Adrienne Halley

Ms. Curtin

Intern/Mentor G/T Period 6

17 March 2017

Comparison of Muscular/Tendon Treatments

Advancements in medical technology have lead to the greater use of minimally or even

non invasive treatments for multiple injury types, especially for those in athletes. This

technology has become increasingly important in the sports medicine world, where injuries are

becoming more common in younger athletes. Treatment methods for muscle and tendon injuries

can vary from surgical methods to injections or physical therapy. However, doctors have yet to

find the most consistent and universal form of treatment for such common injuries such as

tendonitis, arthritis, and muscle or tendon tears. This is an analysis of two non-surgical

procedures that are relatively new in the medical world for the previously mentioned injury

types: platelet rich plasma (PRP) and hyperbaric oxygen (HBO). PRP and HBO are effective in

aiding the bodys natural healing process, decreasing the healing time of muscle/tendon injuries,

and providing a non-invasive form of treatment (not as an alternative to surgery); however, PRP

is the more effective treatment of the two.

According to an interview with Dr. George Balazs, an orthopedic surgeon in the Navy,

the body will always heal itself. Medicine simply allows this process to be sped up, however

natural healing is the best form of healing. For this reason, both PRP and HBO are recognized in

the medical world as injury treatments, as they aid the bodys natural healing processes. In these

methods, the use of higher concentrations of either autologous blood platelets (for PRP) or pure
oxygen (HBO), two very organic components, are used to enhance the already existing use of

these components in the body (Silberner). PRP works by increasing platelet-rich plasma, which

contains platelets, white blood cells, collagen, and other essential growth factors required for a

successful healing process (Taylor et al., 2011). HBO also increases collagen because oxygen

and collagen directly correlate. In other words, the higher the oxygen concentration, the higher

the collagen concentration (Silberner). Another reason that oxygen is crucial in the healing

process is because it is utilized in synthesizing ATP/energy, reducing inflammation, and in tissue

healing (Ishii et al., 2006). Not only does the use of organic material quicken the healing time of

an injury, it also avoids complications. Autologous blood platelets are platelets that are drawn

from the patient, centrifuged and then injected back into the patient. Using the patients own

blood prevents such illnesses (Rentler, 2016). The use of pure oxygen rather than chemical

substances is better for the body and aids in natural processes such as angiogenesis, or blood

vessel regeneration. While each treatment alone can be highly advantageous, they can be even

more so when combined. Studies performed on the effects of PRP and HBO on a lower leg

injury of rabbits showed that the experimental group that was treated with the two treatment

methods combined healed much faster than any other experimental or control groups (Neves et

al., 2006). However this same experiment also exposed some disadvantages of the two

treatments: when used independently, neither treatment showed significant healing results in

comparison to the control group. This shows that on their own, PRP and HBO may not be the

most practical treatment forms, however this does not mean they are useless in the medical

world, as every solution has both advantages and disadvantages.

 These inconsistencies, such as the previously mentioned experiment, should not have too

large an impact on the effectiveness of PRP and HBO treatments because many other

experiments show positive results. Such inconsistencies can also be explained. Regarding PRP,

the technique used by the doctor administering the treatment can vary, therefore, results of each

experiment can also vary. The more common (and effective) technique involves the doctor

moving the needle around during the injection, so that the plasma is able to reach multiple spots

on the tendon (Fitzpatrick et al., 2016). It is speculated that not all doctors practice this

technique, which can explain why not all results are positive. This also means that this

inconsistency among PRP data should not lead to the rejection of the treatment from the medical

world. Inconsistencies among data regarding HBO can be explained by two factors: 1) The

duration and intervals of treatment will not be the same in every experiment. Typical treatment

periods last for a couple of hours for a period of 2-4 weeks; this wide range allows for

inconsistencies in data since there is no set time for HBO treatment (Gill). 2) HBO is often given

to patients who are not in need of it, such as athletes with simple injuries such as sore muscles,

so no improvement may be seen during such experiments or trials (Ishii et al., 2006). With

these minor inconsistencies set aside, PRP and HBO continue to prove to be effective treatment

methods.

These two treatment methods drastically lower the expected healing time of an injury.

For example, patients diagnosed with patellar tendinosis who received PRP treatment were fully

healed in three months, when the normal healing time can be up to six (Charousset, 2014).

When compared to other treatments such as collagen injections or the simple rest, ice,

compression, elevation (RICE) technique, PRP was the most effective and the fastest treatment
for muscle injuries in athletes by one week (Hamid and Yusof, 2014). Post-surgery HBO

treatment used for patients with severe crush injuries was effective in over half of the

participants, with an overall success rate of 87%. Differences between control and experimental

groups during this testing were significant (Corner and Alquier, 1996). Although effective,

neither treatment method can replace surgery.

While PRP and HBO may be highly effective in treating certain injury types, they cannot

be used in place of surgery, especially for more severe injuries. However, they can improve

surgery recovery. An experiment testing PRP as a treatment for ACL tear injuries in athletes

concluded that patients who received both surgery and PRP were able to return to sports after

their healing. Patients who only received PRP were more likely to either re-injure the ligament

due to lack of stability, or chose to have surgery once the testing was over (Grindam, 2014).

Although PRP cannot be used in place of surgery for certain injuries, it is still useful regarding

these injury types because it helps to strengthen the healing of the ligament.

Every treatment method will have its positive and negative consequences. One

disadvantage of PRP is the lack of consistency when it comes to decreasing pain in the patient, as

patients do not feel less pain after using the treatment (Ellingsen et al., 2016). This does not

mean that it is not effective because MRI scans reveal thicker and more stable tendons/ligaments

after use of the treatment (Neves et al., 2006). HBO also has disadvantages and is viewed as

more dangerous than PRP, however these dangers can be avoided. One possibility is oxygen

poisoning due to overexposure to oxygen, however breaks in between sessions can prevent this

(Silberner).
 PRP and HBO are both relatively new treatments for muscle and tendon injuries

that are being introduced into the medical world, and therefore, still require more testing before

being fully accepted into the medical community. Several experiments show the positive effects

of PRP and HBO treatments of muscle and tendon injuries. Most have concluded that the two

treatment methods benefit the healing of these injuries by enhancing the bodys natural healing

mechanisms and have better effect than those of using no non surgical treatment. However, the

two treatments have also shown to be less effective when compared to injuries that have been

surgically treated, especially for injuries of a higher severity. Used together or when

accompanying surgery, the treatment methods have highly beneficial effects for the area of

injury. Another benefit that was discussed was the lack of negative effects from these treatments.

Possible consequences from using them can be avoided through the use of proper technique and

care when administering the treatments. Overall, although PRP has provided better results, both

PRP and HBO are useful when it comes to healing muscle and tendon injuries, however neither

should be used in place of surgery where surgery is needed.