Elbow Tendinosis and PRP

Hi there,
I am a avid climber. I started having pain in my elbow and took 6 months off to rehab but it is still hurting. I finally got an MRI with showed intermediate tendonosis of the distal biceps. I am going to have PRP and/or stem cell therapy. My problem is that prime climbing season is starting. I'm trying to decide if I should do it now and have to take a few months off for the recover or wait until the colder months.

If any of you have had PRP...how much time did you take off between the injection and being back on the rock? There's not good data on this and three orthopedists/physiatrists had three different answers.

Thanks!

I definitely wouldn't risk making the damage worse. Elbow Tendinosis is usually an overuse issue, so further activity will probably only aggravate the tissue. Do the PRP and rest up, so you're in prime condition for next season.

Solutions to tendonitus:
1. cease activity.
2. Get stronger.
3. Surgery.

I'll add a fourth: Use better technique. There is no reasonable expaination for biceps tendonitis due to rock climbing, other than poor technique.

A good discussion here.
mountainproject.com/v/plate…

Tendons don't respond well to long breaks.
I have had good luck following the Dodgy Elbows protocol.

gription..it is not tendonitis but tendinosis. Also, my tendinosis is not from rock climbing...climbing just makes it worse.

I ended up getting the PRP. While I was in the orthopedists office I took note of the PRP system he was using. I'm also a physician and looked it up the cost and efficacy compared to other systems. Unfortunately, it looks like the system used has significantly less platelets and growth factors compared to some of the other systems on the market. So my advice for anyone going to have this procedure.....ask the doctor which one they use and research it. There are open source articles out there comparing the various systems.

I'll give it six weeks to heal but if I don't feel a significant improvement I'll likely have another injection from a different kit.

Do these injections have any sort of averse effects?

Magic pill to make your pains go away? Sounds too good to be true.

As for side effects....it's one of the benefits of these injections. You are essentially injecting your own platelets/plasma/growth factors into your body so the side effects are really only limited to if the injector hits a nerve or vessel. If they are using an ultrasound, this minimizes the risk.

As for it being a panacea....the studies are mixed. This is probably in part to different kits, injection techniques and indications. For example...for arthritis it would probably much less effective than for tendonosis. Oh, and the other side effect is financial. Insurance doesn't really cover it so it is mostly out of pocket.

For me, I've done PT and waited plenty of time and started to get frustrated/impatient so I thought it would be worth a shot. I'm a bit skeptical but have talked to several people who really benefited. We will see.

Brendan N. (grayhghost) wrote:Tendons don't respond well to long breaks. I have had good luck following the Dodgy Elbows protocol.

great link. I have been following this regiment with great results for a few months now, though I was unaware of this paper. I simply did a search for therapy stretches for elbow/biceps pain and pieced it together. Nice to have a medical professional vet my self treatment. Thanks for enlightening me it would seem I also have osis rather than itis...very informative. Thanks again.

Hey nycclimber. I've been in a similar situation you were in. I've had golfer's elbow for about 8 months now. I've tried PT and a cortisone injection with no long term significant improvement. I'm about to have a consult on PRP but was just curious of your results. How'd it work out for you?

Tendinopathy is a non-inflammatory condition.  Cortisone, NSAID's, Rest, or Ice won't effectively treat the problem.  The collagen in the tendon is disorganized and unhealthy from chronic strain and faulty rehab strategies.   PRP could help but the verdict is still out on it's effectiveness.

Studies have shown good results with eccentric muscle work.  (Check the Flex-bar for eccentric elbow exercises.)  The eccentric or lengthening contraction will help break the collagen adhesions and help the tendon collagen to re-align in a healthier arrangement.  

Studies are also positive with the use of an Edge Tool like Graston, ASTYM or the Wave Tool     The edge will cause micro-trauma to the disorganized collagen and re-start the healing response. Then if you use proper stretching and progressive loading you can end up with a much healthier and pain free tendon.  

http://wavetoolstherapy.com/  or Instagram   @wave_tools

https://www.amazon.com/TheraBand-Resistance-Epicondylitis-Tendonitis-Tendinitis/dp/B00067E4YU/ref=sr_1_1_sspa?ie=UTF8&qid=1517508521&sr=8-1-spons&keywords=flex+bar&psc=1

I'd like to add to Jeff's comment and suggest looking into the Armaid. It's another massage tool for the muscles in your forearm and can be used on your triceps and biceps. Spendy but I have been enjoying it so far.  It’s pretty easy to use and targets tight and knotted muscles pretty well while allowing you to apply just the right amount of pressure to the spot. Once I feel like I've gotten the muscles well massaged and the knots out and don't feel pain or soreness while using the massager the plan is to move to eccentric exercise, like Jeff said.

Be careful with constant use NSAIDs as the jury seems to still be out whether or not constant use can further damage your tendons, “We are aware of the fact that non-steroidal anti-inflammatory drugs and corticosteroids may well have a positive effect on the pain control in the clinical situation whilst negatively affect the structural healing” (2009). I’d look into this more but I’m a little short on time at the moment, just something to bring to your attention.

Anti-inflammatory management for tendon injuries - friends or foe? -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770552/

Oh! And watch the Armaid tutorial videos on their website if you get one.

Jeff G. wrote:

Tendinopathy is a non-inflammatory condition.  Cortisone, NSAID's, Rest, or Ice won't effectively treat the problem.  The collagen in the tendon is disorganized and unhealthy from chronic strain and faulty rehab strategies.   PRP could help but the verdict is still out on it's effectiveness.

Studies have shown good results with eccentric muscle work.  (Check the Flex-bar for eccentric elbow exercises.)  The eccentric or lengthening contraction will help break the collagen adhesions and help the tendon collagen to re-align in a healthier arrangement.  

Studies are also positive with the use of an Edge Tool like Graston, ASTYM or the Wave Tool     The edge will cause micro-trauma to the disorganized collagen and re-start the healing response. Then if you use proper stretching and progressive loading you can end up with a much healthier and pain free tendon.  

http://wavetoolstherapy.com/  or Instagram   @wave_tools

https://www.amazon.com/TheraBand-Resistance-Epicondylitis-Tendonitis-Tendinitis/dp/B00067E4YU/ref=sr_1_1_sspa?ie=UTF8&qid=1517508521&sr=8-1-spons&keywords=flex+bar&psc=1

Jeff - what do you mean by progressive loading? I am seeing Katie/Ron at your PT right now and doing wave and eccentric elbow, but I think I am doing a shitty job of easing back into climbing. Thanks

Dr Sanders has an updated version of his Dodgy Elbows, in case people are still reading this thread

http://drjuliansaunders.com/ask-dr-j-issue-223-dodgy-elbows-revisited/

I'm in a similar situation. I've had tendinosis in my left medial epicondyle for about 8 months. I had great success with Graston. The pain went away completely... for a few months... but then it came back 2 weeks ago after a couple of back-to-back training days (my own fault). I just restarted my PT regimen (Graston, eccentric loading, counter-muscle training, masochistic massage), and am doing the exercises described in Dr. Saunder's article (aside: that man is a hilarious writer). But I'm wondering whether the folks who've tried alternative therapies (e.g. PRP) had any success? There's so little data available on efficacy. Any personal accounts?

I did some research on PRP a few years ago and I couldn't find a single placebo-controlled double-blind study showing any efficacy at all.  It seems to be about as effective as injecting saline.

I told this to my doc once, as he was recommending PRP to me... his reply, "Well, we could try injecting saline if you want..."

John RB wrote: I did some research on PRP a few years ago and I couldn't find a single placebo-controlled double-blind study showing any efficacy at all.  It seems to be about as effective as injecting saline.

I told this to my doc once, as he was recommending PRP to me... his reply, "Well, we could try injecting saline if you want..."

Seriously?

Yeah, his attitude was "well, if it's just the placebo effect, we could just do placebo."  Missing the point that placebo's only work if you think they're real...

John RB wrote: Missing the point that placebo's only work if you think they're real...

That's not correct.

Secondary source

​Abstract​​​

​Review​​​