CFLNew injury treatment hits the CFL

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Toronto cornerback Byron Parker, left, is a big proponent of a new medical advancement that's been developed over the last few years. (Nathan Denette/Canadian Press)

Tiger Woods has had it. Kobe Bryant has had it. Byron Parker has had it.

And I've had it.

If there's any justice in the world, the more famous in that above list also yelled like a six-year-old having his first booster shot when they received it, so I can feel better.

"It," in this case, is platelet rich plasma replacement procedure, or PRP, a relatively new medical advancement that has been popping in and out of the sports headlines over the last few years, sometimes incorrectly.

For example, Bartolo Colon, the New York Yankees' pitcher, has been said to be a poster boy for PRP, but that's incorrect. He apparently had microfracture surgery, involving stem cells, on his right shoulder and elbow, and has responded well.

PRP has been linked not just to athletes themselves, but also to at least one doctor who helped pioneer its use in Canada, Dr. Anthony Galea, the former Toronto Argonaut team physician, who earlier this summer plead guilty in a Buffalo court to unrelated charges involving the smuggling of illegal remedies across the border.

The Argos, under Dr. Rick Zarnett, are using the perfectly legal procedure regularly, but it's also now getting serious play with regular, non-professional clients who might, for example, tear 50 per cent of the quad muscles in their right knee by picking up a cricket ball that was not moving and was being used in a game the patient was not participating in.

But enough about me.

Zarnett has a folksy way of explaining how the procedure works.

"What we do is take a vial of your blood and spin it in a centrifuge so it separates by weight the red blood cells from all of those good things," he says, chatting in the office he shares with one of Canadian sport's most well-know doctors, Michael Clarfield, in Toronto.

"Then, you throw out the red blood cells because they don't have what we need, and what you're left with are the platelets and the growth factors and all of those products, and we inject it into the injured tissue to try and promote ... better healing and quicker healing."

Some doctors inject the platelets blindly, by feel, while others, as is the case at the Sports Medicine Specialists, use ultrasound to identify the damaged area so they can see the needle go in and "inject it right into the target," Zarnett says.

The procedure itself is done by Clarfield, who for 16 years was on the Toronto Maple Leafs' medical staff (up to 2004), and now counts as clients the National Ballet of Canada, Tennis Canada, the Argos and Steve Bauer's new Spidertech pro cycling team.

PRP is designed to speed up the healing in muscle and/or tendon injuries (including shoulder, ankle and knee, elbow, Achilles), though some doctors in the U.S. and Europe have used it with varying reported success on everything from chronic back pain to arthritic joints.

And, let's be honest, the procedure can "sting a bit" as doctors like to say. I prefer "hurts," but that's just me.

That's not a needle, it's a screwdriver

After 54 cc's of blood is taken from a particular patient who, say, might be one that normally passes out at a mere pricked finger, it's run through the centrifuge for an hour while you cool your heels in what may be the only doctor's waiting room in Canada that has up-to-date magazines.

Then it's in for the ultrasound, where the technician finds the right spots ("Wow, that's a big tear!") and the doctor sticks the needle in - a much larger gauge than you'd get for a flu shot, for example, because the blood platelets are so thick. And that's the fun part.

"Whatever you do, Dr. Clarfield, please don't tell me this is just going to pinch a little."
 
"OK, I won't."

When your correspondent finished the first treatment, the two nice ladies sitting in the reception area swore they didn't hear a thing.

"Oh, yes, they did," quoth my wife. "And you said more than just "Oh jeez..."

Thanks, honey.

For the second application, two weeks later, the doctor pre-froze the knee area. Didn't help much. Darn needle is just too big. So I sang my way through it. Kansas. Carry on Wayward Son.

Still yelled at inappropriate moments for the chosen tune.

"It really comes down to a person's pain tolerance," Clarfield says.

Thanks doc.

Anecdotal proof

But does PRP actually work? The players who have had it seem to be believers.

Byron Parker, a cornerback with the Argos, says he tore his quad muscles twice last season, including once after playing Montreal.

"I got the PRP, rested a couple of days and was ready to play the next game," he says. "Whoever came up with it is a genius. It works, and I've had good results from it."

Parker's therapy went into his thigh rather than the knee itself, and he says it was no big deal.

"I think it's one of the less painful things I've had done," he says, standing in the Sports Medicine Specialists office. "It was way less painful than getting the fluid drained out of my knee right now."

Clarfield says Parker's injury after the Montreal game was likely a little less serious than the player made it sound, but there are, nonetheless, some solid anecdotal evidence the procedure works.

What the medical community does not have is solid proof, and that's going to take a while.

"Anecdotally we're seeing some amazing results," Clarfield says. "Not all the time, but very good results. The theory and the science of it make great sense, but the question is, will it stand the test of good research?"

There have been few "double blind" studies wherein one set of patients with the same affliction have the PRP and the other gets a placebo treatment. One European study looked at a specific ankle problem and found no real difference, but that's pretty much all that has come out.

And, researchers say, it's hard to find people willing to possibly have a placebo injected into a serious knee injury for the sake of a test. There are, nonetheless, many studies ongoing, Clarfield says.

"Some of the research is showing you are getting faster healing [with PRP], and better healing microscopically of the tissues after treatments," he says. "Tendons ... are looking more like normal tissue rather than dysfunctional tissue, or scar tissue that you often get in an injury."

PRP is a prime topic right now in the sports and orthopaedic community, he says, so much so he's already attended a number of symposiums in the States on the topic, and is organizing his own for this September here in Toronto.

"The concept [of PRP] is so good, and the top guys in the States and North America and in Europe, leaders in the field, are using it, and they wouldn't be doing this as a sham," Clarfield says. "If they didn't believe in it, they wouldn't be using it."

Athletes are buying it, simply because it seems to work, something Parker says is key. 

"Whatever works, as long as it isn't going to jeopardize our career, we're pretty much down for it," says the Argo defender. "We're pretty much down for whatever it takes, and that's the motto we all live by - whatever keeps us on the field, we're willing to do it."

Other CFL teams surveyed show that at least one has used it, while most won't release their medical information.

Not a panacea

Clarfield wants to emphasize, however, that PRP "is not a panacea. It's not a magic bullet. It's not glue that puts everything back together. You are augmenting the body's healing response and bolstering it to speed up healing of injuries.

"You still have to be respectful of the biology and the healing phase of that," he says. "You aren't going to have an injection and play the next day."

Final proof, through peer reviewed studies that will eventually be published in medical journals, is still some years away.

And what about safety?

"What I can say is, I think it's safe, because you aren't injecting anything foreign into the body, there's no drugs" says Zarnett, the Argo doctor.

Clarfield says "[you are] using your own blood, putting it back in your own body, with no cross reactivity, no drug affecting your body, not altering the organs ... so from that point of view [PRP] is very safe."

A personal anecdote

It's now 12 weeks since your correspondent ripped up his knee, and three weeks since the second of the PRP therapies, the latter of which left much less swelling than the first, an effect that disappeared in about a day.

At the same time, there has been hard work under the experienced hands of one of Clarfield's senior therapists Jeff Bird - the same type of work I would have had with or without the PRP treatment.

I walk without a limp, can go up and down stairs normally, can ride a bike, push a lot of weight up with the leg, and just this week started side kicking (Tae Kwon Do) in the living room. Next week they're going to let me start running again.

Would any of this have happened without the PRP? It's hard to say. But I'm still glad I did it.

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