What’s the difference between dry needling and PRP injection when you have Achilles tendinosis and you’re a runner? Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
Achilles tendinosis is one of the worst injuries you can get as an injured runner because it’s chronic, it’s hard to get rid of, it’s noticeably different. The tendon gets thicker, it becomes chronically painful, and every time you run on it, you start to worry that it might rupture or tear completely, so this causes a lot of anxiety in runners. And there are lots of different ways to treat it, everything from doing no activity to surgery. And there are a lot of things in between that can be extremely helpful, and a couple of those options are something like a PRP or platelet-rich plasma injection or a procedure called dry needling. And someone asked me recently about what’s the difference between these two things, and I thought it might be helpful to try to explain it to you the way I explained it to them.
The first thing is, is that you have to look and see is there any evidence that one is better than another? Because that’s always the big question, which one’s better? Well, that’s a good question. Here’s the differences. In terms of the evidence in the medical literature, first of all, there are no real studies that have completely separated injured runners into three groups, meaning a control group where you don’t do any treatment, where you do a PRP injection on the Achilles tendon, and then the third group where you do dry needling. There are no studies that compare those things directly in what we call a randomized controlled trial. But there are lots of studies, in fact.
There’s some big meta-analysis that looked at all of the different research on dry needling versus platelet rich plasma injections in tendons, not just Achilles tendons, but tendons in general. And interestingly in that study, what the researchers found was that there was really no difference between PRP and dry needling procedures for most forms of tendinosis. Now, there was a very marginal difference, a very small difference with PRP being slightly better than dry needling when it came to epicondylitis or this thing called tennis elbow. But this is where you have irritation of the tendon in your elbow, this is not the Achilles tendon. But we as physicians think, of course, that procedures that help one tendon often helps another tendon, and that might be true.
So very little difference in the medical literature between these two procedures in terms of which one might be best, one of the big differences is the amount of pain. When we draw the blood out of your arm, we usually use a fairly large needle and it actually hurts. So I usually tell patients this is the worst part of the procedure, is getting the blood out of your arm. And when I do that for them, I tell them it’s going to of hurt, but once that’s over with most of the worst part is done. But you do have more pain with a PRP procedure than you do with dry needling, because dry needling, it’s dry, meaning we don’t inject any solution through the needle into the tendon when we do the procedure, we just use a dry needle and we fenestrate the tendon to try to increase bleeding within the tendon that’ll convert it to an acute wound.
The next thing is the amount of tendon damage. When we do PRP, we use a larger needle than when we do dry needling, so you actually have a larger needle going through there. And if you look at the bevel on a large needle versus a small needle, like if you compare, let’s say an 18 gauge needle that has a really large bore or hole through the middle of the needle versus a 27 gauge needle, there’s a big difference in size. And that bevel is extremely sharp and it actually cuts through some of the collagen fibers, and so you’re lacerating some of the fibers of the tendon. So if you have a large needle doing a PRP injection, you’ll actually have more tendon damage than if you’re doing dry needling procedure with a smaller needle.
The next thing’s recovery time, basically no difference in these two things. Your doctor’s procedure may vary, but when I do dry needling or PRP, we’re trying to get the same sort of result with a similar avenue, meaning that we’re actually poking holes in the tendon trying to get it to convert from a chronic non-healing wound to an acute healing environment in the tendon itself, and I don’t do a different postoperative routine. I basically do the same kind of routine, the same approach on both, and I analyze it in the same way to make decisions on when you should advance from one level of activity or stage in the recovery to another.
Next thing is cost. PRP costs a lot more. Why? Well, because we have to have equipment for that. So we have to have a centrifuge, we have to have proprietary equipment that separates the blood. We can’t just take the blood and then extract the PRP without spinning it down into centrifuge with specialized equipment. All of that obviously is sterile to use for you particularly. And with dry needling, you don’t have any of that fancy equipment, so it costs a whole lot less. So the big difference is cost.
The other is speed. Sometimes we have to arrange some of that equipment. We have to get a medical device rep to get the equipment to us and then we have to bring it to you to do that procedure. So I often do this at people’s homes, their offices. I’ve even had professional athletes fly in from out of town and I do it in their hotel rooms, but the speed is one thing. So if I came to see you today and we knew that you had Achilles tendinosis, that you had evidence of it on an MRI, or if I actually looked at it at the time I saw you with an ultrasound right when I’m seeing you in your living room and we determine you definitely have tendinosis and you definitely want to get moving right away and you definitely want to do a procedure today, well, I have this stuff and always could do dry needling on the spot, not generally true of PRP because I wouldn’t generally take all that equipment with me on every single house call.
So there’s big differences between these two. Time, cost, access to it, all those things are different, a little bit more pain with a PRP injection, but they’re also very similar in the way they actually work. Those differences are not real big and that currently is what’s really shown in the medical literature as well.
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