PRP, Platelet Rich Plasma, An Update
A couple months ago I did a blog on PRP http://bit.ly/2wVgiUn to try and give the athlete some way to judge for him or herself whether the hype that follows any new product or procedure. Newer websites will promise you the moon for this not inexpensive injection but the more we perform it in a variety of circumstances, the more we learn that it's mostly ineffective except in certain narrow applications. For example, the below quote from Wang et al. shows PRP ineffective for patellar tendinitis, ACL repair, rotator cuff repair to name a couple. But we don't know everything yet so stay tuned as we continue to look for high quality studies that increase our knowledge base and your chances of success if choosing this therapy.__________________________________________
Platelet-rich plasma has shown great promise and potential to stimulate biologic activity in difficult-to-heal musculoskeletal tissue. However, the optimal formulation, method of administration, and dosing for different tissues have yet to be determined.
Within a given platelet-rich plasma preparation technique, there is a high degree of inter-subject and intra-subject variability in the composition of platelet-rich plasma produced. This likely contributes to the inconsistent results reported in the current platelet-rich plasma literature.
Current evidence best supports the use of platelet-rich plasma as a treatment for osteoarthritis of the knee. Evidence on the use of platelet-rich plasma as a treatment or adjunct for rotator cuff repair, lateral epicondylitis, hamstring injuries, anterior cruciate ligament (ACL) reconstruction, patellar tendinopathy, Achilles tendinopathy, and fractures is inconsistent or only available from low-powered studies. To our knowledge, no comparative studies examining platelet-rich plasma treatment for partial ulnar collateral ligament tears in the elbow currently exist.
Current evidence suggests that different platelet-rich plasma formulations are needed for different tissues and pathologies. Ultimately, improved understanding of the underlying structural and compositional deficiencies of the injured tissue will help to identify the biologic needs that can potentially be targeted with platelet-rich plasma.Wang, Dean MD; Rodeo, Scott A. MD
Walk in a Triathlon? Sure You Can"Superman where are you now? Phil Collins, Land of Confusion
30 years ago I ran my first Boston with two friends from Miami. We vowed to do it 25 years later. And 25 years older! Second time around, when the gun started the field of 25,000 in Hopkinton at noon, it was 87 degrees. It was hot! Especially for marathon running.
I've written before that when I got to 20 miles, overheating and way behind on fluids, I made one of the worst decisions of my racing career. I got on the bus, a yellow school bus, and was driven to the finish. In a vehicle! I was transported like a helpless person to the finish. I was a DNF (a DNF for gosh sakes!) in the famed Boston marathon. What a dip!
At a lecture by noted Triathlon Coach Joe Friel, he once compared the running boom of the 70's and 80's to the growth of triathlon today. (If you'd been told 20 years ago that someone would pay $40,000.00 or more to get a slot at Ironman Hawaii, you'd thought them clearly insane. Yet, we find ourselves clearly there. The annual Ironman Foundation auction, puts up 4 entries to the race to the highest bidder/donator, the profits going to the Ironman Foundation Charities. This branch of IM donates a significant sum each year to a host of deserving Kona organizations like the rescue squad, various help agencies, etc.
Friel's story went something like this. In the 70's, folks would have a friend convince them to go jogging, like it, and progress to running. And then strange things would happen. It might start out with a local 5K race, they'd get hooked, and after smoking too much Runners World Magazine, they'd be convinced they could begin marathon training. And some could. Their lives became consumed with running and a myriad of details until they found themselves running the first 10 miles of a 26.2 mile experience. All went well until mile 18, when they found themselves with shot quads, over heated, and out of ideas. (Oh, I see you've have been there.)
Compare the above scenario to triathlon where it seems easy to tackle the local sprint tri, maybe even an Olympic distance race...and then you start to dream...and a friend of a friend is doing IM Lake Placid...and, "With just a little more training, I could be an Ironman." Well, maybe.
But what happens when you get to mile 95 on the bike, are beat, rethinking how you might have hve been overly aggressive for the first 56 miles and would like to call it a day. But you're not even off the bike - and there's some running to do shortly. As Joe Friel says, "You have to have a plan B; you need alternative alternatives." And simply get on the bus isn't one of them.
In other words, it's OK to stop at a bike aid station and sit in a real chair while taking on fluids for 5-10-15 even 30 minutes. No one will penalize you or draw a red slash through your race number. It's OK to ask the medical people for a little help, they're not going to take you out of the race unless you're a danger to yourself or others. It's OK to walk. Well, it's ALWAYS OK TO WALK. Or to sit at a run aid station to collect your wits. Then you can proceed at your pace if that's what it takes. It matters little down the road what your time was, only that you had a plan B and you finished.
You have a full 17 hours to finish this thing. No harm in using all seventeen of them. If you've thought these potential problems through ahead of time, then during the press of the event where folks don't always make the best of decisions, you'll not decide something in haste that you'll come to regret.
Just think about it. It's been a decade since I DNF'd and I still feel stupid.