Skip to main content

Advertisement

SpringerLink
Log in

Rehabilitation of hamstring strains: does a single injection of platelet-rich plasma improve outcomes? (Clinical study)

  • Original Article
  • Published:
Sport Sciences for Health Aims and scope Submit manuscript

Abstract

Purpose

The study aims to elucidate the effects of single platelet-rich plasma (PRP) injection combined with rehabilitation exercises on growth factor concentrations and muscle strength following hamstring tear injury.

Methods

17 physically active male athletes (22.3 years; 1.80 m; 74.7 kg; 24.9 kg/m2) with a 2nd-grade acute hamstring tear were randomized to a treatment group (n = 8) or control group (n = 9). Both groups received the same physical rehabilitation program for 8 weeks; however, only the treatment group received an autologous single PRP injection. Growth factor concentrations, hamstring strength (HS), knee flexion range of motion (KFROM), and return time to play (RTP) were collected at baseline, and 4 and 8 weeks.

Results

Athletes in the PRP group demonstrated at 4 weeks a significantly higher concentration in IGF-1, FGF-2, VEGF, and PDGF than that the control group demonstrated (p < 0.004). However, neither HS nor KFROM showed any significant differences between groups at 8 weeks (p > 0.05), but HS was significant at 4 weeks (p > 0.002).

Conclusion

PRP injection combined with physical rehabilitation for hamstring tear was more effective in growth factor concentration and return time to play than the physical rehabilitation alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Beiner J, Jokl P (2001) Muscle contusion injuries: current treatment options. J Am Acad Orthop Surg 9(4):227–237

    Article  PubMed  CAS  Google Scholar 

  2. Jarvinen T, Kaariainen M, Aarimaa V, Vaittinen S, Kalimo H, Jarvinen M (2007) Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol 21(2):317–331

    Article  PubMed  Google Scholar 

  3. Askling C, Saartok T, Thorstensson A (2006) Type of acute hamstring strain affects flexibility, strength, and time to return to pre-injury level. Br J Sports Med 40(1):40–44

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Heiderscheit B, Sherry M, Silder A, Chumanov E, Thelen D (2010) Hamstring strain injuries: recommendations for diagnosis, rehabilitation and injury prevention. J Orthop Sports Phys Ther 40(2):67–81

    Article  PubMed  PubMed Central  Google Scholar 

  5. Erickson L, Sherry M (2017) Rehabilitation and return to sport after hamstring strain injury. J Sport Health Sci 6(3):262–270

    Article  Google Scholar 

  6. Rettig AC, Meyer S, Bhadra AK. Platelet-rich plasma in addition to rehabilitation for acute hamstring injuries in NFL players clinical effects and time to return to play. Orthop J Sports Med. 2013;1:1

    Article  Google Scholar 

  7. Hamilton B, Valle X, Rodas G, Til L, Grive R, Rincon J, Tol J (2015) Classification and grading of muscle injuries: a narrative review. Br J Sports Med 49(5):306–306

    Article  PubMed  Google Scholar 

  8. Krogh T, Bartels E, Ellingsen T et al (2015) Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 41(6):1435–1446

    Article  Google Scholar 

  9. Lee K, Wilson J, Rabago D (2011) Musculoskeletal applications of platelet-rich plasma: fad or future? AJR Am J Roentgenol 196(3):628–636

    Article  PubMed  Google Scholar 

  10. Charousset C, Zaoui A, Bellaiche L, Bouyer B (2014) Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? A prospective study. Am J Sports Med 42(4):906–911

    Article  PubMed  Google Scholar 

  11. Wasterlain A, Braun H, Harris A. Kim HJ, Dragoo J (2013) The systemic effects of platelet-rich plasma injection. Am J Sports Med 41(1):186–193

    Article  PubMed  Google Scholar 

  12. Simpson A, Milis L, Noble B (2006) The role of growth factors and related agents in accelerating fracture healing. J Bone Jt Surg 88(6):701–705

    Article  CAS  Google Scholar 

  13. Alsousou J, Thompson M, Hulley P, Noble A, Willett K (2009) The biology of platelet-rich plasma and its aspplication in trauma and orthopaedic surgery: a review of the literature. J Bone Jt Surg Br 91(8):987–964

    Article  CAS  Google Scholar 

  14. Molloy T, Wang Y, Murrell G (2003) The roles of growth factors in tendon and ligament healing. Sports Med 33(5):381–394

    Article  PubMed  Google Scholar 

  15. Ahmad Z, Howard D, Brooks R et al (2012) The role of platelet rich plasma in musculoskeletal science. JRSM Short Rep 3(6):40–48

    Article  PubMed  PubMed Central  Google Scholar 

  16. Halpern B, Chaudhury S, Rodeo S (2012) The role of platelet-rich plasma in inducing musculoskeletal tissue healing. HSS J 8(2):137–145

    Article  PubMed  PubMed Central  Google Scholar 

  17. Middleton K, Barro V, Muller B, Terada S, Fu F (2012) Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J 32:150–163

    PubMed  PubMed Central  Google Scholar 

  18. Boswell S, Schnabel L, Mohammed H, Sundman E, Minas T, Fortier L (2014) Increasing platelet concentrations in leukocyte reduced platelet-rich plasma decrease collagen gene synthesis in tendons. Am J Sports Med 42(1):42–49

    Article  PubMed  Google Scholar 

  19. Hall M, Band P, Meislin R, Jazrawi L, Cardone D (2009) Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg 17(10):602–608

    Article  PubMed  Google Scholar 

  20. Hsu W, Mishra A, Rodeo S et al (2013) Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg 21(12):739–748

    PubMed  Google Scholar 

  21. Hee C, Dines J, Dines D et al (2011) Augmentation of a rotator cuff suture repair using rhPDGF-BB and a type I bovine collagen matrix in an ovine model. Am J Sports Med 39(8):1630–1639

    Article  PubMed  Google Scholar 

  22. Manning C, Kim H, Sakiyama-Elbert S, Galatz L, Havlioglu N, Thomopoulos S (2011) Sustained delivery of transforming growth factor beta three enhances tendon-to-bone healing in a rat model. J Orthop Res 29(7):1099–1105

    Article  PubMed  CAS  Google Scholar 

  23. Wagers A, Conboy I (2015) Cellular and molecular signatures of muscle regeneration: current concepts and controversies in adult myogenesis. Cell Curr Rev Musculoskelet Med 8(1–2):145–153

    Google Scholar 

  24. Fader R, Mitchell J, Traub S et al (2014) Platelet-rich plasma treatment improves outcomes for chronic proximal hamstring injuries in an athletic population. Muscles Ligaments Tendons J 4(4):461–466

    PubMed  Google Scholar 

  25. Engebretson L, Steffen K, Alsousou J (2010) IOC consensus paper on the use of platelet-rich plasma in sports medicine. BrJ Sports Med 44(15):1072–1081

    Article  Google Scholar 

  26. Behera P, Dhillon M, Aggarwal S, Marwaha N, Prakash M (2015) Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg 23(1):6–10

    Article  Google Scholar 

  27. Dimauro I, Grasso L, Fittipaldi S, Fantini C, Mercatelli N et al (2014) Platelet-rich plasma and skeletal muscle healing: a molecular analysis of the early phases of the regeneration process in an experimental animal model. PLoS One 9(7):e102993

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hancock C, Sanders T, Zlatkin M, Clifford P, Pevsner D (2009) Flexor femoris muscle complex: grading systems used to describe the complete spectrum of injury. Clin Imaging 33(2):130–135

    Article  PubMed  Google Scholar 

  29. Borrione P, Ruiz M, Giannini S, Gianfrancesco A, Pigozzi F (2011) Effect of platelet-released growth factors on muscle strains: a case control report. Med Sport 64(3):317–322

    Google Scholar 

  30. Demange M, De Almeida AM, Rodeo S (2014) Updates in biological therapies for knee injuries: tendons. Curr Rev Musculoskelet Med 7(3):239–246

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hamid M, Ali M, Ashril YA, George J (2012) Platelet-rich plasma (PRP): an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol (ISCRTN66528592). BMC Musculoskelet Disord 13:138

    Article  Google Scholar 

  32. Kim E, Lee J (2014) Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R 6(2):152–158

    Article  PubMed  Google Scholar 

  33. Hickey J, Timmins R, Maniar N, Williams M, Opar D (2017) Criteria for progressing rehabilitation and determining return-to-play clearance following hamstring strain injury: a systematic review. Sports Med 47:1375–1387

    Article  PubMed  Google Scholar 

  34. Hamid S, Razif M, Yusof A, George J, Lee LP (2014) Platelet-rich plasma injections for the treatment of hamstring injuries. Am J of Sports Med 42(10):2410–2418

    Article  Google Scholar 

  35. Rossi L, Molina R, Bertona A, Burgos F, Scordo W (2017) Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25(10):3319–3325

    Article  PubMed  Google Scholar 

  36. Terada S (2013) Use of an antifibrotic agent improves the effect of platelet-rich plasma on muscle healing after injury. J Bone Jt Surg 95(11):980–988

    Article  Google Scholar 

  37. Marx R (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62(4):489–496

    Article  PubMed  Google Scholar 

  38. Spiliotis B, Alexandrides T, Karystianos C et al (2009) The insulin-like growth factor-I (IGF-I) generation test as an indicator of growth hormone status. Hormones (Athens) 8(2):117–128

    Article  Google Scholar 

  39. Mosca M, Rodeo S (2015) Platelet-rich plasma for muscle injuries: game over or time out? Curr Rev Musculoskelet Med 8(2):145–153

    Article  PubMed  PubMed Central  Google Scholar 

  40. Cook D, Doumit M, Merkel R (1993) Transforming growth factor-beta, basic fibroblast growth factor, and platelet-derived growth factor- BB interact to affect proliferation of clonally derived porcine satellite cells. J Cell Physiol 157(2):30–38

    Article  Google Scholar 

  41. Sundman E, Cole B, Fortier L (2011) Growth factor and catabolic cyto-kine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med 39(10):2135–2140

    Article  PubMed  Google Scholar 

  42. Hamilton B, Best T (2011) Platelet-enriched plasma and muscle strain injuries: challenges imposed by the burden of proof. Clin J Sport Med 21(1):13–36

    Article  Google Scholar 

  43. Sanchez M, Anitua E, Orive G, Mujika I, Andia I (2009) Plateletrich therapies in the treatment of orthopaedic sport injuries. Sports Med 39(5):345–354

    Article  PubMed  Google Scholar 

  44. Hamilton B, Knez W, Eirale C, Chalabi H (2010) Platelet enriched plasma for acute muscle injury. Acta Orthop Belg 76(4):443–448

    PubMed  Google Scholar 

  45. Loo W, Lee D, Soon M (2009) Plasma rich in growth factors to treat adductor longus tear. Ann Acad Med Singap 38(8):733–734

    PubMed  Google Scholar 

  46. Foster T, Puskas B, Mandelbaum B, Gerhardt M, Rodeo S (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37(11):2259–2272

    Article  PubMed  Google Scholar 

  47. Gigante A, Torto D, Cianforlini M, Busilacchi A, Davidson P, Greco F (2012) Platelet rich fibrin matrix effects on skeletal muscle lesions: an experimental study. J Biol Regul Homeost Agents 26(3):475–484

    PubMed  CAS  Google Scholar 

  48. Pizza F, Peterson J, Baas J, Koh T (2005) Neutrophils contribute to muscle injury and impair its resolution after lengthening contractions in mice. J Physiol 1;562(Pt3):899–913

    Article  CAS  Google Scholar 

  49. Jeong D, Lee C, Lee J et al (2014) Clinical applications of platelet-rich plasma in patellar tendinopathy. Biomed Res Int 2014:249498

    PubMed  PubMed Central  CAS  Google Scholar 

  50. Lane J, Healey R, Chase D, Amiel D (2013) Use of platelet-rich plasma to enhance tendon function and cellularity. Am J Orthop 42(5):209–214

    PubMed  Google Scholar 

  51. Zhang J, Middleton K, Fu F, Im H, Wang J (2013) HGF mediates the anti-inflammatory effects of PRP on injured tendons. PLoS One 8(6):e67303

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Dragoo J, Braun H, Durham J (2012) Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med 40(6):1274–1281

    Article  PubMed  Google Scholar 

  53. Bigoni M, Turati M, Gandolla M, Sacerdote P, Piatti M et al. (2016) Effects of ACL reconstructive surgery on temporal variations of cytokine levels in synovial fluid. Mediators Inflamm. https://doi.org/10.1155/2016/8243601

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank all the participants in this study and all the staff members of the Kinesiology and Health Science Department and Sports Medicine Lab at Utah State University, USA. Also, the authors thank the faculty member in the Sports Health Science Department at Damietta University, Egypt, for their assistance while this study was being.

Funding

This study was funded by the Egyptian Ministry of High Education and the Egyptian Educational and Cultural Berue in Washington DC (Grant No. JS-3674).

Author information

Authors and Affiliations

  1. Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA

    Ahmed Gaballah & Eadric Bressel

  2. Department of Sports Health Science, Damietta University, New Damietta, Egypt

    Ahmed Gaballah

  3. Department of Orthopaedic Surgery, Mansoura University, Mansoura, Egypt

    Adham Elgeidi

  4. Faculty of Physical Education for Girls, Alexandria University, Alexandria, Egypt

    Naglaa Shakrah & Azza Abd-Alghany

Authors
  1. Ahmed Gaballah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adham Elgeidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eadric Bressel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naglaa Shakrah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Azza Abd-Alghany
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed Gaballah.

Ethics declarations

Confict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Damietta University Ethics Office and Department of Sports Health Science (Damietta University, Egypt) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gaballah, A., Elgeidi, A., Bressel, E. et al. Rehabilitation of hamstring strains: does a single injection of platelet-rich plasma improve outcomes? (Clinical study). Sport Sci Health 14, 439–447 (2018). https://doi.org/10.1007/s11332-018-0474-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11332-018-0474-x

Keywords

Search

Navigation