Does PRP Actually Work for Hamstring Strains?

0:50SPEAKER_00:On this episode of the Ask My Cry Show, we talk about whether or not PRP injections can help speed up recovery after hamstring strain. The Ask My Cry. Helping people feel better, move better, perform better. Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training. If you want to learn how to get started optimizing and enhancing performance, this is the course for you.

1:29SPEAKER_00:Head to micrunnell.com/slash performance to sign up today. Welcome back, everybody, to the latest episode of the Ask Mike Rhino Show. We're here at Champion PT Performance reviewing another recent journal article for you today. We have Brendan Gates, Dave Tilley, Kevin Coughlin, Lenny McCrina, Mike Scudido, and Anthony Vedetto, all for this article review. Kev, what do we got today? You're going to take the lead on this one, right? What journal article are we going to look at?

1:55SPEAKER_05:All right. Yeah, I thought this was a good one. So this is the efficacy of platelet-rich plasma in grade two hamstring muscle injuries results from a randomized controlled trial. It was published in the European Journal of Orthopedic Surgery and Traumatology in 2025. And the authors were at D'Souza and Shetty. So what they were looking at, so PRP injections in the hamstring, I think this is something, just as an industry, we're seeing a lot more of PRP, whether it's in a muscle belly, a tendon, or a ligament.

2:24SPEAKER_05:So I liked here that they're very specific about what they were doing their PRP injections on. They were looking at the hamstring because it's a very commonly affected area for our athletes. They noted in the study that 27% of athletes will uh in a season will get a hamstring muscle strain, and that there's 1.2 cases per 1,000 hours of sport. And obviously that varies a lot based on what sport you do, right? Like we know it's pretty common in baseball.

2:51SPEAKER_05:It's very common in track and field, very common in soccer. Um, and that there's also a very high recurrence rate. So they note that within the first year, um, a lot of athletes, up to 20%, will sustain a recurrent hamstring strain. So it seems like our standard physical therapy approach and rehab approach isn't cutting it. And that's where there's this interest in PRP for something to perhaps boost recovery. Uh the principal aim of PRP is to reduce excessive inflammation, facilitate tissue regeneration, expedite recovery, and thereby, in theory, helping our athletes return faster.

3:28SPEAKER_05:Uh, the authors were noting that there's been other studies that have looked at this, but they tend to include too many different types of issues. So whether that's different grades of a hamstring muscle strain or a kind of heterogeneity of different injury types. So they tried to get really specific here. Um, their study aim primarily, they were looking at whether standard therapy with ultrasound guided PRP would improve time to return to sport.

3:57SPEAKER_05:And then their secondary outcome were where they were actually looking at the tissue via MRI and ultrasound to see if the tissue changed, which I thought was pretty cool. Um, this was a prospective assessor-blinded randomized control trial. It spanned over four years. Um, it was at a single center sports medicine club, and they recruited athletes uh from the area that were affiliated with different rehab centers or athletic associations. They had 60 athletes included in the study.

4:26SPEAKER_05:Um, their exclusion criteria were any other um strain grade that's not a grade two, so grade two strains only. Um, they did not include tendon avulsion injuries. They did not include any concomitant joint injuries. Um, if you had a hamstring strain in the past year, you weren't allowed to be in the study. And then they also weren't allowing anybody who was getting other biological adjunct treatments. So it was only people who were going to do this study with the PRP.

4:53SPEAKER_05:Uh the baseline characteristics of the group were very similar in turn in terms of age, sport, the mechanism of injury, and obviously the grade. Uh, they made the diagnosis with a physical exam, ultrasound, and an MRI. Their clinical assessment was looking at pain, bruising, swelling, uh, tenderness to palpation, and joint mobility. And then participants were randomized to either PRP only, or sorry, PRP and standard therapy or standard therapy alone.

5:21SPEAKER_05:I'll talk about what was included in the standard therapy. For the injection, they were given their first injection 48 to 72 hours after the initial injury. And then grade 2A were given a second injection seven days after, and grade two C and two B were given a given a third injection seven days after that. So that was the protocol that they used. Uh the standard therapy included uh rice, so resting, icing, compression, elevation. Uh, they were allowed to take NSAIDs and it included a three times per week structured physical therapy program with supervision from the PT.

6:00SPEAKER_05:Uh the first two weeks were only passive. So they were working on pain management and range of motion restoration. Phases, uh, weeks two and four, weeks two, two, four was a progressive strengthening phase. And then week four and beyond was a return to function and sport phase. Uh the results of the study, so they found that there was a statistically significant benefit to getting a PRP. The average return to sport time was 26.4 days uh compared to the standard therapy group was 34 days.

6:31SPEAKER_05:So that was an eight-day uh improvement, and that reached statistical significance. Uh, for the secondary outcome, radiographic healing was achieved by day 21 in the PRP group. Uh sorry, at by day 21, 70% of athletes in the PRP group showed uh near complete healing versus only 36% in the um standard therapy alone group. So that's a huge difference, almost double. And that reached statistical significance as well. Uh the reinjury rate was only one patient in the PRP group, and that was over a period of a year.

7:05SPEAKER_05:And then the standard therapy group, six patients re-injured. Um, but oddly that didn't reach statistical significance, but the authors thought it was uh worth noting. And then um for the subgroup analysis, when they looked at different, you know, subgrades like 2A, 2B, 2C, there was no difference uh in PRP affecting one more than the other. It seemed to affect all equally. It also didn't matter specifically which hamstring muscle was implicated, whether it was, you know, semi-10, semi-mem, or uh biceps femoris, all also uh had equal benefit.

7:39SPEAKER_05:So their clinical implications were that in grade two hamstring muscle strain injuries, our PRP injection reduced return of sport time. It also led to faster improvements in hamstring muscle architecture, uh, suggesting it can accelerate tissue healing timelines. Uh the findings were statistically and clinically significant. Uh, and then I think one thing that they noted that was was awesome is that the early administration may be key. So they were able to do their first injection within two to three days after the injury.

8:10SPEAKER_05:Um, and that might lead to different results if we're doing this, you know, several weeks or even months after an initial injury. So that's kind of the long and short of the study. I thought it was I thought it was interesting and and pretty good. Um, I think like Mike said in a prior paper, it'd be cool to see just a group that did absolutely nothing uh as a comparator, or maybe if they had a little more advanced therapy uh for the hamstring. But I think we're both groups, we're doing the same thing.

8:35SPEAKER_05:It allows you to at least see how helpful the PRP may have been. So I thought it was pretty good.

8:41SPEAKER_00:Yeah, and Kev, I'd say like, you know, their return, right? 26 versus 34 days, give or take. I mean, to me, that at least is in line with what you would expect from a hamstring strain. So we assume like, you know, the rehab was appropriate enough for that. But um wow, another good study um that I think is is great just because like historically, I think we haven't known the answer to this as much as maybe as we want to. Like, I know, for example, like if you go through the past publications from Major League Baseball and going through their database of injuries, if you get a PRP, it actually slows down the healing process.

9:13SPEAKER_00:No, I shouldn't say that the the people with a PRP take longer to get back. And my feedback or my comment on that paper is always that, well, we don't know maybe those injuries were worse, and maybe that's why they got the PRP. It was retrospective, that type of thing. So I, you know, this thing was fantastic because of the methodology. Really solid methods and very specific injuries and a very specific PRP. You know, you know, my limited understanding of PRP is there's still multiple ways to do PRP injections that are more or less effective or and maybe even potent in terms of like how they actually prepare it.

9:48SPEAKER_00:So to us, it shows that there is a way that, man, you can come back eight days sooner. Um, you'll have greater healing three weeks out, and then more importantly, a lower chance of reinjury. That's awesome. So, what do you guys think? Like, anyone jump in here? Anything that like surprised you or you uh, you know, like thought was a little different from your perspective, Dave?

10:09SPEAKER_04:Yeah, I'll just be quick because I don't want to steal all the thunder, but um, I had a couple thoughts. One is I agree, I love the inclusion criteria, like having an ultrasound MRI, a board certified, you know, sportsman physician. Like they were very specific about who was getting this intervention. And I think that's important because you know, grade one strain, you probably don't tell anybody about. And obviously, grade three is a whole different ballpark of treatment.

10:29SPEAKER_04:So I really like that inclusion. Um, you you mentioned it, but the recurrence rate was what stuck out to me the most. Is like we in we see a lot of people who have, you know, unfortunately, like really high recurrence rates. Like every like four to six weeks, we do really good therapy, they get back, and then they're randomly at another, they follow the workload progression well, and they're just sprinting in a game and they feel it again, and then they're all the way back.

10:51SPEAKER_04:And it's very like mentally draining for an athlete to not be able to get through a season because every time they try to get above 90 or 100% or get back to full, they keep tweaking their hamstring and then it's all the way back to the beginning. So that's a very frustrating loop for a lot of um people to be in. So that was really cool is to see like the very low recurrence rate in someone, and that was up to 24 months, right? That wasn't like in you know a week or two or three weeks.

11:11SPEAKER_04:That was like substantially like through a season, which is good. Um, the only other thought that I had is like, man, can you imagine how awful that must feel to get PRP directly in the spot that hurts right after it happened? Like that's what was on my mind. PRP hurts a lot. I have two people who just got it, and they were like, that was the worst experience of my life getting needled in my hamstring, let alone a PRP. So shout out to these people.

11:34SPEAKER_00:I agree, I agree.

11:35SPEAKER_02:I think one thing that jumps out at me, a limitation of the paper, is we don't know the concentration of the PRP. I don't think they ever said it. I've kept I'm like leaning reading it again now, and I still don't see what their concentration was, and that seems to be a critical factor. Could it be better, or did they use the inappropriate concentration that seems to be uh acceptable and clinically beneficial uh and significant? Because it seems to be over about three and a half, four pots per billion is what is critical in a PRP.

12:05SPEAKER_02:And it looks like they use Leukocyte-rich um PRP, which seems to be the standard of care for like a muscle injury. Um so that was good. But I was surprised that they didn't want to at least um you know brag on their concentration of uh PRP, because that's a a critical, it seems like that's a critical aspect of what docs are going towards. A more concentrated uh PRP seems to be better um for these type of injuries. But overall, I think it's an interesting study.

12:33SPEAKER_02:I think it's I'm I'm I'm getting more and more on the PRP bandwagon than what I used to be, you know, two, three, four years ago and even beyond when I was very skeptical. So encouraging.

12:42SPEAKER_00:For hamstring strains. For hamstring strings. Based on this study. Right hamstring strains.

12:47SPEAKER_03:Lamens. I mean, no, no, yeah. Uh what do you got, Anthony? Yeah, again, I I think this is a really interesting study, especially with the recurrence rate of these, you know, hamstring strains being so low after PRP. I think that's awesome. The only thing I wanted to bring up was all of these athletes got the PRP within 48 or 72 hours after the injury, right? And in my head, it's like, how practical is that in our setting, right? Like I see someone for a hamstring strain, maybe it's the day after, maybe it's a week after.

13:18SPEAKER_03:But okay, so let's say it's a day after. Now I only have 48 hours to try to get them an ultrasound, an MRI, and then also a PRP within that same window. It just seems very difficult in maybe our standard of care as PTs. Um, I'd argue, you know, at the professional level, that seems like it's a lot more appropriate, or maybe the high-level college setting as well. But, you know, I'm just thinking like if I'm in the clinic at Champion and I have a, you know, a hamstring, grade two hamstring string come in, how how quickly am I going to be able to facilitate this process theoretically if I'm trying to get them a PRP within this 72-hour window or five-day window they they kind of mentioned.

13:54SPEAKER_03:So that's the only hesitation that I might have with with this study.

13:58SPEAKER_00:Yeah, that's a that's a real one though, Anthony. I mean, I think that is important. And you know, it goes back down to having just good relationships with somebody to get them in, you know, pretty quick. I feel like we could get people in, right? We have enough people that we know that we probably could, but you're right, not everybody and not everybody could. That's a really good point. Uh Mike, what do you think? Oh sorry.

14:17SPEAKER_02:I'll say one more thing I meant to mention earlier was uh as a PT, it's always like frustrating that they don't talk about what they actually did for a standard of care treatment. It's just they had different phases, phase one, two, and three of like calm down, build up, and then return to sport. Like, what does that mean? Like, what were they doing? I'd like to know more details of like what the actual rehab is.

14:37SPEAKER_03:Yeah, and they they also didn't really include any like return to sport criteria either. So it was like, were they ready to return to sport at the time? Did they just look better and they were like, okay, you can start playing again? Like, I would have loved to see some like return to sport stuff in there as well.

14:50SPEAKER_00:My gosh, yeah. If you're if you're a surgeon and you're listening to this podcast, which you're not, I get it. But if you were, right, just include your PT in the paper. What is wrong with you, guys? Just just just say, like, hey, write a paragraph for me of what you did. I mean, it's that easy. That's why these clinical papers that like people like Kevin Wilk and us, like that we've done over the years, like our colleagues, you know, everybody appreciates the collaboration there.

15:11SPEAKER_00:But my gosh, just get your PT to write a paragraph. All right, sorry. Uh Mike, what do you think?

15:16SPEAKER_06:I was again just like Anthony, looking at it from the the practical side of things. Like, I think, you know, I know this was in the European journal. So maybe the the cost of a PRP is is different in Europe, uh, if that's an out-of-pocket cost or not. Um, maybe this and maybe this will go um a long way in terms of insurance coverage for PRP in America, specifically for hamstring trains. Um, but to the best of my knowledge, right now, it's it's not covered by insurance.

15:39SPEAKER_06:So if we're doing repeat, um, you know, one, maybe two PRP injections that can be in the ballpark of$3,000. Is that eight days, you know, of uh faster return to sport? Is that worth$3,000 for a high school athlete? I don't know. That's a that's a family decision. So I think um it definitely we can present this research to people. Um I think there's gonna be other considerations whether that's practical for them. Um and but again, maybe this this paper can go as evidence to insurance companies and maybe they'll start covering it.

16:10SPEAKER_06:I have no idea how that works.

16:13SPEAKER_00:Yeah, no, but that that's a really good point, though, Mike, on on that. This isn't cheap, right? So, you know, eight days for three thousand dollars, that's that's a really good way of of of putting it. But you know, to your point, not our decision theirs, but um good stuff. But Gates, what do you think?

16:29SPEAKER_01:Yeah, I think um just wanted to hammer back a couple points. When uh when I was in college, I got PRP in both knees, and then I played in a game three days later. And so like it obviously didn't do anything. So I think it's nice that we're finally paying attention to like you have to treat the procedure, you know, with some care and like a any procedure, you need to do a little bit of uh like uh appointed rehab afterwards. So the four plus weeks of this is nice to see that there's an outline, but I agree.

16:53SPEAKER_01:I do wish there was a little bit more specificity on the protocol that they used. Um Lenny talked about the platelet concentration. I think that's important. Um the minimal effective dose is worth noting. And I think like if you don't know what you're getting, um that can be at your detriment, and you don't want to just waste money like uh Mike said. Um one thing that I had a question on, Kev, was they said leukocyte rich. Um, and obviously the other option of TRP is leukocyte poor.

17:20SPEAKER_01:Is there a like a quantifying level of leukocyte that makes it rich? Um and is more better. Do we know that yet? I was trying to do.

17:31SPEAKER_05:I don't I honestly don't know.

17:33SPEAKER_02:I looked this up a little last night because I was curious to kind of re-establish this in my head. I think it's the when the when they spin it down, there's different levels of of uh I guess sections. It spins out into like the heavy stuff goes to the bottom, and then they can take just the top layer, which is gonna be your leukocyte pore. Um, it's just the plasma that they can inject. That's gonna be more for like a joint, like an OA joint or something like that.

17:56SPEAKER_02:The leukocyte rich is the next layer down where it has more of the white blood cells, um, which is what seems to be a better option for muscle injuries. And then you have also platelet pore plasma, PPP, that is kind of coming out right now that could be even better than leukocyte rich. So it's tough to keep up with all the terminology and all the biology, but I think it's how they spin it down, the different layers that develop and where they um aspirate or pull out the um the different layers is determined.

18:29SPEAKER_02:I I don't know if they I guess they could quantify, they could run tests, but that's probably an extra step to figure out what exactly is in it. But I think them them just pulling out the different layer that develops after they centrifuge it, I think is the is the step that determines is it leukocyte rich or leukocyte poor? And then it's obviously where they're injecting it. A joint's gonna be poor, a tendon or a muscle is gonna be leukocyte rich.

18:52SPEAKER_02:So yeah, that's what I understood.

18:54SPEAKER_04:And just one more quick point. I remember when Eric, uh Dr. Latca came to us and talked, he said that like the math and the calculation based on like the person, the injury, their weight, like there's a huge amount of math that goes into doing it well. And he I remember him saying that they have to like the patient has to be there for 30 to 45 minutes after they draw for them to do all these crazy calculations. And if we don't do that well, it more or less is not doing what we think and or at all.

19:18SPEAKER_04:So he would be better to speak to that. But I think there's a lot of heavy math and like specificity that goes into the proper dose, the proper person in the right tissue spot.

19:26SPEAKER_02:So yeah. And the extra centrifuge step to get it down to four pots per billion. I think there's an extra step that not many places do or utilize, at least when I spoke to him a year ago, was the centrifuge, the the extra step of getting it even richer into that deeper concentration is what many don't do or hadn't done. And I don't know if it's been updated, but it seems like that's the key step that many miss. And I again we don't know what went on in this study.

19:51SPEAKER_00:And those probably have a huge you know impact on the outcome. And the cost, right? No, it does, right? And in the time, right? And I think a lot of places like they don't want to put the time. You know, I you know what I think the biggest take-home message of all this is is that like PRP is evolving, right? And I think we just started doing PRPs with everything, and you know, we were a little bit sloppy with maybe the preparation, how we did it just historically here.

20:12SPEAKER_00:I think the big take-home for me is that find someone near you that does this and is an expert at this. And they actually have centers that this is what they do, this is their specialty now. It's not necessarily like going to the surgeon. They actually have people that have their own specialties or their surgeons have their own people that do them within their practice. Find somebody that does this and does a great job with it. And I think you know, that's that's the best case scenario here to make sure that you're getting the you know, the right type of PRP is that you're sending them to an expert with that.

20:40SPEAKER_00:And I think that would be a great relationship too, even going back to the you know, the point from Anthony on can you get somebody in quick? Yeah. I mean, if there's a center for like biologics that like, you know, is in your area that you can send them to, um, yeah, they're gonna they're gonna love getting them in within 48 hours because they want a good outcome too, right? They they want to maximize that outcome. So that's probably how they're gonna operate.

21:00SPEAKER_00:So I urge you to kind of check your area and see if these are popping up in your area. But there's there's a huge subspecialty that's happening in orthopedics that kind of focuses on this. So take a peek. But um, awesome. Thank you, Kevin. Great article review. Another good article again, I think that that is making us all better. I know we're better here at Champion. Hopefully you're better from listening to this too. Um, but yeah, again, just subscribe, rate review on on wherever you listen to your podcast, and we'll keep doing these episodes for you.

21:25SPEAKER_00:Thanks so much.