Recovered Rahlves Performance Impressive Despite Fall

On February 21, 12-time World Cup winner, Daron Rahlves, took the slopes for the first round of the Olympic Games Skicross event. In contention to proceed to the finals, Rahlves fell during his run when he was 2nd in his heat. He quickly got to his feet and crossed the finish line just outside the position required to move to the final round.

While it was a disappointing result for Rahlves, his participation alone defied the odds. Three weeks before the Olympic Skicross event, Ravhles sustained a hip dislocation for the fourth time in his career — an injury normally requiring months of therapy for a full recovery.

The likelihood Rahlves would race in the Olympics was bleak. Rahlves turned to a variety of treatments to hasten his return: platelet-rich plasma (PRP), physical therapy, magnetic pulse stimulation and acupuncture. After his first round opportunity concluded, Rahlves did not have any excuses.

“I felt ready to roll. Today was the outcome I didn’t really expect it. I thought I was going to be moving through to the finals,” Rahlves said. “I felt great. I’ve been skiing hard and as of yesterday I had zero pain in the hip. I was still doing physical therapy every morning. To be back this way three weeks after dislocating my hip was a pretty outstanding recovery.”

While Rahlves’ hope of winning a medal is over, his speedy recovery will be a source of hope for future injured professional athletes. Because multiple therapies used simultaneously expedited Rahlves’ recovery, claims that any one treatment was solely responsible are unsubstantiated.

Ultimately, it was the amazing determination of Rahlves and his support team that led to his ability to compete.

Rahlves’ Olympic Medal Hopes Contingent on Medical Hopes

US Olympic Skier Daron Rahlves dislocated his hip for the fourth time in his professional career during the January 31 Winter X Games. The injury came during the skicross competition, the same competition for which 2 days prior, Rahlves was selected to the Olympic Games. While a typical dislocation requires months to heal, ESPN reported Rahlves will undergo a variety of treatments to hasten recovery including: platelet rich plasma (PRP), physical therapy, magnetic pulse stimulation and acupuncture.

From his home in California, Rahlves said the decision to compete would be made the day before the Olympic race, scheduled for February 21.

“There is a glint of hope and a chance I could pull it off,” Rahlves told The Associated Press Friday. “It’s pretty much going to come down to the day before.”

Over 90% of Alpine skiers’ hip dislocations are diagnosed posterior dislocations. In this dislocation type, large force placed on the skier’s flexed knee and hip cause hip adduction and internal rotation, separating the joint’s ball and socket. Because Rahlves injury is recurring, it is likely the ligaments usually holding the ball and socket together, are damaged. The use of platelet rich plasma therapy in Rahlves’ hip is indicative of this. While PRP has been credited by some professional athletes for its ability to expedite healing time before competition, there is no legitimate clinical data suggesting Rahlves will be back on skis, competing against the world’s best by the February 21 Olympic race.

Simultaneous treatments are this 12-time World Cup winner’s only hope of bringing home his first Olympic medal. “I’m not counting it out,” Rahlves stated. “But, I’m not 100 percent saying I am doing it, so I don’t have all those expectations get crushed if I find out I can’t compete.”

Joakim Noah’s Injury and Physician Commentary

The Chicago Sun-Times reported yesterday (Feb.9), “The only surefire remedy for the severe case of plantar fasciitis that has sidelined Bulls center Joakim Noah is extended rest. But the Bulls are trying to speed up the healing process.”

While conventional methods of treatment for plantars fasciitis include anti-inflammatory drugs, physical therapy and steroid injections, Noah’s doctors are treating the injury in a variety of other ways simultaneously.Using a combination of therapies that include Platelet-Rich Plasma (PRP), a protective boot, massage and electric stimulation, Noah’s doctors are attempting to hasten the healing process and give every potential treatment advantage possible.

University of Chicago Medical Center sports surgeon, Dr. Martin Laird said, “platelet-rich plasma therapy — known as PRP and used in plastic surgery since the 1990s — is increasingly popular among athletes, getting a push when Pittsburgh Steelers wide receiver Hines Ward credited the treatment with getting him on the field in time for last year’s Super Bowl.”

Because significant media hype has surrounded PRP in pro athletes’ treatment methods, PRP could be wrongly perceived as an effective means of therapy. While the healing potential of PRP remains, its true effectiveness remains in question. Returning pro athletes to action quickly may be the difference in making the playoffs or ending a season early. This amounts to millions in revenue. Star athletes and teams will spare no cost and be offered a treatment plan that includes a variety of therapies performed simultaneously.

Based on a recent Achilles tendinopathy study from the Netherlands concluding PRP was no more effective than conventional methods of treatment, if Noah were back on the court today, PRP may inaccurately receive credit for his early return. If Noah’s return came sooner than expected, the credit should be given to the array of healing therapies working in unison and pro teams’ willingness to try unconventional methods. These methods are luxuries athletes and teams can afford.

The Big Game Injury Report

Indianapolis Colts’ star defensive end Dwight Freeney sustained a game injury from the Colts’ conference championship victory over the New York Jets. 5 days before the Super Bowl, Freeney remains on the injured report list for a torn ligament in his right ankle. Freeney begun immediate treatment for the game injury after the AFC title win. Freeney arrived in South Florida early for “intense treatments designed to heal his ankle as quickly as possible,” reports ESPN.

While Freeney’s status remains questionable, he would not the first star to sustain a game injury during a conference title match up and return speedily for a Super Bowl victory. During last year’s 2008-2009 season, Hines Ward acquired a game injury versus the Baltimore Ravens in the AFC title. Ward was questionable to return in time for the Super Bowl against the Arizona Cardinals. Ward’s sprained right knee was treated with Platelet-Rich Plasma (PRP) therapy, which he credited for his expedited return.

New York Giants Chris Canty underwent the PRP procedure earlier this season. In an ESPN article about Canty’s treatment, Dr. Victor Khabie , co-chief of the Department of Orthopedic Surgery at Northern Westchester Hospital in Mount Kisco, N.Y said of Ward’s treatment “…Hines Ward injured his medial collateral ligament in his knee several weeks before the Super Bowl and wasn’t healing,” Khabie said. “He had this injection done I believe a few weeks before the Super Bowl and reports and in interviews with him, he said it was the reason he was able to play in the Super Bowl.”

Ward made two big catches in the Superbowl and the Steelers eventually beat the Cardinals. Based on the success of Ward’s therapy under comparable circumstances, it is likely Freeney will undergo a similar treatment model. Based on last year’s Super Bowl, if Freeney does suit up against the New Orleans Saints, it may prove a bad omen for the Saints’ explosive offense and their first Super Bowl appearance.

Brandon Roy to Receive Platelet-Rich Plasma

Portland Trail Blazers Brandon Roy will receive platelet-rich plasma (PRP) in his strained right hamstring.  During the therapy, a small amount of Roy’s blood is spun in a centrifuge to remove healing blood components called platelets. These platelets are then concentrated and injected directly back into Roy’s injury.

The physician performing the treatment is Seattle Seahawks team doctor. PRP has received significant media attention through NFL team doctors who have used the procedure extensively and claimed success.

Trail Blazers GM Kevin Pritchard stated he expects Brandon Roy to return in 7-10 days, meaning Roy will miss at least 4 games. As ligament strains heal naturally and healing time is unique to the individual, PRP is far from an acceptable and proven therapy for ligament and tendon strains. When fans of Roy with similar diagnoses study the results of Roy’s therapy, this should be taken into consideration.

For Wes Welker, Hope Could be Spelled “PRP.”

New England Patriots’ fans were stunned when they watched Wes Welker being carted off the field Sunday, following what appeared to be a serious knee injury. The diagnosis was confirmed Tuesday that Welker tore both the anterior cruciate ligament and medial collateral ligament in his left knee. While early predictions regarding the injury seem dire, there may be some hope for an early Welker recovery.

Coach Bill Belichik blamed the inconsistent field for the injury. Tom Brady, who was sidelined last season due to the same injury, had tears in his eyes as Welker left the field. Brady’s emotional display of  empathy signaled the severity of injury. Former Patriot Rodney Harrison, predicted Welker’s return may be later than next November. Harrison suffered a similar injury in his career requiring 11 months of surgery, rehab and practice before he was ready to take the field.

However, new expediting therapy could be introduced to the rehab process, potentially bringing Welker back in time for the opening of next season. Platelet-rich plasma (PRP) therapy, or “blood-spinning” was used to treat the ligament injuries of Pittsburgh Steelers’ Hines Ward, Troy Palamalu, #1 NBA draft selection Blake Griffin and Tiger Woods.

PRP therapy involves spinning a small amount of an injured person’s blood to separate natural growth factors from red and white blood cells. When concentrated, these growth factors create cells and encourage healing. Thus, the growth factors are concentrated and injected directly into the injury, catalyzing the body’s natural healing response. While the therapy remains clinically unproven, both professional athletes and weekend warriors are having success expediting their recoveries. If PRP injections are introduced to the rehab process and work accordingly, the Pats may see an early Welker return next season.

The Pats now prepare for a more formidable Baltimore Ravens’ defense in their wildcard match up on Sunday. Belichick is 6-0 in first round playoff games during his tenure as Patriots’ head coach. Against both a strong Ravens’ defense and plaguing injuries, all of Belichick’s innovative coaching skills will  be required to make it 7-0.

Dr. Anthony Galea Not the Developer of Platelet-Rich Plasma

The Associated Press reported in a December 15 article appearing in the San Fransisco Examiner on Tiger Wood’s doctor, Anthony Galea, “Galea has developed a blood-spinning technique — platelet-rich plasma therapy — to help speed post-surgery recovery.” 

This is an incorrect statement as Galea only performs the therapy, he is not the developer of it. Platelet-rich plasma (PRP) was used over 20 years ago to aid jaw reconstruction. More recently, its application extended many medical fields from cardiovascular surgery to orthopedics.  PRP as an injectable  
therapy to heal soft-tissue injuries (as it was used by Galea) was widely used and studied in Europe before gaining prominence in the US in early 2006, when it was introduced to the Orthopedic Community by the research of Stanford University Medical Center’s Dr. Alan Mishra. Further Studies and trials are now underway in the US to refine PRP therapy and discover its full effectiveness.

The PRP Treatment of Tiger Woods: Just the Facts Please

It makes sense that the evolving platelet-rich plasma therapy which Tiger received multiple times in his knee following surgery from Canadian doctor Anthony Galea, is in the spotlight. After Galea was arrested for suspected distribution of illegal growth hormone in the US, it is logical to conclude people want to know the extent of Tiger’s association with the Galea, especially given Tiger’s prior ”transgressions.”

However, it is important that writers are inquisitive and do their research. If they provide misinformation, they are nothing but gossip columnists and even under that title, should do their research. Speculating gossip columnists should check up on existing facts if they want readers to trust their opinion. Otherwise, they are fiction writers, not journalists and their articles should be framed as such.  

One such piece sarcastically described Dr. Galea’s methods as “…innovative” and added that PRP involved using “calf’s blood.” The article went on to mention “there is no reason to trust any doctor nicknamed Miracle Man.”

For readers (and writers) who are not aware of what the PRP process entails: PRP is the removal of a small amount of blood from a patient with a soft tissue injury (tendon, ligament, muscle, etc.). The blood contains healing components called platelets that release growth factors used by the body to grow and create cells. These platelets are not normally used by the body in large enough concentrations in such injuries. Patients’ blood is thus spun in a centrifuge, which extracts these natural platelets. The platelets are then concentrated in a specific dose and injected directly into the injury, catalyzing the body’s natural healing abilities. This entire process takes roughly an hour.

Yes, PRP is an emerging therapy. The treatment is not yet FDA approved, although the plasma itself is. The World Anti-Doping Agency has approved the therapy in tendon, ligament and joint use. While the majority of study of PRP is internationally based, extensive study is underway in the US to fully discover PRP’s potential. It is a very safe and natural method of healing with minimal side effects (regardless of treatment type, any injection carries a small risk of infection). A positive review of PRP was featured in the October edition of the prestigious American Academy of Orthopedic Surgery. PRP is a preventative treatment as it preempts having to get surgery – a far more expensive and time-consuming treatment option. So yes, it can be described as innovative.

It does not involve using calf’s blood. The writer of that Tiger treatment article did get one thing right however. Patient’s should always seek the facts when cycling through their treatment options. They shouldn’t take for granted that any doctor is to be trusted. Similarly, no reader should take for granted that their writers can be.

Tiger Woods and Platelet-Rich Plasma

If things can go bad for Tiger Woods right now they will. This article is to dispel any notion or gossip that Tiger Wood’s platelet-rich plasma injections for his surgically repaired knee can be classified as blood doping or PED use (performance enhancing drugs). The rumors surrounding Tiger’s association with PEDs are connected to the possibility that the doctor who may have treated Woods following knee surgery, was Canadian sports medicine specialist, Dr. Anthony Galea. Dr. Galea is under investigation to determine the extent of his involvement with PEDs. The drugs he may have distributed to athletes are HGH, Actovegin and anabolic steroids. Platelet-rich plasma however, does not fall into the PED category.

As has been written on this blog previously, platelet-rich plasma therapy (PRP) is the process of removing a small amount of blood from a patient with a soft-tissue injury (tendon, ligament), concentrating the naturally occurring healing platelets found in blood, and re-injecting the concentration into the injury. While extensive research in the US to determine PRP’s full effectiveness is underway, thus far the results have been encouraging and have proved the therapy is safe and natural.

This would have been a very likely treatment option for Tiger to have had following surgery. PRP would have been used in an effort to expedite and aid his knee’s recovery. While an orthopedic surgeon should perform PRP therapy, it is possible Woods opted for Dr. Galea, who is not an orthopedic surgeon, to administer the treatment.

Thus, platelet-rich plasma is not categorized as a PED. Only time and the high-powered scrutiny of the media will determine whether Dr. Galea treated Tiger with a drug or substance that falls under the dangerous and potentially career ending PED umbrella.

LA Clippers rely on Platelet-Rich Plasma

LA Clippers coach Mike Dunleavy, is hoping platelet-rich plasma therapy works for #1 Draft Choice, Blake Griffin. Griffin suffered a stress fracture to his left knee cap and is expected back in mid-December pending treatment. He received a second platelet-rich plasma therapy last week. As the Clippers record sits at 4-9 this year, Dunleavy is hoping for an expedited return of Griffin.

As speculation mounts regarding the security of Dunleavy’s job, the coach reiterated the importance of waiting until his #1 draft choice was back in the lineup.

“We’ve had an awful run with this, but my track record is that I have not lost with my players. I have lost without my players, but I haven’t lost with my players.”

The organization is wagering their season and the coach’s job, on the effectiveness of platelet rich plasma. Let’s hope for the sanity of their fans, it’s the right bet.