Injured athletes turn to controversial blood treatments

Seattle Mariners pitcher Cliff Lee and golfer Tiger Woods, along with many amateur athletes, have used a treatment called platelet-rich plasma to speed healing of their injuries. But the scientific evidence to support the procedure is ambiguous and some doctors advise caution.

Here's how it works.

-- A small amount of the patient's blood is spun in a centrifuge to separate out cells called platelets, which contain substances that in theory should foster healing.

-- The platelets are then injected directly into the patient's damaged tissue. Most patients get one injection; some get two.

-- The treatment could be particularly helpful in tendons and ligaments, which are often slow to mend.

Lee isn't sure how he got the abdominal strain that kept him on the bench early this season. Was he throwing too hard? Did something rip when he collided with a catcher in spring training?

Likewise, Lee can't say whether the curious treatment he tried -- injecting a therapeutic component of his own blood into the sore spot -- accelerated his recovery.

"It seemed like it should help, but who really knows?" said the 2008 American League Cy Young Award winner. He was back on the mound after six weeks. Which, he says, is about the same time it took for his two previous abdominal strains to heal.

While the scientific evidence to support the treatment is ambiguous, that hasn't kept athletes, both amateur and pro, from clamoring for it. And while some doctors advise caution, others now rely on the plasma as one of their main tools to treat patients with stubborn tendon and joint pain.

"We've had some amazing successes with it, and we've had some people who haven't gotten better," said University of Washington sports-medicine specialist Dr. Kim Harmon, who estimates she and her colleagues have administered at least 400 injections.

Demand is fueled partly by the examples of high-profile athletes, such as Woods and Pittsburgh Steelers wide receiver Hines Ward, who both used it for knee problems. Other drivers are the desperation of folks hobbled by their fraying infrastructure, and the frustration of doctors with few other options to offer.

Enthusiasm has so outpaced research that an editorial in the American Journal of Sports Medicine warned that PRP has been "elevated to the level of platelet-rich panacea." Even the cost per shot treatment, which can range from $800 to $1,200 or more and isn't covered by most insurance, hasn't proved much of a deterrent.

Best known for their role in blood clotting, platelets also contain dozens of growth factors and other substances that help clear away dead tissue, patch up damaged areas and attract other repair cells to a wound.

In theory, injected platelets should foster, and perhaps speed, healing. The boost could be particularly helpful in tendons and ligaments, which have a poor blood supply and are often slow to mend, Harmon said.

And few side effects are likely from a treatment that simply taps the body's own healing cells.

Because PRP can contain small amounts of human growth hormones, the International Olympic Committee is investigating whether it might unfairly boost performance. There are no rules against it in professional sports or in the NCAA.

But results are mixed from the few rigorous studies in humans. In one of the first, Dutch scientists found PRP no more effective than saline shots at relieving Achilles tendon pain.

Another study concluded that patients treated with PRP for tennis elbow did better than patients who got cortisone shots.

Lots of research is under way, said Dr. Allan Mishra, adjunct assistant professor of orthopedics at Stanford University. A pioneer in the use of PRP for sports injuries, Mishra is convinced it works, but acknowledges that little is known about the mechanism, which patients might benefit most, or the optimum treatment regimen.

For now, PRP seems best suited for people with chronic tendon problems who have tried everything else, said Mishra and Harmon.

People like Tony Dodson. The 44-year-old firefighter was dogged by a tight hamstring that cramped his training for Ironman triathlons -- the kind where the marathon is but a third of the race.

After receiving two PRP injections from Harmon, Dodson is back at full strength and getting ready for Ironman Canada this summer. "I've never had a problem since," he said.

Reach Sandi Doughton at sdoughton(at)seattletimes.com. For more stories visit scrippsnews.com