Today on the Doc On The Run podcast, we’re talking about dry needling versus PRP in runners.
Today’s episode comes from a great question I got during one of the Runners Aid station calls and this was someone who had a plantar plate sprain and had talked to a doctor about a couple of different procedures that might actually, potentially, speed up the healing.
He wanted to know about the difference between these two things called dry needling or a PRP injection. Well, the first thing is PRP, in case you’re not familiar with it, it’s platelet-rich plasma. What that is, is we actually draw some blood out of your arm. We put it in a centrifuge, we spin it down, and we separate out the red blood cells versus the platelet poor plasma, versus the platelet-rich plasma that has all the platelets concentrated in it.
Now, the platelets contain everything that you need to actually activate wound healing and to jumpstart the process of tissue repair. So, it has become popularized because it can take these things that don’t have a great blood supply like the plantar fascia or plantar plate ligaments or Achilles tendons. These things made mostly of collagen, they start to degenerate after they get stuck in a situation where they’re not healing.
The idea is to take something, inject it in there, and convert it from a chronic non-healing state to an acute wound that actually unlocks the key to this whole potential of your body healing it. Now, what’s the difference between dry needle and PRP? Well, as the name implies, dry needling, we do not take anything out of your arm. We don’t get any blood. We don’t get any platelets, but we take a very small needle and we puncture it multiple times, the same way that we would do when we inject PRP.
When we inject PRP, we go through and we make several little passes through the injured area to try to get it to start healing and there are some similarities, but number one, dry needling, there is nothing to inject. So, it’s just the needle making the damage to the tendon or ligament that has acute damage that actually we hope will convert it to an acute healing state instead of it being stuck in this chronic non-healing state. So, they’re not the same. That’s the first thing, but the goal is the same.
The goal is really to stimulate your body to get the co-factors in the coagulation cascade that actually start this inflammatory process. That’s the first phase of wound healing. Instead of it being stuck in chronic inflammatory situations, you’re trying to get it in an acute healing situation and convert it to an acute wound. It’s really simple, and one of the biggest differences in these two procedures is the size of the needle.
If you take a really small needle, and you inject platelets through them, you get this thing called the Venturi effect that actually obliterates and pulverizes the platelets. So, if you take your thumb, and you put it over a garden hose, you can shoot it all the way across the yard. But if you do that, it’s high pressure and that high pressure of forcing the platelet-rich plasma through a very, very small needle can actually damage the platelets.
So, when I do that procedure, I actually use a pretty large needle. Well, if you have a small structure like the plantar plate, obviously, if you’re using a huge needle, you’re really lacerating and tearing up that tissue in a way that could be damaging. In fact, even more damaging. If you have the Achilles tendon, obviously, if we use a small needle to go through it, they’re much smaller holes and you damage less of the collagen bundles when you cut through it with that sharp needle. That’s one of the big differences.
Now, the recovery procedure, you would think, because you’re not having big holes or whatever, that the dry needling procedure might take less time to heal, and recovery would be different, but that’s not really true. So, when I do these procedures, whether it’s platelet-rich plasma injection, PRP, or the dry needling procedure, well the recovery afterwards, you should expect the same. So, we’re trying to get the same process to take place. So, you should expect the same kind of recovery to happen afterward.
Just because we don’t draw blood out of your arm, spin it down and do this whole complicated thing with PRP, and we just do dry needling. I don’t change the timeline, so I don’t tell you, “Oh, yeah. This is a smaller needle, so you’ll be in the boot less time.” Or any of that. So that’s not really something that’s going to be different. One thing that’s huge in terms of difference is cost. So, when we do PRP, we have to use a sterile kit. We have to draw blood out of your arm, we have to put it in this thing.
Obviously, if we put your blood in some gizmo to spin in a centrifuge, we’re not going to reuse it and those sterile kits are all patented, and they’re fairly expensive. So, it uses expensive equipment that we don’t use with a needle. Now, the needle that we use when we do dry needling is a very small needle that cost about 15 cents. So, the cost is very low on dry needling compared to PRP. So, if you do dry needling, if you choose that, over PRP, it could save you hundreds or thousands of dollars depending upon who’s doing it. So those are the big differences really, between dry needling and PRP. But you got to talk to your doctor and figure out, first of all, if one of these procedures is actually right for you or reasonable for you.
This is one of the things I talk about a lot during second opinion consultations because patients often have these questions and want to know, is there really an advantage or a disadvantage to either? and there are advantages and disadvantages to both, but you’ve got to talk to your doctor.
You got to get a second opinion, you’ve got to figure out if it’s right for you, and then you can make the best decision about how to actually get your tissue to start healing and moving in the right direction so you can get back to running. Now, if you like this episode, please like it, please share it and I’ll see you in the next training.