Marc Darrow MD,JD

Someone will email an MRI of their hamstring problem. They will talk about the microtearing in the hamstring tendons and pain and soreness with certain movements and especially sitting. They have had a cortisone injection and anti-inflammatories. They have rested it and rested it and it is still not improving. Can PRP treatments help? Over the years we have seen many patients with hamstring injuries and we have helped many achieve their treatment goals. Let’s look at the research.

The hamstrings comprise a group of muscles at the back of the thigh. Among the muscle group is the semitendinosus muscle, semimembranosus muscle and the long and short head of the biceps femoris.The semitendinosus muscle, semimembranosus muscle and the long head of the biceps femoris hamstrings attach to the pelvis at the ischial tuberosity, the bony prominences sometimes referred to as “sit bones.” So named because they are the bones we do sit on. They are also often referred to as the Proximal hamstrings (the center hamstrings) because of their attachment or insertion at this “center” point.

Wear and tear, partial tear, full hamstring tear treatments

When we get emails into the office about hamstring injuries it is usually from someone who has a full devastating tear or a recent acute partial tear, or someone who has been suffering from a “nagging,” hamstring problem. A confirmed complete rupture  would require surgery to get an athlete back to his/her sport. A partial acute tear, or, wear and tear damage can be treated non-surgically. Let’s get to some research.

Treatment with cortisone or PRP?

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. 

As hamstring injury is usually accompanied by inflammation, cortisone is often suggested as a treatment. There are times cortisone may be called for, we very, very rarely see a patient where we would suggest cortisone. In our office we specialize in regenerative medicine, treatments that rebuild tissue. Cortisone removes inflammation, it does not rebuild tissue.

An April 2019 study (1) compared the effectiveness of pain relief in patients with grade 2 proximal hamstring injury (typically a partial tear that causes you to limp, have some muscle swelling, and soreness to the touch), treated with platelet-rich plasma (PRP) or corticosteroid injection.

In a group of 56 patients:

  • 32 received PRP
  • 24 received steroid injections

At 1 week post-injection follow-up, 23 patients (71.9%) from the PRP group and 11 patients (45.8%) from the steroid group showed positive response, (as measured by VAS pain scale).

At 4 weeks post-injection, 23 patients (71.9%) from the PRP group and 13 patients (54.2%) from the steroid group showed positive response, (as measured by VAS pain scale).

The research concluded: “The PRP group had shown more favorable response compared to steroid group at 1 week post-injection, which suggests that PRP therapy can be considered as a conservative treatment choice for grade 2 proximal hamstring injuries with better short-term pain relief based on limited pilot data.”

Hamstring injuries may need more than one treatment or single injection

Many times we will get an email from someone with chronic hamstring problems seeking stem cell therapy for their injury. A main reason for seeking stem cell therapy to the patient is that they already tried PRP and it did not work for them. Why would it not work for them? Many of these people received a single PRP injection. The single PRP injection is a treatment type that we typically see as not effective for many people. We will suggest to patients that, realistically, to achieve the type of healing they are looking for, 2 – 3 treatments may be required. This was confirmed by research in a March 2019 paper in the Journal of science and medicine in sport.(2)

In this study, doctors tested the efficacy of an ultrasound-guided platelet-rich plasma (PRP) injection in the treatment of patients with proximal hamstring tendinopathy.

  • The patient was given “a single PRP injection under ultrasound guidance.” Following the injection, pain, function and sporting activity were measured via the Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H) questionnaire, administered before injection and at 8-weeks follow-up.
  • 69% of patients reported no change in their ability to undertake sport or other physical activity at 8-weeks follow-up. Conclusion: “Patients with proximal hamstring tendinopathy receiving a PRP injection did not improve on clinical outcomes at 8-weeks follow-up.”

Does this mean a single PRP treatment will not help? No, not at all. Even in this the above study 69% of the people said that they had no improvement, 31% had a different outcome. In a study, published in the Journal of Ultrasound Medicine, (3) doctors offered these more positive findings: 

The researchers of this study compared the effects of ultrasound-guided platelet-rich plasma (PRP) and whole blood (WB) injections in patients with chronic hamstring tendinopathy. Again this was a single injection. In our office we have seen consistently better results when a second or third treatment was offered.

  • The doctors performed a  prospective double-blind randomized controlled trial, PRP or WB was injected under ultrasound guidance into the proximal hamstring tendon in a group of patients with clinically suspected hamstring tendinosis. Questionnaires were administered before injection and 2, 6, and 12 weeks and 6 months after injection. Pain and function outcomes were measured.

Results: The whole blood (WB) group showed greater improvements in pain and function over the PRP group before 12 weeks, whereas the PRP group showed improved outcomes over whole blood (WB) at 6 months. “Both PRP and WB groups showed improvements in all outcome measures at 6 months. The PRP group showed significant improvements in 6-month pain and function scores.”

PRP speeds up rehab

Accelerating the rehab process following an acute hamstring injury is one of the main reasons people reach out to us following hamstring injury. These people tells us that they are already in physical therapy and that they were told by their therapist that the should look into PRP therapy to help accelerate the healing process. In agreement with our own clinical observations, a study in the American Journal of Sports Medicine (4) reported these results:

  • Twenty-eight patients diagnosed with an acute hamstring injury were randomly allocated to autologous PRP therapy combined with a rehabilitation program or a rehabilitation program only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and pain interference scores over time were examined.
  • Patients in the PRP group achieved full recovery significantly earlier than controls. The mean time to return to play was up to 15 days sooner for the PRP group vs the control group. Significantly lower pain severity scores were observed in the PRP group throughout the study. A single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone.

We have been offering regenerative medicine injections for more than 20 years. We have helped many people with hamstring problems. Can PRP or stem cell therapy be an option for you? Use the contact form below so we can assess your candidacy for treatment.


Do you have questions? Ask Dr. Darrow



A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References

1 Park PY, Cai C, Bawa P, Kumaravel M. Platelet-rich plasma vs. steroid injections for hamstring injury—is there really a choice?. Skeletal radiology. 2019 Apr 1;48(4):577-82.
2 Levy GM, Lucas P, Hope N. Efficacy of a platelet-rich plasma injection for the treatment of proximal hamstring tendinopathy: A pilot study. Journal of science and medicine in sport. 2019 Mar 1;22(3):247-52.
3 Davenport KL, Campos JS, Nguyen J, Saboeiro G, Adler RS, Moley PJ. Ultrasound‐Guided Intratendinous Injections With Platelet‐Rich Plasma or Autologous Whole Blood for Treatment of Proximal Hamstring Tendinopathy: A Double‐Blind Randomized Controlled Trial. Journal of Ultrasound in Medicine. 2015 Aug;34(8):1455-63.
4. A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LP. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. The American journal of sports medicine. 2014 Oct;42(10):2410-8.

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