What should I expect as I recover?
The most surprising aspect of recovery after treatment with platelet-rich plasma is the speed of recovery. For example, some high-level athletes have found that they could return to full sports participation and competitive play in half the time expected for acute tendon injuries and with no negative side effects and minimal scar tissue or adhesions. The majority of patients report being pain free. Patients have also reported using less pain medication, and gaining greater joint motion over a shorter period of time. Overall, patients get back to regular daily activities with greater speed and ease.
Treatment from a physiotherapist at Advantage Physiotherapy after PRP injections will help you regain motion, strength, motor control, and function of your injected area. Physiotherapy can begin as soon as your doctor allows. As research is still ongoing into this treatment, there isn’t a standard proven rehabilitation program to follow yet. Your doctor will decide, based on your individual injury and his or her clinical experience when the best time after the injection is to start rehabilitation. Your physiotherapist at Advantage Physiotherapy will liaise closely with your doctor to ensure you return to activity as soon as possible without disturbing the healing process initiated by the PRP injection.
If you have any residual excessive pain after the injection your physiotherapist may use modalities such as ultrasound, interferential current, or ice or heat to assist with this pain. Massage around the area may also be used although direct deep massage over the healing injury is generally avoided so as not to disturb the healing process. Again, the idea is to allow inflammation to occur (in a controlled fashion) so excessive use of modalities for the purpose of reducing inflammation will be avoided.
As your doctor allows, your physiotherapist will teach you stretching and strengthening exercises to be done in the clinic and as part of a home exercise program. Gentle stretching for the muscles around the injected area can usually be started nearly immediately after the injection; however, strengthening exercises and other forms of exercise involving the area will not begin immediately as the tissue requires healing time after the injection before being heavily stressed. Again, time frames recommended prior to strengthening can vary depending on many variables including the number of injections and the time between these injections. In some programs where PRP injections have been used for tendon problems, patients were allowed to do light activities after a second injection given 15 days after the first injection. Strengthening exercises were started after a third (and final) injection given 15 days after the second injection. In all cases, strengthening exercises will be progressed by your physiotherapist at Advantage Physiotherapy as soon as your doctor allows. These exercises may include the use of light-weights or Theraband for added resistance. As the healing process progresses, eccentric exercises will be added. Eccentric exercises are those that force the healing tissue to bear weight while the tissue is lengthening or in a lengthened position. These exercises are particularly important in preparing the healing tissues to withstand the rapid motions encountered in everyday life and sport such as lifting a bag, throwing, running, or jumping. For example, an eccentric exercise after an achilles tendon PRP injection would be a calf raise on a stair followed by a rapid drop back down into a stretched calf position. As rehabilitation progresses, jumping from a height would be incorporated.
Proprioception exercises will also be an important part of your rehabilitation at Advantage Physiotherapy. Proprioception is the ability to know where your joint or limb is in space without looking at it. Injury to any area can decrease the functioning of the receptors that assist with proprioception. Injury to a joint or the tendons that attach close to the joint are particularly sensitive to a decline in proprioceptive function. Exercises that incorporate balance (standing on one foot for the lower extremity) or those requiring precision (throwing a ball at a target for the upper extremity) will challenge your proprioception and assist in maximizing the function of your injured area so you can return to high level activities.
Avoiding unnecessary stress to the area will also prevent re-injury. For this reason, your physiotherapist will also look closely at your body alignment and how you use the injured area in everyday tasks such as using the computer or climbing stairs to ensure unnecessary stress is not added to your body. Proper alignment and good technique with all your rehabilitation exercises will also be emphasized for this same reason.
A critical part of our treatment for any injury at Advantage Physiotherapy includes education on the appropriate time to return fully to the physical activity that you enjoy participating in. For athletes, sport-specific exercises, such as throwing or simulated sport drills will be gradually encouraged as soon as possible to prepare you to return to your desired sport. Others may require education on returning to a full occupational workload or duties of the home such as gardening or housecleaning. For athletes and non-athletes alike your physiotherapist will discuss the most appropriate return-to-sport or activity plan for you after a PRP injection and will advise you on the acceptable level of activity at each stage of your rehabilitation process.
Developing optimal tendon healing and muscle strength and then assisting you in returning to your activities as quickly as possible while avoiding any risk of re-injury is the goal of rehabilitation at Advantage Physiotherapy after PRP injections. If a tissue does not re-gain the needed strength after the injection, another injury can occur. By modifying your activities as suggested by your physiotherapist, the chance of re-injury will be greatly reduced. With a well-planned rehabilitation program and adherence to suggested levels of rest and activity modification, good success at returning to full activity can be achieved with PRP injections. If however, at any stage, your physiotherapist at Advantage Physiotherapy feels that your rehabilitation is not progressing as it should; we will liaise with your doctor to ensure that optimal management of your injury occurs.
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