least in the U.S.) they won’t do now.
I'm a cautiously optimistic fan of PRP, having had a course of 3 injections in my knees between June and August this year, which significantly reduced my pain levels. I also noticed it significantly reduced the horrible noises that came from my knees if I couched down and then got up again (something I try to avoid due to the noise/discomfort). But I don't think it eliminated the need to be careful and continue to rehab my knees slowly.
ReplyDeleteI was offered PRP here in Oz about 2 years ago by a Sports Dr, but it was going to be $500/knee/injection and I was only at the start of my knee journey, so did not take it up. But after 2 more frustrating years, my new Pain Specialist recommended it again and he did the job for just $110/knee/injection, so I went with it - worth a try at that price.
Also note, I got into a discussion about PRP on the KneeGeeks Forum, and some responders in the US had noted there was some dubious marketing going on over there - medicos who claim their platelet spinning method was superior and charging accordingly. The KneeGeek view is that a centrifuge is basically a centrifuge as as long as you spin the blood at the required speed/time, you will get adequate separation of the platelets which can then be extracted and injected. There is some talk about the level of contamination of the platelets with other parts of the blood fraction (e.g. white cells), and that these contaminants can increase the initial level of inflammation response after the injection. All I know is my Pain Specialist uses a Swedish platelet separation system, called Regen - and the Swedish have a habit of doing things properly!
cheers, TriAgain
Thanks for some good detail, TriAgain. I don't know much about how the procedure is marketed/performed in the U.S., but that's good for people to know that shopping around for a fair price might be a good idea.
DeleteHi Richard,
ReplyDeleteThis therapy is interesting, I've heard of people who got better. I'd like to try it out.
I've been reading your blog and book, as I recently found out about my 'chondro'. Also read The runner's knee bible and Doug's blog. It is the most reasonable approach to this condition. While reading your book Richard, I'm wondering, when you were doing your outdoor walkings, I guess that was completely pain free? I would struggle to do that much at the moment, as it is sore when I walk. I was trying to walk and rest in my house and my knees are not so stiff so I guess is a good habit, I will have to experiment more though.
I've also quit my job... the reason at that time were not my knees but now I think I'd benefit for being off for a while.
Regards,
Athenea
Hi, and welcome Athenea (great name). Yes, I was lucky that my outdoor longer walks were largely free of pain and discomfort. Once I realized that healing was going to be a long and gradual process, I made myself go very slowly. Sounds like you're in the experimentation stage for sure, and maybe at a worse place than I was. You can get in a lot of movement just around a house/apartment, I discovered. Or my other trick walking outside: I would walk for a couple of minutes, sit for ten minutes, walk for a couple of minutes, sit for ten minutes (I could always find a bench in the city). Boring as hell, but I was determined to get in as much motion as I could, without overstressing my joints. :)
DeleteFor some time I plan to write this. Richard's blog for us is like a religion, a daily reading like going to church, but not in a negative way. If the true faith associated with religion then it is good thing because it drives a man to go on. The health system cannot cure our problem. Richard is like our “savior”, because in him and in his experience, we see hope. On the other hand there is a saying that hope is man's greatest enemy because it prolongs suffering. Man is an animal that can withstand that no other animal can. In addition of little better brains and skilled hands, that is the reason evolution put him at the top of the food chain.
DeleteRichard, thank you for the hope!
Goran
Thanks, Goran, though I'm not sure how I feel about being compared to a religion and am less a "savior" than a "saver," if I'm lucky. ;) In any event, having hope is critical for conquering a condition when the recovery period spans months or years. So if I can supply some of that, that's all good from where I sit.
DeleteAthenea, I too have some pain when I walk for longer that 20min, or any faster than baby steps. However, I found that by doing these baby steps and being mindful of how my feet hit the ground, stopping when I need too, I get further before the knee starts to get sore again. I should point, however, that my pain when it appears is never higher than 5 out of 10. Not sharp, but nagging in a always-in-the-background type of pain
ReplyDeleteWalking with a stick might also help, but be careful as you might get too carried away and walk faster than you intended (I know, I did....)
deloupy, that sounds very much like my pain, though thankfully mine is now less of an ache, more like the inside front of my knees are severely sunburnt. They also get stiff. And like you, if I walk too far/too fast, or do work up a ladder, or a whole myriad of what in my past were totally innocuous activities, they start to burn. A nagging background pain/sting.
ReplyDeleteMy physio recently gave me a TENS machine to try, and it has been a Godsend. I just put the electrode pads on each side of my kneecaps for 45mins per day while lying on the couch and finds it significantly reduces any pain, and seems to have a lasting effect. Re-programming the nerves is her theory - at $125 for the machine, I'm happy to go with that!
It tallies with what I've always suspected - that there is a condition the medical world knows little about whereby cartilage damage in the knees leads to changes in the nervous system which give you pain signals beyond where they should be at, or that last longer than they should. I've often felt my knee pain was as much about nerve/CNS issues as it is about cartilage. The day I was given the TENS machine, I was having a bit of a setback and the improvement was instantaneous, so it seems to stack up.
I'm pretty sure my cartilage has healed a lot due to a combination of more gentle activity, avoiding aggravators, PRP injections, perhaps some supplements and time, but the my nervous system is still not entirely convinced.
cheers, TriAgain
Interesting. I sometimes experience 'itchy knees', like if the itch is on the inside of the knee, rather than on the skin. I once suffered from facial neuralgia (awful, wouldn't wish that to my worst enemy), and the sensation was sometimes similar. Sometimes like an electric current. So there could be some nerve issue there too
DeleteMy osteopath explained that the joints shared the same nerve influx than the muscles. He also explained that when he was pressing on tight points on my legs (and there are many!) for a few minutes, the nerves would eventually stop sending pain signal to the brain and tada! The pain was gone. The only issue was that the effect was short lasted and unless I asked my husband to sit on my lap permanently to release the pressure points, it wasn't going to work in the long term. Hubby would have been delighted of course.
So I guess that by using a TENS machine, you somehow get the same effect, release the pressure points and tell the nerves to stop overworking... What's the brand you are using, there seem to be many on the market?
If you are convinced it's a nerves problem, Gapebentin could be prescribed b y the pain specialist
deloupy the TENS machine brand is Comffit - http://www.acuneeds.com/Comfit-TENS
DeleteAnd I agree, it seems to stop the nerves overworking. I think it is a mixture of cartilage damage which for some reason led to nerve over-reaction. I was on Lyrica for almost a year, but have weaned myself off it as I don't like taking those sort of drugs. I've reached a stage where I don't really need it anyway, the TENS and being sensible with what I do is working for now.
I'm hopeful that if I carry on this path for another year or two, I'll be able to resume cycling - though probably not competitively again, more for fitness/fun. Looking to sell my slick Time Trial triathlon bikes which have been under the house collecting dust for two years and buy an MTB to cruise around on - maybe buy one for my wife too, whose road bike is also collecting dust.
TriAgain
Thanks Tri Again. Yours is not sold here in Ireland, but I have found one that combines TENS, EMS and massage. Have tried it for the last 3 days and it seems to calm down things.
DeleteHope you'll be able to return to cycling. My own bike will certainly gather dust for another months. I had bought it just before injuring, so only got a few uses out of it. I might have to get a lighter one, though. Mine is a Dutch bike, and weighs about 35 pounds
My TENS machine should be much better (due to cost), and even has a program for chondromalacia. Link: http://www.globuscorporation.com/sportfitnesswellness/eng/premium-200-1239.asp?
DeleteBut, I can not feel any difference after treatment. Pain is equally strong.
Tens machine did nothing to stop the pain in my knees. I'm also pretty sure my cartilage has healed to some point, but my nervous system is problem.
ReplyDeleteGoran from Croatia
Yes that's the type of pain I have...it's not awful but is always there somehow...I would say like burning...I don't really know how to describe it. I'm so depressed guys, and it's only been 2 months...I just don't see any solution... I'm seeing myself going to Austin for rehab at the sports center... The down side is I live in Ireland! Maybe I could spend all my savings...
ReplyDeleteThe price of orthokine treatment varies (probably the same goes for PRPs) from country to country. In Germany 5000 euros, in Croatia 1000 Euros for 5-6 injections. There isn't a easy sollution for our problem. Blood injections is the best we can do! After orthokine treatment i was able to returm to my job. After treatment constant burning in my right knee decreased for 70%. Sometimes, in the morning I feel no pain at all, but in the afternoon it comes back.
ReplyDeleteGoran from Croatia
Sounds good Goran. I'm not sure if they do them here in Ireland, probably they do... I'm originally from Spain and I know that over there it can cost € 900 for 3 injections.
ReplyDeleteBut man if it helps that's no money! although is also a bit of a lottery, it doesn't work for everyone... In my case MRI says my chondro is ' mild ' ... maybe I'll be lucky.
Athenea, 2 months in cartilage time is a micro-second. I finally accepted I needed to think in years. The MRI of my right knees chondro said severe years ago (no idea about my left knee), yet it only gave me intermittent problems (even my OS was puzzled that I could still race Half-Ironmans). Then meniscus surgery in the OTHER knee caused both to have a melt-down.
ReplyDeleteSeriously, I got to the point of dreaming about double-amputation above the knees just to lose the constant pain, and being able to compete again on carbon legs. I'm beyond that now, and really think I've turned the corner due to the combination of things I mention above.
As Luis said in his posts, patience is the key, along with really concentrating on what movement does not aggravate, and whats does. Then when you start to get some improvement, be vary careful, don't go too far too soon. I've had days recently where I'm sure I could hop back on my bike, but I'm not going to any time soon.
TriAgain
Yeah I guess I'm at the very beginning of the journey... Will have to work on patience a lot. Thanks for your advice though.
ReplyDeleteAthenea, I'm in Ireland too. I'd highly recommend hydrotherapy with Lisa Kernan. She has had me back on my feet, I have more good days than bad ones now. She is working with athletes and people like you and me, and will adapt the programme to how you feel (I'm the youngest, but slowest in the pool.... I don't care, it works!). She is based in Clontarf. Much cheaper than flying to Austin :-)
ReplyDeleteHey deloupy! Thanks a mill for that! Will have a look :)
ReplyDelete