PRP Therapy - What to Expect on Treatment Day

The initial consultation is quite thorough. It begins with the fundamentals of any good initial consultation, which is the history of the problem, and what has been done to help the problem to date. Physical examinations is quite unique and patients are usually amazed we can feel the areas that are causing pain and dysfunction. The Greenberg method is so much more than that as it is a comprehensive look at biomechanics and all of the adjoining structures to the painful area. Dr. Greenberg also analyzes and developed the treatment for lateral pelvic tilts and scauplothoracic disorders.

This is assessed in history and the comprehensive physical examination. Based on this information we know, based on 25 years of experience if the problem is well served by PRP and the Greenberg method.

Duration of the problem, how it started, what makes it better, what makes it worse. what interventions have been done and diagnostic testing has been done. We also need to understand how it is affecting the patient’s quality of life and what they are not able to do as a result of this problem.

Most patients have had some sort of imaging which may or may not show the problem. However most importantly is identifying the issue using the Greenberg method and the highly specialized physical examination.

With our palpatory skills and evaluation of pertinent X-ray and MRI findings, along with the patient’s history helps to determine the severity.

While careful physical examination is paramount we use X-ray and MRI imaging to assess the patient. On occasion ultrasound may be used as well.

We may vary the concentration based on size of the treated area and also the degree of arthritis.

Many of our patients want to maintain an active lifestyle and during our evaluation, we want to make sure that our treatment will help that patient regain this lifestyle. Often patients may need to modify their activity level, but we usually do not shut them down as is typically done from surgical procedures.

All of our procedures are completely individualized to the patient and their lifestyle. For example, a young football player with an acute injury may be treated more frequently than an older individual with a chronic problem as the older person needs more time to regenerate tissue.

A personalized treatment plan is developed first by understanding the issue and then understanding what will be required to obtain healing for that patient. Sometimes the plan may need to change along the way if the patient wants to travel or make a specific tournament.

In follow up visits as we discuss improvement in symptoms but mostly by our palpatory physical examination.

Patients are followed up and treated typically on a 3-4 week cycle until we achieve full healing.

As the patient starts to show significant improvement we start to incorporate more physical activity and therapeutic exercises into the plan. We may also increase the amount of time until the next follow up visit.

We can assess the therapy both by our physical examination where we feel the character of the damaged tissue and how it is responding plus what the patient is physically doing… as a patient is feeling better they usually naturally resume activities they were not previously able to do.

It’s not done as often as we like as it’s difficult to have patients who feel great and are back to being active get repeat imaging. However we have documented improvements in joint arthritis, significant reductions in spinal stenosis, and resorption of herniated discs.

This is mostly done by our signature methodologies in palpation of the damaged areas.

Fortunately any complications are extremely rare but they are addressed expeditiously. At any time if there is patient concern, we will see that patient. Often when patients are progressing well from their chronic problems and then have a step back, they usually have something simple such as a recurrent tilt in their pelvis, and we can correct that tilt quickly to get the patient right back on track. We take our patient care very personally and treat everyone like they are a family member.

Yes patients are treated until we have full clinical resolution of their condition. It’s not usually one and done especially for long standing problems.

This is always done at every stage of treatment. Patients report their progress and we correlate that with their physical examination.

The patient’s blood is taken by a simple iv placement and blood is collected in specific tubes. These tubes are taken to the lab and, underneath a laminar flow hood that is used to protect against infection, the blood is transferred into a conicle. These conicles are then centrifuged and the byproduct is then transferred back into the laminar flow hood where the plasma is extracted. Further processing may take place depending on the condition of the patient. Fortunately, since we use our own system, we have the ability to customize the PRP based upon the patient.

Precise lab-grade adjustable centrifuges, laminar flow hoods, syringes, conicles, needles.

About 20 minutes start to finish.

Definitely not. Most clinics use off the shelf systems that are not customized for the individual patient.

This has to do with our nurses training and how we extract the appropriate layers of the centrifuged blood.

The anticoagulants keep the platelets from clumping together and clotting. Without them we can not produce PRP.

This is individualized and the concentration can be adjusted by further degrees of centrifugation. When it comes to the white blood cells, typically we remove them as they tend to produce a lot of inflammation when injected into the patient thus producing a painful reaction. Furthermore the white blood cells are not an integral component of healing damaged tissue.

There are high and low concentrations of platelets and research is still ongoing to determine what type of PRP is best for each condition. Generally in our office we produce very high volumes of PRP as we just do not treat one area of damage that may be found in an MRI or ultrasound, we treat everything that needs to be fixed based upon the Greenberg method of diagnosis and treatment.

This is done by our nurses training and ongoing performance evaluations.

Yes this is essential. It has to be performed on the same day according to FDA guidelines.

 It is administered by very precisely placed injections into damaged regions according to the Greenberg method of diagnosis and treatment.

The entire region is palpated and its biomechanics are examined to determine all of the factors involved in the injury or degeneration. This determines the number of sites that need to be tr to have a successful outcome. The areas are cleaned with surgical cleaning agents and then the areas are directly injected. If needed a nerve block may be placed to aid in patient comfort.

Yes, the PRP procedure is completely outpatient based.

A session from start to finish could take about an hour.

We do not sedate our patients to the point of where they are incoherent as we need to have them in different positions to treat all of the involved areas that cause pain and abnormalities in biomechanics. However if patients are nervous about undergoing the treatment they may take a light sedative like Xanax and also medication like Ketamine is also but rarely used for pain. Some areas like thumbs, knees, shoulders, and toes respond well to nerve blocks. However the vast majority of patients do not need anything for pain control or sedation and tolerate the procedure quite well.

We use gloves and the same surgical scrubs that are used in the operating room to cleanse an area.

It can be combined with ultrasound. Studies have shown that treatment by a skilled physician using palpation is equivalent when compared to ultrasound. However the Greenberg method of diagnosis and treatment is much more comprehensive than receiving one or two injections under ultrasound.

This is done by 25 years experience in developing the Greenberg method of diagnosis and treatment where not only the area of pain is examined but everything that is connected to that area both anatomically and biomechanically is evaluated and treated.

They may feel brief episodes of discomfort or pressure.

We have resources such as videos and instruction sheets that outline our post-treatment care in depth. The instructions have a few general guidelines such as not to reduce the initial inflammatory response, take the prescribed supplements and start the recommended corrective exercises.

This is very individualized based on the patient and their issue and level of performance but at the very least we want patients to be up and walking and also performing their usual activities of daily life. For patients who have a higher level of physical fitness they may want to continue to use the treated area but may want to reduce the intensity of their activity to help allow healing.

They can use heat for the first 72 hours but if swelling persists then some ice may be helpful but it is not necessary if the swelling is minor which it often is. Patients can also use acetaminophen (Tylenol) for the first 72 hours, but sometimes anti-inflammatory medications may be recommended if the inflammation persists. We also have a potent CBD cream that was developed by physicians that can also help helpful for patient comfort.

Our follow ups are typically best accomplished by a skilled physical examination.

The most serious but rare complication is infection. If an area is very painful, red, and very swollen the patient needs to seek medical attention immediately.

As soon as their initial soreness resolves.

We certainly recommend taking their prescribed supplements. We believe for optimal health and healing it is best to follow a healthy whole food diet and avoid processed foods and excessive sugars.

Often they can unless they are taking NSAIDs which are recommended to be avoided for at least 72 hours.

It’s monitored both by patient report of symptoms and by a careful physical examination.

Generally every 3-4 weeks but more acute cases or high level athletes may be treated more frequently. As patients improve they may be treated less frequently until the process is complete and the patient is back doing the things they love to do.

This really varies based upon the patient’s age, complexity of their condition and their individual ability to heal. For example a case of tendonitis may resolve quicker than a patient who has 20 years of unresolved lower back pain and spinal stenosis.

It is usually multiple sessions considering that most of our patients have exhausted traditional methods of treatment before they come to Greenberg Regenerative Medicine.

Patient age and the degree of injury. Furthermore each individual patient heals at their own rate and this may be genetically determined. Patients who have conditions such as Ehlers-Danlos syndrome (EDS) may take longer to heal based on their inherent joint weakness and ligament laxity.

Yes and a comprehensive assessment leads to a more comprehensive treatment. It’s also important, and this is the fundamental basis of the Greenberg Method, to evaluate all of the areas related to the area of injury or arthritis.

Generally PRP is safe for patients with most medical conditions but otherwise this is discussed during the initial evaluation. For example if a patient has atrial fibrillation and takes an anti-coagulant such as Eloquis, they may experience more bruising when compared to the average patient.

For most cases we try to cure the problem permanently. For patients with chronic arthritis it may be worthwhile to perform a yearly tune up to keep the problem at bay.

Yes it is so important to evaluate and treat anything and everything related to the area of injury and correct abnormal biomechanics.

We think PRP works great by itself and more severe cases may also need stem cell or VSEL therapy. Other modalities like red light therapy may help with mitochondrial function and healing.

Generally for most patients we will perform the stem cell or VSEL procedure after the first PRP procedure.

They can expect to have an elimination or significant reduction in their pain with a return to function of their injured or degenerative area.

Providing growth factors directly into an area stimulates regeneration and healing.

Yes it can but also will also help to return a more normal range of motion since it is a repair of damage, not just a treatment for pain.

Their mobility and function can return to normal levels in most cases.

So imagine that the tendons and ligaments are the nuts and bolts of connecting an area to bone. If they are weakened the muscle cannot function properly and may spasm causing an area to feel tight. So repair of this area helps the muscle function normally and reduces spasm. Furthermore when this junction is healed strength naturally will be restored as the muscle is not compromised by pulling against a weak tendon or joint.

Yes it can but more severely torn tendons may require stem cell and fat graft procedures.

Accordion Content

If you repair a joint it both works better and lasts longer. PRP inside the joint has also been shown to be effective in preventing arthritic pain and inflammation.

Not that we are aware of. We use VSELs for these issues.

Yes it can by both providing a matrix for healing and the BMPs (bone morphogenic proteins) directly stimulate bone growth.

It varies depending on the degree of injury among other factors. Some patients may feel better within a few days while others may require weeks to several months to begin to feel the benefit of PRP. However it’s worthwhile to stick it out as the results can be lifelong especially when compared to short-term treatments like cortisone.

It varies depending on the degree of injury among other factors. Some patients may feel better within a few days while others may require weeks to several months to begin to feel the benefit of PRP. However it’s worthwhile to stick it out as the results can be lifelong especially when compared to short-term treatments like cortisone.

They can be lifelong and can also help prevent further injury to an area. However every area even if fully healed is subject to normal wear and tear.

It is generally permanent but in some cases a touch up could be needed if a reinjury occurs.

Some depends on the patient’s age but there are other factors such as the patient’s own innate ability to heal, degree of hypermobility, nutritional status. Generally the pro athletes we treat heal quicker than any other person. Young people typically heal faster than older ones but we have many patients in their 80s or 90s that heal faster than younger people.

Yes this is possible and sometimes we see this even in cases of spinal stenosis.

Generally more severe injury requires more time for recovery.

Each patient heals individually but as that patient gets older they will heal slower than when they were younger.

It could be lifetime if an area heals completely from the session.

There are hundreds of studies showing that PRP is effective both in the long and short term and also more effective than corticosteroids and other traditional methods.

We find that over 90% of our patients experience good relief and return to function.

In studies, Prp has been more effective than other treatment modalities, whether it be cortisone, physical therapy, chiropractic, or acupuncture. There are also studies showing that it can be more effective than surgical techniques, depending upon the case.

It shows that it is extremely efficacious, even when other methods have not helped the patient.

There are and one example is a meta-analysis of lower back pain to wear 85% of patients had significant improvement and this improvement also was measured eight years later and these patients still had significant improvement in their back pain. This indicates how Prp reconstruct an area and rebuild it not just treats pain which is a temporary phenomenon.

The results of research are very similar to what we see in the office regarding long-term results. However, many of the cases we deal with are end of the line and difficult cases, sometimes surgical failures. Even in these difficult cases, most of our patients improve significantly or are cured of the pain.

Most of the areas that we treat are promising because most of the PRP procedures that are performed by Greenberg Regenerative Medicine are successful, especially using our proprietary method of diagnosis and treatment.

And he studies have shown approximately 85% of patients improving with PRP therapy.

Combination of reduction of pain, and also an improvement and function and range of motion.

At the bedside, this is done by a careful physical examination. However, patients have been evaluated by different modalities, ranging from ultrasound to follow up MRI.

There are so many patient testimonials that we have gathered over 25 years of performing these procedures. It would be best to look at the reviews of patients on various platforms and also look on our website as we have many video testimonials from patients with a variety of problems.

 Some of the most inspiring outcomes are with conditions of the neck and head. We see many patients with severe cervicocranial syndrome who have terrible headaches, cannot think clearly, their eyes do not focus or track properly, have anxiety, heart, racing vertigo, and other symptoms and when we get these patients back to normal an incredible weight is lifted off of their shoulders.

Patients are usually ecstatic and tell all of their friends and family and encourage them to undergo this treatment. Many of our referrals come from word-of-mouth from our patient success stories.

We have hundreds of them from a person who had a terrible rotator cuff issue who could pitch again to people with chronic back pain for 40 years that was solved and the stories go on and on for every joint in the body that you can think of. One patient who had knee pain for 30 years says that every New Year she says a prayer for me since I took away her chronic pain permanently and she can’t imagine where her life would be. Otherwise, as now she can exercise and go up and downstairs, which before would cause her terrible pain.

The patient satisfaction rates are much higher because we are performing a more effective treatment.

One of the most common things they wish that they had found this procedure sooner and also they are so happy with the Greenberg method because we are addressing their body holistically not just looking at an MRI or x-ray.

Examples are endless and could include anyone from pro and Olympic athletes who are completely able to return to sport to patients who have had severe spinal stenosis and could not walk a block now can walk miles.

The patient has to be guided through the course of therapy and follow up examinations help to let the patient know where they are in the treatment cycle.

Testimonials are not scientific. They are real life stories of patients and how their suffering is alleviated by the procedures that we perform at Greenberg Regenerative Medicine. I think it’s really important when someone is in chronic pain, understanding that they can get help and hearing another person story that’s similar to theirs helps them feel like they can connect with someone who had their condition that did improve and not left hopeless.

We always ask permission when sharing patient stories and ask the patient not to give their whole name. However, some patients are so ecstatic about their results that they are happy to share their personal personal stories and really want to do so in order to help others get the care that they need.