September/October 2020 - 33

By Nick Friar, contributing write
When it comes to innovative treatment options, PlateletRich
Plasma (PRP) and stem cell therapy comes up
a lot. But what is the level of understanding of these
regenerative medicine among the average person? The
goal of regenerative medicine is to stimulate the body to
heal itself, utilizing the person's natural healing abilities.
To understand PRP vs stem cell treatments, you need to
know more about the science behind each.
Dr. Allan Mishra is an orthopedist who specializes in
sports medicine for the Menlo Medical Clinic in California,
which is part of the Stanford Health Care system.
He also conducted the first PRP injection study on tennis
elbow in 2006, and he remains a prominent voice in the
advancement of PRP injections in sports medicine. Dr.
Mishra spoke with Coach & A.D. about the advancements of
PRP injections, how those differ from stem cell injections,
and how he recommends the procedure to patients.
Coach & AD: You've seen the development of PRP
injections from the ground up. What are some of the
changes with PRP over the years that have made this
come to the forefront, where we now see big-time athletes
turning towards this option depending on the injury?
Dr. Allan Mishra: Ten, 15 years ago, using a component
of your own blood to treat a tendon or a ligament injury
or knee osteoarthritis or degenerative disc disease, I
think, was considered flat out crazy. I know that when I
first started doing it, people were highly skeptical - and
appropriately so, because there was no data to support the
use of PRP or stem cells as preparations for a variety of
different athletic or sports medicine disorders.
So, I went about it as scientifically as I possibly could.
We did, initially, a pilot study - a small number of patients,
but controlled - and found that using your own blood in
the form of Platelet-Rich Plasma was effective in a small
pilot study. Then we did a large prospective randomized
trial of 230 patients (at) 12 centers across the United
States. We gathered elite data showing that PRP worked
for tennis elbow.
I've also done some basic science studies that have
shown that PRP can help stem cells proliferate. I also have
some other data that shows that PRP helps if I injected
your patellar tendonitis or your elbow. PRP acts as what's
called a chemoattractant, or it sort of pulls at your stem
cells. Because I actually didn't understand completely how a
single injection of PRP would make such a big difference.
Right now in the United States using stem cells, or
providing different versions is very challenging because
(of) the regulations; it's not necessarily used that often.
(The use of stem cells is) most often just in clinical trials,
but PRP is widely used. Unstaggered. Flat out staggered
how much PRP is used across the country and the world.
CAD: You brought up how early on when you first
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September/October 2020

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